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CLSC 6205 – Clinical Neurology – Neuro Exam, Neuron Theory

Miguel Chiusano, DC, MBA, DACNB

Lecture Objectives:

 Neurological Examination
 Neuron theory, examination issues and Chiropractic application concepts

Neurological Examination:
Components of a Neurological Examination
Demographics – Age, sex, handedness, occupation (current and previous)
A. Hx of present complaint (open questions, active listening, let Pt use their own words, think)
i. Interpret Pt’s Sx (what do you mean by dizziness???)
ii. Time course of Sx (onset [acute or insidious], progression and pattern [constant or intermittent,
frequency and duration] – tell you about the possible pathologies)
iii. Generate hypothesis and DDX
iv. Test hypothesis
v. Ask about associated symptoms
vi. Ask about risk factors
vii. Neurological screening Hx
viii. Impact of neurological problem on life, home, work and family
B. PMH
i. Drug Hx
C. Family Hx
D. Social Hx
E. ROS
F. Synthesize DDX and Hypothesis to test during examination

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CLSC 6205 – CLINICAL NEUROLOGY – NEURO EXAM, NEURON THEORY
Miguel Chiusano, DC, MBA, DACNB

Neuron Theory
A neuron requires 1) Activation, 2) Oxygen and 3) Fuel (glucose)
(It actually requires more – proteins, fats, H2O, anions/cations, etc…..
Activation without proper oxygen and fuel will lead to neuronal fatigue

Activation of a neuron depends on the membrane resting cell potential


Hypopolarized Vs Hyperpolarized neuron

Clinically there may be no initial presentation difference between a dead neuron and a hyperpolarized neuron.
So…… How can we tell them apart?

The human body contains receptors that provide information to the CNS.
These receptors are amplitude modulated and propagated (explain what this means clinically)
The receptors stimulate “All or None” neurons of the CNS
All or None Neurons can be activated either 1) Temporally or 2) Spatially (explain)

The CNS is composed of numerous nuclei, all at different central integrated states, which depends on the input
from the receptors and each other

Various nuclei talk to each other – homologous columns

Output of the CNS will be 1) Motoric (movement, speech, glad secretion, etc) and/or 2) Thought

The ability of the human body to interface with and respond to its environment (quality of life) will depend on the
CNS ability to function properly

We are interested in the function and physiology of the patient and their ability to maintain homeostasis

The clinical application of neurology in Chiropractic is NOT a cookbook technique.

Every patient has it’s own unique central integrative state; therefore treatment needs to be based on the
individual’s nervous system presentation.

Two individual with similar complaints may be treated totally different

Best practices calls for pre and post assessment of the nervous system when treated (Adjusted)
Updated 2017-01-12