Assessing Neurological Impairment in a Trauma Patient – Babinskis Sign and Motor Dysfunction
Paraplegia
Spinal cord injury is one of the many medical conditions that describe paralysis of the lower limbs where a person cannot move their legs voluntarily. This is due to injury to the spinal cord or head, resulting in impaired signal transmission from the brain to the limbs. In this case, some trauma resulting probably from the motorcycle accident the patient had, rendered the patient unable as shown above.
Basic Reflex Pathway Components
A basic reflex pathway involves several critical components working together seamlessly to produce a reflex action. First, the receptor detects the initial stimulus, such as when the skin senses a sharp object or sudden heat. This sensory information is then transmitted via the sensory neuron to the central nervous system (CNS), specifically to the spinal cord. Within the CNS, the signal reaches the integration centre, where it is processed. This often involves one or more interneurons that relay the message. Following this, the motor neuron carries the response signal from the CNS to the relevant effector. Finally, the effector, typically a muscle or gland, carries out the response, such as pulling a hand away from a hot surface. This rapid pathway allows for swift reactions to potentially harmful stimuli, minimizing injury
Babinski’s Sign
Babinski’s sign is an upgoing plantar reflex induced by stimulation of the sole of the foot with a blunt instrument. While in the normal plantar reflex, the toes ball up or curl, in this test, the large toe moves upwards and the others splay out (Alizadeh et al., 2019). This sign is suggestive of an upper motor neuron lesion involving the pyramidal tract, which is involved in the modulation of voluntary movements.
Normal vs. Abnormal Reflex
Stimulating the sole of the foot causes plantar flexion, where the toes bend down or do not respond at all. On the other hand, a positive Babinski’s sign, which entails the movement of the big toe upwards and the other toes pointing in different directions, is indicative of a problem with the nervous pathways that should inhibit this reflex.
Central Nervous System Lesions
The presence of Babinski’s sign in this patient indicates an upper motor neuron lesion. This suggests that the injury is within the central nervous system, specifically the corticospinal tract, rather than the peripheral nerves. Peripheral nerve damage would typically result in loss of sensation and absent reflexes, neither of which are present in this case.
Spinal Cord Lesion Location
Given the patient’s symptoms of paraplegia and a positive Babinski’s sign, the lesion is likely located in the thoracic or lumbar regions of the spinal cord. These areas are crucial for the motor control of the lower extremities (Teleanu et al., 2022). The CT scan, once available, would likely show damage affecting these regions, disrupting the pathways responsible for voluntary movement in the legs.
References
Alizadeh, A., Dyck, S. M., & Karimi-Abdolrezaee, S. (2019). Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Frontiers in Neurology, 10(282). https://doi.org/10.3389/fneur.2019.00282
Teleanu, R. I., Niculescu, A.-G., Roza, E., Vladâcenco, O., Grumezescu, A. M., & Teleanu, D. M. (2022). Neurotransmitters—Key Factors in Neurological and Neurodegenerative Disorders of the Central Nervous System. International Journal of Molecular Sciences, 23(11), 1–24. https://doi.org/10.3390/
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Question 
A 25-year-old male involved in a motorcycle accident was brought to your ER. The patient complains of being unable to move his legs voluntarily.
The doctor orders a CT but the CT is currently out of commission so you must do some inductive reasoning. One thing you must determine is the severity and location of the patient’s lesion. You begin by scraping the bottom of their foot with the dull-pointed end of a reflex hammer starting at the heel moving to the small toe and then following the ball of the foot toward the big toe. The patient’s foot demonstrates a Babinski’s sign.
Assessing Neurological Impairment in a Trauma Patient – Babinskis Sign and Motor Dysfunction
Instructions
Answer the following questions and save your responses in a Microsoft Word document. Provide a scholarly resource in APA format to support your answers.
The term used for this condition (inability to move legs voluntarily) is called:
Name the parts of a basic reflex pathway.
Describe Babinski’s sign and compare it to what a normal response would look like.
Why would one see a Babinski sign rather than a normal sign?
Why do you think this is not a first-order neuron issue? Hint: What would you see (or not see) if the nerves were damaged?
Where along the spinal cord could you see a lesion in the CT for this patient?