1. VITAL SIGNS
Before
During
After
BP (mmHg)
PR (bpm)
SpO2 (%)
Temperature
2.
3.
4.
5.
Cognition
Communication
Arousal
SENSORY INTEGRITY
1. Sharp/dull
discrimination
2. Temperature
Awareness
3. Light touch
4. Pressure perception
5. Kinesthesia
6. Proprioceptive
Awareness
7. Vibration Perception
C2
C3
C4
C5
C6
C7
C8
T4
T10
T12
L2
L3
L4
Occipital
protuberance
Supraclavicular fossa
Top of
acromioclavicular
joint
Lateral side of
antecubital fossa
Thumb
Middle finger
Little finger
Nipple line
Umbilicus
Inguinal lig. At
midpoint
Mid anterior thigh
Medial femoral
epicondyle
Medial malleolus
FINDINGS R
FINDINGS L
2
2
2
2
2
2
2
2
2
2
0
0
0
0
0
0
Dorsum of foot at 3rd
MT joint
Lateral heel
Popliteal fossa
Ischial tuberosity
Perianal area
L5
S1
S2
S3
S4-5
0
0
0
0
Dorsal column: proprioception & vibration
Lateral spinothalamic tract: sharp or dull & temperature
Anterior spinothalamic tract: light touch
Grading:
0-absent
1-impaired
2-normal
NT- not testable
6. RANGE OF MOTION
Joint
Shoulder
extension
Hip extension
ROM Needed
>50
Findings (R)
Findings (L)
Active:
Active:
Passive:
Passive:
>10
Active:
Active:
Passive:
Passive:
Hip flexion
>90
Active:
Active:
Passive:
Passive:
Knee flexion
>110
Active:
Active:
Passive:
Passive:
Ankle
>neutral
Active:
Active:
dorsiflexion
Passive:
Passive:
Pt with SCI must have sufficient range in:
Shoulder extension, ER, & scapular adduction for weight-bearing in long sitting
Elbow & wrist extension & forearm supination for support in long sitting
Hip flexion (greater than 90) for sitting
Hip extension ( at least 10) for ambulation
Ankle dorsiflexion ( at least neutral or better than 10) for standing & ambulation)
Pts with SCI need sufficient hamstring length (hip 90, knee at least 110) for dressing & transfer
activities
7. MUSCLE TONE


Flaccid or Spastic?______
MAS Grading:______
8. DEEP TENDON REFLEX
Biceps
Brachioradialis
Triceps
Patellar/quadriceps reflex
Achilles/ plantar flexors
Grading of Reflexes:
0-Absent (no response)
1-slight reflex (low normal; present but depressed)
2-normal (typical reflex)
3-brisk (may be normal or pathological)
4-very brisk/clonus (hyperactive; pathological)
9. PATHOLOGICAL REFLEX
Plantar reflex
Procedure: Stroke the
plantar surface from heel
up and over lateral
border of foot & ending
on the base of big toe
Positive
reflex: Response:
extension of the
big toe; often
observed
in
patients with UMN
involvement
(Babinski’s sign)
10.MUSCLE STRENGTH
Findings (L)
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
Grading:
Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors
(distal phalanx of
middle finger)
Little finger
abductor
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe
extensors
Ankle plantar
flexors
Findings (R)
11.BALANCE/TOLERANCE
a. Sitting tolerance:
12.FUNCTIONAL CAPABILITIES
a. Bed mobility: independent or dependent or with assistance? _______