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Paraplegic Rehabilitation in South Africa

Initial Assessment and Investigations

Cranial Nervous System

Glasgow coma scale: 15/15 (full consciousness)
Cranial nerves: normal

Respiratory System

Zamani had good function of his muscles.
All respiratory muscles had normal neural innervation, except T12 innervation of the intercostal and abdominal muscles.
Oxygen saturation: 98%.
Auscultation: air entry was good bilaterally and no abnormal sounds were audible.
Coughing: he had an effective, unproductive cough, though he experienced pain at the fracture site with coughing.
He demonstrated good respiratory function and no further tests were deemed necessary.

Cardiovascular System

Pulse: 75 beats / min.
Blood pressure: 110/70
Heart sounds: normal

Gastrointestinal Tract

Abdomen: bowel sounds were normal.

Rectal Examination

Tone: absent
Sensation: absent
Voluntary: absent

Urinary Tract

Due to the level of the lesion, Zamani had no voluntary bladder control and an indwelling catheter was inserted on admission.

Sensory Examination

Sensation was tested according to segmental spinal innervation.
Sensation tests performed:

Touch: normal to T11 dermatome, absent from T12 and below.
Pain (pinprick): as above.
Joint position: as above.
Deep pressure: as above

Motor Examination

Manual resisted motor testing was done to assess muscle strength. Muscle strength was graded according to the Oxford, 0 - 5 scale. The following table summarizes the grading system used. The abdominals and erector spinae muscle group could not be tested according to this scale and only a subjective grading based on palpation was done.

Reflexes

Both tendon and superficial reflexes were tested.

Investigations

X-rays of the thoraco-lumbar spine taken on November 20 confirmed a T12/L1 fracture dislocation of the flexion/ distraction type of injury mechanism.