| Motor and Sensory Function | Spinal Cord Assessment | Glasgow Coma Scale | Pupil Response |
|---|---|---|---|
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What is to ask the patient to close their eyes and stretch out both arms with palms facing up (“hold up a pizza box”). Count to 20 and assess whether the patient can maintain this position. The arms should remain equal without falling to the left or right if their motor pathway is intact. If drift is observed, document which arm and in what direction.
The pronator drift test
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What is the assessment of the sensory, motor, and autonomic function of the spinal cord. Depending on the results, it can be determined whether there is a loss of sensation in a specific area.
Significance of the spinal cord assessment
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What is using 3 aspects of responsiveness: eye-opening, motor, and verbal responses, this scale describes the extent of impaired consciousness of patients
GCS uses
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What is size, shape, and reactivity to light
Aspects testing the pupils
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What is to test plantar flexion, ask the patient to point their toes and foot away from the body, towards the end of the bed. To test for dorsiflexion, ask the patient to point their foot towards their knee.
Assessing plantar flexion vs dorsiflexion
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What is ask the patient to close their eyes. Using something soft (cotton ball) and sharp (edge of an alcohol swab), assess whether the patient can feel the two sensory stimuli (prick and light touch) for each dermatome on the left and right side of the body.
The process of testing
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What is 15 in which the eyes open spontaneously (4), the patient is orientated to time, place, and person (5) and obeys commands (6).
Highest GCS sore
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What is hold each eyelid open and shine a light into the eyes starting from the outer canthus of each eye. Essentially, the pupils should constrict and when the light is removed, they should dilate to their baseline. Using this, the shape, size and reactivity can be assessed.
The process of testing the pupils
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What is
0 – no contraction 1 – no movement but slight visible or palpable muscle contraction is present 2 – limb movement but not against gravity 3 – movement against gravity but not resistance 4 – movement against some resistance 5 – full strength
The motor strength grading
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What is the cervical (neck), thoracic (upper), lumbar (low-back), and sacrum (tail bone).
4 regions of the spine that are tested
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What is the importance of knowing the patient’s baseline scores because factors such as sedation, hard of hearing, mental deficits, paralysis, and swelling can affect their response to stimuli or verbal responses.
Factors interfering with the GCS assessment
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What is a normal pupil reaction would be brisk. A sluggish response is when the pupils react slowly and could indicate increased ICP. Non-reactive/fixed pupils can be associated with severe brain damage.
Pupillary response indication
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What is the grip of the left and right hand, motor strength of the RUE, LUE, RLE and LLE, the motor response of the RUE, LUE, RLE and LLE, the sensation of the RUE, LUE, RLE and LLE, plantar flexion of the right and left foot, and dorsiflexion of the right and left foot.
The 6 aspects that are assessed
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What is the level of function is also tested. For example, the patient will be asked to wiggle their fingers (T1), shrug their shoulder (C4) and straighten their knee (L3, L4).
Other aspects tested in addition to sensory function
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What is 8 or less indicates severe injury, 9-12 moderate injury and 13-15 minor injury.
Glasgow coma scale scoring
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What is the pupils can be reported as round, irregular or oval. A normal shape would be round. The pupil size is reported as the diameter in millimeter. A normal size is usually around 2 to 5 mm dependent on the patient.
Pupil sizes and shapes
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