for more presentations

2. Paraplegia is an impairment in motor or
sensory function of the lower extremities

3. HISTORY OF PRESENT ILLNESS
 DATE OF ONSET
 MODE OF ONSET
 Sudden
 gradual

4.  PRECIPITATING FACTORS
 SPINAL INJURY
 VACCINATION
• EVOLUTION OF PARALYSIS

5. PROGRESS OF PARALYSIS
A. Increasing in severity and extent-cord
compression.
B. Improving-inflammation,acute transverse myelitis
or multiple sclerosis.
C. Static but progressing very slowly-Degenerative
lesions.
D. Waxing and waning-MULTIPLE SCLEROSIS

6.  Degree And Duration Of Paralysis
 Motor symptoms
 HISTORY OF PAST ILLNESS
 TB,Fever,Syphilis
 Hypertension,DM,alcoholism
 Lymphadenopathy,pain in spine
 SIMILAR EPISODES(Multiple sclerosis)

7. FAMILY HISTORY
 Hypertension,DM
 h/o paraplegia in other members of the family-
indicate hereditary paraplegia,paraplegia with
hereditary ataxia or lathyrism
 TB

8. ENQUIRY OF SENSORY SYMPTOMS
1. Loss of sensation
2. Sense of CONSTRICTION
3. Zone of hyperasthesia
4. Root pain
5. Sensation of pins and needles in lower
extremities

9. SPECIAL POINTS IN PHYSICAL
EXAMINATION
1. GENERAL SURVEY
 Level of consciousness
 Decubitus
 Lymph nodes
 Pulse
 BP
 Respiration
 Temperature
 Oedema

10. SPINE EXAMINATION
1. KYPHOSIS 2. SCOLIOSIS

11. 3.GIBBUS 4.SPINA BIFIDA
5.TENDERNESS

12. NERVOUS SYSTEM
 Level of consciousness,alertness,orientation and co-
operation
 HIGHER FUNCTIONS
1. Unconscious or alteration of
consciousness, delirium,photophobia
2. Behavioural abnormality with speech defects

14. Cranial Nerve Examination
 Olfactory
 Optic
 Acuity of vision
 Field of vision
 Colour vision
 Ophthalmoscopy or Fundoscopy
 Oculomotor ,Trochlear and Abducens
 Trigeminal

15.  Facial
 Palpebral fissure,frowning,eye closure,nasolabial
folds,angle of mouth,blowing,whistling,showing of
teeth,dribbling of saliva
 Power of individual facial muscle
 Upper half of face escaped or not
 Taste sensation of anterior 2/3 of tongue

16.  Vestibulocochlear
 Glossopharyngeal and Vagus
 Spinal accesory
 Hypoglossal

17.  CRANIAL NERVES
 Search for optic atrophy-Friedreich’s ataxia,multiple
sclerosis
 VII th Nerve palsy –1.GBS
2.Lymphomatous deposits
producing unilateral or bilateral VIIth nerve palsy

18. MOTOR FUNCTIONS
 BULK OF MUSCLE
1. Inspection
2. Palpation
3. Measurement

19.  Tone of muscle
 Hypotonia
 Hypertonia
1. Spasticity-pyramidal lesions
2. Rigidity-extra-pyramidal lesions

20. POWER OF MUCLE
Muscle Nerve Root value Method
Flexors of Femoral L 1,2,3 Patient lies supine.Hip is fully
thigh flexed and resists attempt to
extend it
Adductors Obturator L2-L4 Patient tries to bring legs
of thigh together against resistance
Extensors Inferior gluteal L5-S1 Patient lies prone and tries to
of thigh nerve raise the thigh against
resistance
Abductors Superior L4-S2 Patient tries to abduct the
of thigh gluteal thigh against resistance
Flexors of Sciatic nerve L4L5 Lies prone and tries to flex
knee knee against resistance
Extensors Femoral nerve L3L4 Lies supine ,knees extended
of knee and examiner resists it.

21. GRADING OF MUSCLE POWER
MEDICAL RESEARCH COUNCIL SCALE
 Grade 0-Complete paralysis
 Grade 1-A flicker of contraction only(visible or
palpable)without any movement of joint.
 Grade 2-Movt. possible only after elimination of
gravity(side to side movt. of a limb).
 Grade 3-Movt. possible against gravity but not
against resistance.
 Grade 4-Movt. Possible against gravity plus
resistance but weaker than normal
 Grade 5-Normal power.

22.  Co-ordination of lower limbs
-If muscle power grade is 4 or above
Heel knee test
Toe-finger test
 Involuntary movements

23. SENSORY FUNCTION
 Superficial –Pain,Touch and Temperature
 Deep-Joint sense,position sense,pressure sense
,vibration sense
 Cortical sensation-Point localisation,stereognosis

24. REFLEX
 SUPERFICIAL
 Abdominal
 Cremastric
 Plantar
 DEEP
 knee jerk
 Ankle jerk
 Clonus

25.  VISCERAL
 Bladder
 Bowel
 Swallowing
 TROPHIC CHANGES-Bed sores
 CEREBELLAR FUNCTION
 AUTONOMIC FUNCTIONS

26.  RESPIRATORY SYSTEM
 GI TRACT AND GENITOURINARY SYSTEM
 CVS
 LYMPHORETICULAR SYSTEM