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Neurodiagnosis - #21140


Online Neurological Course (media-enriched exam with text and video case study review)

Neurology Charts (color dermatome, peripheral nerve and sclerotome charts)

Baseline Neurological Examination
(5-min procedural review video)

Upper Extremity Peripheral Nerve MMT (pdf)

 

 
Stacy M. Thornhill Peterson,  DC, DACRB
3
52.5
2.0
1.5 +0.25IS*
Students will study the presentation, diagnosis and treatment of common disorders and complaints of the peripheral and central nervous systems.


*IS refers to Independent Study
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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By the end of this course the student will be able to:

  1. Describe the manifestations and diagnosis of common neurological diseases via history, exam findings as well as ancillary methods of study.
  2. Describe the pathophysiology and natural history of the most common diseases of the neurological system.
  3. Employ low-technology techniques to assess neurological function and to treat those problems amenable to conservative care.
  4. Describe common high technology and/or non-conservative measures used by allopathic physicians to diagnose and treat neurological diseases
Materials
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A. Required Text(s):
  1. Neuroanatomy through Clinical Cases, by Hal Blumenfield, 2002.

B. Recommended Text(s):
  1. Netter's Neurology, by H. Royden Jones, 2005.
  2. Mayo Clinic Examinations in Neurology, Seventh Edition, by Mayo Clinic Department of Neurology, 1998.
  3. Principles of Neurology, Seventh Edition, by Maurice Victor and Allan H. Ropper, 2001.
  4. Tunnel Syndromes, Third Edition, by Marko M. Pecina, et al., 2001.
  5. Neurology for Non-Neurologists, Fourth Edition, by Wigbert C. Wiederholt, 2000.
  6. The Little Black Book of Neurology, Fourth Edition, by Osama O. Zaidat and Alan J. Lerner, 2002.
  7. Alternative and Complementary Treatment in Neurologic Illness, by Michael I. Weintraub, 2001.
  8. Myelopathy, Radiculopathy, and Peripheral Entrapment Syndromes, by David H. Durrant and Jerome M. True, 2002.
  9. Nutrients for Neuropathy, by John A. Senneff, 2002.
  10. Rehabilitation of the Spine, Second Edition, by Craig Liebenson, 2007.

Recommended Video(s)/DVD(s):

  1. Samuels MA: Video Textbooks of Neurology for the Practicing Physician. Harvard Medical School: Brigham & Women's Hospital, Boston, MA. Butterworth-Heinemann, 1998. (on reserve in the library)
  2. Janda V & Vavrova M: Sensorimotor Stimulation. OPTP (800) 367-7393 (on reserve in the library)
  3. Liebenson, Craig: Rehabilitation of the Spine. Lippincott Williams & Wilkins, 2007 (associated with second edition of textbook).

C. Required Materials for Lab:
  1. Neurodiagnosis #21140 Lecture Manual Winter 2007.
  2. Neurodiagnosis #21140 Lab Manual Winter 2007.
  3. Diagnostic equipment and supplies (per list developed for the Trimester 3 Physical Diagnosis #20130 course)
  4. Tromner's/Babinski/Tomohawk/Mallet reflex hammer & 128 Hz tuning fork
Assignments
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  1. Reading Winter 2007 Neurodiagnosis Lecture & Lab Manuals #21140 (available in the bookstore)
  2. Reading handout materials
  3. Studying lecture and laboratory information
  4. Practicing laboratory procedures
  5. Studying the online neurological course which can be accessed through www.nwhealth.edu Academic Resources > Neurodiagnosis > Online Neurological Course.
  6. Studying the online baseline neurological examination (review) which can be accessed through www.nwhealth.edu Academic Resources > Neurodiagnosis > Baseline Neurological Examination.
Attendance
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Attendance is required. The student is responsible for anything that transpires during each session, even if the student is not able to attend. In the event that a class session is missed, the student is responsible for obtaining information regarding schedule changes and/or other announcements that may have been made. Students with health-related condition(s), which contraindicate participation in any class activity, must notify the instructor during the first week of class or immediately following the onset of the condition(s). Students who believed that they have incurred an injury or have exacerbated a pre-existing condition while in class should report to the instructor immediately.
Grading Criteria
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A. Quizzes*:

There will be three (3) laboratory quizzes. Each quiz will be administered in the lab and is worth 40 points. Each quiz will primarily be practical in nature; however, there will be an oral (or possibly written) component as well. Please see the "Calendar Overview" for the pre-scheduled lab quizzes 1-3. Total from laboratory quizzes = 120 points.

The instructor reserves the right to provide (no more than 2) "unannounced" quiz or in-class assignment(s) in the lecture component of the course. The quiz or in-class assignment will/would be worth 15 point per assignment. The point allocation in the course would subsequently be adjusted accordingly, i.e., 335 total points for one addition and 350 total points for two additions. There will be NO mechanism with which this quiz or in-class assignment(s) may be "made-up".

Students will be tested on the previous week's material or on information covered up to the date of the particular quiz. For all quizzes, students are responsible for reading the Neurodiagnosis manuals, studying the online neurological exam, online baseline neurological exam, and keeping up-to-date on the material covered in the previous session(s).
C. Midterm*: 100 points; multiple choice/matching-type questions
D. Final*: 100 points; multiple choice questions/matching-type questions; cumulative (approximately 1/2 - 2/3 of the questions from after midterm).

*Student handbook policy will be followed in regards to any missed quiz/test.

* The Neurodiagnosis lecture and lab manuals as well as online coursework serve as a guide to help with the information that the student is responsible for during the trimester. Not all information the student is responsible for is in the manuals, but the student is responsible for it nonetheless. The student is strongly encouraged to fill in all the detail necessary in the notes from the lecture/lab sessions and his/her independent learning time to assist with the learning process. This proves to be very beneficial to the student.

* At the end of week two of the following trimester, all quizzes, examinations and case studies will be shredded.

Guaranteed grades are as follows:

A = 90 - 100% of the 320 total points
B = 80 - 89% of the 320 total points
C = 70 - 79% of the 320 total points
D = 68 - 69% of the 320 total points
F =

Failure to accrue at least 68% of the 320 total points
Course Competencies
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-

COGNITIVE DOMAIN


Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following neurological signs/symptoms:

  1. Agnosia
  2. Akathisia
  3. Allodynia
  4. Analgesia
  5. Anesthesia
  6. Anosmia
  7. Aphasia
  8. Apraxia
  9. Ataxia (gait, trunk)
  10. Athetosis
  11. Asterixis
  12. Ballismus
  13. Bradykinesia
  14. Chorea
  15. Choreiform movement
  16. Clonus
  17. Cognitive deficits
  18. Diminished visual acuity
  19. Diplopia
  20. Dizziness
  21. Dysarthria
  22. Dysdiadochokinesia
  23. Dysesthesia
  24. Dyskinesia
  25. Dysmetria
  26. Dysphagia
  27. Dysphonia
  28. Dyssynergia
  29. Dystaxia
  30. Dystonia
  31. Fasciculation
  32. Fever
  33. Fibrillation
  34. Flaccidity
  35. Gait abnormalities (ataxia, steppage, scissor, spastic, festinating, circumducting, etc.)
  36. Hearing loss (sensorineural vs. bone conduction)
  37. Hyperpathia
  38. Hyperreflexia
  39. Hypertonicity
  40. Hyperventilation
  41. Hypo/hyperkinesias
  42. Hypomimia
  43. Hypophonia
  44. Hyporeflexia
  45. Hypotonicity
  46. Incoordination
  47. Intention/ataxic tremor
  48. Loss of consciousness
  49. Loss of discriminative sensory functions
  50. Loss of proprioception
  51. Memory loss
  52. Myoclonus
  53. Myokymia
  54. Numbness
  55. Nystagmus
  56. Oscillopsia
  57. Pain (neurogenic, referred, headache, etc.)
  58. Pallanesthesia
  59. Papilledema
  60. Paralysis
  61. Paresthesias
  62. Postural tremor
  63. Resting tremor
  64. Rigidity (lead-pipe, cogwheel, paratonic)
  65. Spasticity
  66. Terminal/endpoint tremor
  67. Tic
  68. Tinnitus
  69. Vertigo
  70. Weakness


Students will be able to explain the clinical utility and indications for the following laboratory, imaging and other diagnostic tests in patients with suspected neurologic disease:

  1. Plain film radiography
  2. CT (computed tomography)/MRI (magnetic resonance imaging)
  3. EEG (electroencephalography) studies
  4. EMG (electromyography) and NCV (nerve conduction velocity)
  5. VEP (visual evoked potentials), BAER (brainstem auditory evoked response) studies, SSEP (somatosensory evoked potentials) studies
  6. PET (positron emission tomography) scan
  7. CSF (cerebrospinal fluid) analysis
  8. CBC (complete blood count) with differential
  9. Comprehensive metabolic panel
  10. Urinalysis


Conditions:

Students will be able to make case management decisions regarding common neurologic conditions based on their understanding of the following information regarding each condition. (See key on following page for description of codes.)

Clinical Etiol. & Patho- Nat.History Exam & RX/
Condition Epidem. phys & course Dx Mgmt
Acoustic Neuroma 1 1 1 1,2,3,6 6
Auditory Processing Disorder 1 1 1 1 1
Alcoholism 2 2 2 1,2,3,7 3,5
ALS (Lou Gehrig's) 3 3 3 1,2,3,6 4,5,6,7
Alzheimer's Disease 2 2 2 1,2,3,6 3,4,5,6,7
Bell's Palsy 3 3 3 1,2,3,4 1,2,3,4,5,6,7
BPPV 1 1 1 1,2,3 1,6,7
Carpal Tunnel Sy. 3 3 3 1,2,3,4,7 1,2,3,4,5,6
Cerebral Palsy 2 2 2 1,2,3,6, 4,5,6
Cervicogenic Vertigo 2 2 2 1,2,3,4 1,5
Cubital Tunnel Sy. 3 3 3 1,2,3,4,7 1,4
Diabetes Mellitus 2 2 2 1,2,3,5 1,3,4,5,6
Disc Herniation - C/S 3 3 3 1,2,3,4,6 1,2,4,5,6,7
Disc Herniation - L/S 2 2 2 1,2,3,4,6 1,2,4,5,6,7,
Disc Herniation - T/S 2 2 2 1,2,3,4,6 1,2,4,5,6,7
Encephalitis 1 1 1 1,2,3,5,6 6
Freidreich's Ataxia 1 1 1 1,3 0
Genitofem. N. Entrap. 2 2 2 1,2,3,4,7 1,4
Guillain-Barre Sy. 1 1 1 1,2,3,5 6
Headache - Cluster 2 2 2 1,2,3,4,6 1,2,3,4,5,6
Headache - Migraine 3 3 3 1,2,3,4,5,6 1,2,3,4,5,6,7
Headache - Rebound 1 1 1 1,2,3,4,5 1,2,3,5
Headache - Tension 2 2 2 1,2,3,4 1,2,3,4,5,6
Herpes Zoster 2 2 2 1,2,3,4 1,2,6,7
Intracranial Masses 2 2 2 1,2,3,5,6 6
Labyrinthitis 1 1 1 1,2,3 1,6,7
Maigne's Syndrome 1 1 1 1,2,3,4,7 1,4
Meniere's Disease 2 2 2 1,2,3 1,3,5,6,7
Meningitis 2 2 2 1,2,3,5,6 6
Meralgia Paresthetica 2 2 2 1,2,3,4,7 1,4
Multiple Sclerosis 3 3 3 1,2,3,4,5,6 1,2,3,4,5,6,7
Muscular Dystrophy 2 2 2 1,2,3,5,6,7 1,4,5,6
Myasthenia Gravis 2 2 2 1,2,3,5,6,7 1,4,5,6
Myelopathy 3 3 3 1,2,3,4,5,6 1,2,4,5,6
Neurofibromatosis 1 1 1 1,3 0
Optic Neuritis 2 2 2 1,2,3,5,6 6
Parkinson's Disease 3 3 3 1,2,3,4,5,6 1,2,3,4,5,6,7
Peroneal Tunnel Sy. 1 1 1 1,2,3,4,7 1,4
Piriformis Syndrome 2 2 2 1,2,3,4,7 1,4
Post-Concussive Sy. 3 3 3 1,2,3,4,6,7 1,2,3,4,5,6,7
Pronator Teres Sy. 2 2 2 1,2,3,4,7 1,4
Radiculopathy - C/S 3 3 3 1,2,3,4,5,6 1,2,4,5,6
Radiculopathy - L/S 2 2 2 1,2,3,4,5,6 1,2,4,5,6
RSD/CRPS (Causalgia) 3 3 3 1,2,3,4,6,7 1,2,3,4,5,6,7
Schizophrenia 1 1 1 1,2 6,7
Seizures-Epileptic 2 2 2 1,2,3,4,5,6,7 1,3,4,5,6,7
Seizures-Nonepileptic 2 2 2 1,2,3,6,7 6
Stroke 3 3 3 1,2,3,4,5,6 1,2,3,4,5,6,7
Supinator Sy. 2 2 2 1,2,3,4,7 1,4
Syringomyelia 2 2 2 1,2,3,6 6
Tarsal Tunnel Sy. 3 3 3 1,2,3,4,7 1,4,6
Thoracic Outlet Sy. 2 2 2 1,2,3,4,7 1,4,6
Thyroid Disorders 2 2 2 1,2,3,5 1,3,4,5,6
TIA 3 3 3 1,2,3,4,5,6 1,2,3,4,5,6,7
Tourette's Syndrome 1 1 1 1,2,3,6 6
Trigeminal Neuralgia 3 3 3 1,2,3,4,6 1,2,3,4,5,6,7
Ulnar Tunnel Sy. 3 3 3 1,2,3,4,7 1,4
Vestibular Neuritis 2 2 2 1,2,3 1,6,7
Whiplash Injuries 2 2 2 1,2,3,4,6 1,2,4,6

 

Elaboration of Coding Definitions
Regarding the Conditions

The following codes refer to the depth of coverage for Etiology and Epidemiology; Pathophysiology, and; Natural History and Course:

0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handout material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1 Presenting sy's: Presenting symptoms related to condition are discussed.
2 History findings: Relevant personal and family histories are discussed.
3 Exam findings: General physical exam findings are discussed.
4 Chiro. Findings: Posture, subluxation, muscle tone and length, trigger pts .
5 Lab findings: Blood, urine, CSF . . .
6 Imaging findings: Normal, CT, CAT, MRI . . .
7 Special test findings: eg sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1. Chiropractic: Adjustments, soft tissue techniques
2. PT: Physical therapy modalities of all types
3. Nutrition/Suppl: Diet and supplement recommendations
4. Exercise: Stretching, strengthening, aerobic exercise recommendations
5. Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance . . .
6. Medical: Drugs, antibiotics, surgical procedures, radiotherapy . . .
7. Other: Acupressure/puncture, massage, music-based auditory stimulation therapy™, homeopathic or herbal Rx . . .
8. Guidelines: Included, if relevant



PSYCHOMOTOR DOMAIN


Students will be able to conduct, in a patient presenting with neurologic disease manifestations, an appropriate physical examination using the following
procedures:

  1. Motor testing (strength/power, tone, bulk/volume/contour)
  2. Reflex testing [muscle stretch reflexes, superficial (cutaneous) reflexes, pathologic reflexes]
  3. Primary (subcortical/thalamic) sensation (pain, temperature, light touch, proprioception, vibration)
  4. Cervical spine provocation (to detect C/S myelopathy)
  5. Mini-mental status examination (MSE)
  6. Cranial nerve examination
  7. Cerebellar testing
  8. Cerebral testing (2-point discrimination, stereognosis, topesthesia, graphesthesia)
  9. Sensorimotor evaluation (Romberg's, single leg stance)
  10. Peripheral examination (tracing & relevant motor, sensory and reflex testing) of median, ulnar, radial, lateral femoral cutaneous, genitofemoral, tibial and peroneal nerves

Students will be able to select and properly employ the following treatment
techniques (either singly or in condition specific treatment "packages") to male
and female patients who have neurologic disease:

  1. Sensorimotor stimulation training
  2. Myofascial release
  3. Strengthening muscles in the periphery (cross-over therapy, physiotherapeutic assist, isometrics, PNF)
  4. Acupressure (including auriculotherapy)
  5. Auditory/visual processing techniques
  6. Neuromuscular coordination activities [cross-crawl, general facilitation of the phasic system (due to flexor dominance)]

In addition, students will be able to advise and instruct patients regarding the
following home care concepts and activities as they apply to specific neurologic
conditions:

  1. Nutrition and supplementation
  2. Exercises
  3. Use of certain herbal remedies
  4. Adjunctive apparatuses to aid activities of daily living


AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion
and professionalism at all times, both in lectures and labs, and will be able to
apply the history, physical examination and treatment techniques learned in this
course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Neurodiagnosis Calendar Overview Winter 2007. The "Calendar Overview" may be changed during the course of the trimester (as circumstances require). Students will be given reasonable notice whenever possible.
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 20 February, 2007
 

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