module 5 mastering history & clinical examadhdwellnessexpert.s3.amazonaws.com/module...

Dr. Yannick Pauli

www.adhdwellnessexpert.com

Module 5

Mastering History& Clinical Exam

LEVEL 5Clinical Exam

Mastering History and Clinical Exam

Module topicsModule topics:

• Equipment

• Neurological Exam

• Chiropractic Exam

• Metabolic Exam

• Emotional

EQUIPMENTEQUIPMENT

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

NEUROLOGICAL EXAMNEUROLOGICAL 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

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

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

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)

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

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

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

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

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

CORE STABILITY

• 1 minute Rhomberg arms straight

• Supine bridge

• Side bridge

• Superman fly

CEREBELLAR FUNCTION

• Finger to nose – opposite to hemisphericity

• Piano playing – opposite to hemisphericity

• Alternating pro/supination – opposite to hemisphericity

Step 6Step 6 –– Vestibular evaluationVestibular evaluation :

• Vestibular Ocular Reflex (VOR)

• Post-rotational nystagmus

Step 7Step 7 –– Specific sensory modality evaluationSpecific sensory modality evaluation :

VISUAL SYSTEM

• Light sensitivity test

• Pursuits

• Saccades

• Convergence

AUDITORY SYSTEM

• Tuning fork

• Dichotic listening

OLFACTORY SYSTEM

• Smell test

CHIROPRACTIC EXAMCHIROPRACTIC EXAM

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)

METABOLIC EXAMMETABOLIC EXAM

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

EMOTIONAL EXAMEMOTIONAL EXAM

In the next videoIn the next video

• Level 6 – Basic Lab work

module 5 mastering history & clinical examadhdwellnessexpert.s3.amazonaws.com/module...

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