JL

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.