脊髓损伤自主神经评估_2009

2 = Normal function, 1=Reduced or Altered Neurological Function 0=Complete loss of control NT=Unable to assess due to preexisting or concomitant problems Urodynamic Evaluation System/Organ Score Lower Urinary Tract Awareness of the need to empty the bladder Ability to prevent leakage (continence) Bladder emptying method __________ (specify) Bowel Sensation of need for a bowel movement Ability to Prevent Stool Leakage (Continence) Voluntary sphincter contraction Sexual Function Genital arousal Psychogenic (erection or lubrication) Reflex Orgasm Ejaculation (male only) Sensation of Menses (female only) System/Organ Findings Abnormal conditions Check mark Autonomic control of the heart Normal Abnormal Bradycardia Tachycardia Other dysrhythmias Unknown Unable to assess Autonomic control of blood pressure Normal Abnormal Resting systolic blood pressure below 90 mmHg Orthostatic hypotension Autonomic dysreflexia Unknown Unable to assess Autonomic control of sweating Normal Abnormal Hyperhydrosis above lesion Hyperhydrosis below lesion Hypohydrosis below lesion Unknown Unable to assess Temperature regulation Normal Abnormal Hyperthermia Hypothermia Unknown Unable to assess Autonomic and Somatic Control of Broncho- pulmonary System Normal Abnormal Unable to voluntarily breathe requiring full ventilatory support Impaired voluntary breathing requiring partial vent support Voluntary respiration impaired does not require vent support Unknown System/Organ Findings Check mark Sensation during filling Normal Increased Reduced Absent Non-specific Detrusor Activity Normal Overactive Underactive Acontractile Sphincter Normal urethral closure mechanism Normal urethral function during voiding Incompetent Detrusor sphincter dyssynergia Non-relaxing sphincter AUTONOMIC STANDARDS ASSESSMENT FORM Anatomic Diagnosis: (Supraconal □, Conal □, Cauda Equina □) Patient Name: _________________ General Autonomic Function Lower Urinary Tract, Bowel and Sexual Function Date of Injury__________________ Date of Assessment_________________ Examiner________________________ This form may be freely copied and reproduced but not modified (Sp Cord, 2009, 47, 36-43) This assessment should use the terminology found in the International SCI Data Set (ASIA and ISCoS - http://www.asia-spinalinjury.org/bulletinBoard/dataset.php) User Stamp User Stamp Urodynamic Evaluation