Review: Examination of the Neurological PatientDownload a PDF of this review. ReviewerNameDr Andrew King InstitutionCoventry University DepartmentPhysiotherapy and Dietetics Job titleSenior Lecturer Video DetailsTitleExamination of the Neurological Patient CountryUK Duration (mins)56 mins 24 secs CollectionSt George's Hospital Medical School Collection Year1996 DescriptionA guide to the medical examination of the nervous system, summarising and demonstrating the steps and sequences involved Subject classificationOphthalmology, Physicians, UK, Nervous Systems, Testing, Patients, Neurology Intended audienceFilm produced by St George's Hospital Medical School for medical students. Brief summaryThis is a very good straightforward demonstration of how doctors perform their initial examination of the neurological system, without any digressions into unusual diagnoses or special tests for uncommon presentations. ReviewAudience and UseThis video is intended for medical students training for clinical examination. But it could also be used for teaching students of other professions, such as nursing or physiotherapy, and can also be used to see what doctors do during such an assessment. There is a considerable amount of technical language involved, and there is an assumption of considerable knowledge of anatomy, physiology and some pathology. For this reason it is not an appropriate means of education for most patients. The video could be used individually or in groups to consolidate prior learning. Alternatively, individual clips could be used to spice up lectures to larger groups of students with a visual demonstration of what is being discussed. ContentThe content is a sequential demonstration of the practical structure and procedures involved in the medical assessment of a patient's neurological system. The film runs through testing of gross motor function, cranial nerves, motor system including muscle tone, reflexes, and sensation. It demonstrates various tests but does not usually go into the mechanisms of how each particular test works. For example, with regard to testing of reflexes, knowledge is assumed of the individual receptors stimulated by the tendon tap, and the necessary afferent and efferent pathways. Students need to know the levels of spinal innervation for muscle testing before they can understand the tests of muscle strength demonstrated. The content is at an appropriate level and accurate, although the muscle temporalis is tested using resisted opening of the jaw rather than with resisted closure. Technical issuesTechnically the film is easy to use. Division into 12 separate clips aids use of smaller segments, but there is still the option of viewing the film as a whole. The clips are all available for viewing either by Windows Media Player or by QuickTime. Quality of the video is fairly good, although sometimes the lighting is such that small changes on the skin surface (as in testing reflexes) cannot be seen on screen. The ex tempore commentary is easy to listen to and very clear, and small amounts of stumbling do not hamper the listener. General commentsThis is a very useful resource for students with a particular need in relation to examination of the neurological system. It is a little prescriptive and asks few questions about the validity of the tests involved. I have used the clip on testing reflexes with physiotherapy students, with generally positive responses. The film includes some very short clips of patients to demonstrate involuntary tremor of the fingers, myoclonus of thigh muscles, and chorea in the feet. If I have any criticism, it is that these examples are a bit arbitrary. Clips could also have been provided for positive results for any number of the tests, which the presenter sought to act out on his normal subject. For example, video clips could have been used to show clonus, or a positive Babinski sign, or of the catch when testing tone in the muscles of the forearm. Overall, an hour's viewing which would benefit many students providing they have done the relevant anatomy and physiology. |
