CNS & PNS Assessment Notes

Learning Outcomes

• Identify important aspects of a general survey and health history related to CNS and PNS

  • General survey includes the patient's overall impression and health history recap.

• Review attributes of signs and symptoms related to neurological assessment

  • Understanding how to describe and document symptoms accurately.

• Identify key components of neurological assessment

  • Higher cognitive functions: memory, language, judgment.
  • Cerebellar functions: coordination and balance.
  • Sensory functions: touch, pain, temperature.
  • Motor functions: strength and tone.

• Identify focused assessments and when to use them:

  • Rapid Neuro Assessment: Quick evaluation of neurological status.
  • Neuro Vital Signs: Glasgow Coma Scale, Ranchos Los Amigos Scale for cognitive functioning.
  • Spinal and Neurovascular Signs: Checking for spinal reflexes and blood flow.

• Identify functional assessments related to CNS

  • Evaluating everyday functionality impacted by neurological conditions.

• Components of Peripheral Motor and Sensory Assessment

  • Focus on extremities and future integration with peripheral vascular (PVS) and musculoskeletal (MSK) assessments.

• Understanding components of symptom/health assessment and documentation

Review of Motor and Sensory Function: CNS

• Left Cerebral Hemisphere: Handles conscious thought and intellectual functions.
  • Cerebrum: Memory processing and muscle regulation.
• Diencephalon components:
  • Thalamus: Sensory relay and processing center.
  • Hypothalamus: Manages emotions and autonomic functions.
• Mesencephalon:
  • Responsible for processing auditory and visual data.
  • Maintains consciousness and generates reflex responses.
• Cerebellum:
  • Coordinates complex somatic motor patterns and adjusts motor output.
• Brainstem sections**:
  • Pons: Relays sensory information to the cerebellum and thalamus.
  • Medulla Oblongata: Controls autonomic functions and relays data to higher brain functions.

Process of Assessment

General Survey

• Overall Impression: Observations on appearance and movement.
• Skin: Assessment related to health status.
• Anatomy: Basic checks of body symmetry and tone.
• Behaviour: Observing coordination and responsiveness.

Symptom History

• Use of 10 Attributes (O, L, D, C, A, R, T, S, P):
  • O nsent, L ocation, D uration, C haracteristics, A ggravating/Alleviating factors, R adiating pain, T iming, S everity, P ast medical history.

Health History (Review of Systems - ROS)

• Various systems to check:
  • Neurologic symptoms, trauma history, cognitive disorders, etc.
  • Documentation of past medical history, medications, and social context.

Physical Examination

• General Inspection: Checking for symmetry, tone, coordination, and consciousness level.
• Specific tests:
  • Pronator Drift: Observing for arm movement consistency.
  • Tremor: Evaluation of rest and intention tremors.
  • Cognitive Function Tests: Mini-mental states, clock drawing.
  • Cranial Nerve Function: Checking reflex responses and function.

Assessing Level of Consciousness

• Categories range from alert to coma, assessing response to stimuli and orientation to time, person, and place.
  • Tools include AVPU scale (Alert, Voice, Pain, Unresponsive).

Assessment Techniques

Gait

• Assessment of gait patterns to identify abnormalities in movement.

Pronator Drift

• Procedure: Patient holds arms up, eyes closed to observe pronation indicating loss of motor function in contralateral tract.

Tremors

• Examination using drawing tasks to categorize tremor types (e.g., essential tremor).

Romberg Test

• Checks proprioception and balance; not a direct cerebellar test.

Clock Drawing Test

• Evaluates cognitive impairment through spatial awareness and planning.

Mental Status Assessment (ABSCATT)

• Appearance, behavior, orientation, cognition, thought processes/contents, affect/mood.

Motor and Sensory Function Pathways

• Motor Control: Governed by the left hemisphere for the right side of the body.
• Sensory Input: Conversely managed by the right hemisphere receiving input from the left side.

Dermatomes and Myotomes

• Dermatomes: Skin sensory areas specific to spinal nerve roots.
• Myotomes: Muscle groups innervated by peripheral nerves.

Deep Tendon Reflex Testing

• Assessment involves testing specific reflexes: Brachioreadialis, Biceps, Triceps, Patellar, Ankle reflexes.

Involuntary Movements

• Categories include spasms, tremors, and fasciculations.

Sensation Testing

Pain and Temperature Assessment

• Method: Sharp vs. dull discrimination; temperature testing with tuning forks or warm/cold water.

Vibration and Proprioception

• Testing sensations through tuning forks and joint position sense to assess peripheral nerve function.

Glasgow Coma Scale

• Used for assessing consciousness level and neurological status in a standardized manner:
  • Scoring based on eye opening, verbal response, and motor response.

Red Flags in Neurological Assessment

• Signs of deterioration in ALOC (Altered Level of Consciousness), headaches, or any noted changes in sensory/motor function.

Documenting Observations

• Clear documentation of assessments, reflex responses, symptoms, and patient observations is crucial for continuity of care.