Rethinking the neurological examination II: dynamic balance assessment

Maranhão-Filho, Péricles; Maranhão, Eliana Teixeira; Lima, Marco Antônio; Silva, Marcos Martins da

doi:10.1590/s0004-282x2011000700022

Cited by 24 publications

(17 citation statements)

References 16 publications

(17 reference statements)

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“…Reciting the alphabet has been used with "walking while talking" tests, showing an increased performance time under the additional task. 25 In the second condition, participants performed the TUG test while subtracting by 3s backward (referred to as TUG-3s), 17 starting at either 46 or 71 (chosen at random).…”

Section: Resultsmentioning

confidence: 99%

Effect of Cognitive Demand on Functional Mobility in Ambulatory Individuals with Multiple Sclerosis

Ciol¹,

Matsuda²,

Khurana³

et al. 2017

International Journal of MS Care

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CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit (none in the area of pharmacology). Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has received consulting fees from Acorda Therapeutics and Atlas5D and has received research support from Acorda Therapeutics and Atlas5D.Francois Bethoux, MD, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Marcia Aparecida Ciol, PhD, has disclosed no relevant financial relationships.Patricia Noritake Matsuda, PT, PhD, DPT, has received consulting fees from Mallinckrodt and has received research support from Mallinckrodt and Medtronics.Seema Rani Khurana, DO, has disclosed no relevant financial relationships.Melissa Jaclyn Cline, MD, has received research support from MC10, Inc, and Perimobile, Inc, and has an ownership interest in Intelliwheels, Inc.Jacob Jonathan Sosnoff, PhD, is a member of the Axon Council, Acorda Pharmaceuticals.George Howard Kraft, MD, MS, The anonymous peer reviewer for the IJMSC has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Method of Participation: Release Date: August 1, 2017 Valid for Credit Through: August 1, 2018 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

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Section: Resultsmentioning

confidence: 99%

Effect of Cognitive Demand on Functional Mobility in Ambulatory Individuals with Multiple Sclerosis

Ciol¹,

Matsuda²,

Khurana³

et al. 2017

International Journal of MS Care

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“…Unfortunately, regarding the neurological teaching and learning, many professors create expectations for performance of complete examinations that they usually do not perform or need 4,5 . Clearly, some tests are more marginal than others, and in a general situation regarding a specificity, it is expected that neurology professors will differ in their choices for pruning the traditional examination 6,7 . The NE varies widely by disorder (e.g., dementia versus low back pain), and the examination is directed by the history.…”

Section: Discussionmentioning

confidence: 99%

What is the essential neurological examination?

Lima

Maranhão-Filho

2012

Arq. Neuro-Psiquiatr.

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Many clinicians consider the neurological examination (NE) the most difficult and intriguing aspect of semiology. A common complaint is how to perform an excessive number of complex maneuvers in order to obtain clinical relevant information.In 2009, Frazer Moore and Colin Chalk 1 published the results of an interesting study called "The Essential Neurological Examination". In an early part of their work, they elected to investigate how neurologists use NE when faced with a common clinical situation: a patient referred with a potential neurological complaint in which the history suggests that a neurological problem is in fact unlikely, and the NE is being used to confirm that the patient is neurologically normal. Such researchers asked 19 McGill University neurologists to consider this scenario, and then asked them to state how likely they would be to use each of the 46 items of a reasonably complete NE. As an external validation, 38 neurologists across Canada and 168 students from McGill Medical School in a range of practice settings were asked to rate the 46 NE elements, using the same scenario and rating scale. This study sought to evaluate how a group of neurologists based in Rio de Janeiro, Brazil, would use NE in the same scenario by Moore and Chalk's study. METHODSIn order to investigate how experienced neurologists use the NE, we hypothesized a common clinical scenario: a patient referred with a potential neurological complaint, but the history suggests that a neurological problem is in fact unlike, and the NE is being used to confirm that the patient is neurologically normal. ABSTRACTIn order to determine which aspects would be essential to the neurological examination (NE) in a given specific situation (a patient referred with a potential neurological complaint, but the history suggests that a neurological problem is unlikely), we presented the same questionnaire used by Moore and Chalk in Canada to 19 neurologists in Rio de Janeiro, Brazil. We considered significant aspects of NE, whose average responses were greater than or equal to 3.5: visual fields, fundoscopy, pursuit eye movements, facial muscle power testing, gait, pronator drift or rapid arm movement in upper limbs, finger-nose, tone in arms and legs, five tendon reflexes, and plantar responses. We concluded that, despite geographical and economical differences between Brazil and Canada, neurologists from both countries agree about the essential NE in the proposed scenario.Key words: neurologic examination, neurosemiology, neurological complaint. RESUMOVisando determinar quais aspectos do exame neurológico (EN) seriam essenciais em uma situação específica (paciente com queixa neuroló-gica, mas cuja história sugere ser improvável um problema neurológico), apresentou-se o mesmo questionário utilizado por Moore e Chalk no Canadá a 19 neurologistas do Rio de Janeiro, Brasil. Foram considerados os aspectos significativos do EN com pontuação igual ou superior a 3,5: campo visual, fundoscopia, movimentos de perseguição ocular, mímica facial, marcha, ...

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“…Péricles Maranhão-Filho and colleagues show in this issue of the Arquivos 4,5 that just one part of the neurologic examination, the balance (static and dynamic) assessment, has also become rather refined over the last decades and properly executed brings diagnoses that may lead to effective treatments or interventions that can markedly diminish morbidity and mortality from falls. Moreover, most of the diagnoses that can accurately be made with a precise balance assessment cannot be made with routine imaging modalities.…”

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“…The difficult problem of differentiating early stages of Parkinson's disease from other progressive Parkinsonian syndromes can be accomplished with details of balance and gait: tandem gait and cycling 6,7 , and the arduous differential diagnosis of dizziness can be much helped with all the tests presented in this issue by Péricles Maranhão-Filho and colleagues 4,5 . Other Brazilian authors have also studied gait and balance disorders in specific diseases:…”

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confidence: 99%