Importance of Connecting Reflexes, Motor and Sensory Exam in Spinal Neurological Complaints

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Importance of Connecting Reflexes, Motor, and Sensory Examination in Spinal Neurological Complaints 

The neurological examination is a clinical assessment tool that determines the extent of function from the nervous system. The spinal cord acts as a primary pathway for messages that travel between the body and brain peripheral areas. The reflex arc of action is hosted in the spinal cord which is the pathway that a nerve reflex like the knee jerk reflex follows (Lin & Bono, 2010). Motor and Sensory exams access the functions related to the spinal cord and the nerves that connect it. Motor functions are associated with the ventral side of the spinal cord while sensory functions are associated with the dorsal region. Spinal cord localized damage is related to the peripheral projections assessment mapped to dermatomes. 

According to Kim (2008), the sensory test focuses on the various somatic senses sub-modalities – temperature, touch, pain, vibration, and proprioception. The subset results point to spinal cord trauma in white matter, grey matter, or even in cerebral cortex connections. Reduced perception or abnormal sensation may be an indication of damage to the spinal cord, sensory nerve, or some parts of the brain. It is possible to pinpoint specific damaged level in the spinal cord through identification of the areas with abnormal or lost sensation. Reflexes can be based on either superficial skin stimulation or deep tendon stimulation.  The reflexive contractions help in differentiating motor disorders between the lower and upper motor neurons. The reflex examination includes abdominal reflexes, standard joint reflexes, cross abductor reflexes, and Babinski and cremasteric reflexes.

The motor tests address the muscle functions and the descending motor pathway connections. In patients with spinal pathology, it should be the central focus in neurological examinations.  Muscle strengths and tones should be tested for lower and upper extremities. Uneven muscle tone which suddenly increases while moving the relaxed muscle can be an indication of spinal injury (Lin & Bono, 2010). Combining the three tests will help in distinguishing the type of nerve disorder. Reflex pathway does not get involved with the brain as it consists of a sensory nerve to the spinal cord, connections of nerves in the spinal cord, and motor nerves moving to the motor.

Reflex testing determines whether all the parts of the pathway are functioning. For example, a knee tap will stimulate sensory receptors that will generate a nerve signal. The signal will travel through the nerve to the spinal cord where the signal will be transmitted to the motor nerve from the sensory nerve (Kim, 2008). The motor nerve will send the signal back to the thigh. The muscles will contract causing the lower leg to jerk in an upward movement. This entire reflex does not involve the brain and, hence, it calls for the three examinations to distinguish spinal cord neurological complaints.

References

Kim, D. H. (2008). Surgery of the pediatric spine. New York: Thieme.

Lin, V. W., & Bono, C. M. (2010). Spinal cord medicine: Principles and practice. New York: Demos Medical.