101 Basic Neuro Principles.pdf

Basic Neuro Principles “The mind, once expanded never returns to its original size” -Oliver Wendall Holmes Learning Objectives ◦ Understand the 7 steps of The NBC Assessment ◦ Understand the 7 Longitudinal Levels of Lesion ◦ Can demonstrate the process of a therapeutic trial and retesting The NBC...

Basic Neuro Principles “The mind, once expanded never returns to its original size” -Oliver Wendall Holmes Learning Objectives ◦ Understand the 7 steps of The NBC Assessment ◦ Understand the 7 Longitudinal Levels of Lesion ◦ Can demonstrate the process of a therapeutic trial and retesting The NBC Assessment 1. History 2. Neurological Exam 3. Anatomical Diagnosis 4. Therapeutic Trial 5. Retest 6. Create Treatment Plan 7. Order Additional Tests as Needed History 1. Look through the patient’s history at each symptom 2. For every symptom, list possibilities on where in the neuroaxis it’s from 3. Identify the main diagnosis and differential diagnoses in case the diagnosis is incorrect 4. Consider the possible diagnoses/affected areas while doing the exam Neurological Examination 1. Designed to give data on a patient’s physiological issues 2. A thorough exam helps identify all factors that may be involved 3. Using the data, piece together the patient’s clinical puzzle and identify the level(s) of the lesion, proving/disproving your diagnosis 7 Longitudinal Levels of Lesion This is the neuroaxis broken down into 7 parts. Each of these levels have associated findings. Use pattern recognition to see where most of the findings are. Anatomical Diagnosis 1. Understanding the pathophysiology and how it relates to the symptom is the most important part of neuro rehab 2. Create a working diagnosis based on the exam findings 3. The more specific you can get the better chance the patient improves 4. Find the primary lesions, not the secondary or tertiary - treating primary lesions will be a “root cause” fix, vs a compensation Therapeutic Trial 1. Brainstorm ideas on therapies that will affect the lesioned area 2. Pick which exam findings to evaluate before/after the therapeutic trial to prove your hypothesis 3. Check the finding(s) before treatment to get the patient’s baseline 4. Apply the treatment to the patient 5. Have expectations in mind on what would happen if the treatment was appropriate or not Retest 1. Recheck the finding to see if the finding improved 2. If no improvement is noted, consider the following: ◦ Incorrect region ◦ Inappropriate application ◦ Fatigue ◦ Sometimes symptoms get worse as patient becomes more aware with better brain activity Create Treatment Plan 1. Using all the data create a plan to fix the primary issues at hand and provide symptomatic relief 2. Avoid “If, then” treatment ◦ Ex. If they have issues with “symptom”, do this exercise 3. Be aware our diagnostics are not the “end all” to a person’s issues ◦ If the diagnostics improve but the person’s main issues did not, the objectives of tx were not met ◦ The Anatomical Diagnosis and localizing the level of the lesion was done incorrectly Order Additional Tests as Needed 1. If there are red flags or the findings don’t point to a functional lesion, other tests may be appropriate 2. Imaging such as MRI, CT, ultrasounds can be ordered to rule out other diseases 3. Referrals to other professionals can be given The Puzzle Solver 1. As clinicians we are the puzzle solvers and the patients are the puzzles 2. By seeing patients and practicing this assessment, you will develop speed and have more intuition on what the patient is dealing with 3. The best clinicians are the ones that can identify where the lesion is, and apply appropriate therapies in the correct amounts 4. By doing so you have the potential to change the trajectory of someone’s life for the better