chiropractic neurological exam

[pic]
Dear Madam, Dear Sir,
I would like to thank you for your trust and for your opportunity to let me
evaluate your child during our first consultation. You have probably realized that I have introduced you to many concepts
during this first evaluation and that a majority of those are probably very
new for you. It is possible that you feel a little bit overwhelmed by the
amount of information you have received. The pages included in this report are designed to summarize the main points
of the evaluation, as well as to explain to you the importance and meaning
of each exam. I hope that the information that you find herein will help you get a better
understanding of your child's challenges, so that you can understand and
help him or her better. Obviously, I am always available to answer any questions, challenges or
preoccupations you may have. Sincerely, Dr. Yannick Pauli Centre Wellness NeuroFit Dr. Yannick Pauli
Vinet 19 - 1004 Lausanne
Tél : 021 646 52 38 [pic]
REPORT OF FINDINGS [Insert Child Complete name] - born [Insert DOB]
[Insert Exam Date] |NEUROPSYCHOLOGICAL QUESTIONNAIRE | As explained during the first consultation, there are no biological or
imaging exams that can confirm whether or not your child indeed suffers
from a neurobehavioral disorder. The diagnosis is therefore made on the
basis of a subjective evaluation of the child's behavior by third parties
such as parents or teachers. There are several questionnaires used by health care professionals to
better appreciate and evaluate your child's behaviour. Medical diagnosis is
based upon meeting a certain amount of diagnostic criteria described in a
textbook called DSM-Iv ("Diagnostic and Statistical Manual" produced by the
American Psychiatric Association. The questionnaire that we used is called "Childhood Behavioral Checklist"
(CBC) developed by Achenbach. It evaluates your child behaviour through 113
questions. The CBC gives us three important types of results: . A total score
. A score by behavioural categories, specific to CBC
. A score by behavioural categories, correlated to the DSM-IV. When a child scores abnormally on a DSM-IV correlated category, it is
likely that he would meet the DSM-IV diagnostic criteria for that disorder. The behavioural categories specific to CBC cover the following domains:
. Anxiety/depressed
. Withdrawn / depressed
. Somatic complaints
. Social problems (difficulties bonding with others)
. Thought problems
. Attention problems
. Rule-breaking behavior
. Aggressive behavior The DSM-IV correlated categories contain the following diagnosis:
. Affective problems (self-esteem)
. Anxiety problems
. Somatic problems
. ADHD
. Oppositional defiant problems
. Conduct problems TOTAL SCORE [pic] |NORMAL = 65 or less |
|BORDERLINE = 65 to 70 |
|ABNORMAL = 70 or more |
[pic] [pic] |CHIROPRACTIC NEUROLOGICAL EXAM | The results of the chiropractic neurological exam have revealed several
dysfunctions compatible with a [right/left] hemisphericity. This means that
the involved hemisphere is weaker or delayed in its development compared to
the other one, resulting in a functional disconnection syndrome. We have
also found the following problems [core postural instability], [cerebellar
imbalances], [oculomotor control dysfunctions]. The traditional chiropractic exam has revealed several areas of imbalances
and loss of motion of the cranium, spine and pelvis. Those imbalances,
called vertebral subluxations, prevent proper communication between the
brain and the rest of the body. |PARASPINAL SURFACE ELECTROMYOGRAPHY | This exam allows to objectively measure the amount of tension and
imbalances of the postural musculature. Remember that the postural
musculature and the spine are the two most important sources of stimulation
for the brain. The colours mean the following (see results on the addendum page):
White = normal
Yellow = hypotonic
Green = light tension or imbalance
Blue = moderate tension or imbalance
Red = severe tension or imbalance
Black = very severe tension or imbalance |INTERACTIVE METRONOME | During this test, we ask the child to perform coordination exercises to the
rhythm of a metronome. The child is equipped with sensors on his hands and
feet. The objective is to coordinate movement and tap exactly on the beat.
The software calculates whether your child is too early or too late in his
coordination. This test gives us some information about timing, sequencing,
neurological processing speed and coordination. The test has 13 different
exercises. The software calculates a global score for your child, which is
compared to normative data. According to his score, your child is place in
one of the following categories (from worst to great): dissociative, severe
deficiency, below average, average, above average, excellent and superior.
|Score |[52.8] milliseconds |
|Category : |[average] | |« TEST OF VARIABLES OF ATTENTION » (TOVA) | In this computerized test, your child is presented with a target and a non-
target. Your child must press on a trigger when he sees the target and
refrain from pressing when he sees the non-target. The test lasts 22
minutes and gives the following information:
. Omission errors (your child forgets to press when he is supposed to)
are a measure of inattention
. Commission errors (your child presses when he is not supposed to) are
a measure of impulsivity
. Reaction time (the speed with which your child presses after having
seen the target)
. Variability (whether your child is constant in his performance or has
ups and downs) Two other parameters are calculated by the software:
. D´(D prime), a measure of perceptual sensitivity, i.e the ability of
your child to distinguish between the target and non-target. This
ability is affected in ADHD.
. Anticipatory answers (your child presses before having seen the
target), which are, when in excess, connected to impulsivity problems. Those various parameters give us information about your child's attention
and impulse control. When the software calculates an overall score, some
parameters weigh more than others in the equation. In order of importance
we have:
1. Variability
2. Reaction time
3. Perceptual sensitivity
4. Commission errors
5. Omission errors. The TOVA is done in two different "modes": 1. In the first half of the test ("infrequent mode" or vigilance),
targets rarely appear. This part of the test evaluate for vigilance,
i.e. the ability to remain concentrated in an environment that is not
interesting (e.g. in a classroom where the child is not solicited). In
general, children who get quickly bored have difficulties with this
part.
2. In the second half of the test ("frequent mode" or distractibility),
targets appear frequently. The child must frequently press on the
trigger but has to be careful not to press when he is presented with a
non-target. This part evaluates for distractibility (the child can
concentrate but is easily distracted by extraneous stimuli). It gives
us some information about impulsivity (the more impulsive the child,
the more problems he will have not to press when presented with the
non-target. This part is more similar to a classroom environment that
is more stimulating but also has numerous distractions (e.g. a noisy
classroom). Children who are easily stimulated or distracted have more
problems with this part.
A global score is calculated for each quarters, each halves and for the
entire test. A normal score should be between 85 and 115 for a child with
normal IQ. A score below 80 is suggestive of attentional and impulse
control problems. If your child has one score below 80, this is highly
suggestive of ADHD. The TOVA also calculates what is called the ADHD score. Normal is -1.80 or
more positive (e.g. -0.96 or +0.15). A score below -1.80 (e.g. -1.82 or -
4.43) is highly suggestive of ADHD. |An ADHD score more positive than -1.80 does not mean that the |
|person has no problems. There are other parameters to consider. A|
|person with a normal ADHD score can still suffer from ADHD if |
|some of the other parameters are involved. . | |Normal = 85 or more |
|Borderline = 80 to 85 |
|Abnormal = 80 or less | [pic][pic] [pic][pic] The results of the TOVA are compatible with a severe attention deficit. |INTERPRETATION | From a functional neurology standpoint, our evaluation has shown that your
child is suffering from a functional disconnection syndrome secondary to a
[right/left] hemisphericity. Objective evaluation using the TOVA has revealed that your child has [no
attention deficit/ a light attention deficit/ a moderate attention deficit
/ a severe attention deficit / a very severe attention deficit]
----------------------- Normal = 60 points or less « Normal » - 1. 80 Abnormal < 40 < 40