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Dr. Yannick Pauli
www.adhdwellnessexpert.com
Module 5
Mastering History& Clinical Exam
LEVEL 5Clinical Exam
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Mastering History and Clinical Exam
Module topicsModule topics:
• Equipment
• Neurological Exam
• Chiropractic Exam
• Metabolic Exam
• Emotional
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Mastering History and Clinical Exam
EQUIPMENTEQUIPMENT
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EquipmentEquipment:
Blood pressure cuff and stethoscope (optional)
A small ball or tennis ball
Tuning fork
Pen light
Pinwheel
Reflex hammer
A chair that spins (optional)
3 essential oils of different smells familiar to children (optional)
Muscle-testing challenges Kit
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Mastering History and Clinical Exam
NEUROLOGICAL EXAMNEUROLOGICAL EXAM
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Mastering History and Clinical Exam
Neurological Exam is composed ofNeurological Exam is composed of:
Step 1 – Vital signs
Step 2 – Dominance and lateralization evaluation
Step 3 – Primitive Reflexes & Neurological Disorganization
Step 4 – Sensori-motor evaluation
Step 5 – Proprioceptive evaluation
Step 6 – Vestibular evaluation
Step 7 – Specific sensory modalities evaluation
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Step 1Step 1 –– Vital signsVital signs:
• As the brain develops and matures, it exerts a controlling effect onvital functions
• Heart and respiration rate decrease with age
• Hemisphericity will have a differential impact on left-right bloodpressure and oximetry
• Assess heart and respiratory rate & compare to “norms”
• Evaluate right and left blood pressure & compare
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Mastering History and Clinical Exam
Step 2Step 2 –– Dominance and lateralizationDominance and lateralization:
• Neurologically, we need a dominant side
• If language center is on the left, right-sided dominance is ideal
• We will be evaluating for mixed dominance
• Up to about 6-8 yo, dominance may change with our program
• After that, it remains fixed and is a matter of understanding thestrength and weakness of the specific mixed dominance
• Based on the work of Carla Hannaford, PhD
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Mastering History and Clinical Exam
Step 2Step 2 –– Dominance and lateralizationDominance and lateralization:
• Hand (catch & throw; writing & drawing; teeth brushing)
• Foot (kick a ball; write name with foot)
• Eye (telescope/spyglass test)
• Ear (cell phone; tuning fork; listen to the door)
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Step 3Step 3 –– Primitive Reflexes and Neurological DisorganizationPrimitive Reflexes and Neurological Disorganization:
• Primitive reflexes are a set of reflexes designed to ensure newborn’simmediate response to his/her environment
• Essential for survival in the first few weeks/months
• Provide the basis for some later voluntary skills
• Should not remain active beyond 6-12 months
• Presence of primitive reflexes is a sign of developmental delay
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Mastering History and Clinical Exam
Step 3Step 3 –– Primitive Reflexes and Neurological DisorganizationPrimitive Reflexes and Neurological Disorganization:
• Erect Moro
• Palmar reflex
• Asymetrical Tonic Neck Reflex
• Spinal Galant
• Symmetrical Tonic Neck Reflex
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Mastering History and Clinical Exam
Step 3Step 3 –– Neurological DisorganizationNeurological Disorganization:
• Our nervous system is organized in a contralateral pattern
• Walking is dependent on facilitation of the anterior compartment withinhibition of the posterior compartment of one upper extremity withidentical pattern for the contralateral lower limb
• Improper pattern of activation is called neurological disorganization
• Neurological disorganization is a sign of brain developmental delay
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Mastering History and Clinical Exam
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Mastering History and Clinical Exam
Step 4Step 4 –– SensoriSensori--motor evaluationmotor evaluation:
• Head tilt – to side of hemisphericity
• Eye balance – larger eye to side of hemisphericity
• Fixation – inability usually related to right hemisphericity
• Pupillary reactions – larger pupil on side of hemisphericity
• Distal muscle testing – weakness on side of hemisphericity
• DTR and pinwheel
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Mastering History and Clinical Exam
Step 5Step 5 –– ProprioceptiveProprioceptive evaluationevaluation :
BALANCE
• Rhomberg – sway opposite to side of hemisphericity
• Tandem gait balance – sway opposite to side of hemisphericity
• One leg stand – difficulty on side opposite to hemisphericity
• Straight line walking – sway opposite to hemisphericity
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Step 5Step 5 –– ProprioceptiveProprioceptive evaluationevaluation :
CORE STABILITY
• 1 minute Rhomberg arms straight
• Supine bridge
• Side bridge
• Superman fly
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Mastering History and Clinical Exam
Step 5Step 5 –– ProprioceptiveProprioceptive evaluationevaluation :
CEREBELLAR FUNCTION
• Finger to nose – opposite to hemisphericity
• Piano playing – opposite to hemisphericity
• Alternating pro/supination – opposite to hemisphericity
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Mastering History and Clinical Exam
Step 6Step 6 –– Vestibular evaluationVestibular evaluation :
• Vestibular Ocular Reflex (VOR)
• Post-rotational nystagmus
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Mastering History and Clinical Exam
Step 7Step 7 –– Specific sensory modality evaluationSpecific sensory modality evaluation :
VISUAL SYSTEM
• Light sensitivity test
• Pursuits
• Saccades
• Convergence
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Mastering History and Clinical Exam
Step 7Step 7 –– Specific sensory modality evaluationSpecific sensory modality evaluation :
AUDITORY SYSTEM
• Tuning fork
• Dichotic listening
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Step 7Step 7 –– Specific sensory modality evaluationSpecific sensory modality evaluation :
OLFACTORY SYSTEM
• Smell test
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Mastering History and Clinical Exam
CHIROPRACTIC EXAMCHIROPRACTIC EXAM
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Chiropractic Exam is composed ofChiropractic Exam is composed of:
Step 1 – Spinal evaluation
Step 2 – Cranial evaluation
Step 3 – TMJ evaluation
Step 4 – Cranial nerves
Step 5 – Myofascial / Visceral
Step 6 – Neurospinal integrity
Step 7 – Objective evaluation (Insight Subluxation Station)
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METABOLIC EXAMMETABOLIC EXAM
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Metabolic Exam is composed ofMetabolic Exam is composed of:
Step 1 – Core system evaluation
Step 2 – Endocrine
Step 3 – Food intolerances
Step 4 – Gastro-intestinal dysbiosis
Step 5 – Toxicity
Step 6 – Immune system
Step 7 – Nutrient deficiency
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EMOTIONAL EXAMEMOTIONAL EXAM
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In the next videoIn the next video
• Level 6 – Basic Lab work
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