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NeuroLogic Exam

Clinical "Dissection" of the Nervous System - An Internet Accessible Tutorial for Medical Neuroscience

The Challenge

The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful, a medical student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes a disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?" The online tutorial needed to reinforce these principles in scope and approach.

• The purpose of this computer-based tutorial is not only to teach the elements of the neuro exam, but more importantly, how the parts of the exam are organized.
• In the first step, by examining predominantly longitudinal or intersegmental systems and then determining a level within the involved system based on segmental findings, the student develops a logical system of Cartesian coordinates.
• The second step is to correlate the parts of the neurologic exam with the neuroanatomy of the system examined.
• The third step is to show abnormalities in the exam and let the student figure out where the lesion is.

The Solution

The neuro exam is a series of tests and observations that reflects the function of various parts of the brain. If the exam is approached in a systematic and logical fashion that is organized in terms of anatomical levels and systems, then a clinician is lead to the anatomical location of a patient's problem. The online experience of "NeuroLogic Exam" provides comprehensive tutorials combined with digital video and rich media resources for medical students. The site is available in both English and Spanish.

The site content experts and designers demanded the online experience be uncluttered and use very simple, direct navigational access to any of the neuro exams. A limited number of scrolling pages of content was preferred over a heavily nested subpage structure. The three-step process identified as part of the project requirements needed to be reflected throughout the site. Rich media resources were determined to be the only way in which to present actual patients.

The site's content was divided into seven essential modules accessible through an ever-present columnar Table of Contents

• Anatomical localization on the neuraxis
• Mental Status Exam - evaluates cortical function
• Cranial nerves - examines the brain stem
• Coordination - examines the cerebellum
• Somatic Sensation - examines ascending body and facial sensation
• Motor - examines the corticospinal system and motor unit
• Gait- recognizing patterns of neurological abnormal gaits

Each module was divided into four consistent subsections:

• Anatomy: A schematic review of the anatomical pathway(s) being examined.
• Normal Exam: A video demonstration of that portion of the exam using a normal patient.
• Abnormal Examples: Video demonstrations of patients collected from various sources. For each portion of the exam, there is a patient who displays a neurologic abnormality.
• Quiz: Self-evaluation quiz for each module in a multiple choice question format.
  • High quality, downloadable QuickTime video clips were acquired and posted to demonstrate patient exams. These were available in small, single-user size, or as full-screen, lecture-hall size.

Because the site was intended to be bilingual for use in other Latin countries, the QuickTime movies used innovative techniques to allow either English or Spanish to be heard as well as English or Spanish captions to be read.

Other Benefits

NeuroLogic Exam, Clinical "Dissection" of the Nervous System: An Internet Accessible Tutorial for Medical Neuroscience interweaves the neurological examination with neuroanatomy. It lays the foundation for clinical problem solving by first, establishing the anatomical concept; second, demonstrating the problem solving method; then third, allowing active participation in applying the method. The tutorial combines the use of anatomical diagrams, live patient exam, video patient cases and self-evaluation tools to accomplish its educational goals. It also repurposes clinical video patient cases on streaming video for use in the tutorials as well as being available for use on demand. A complementary site attached to NeuroLogic Exam is Neurological Cases. It allows students to practice the three step-method to the anatomical localization of neurologic pathologies.

Project Details

Client: Paul D. Larsen, MD (University of Nebraska Medical Center); Suzanne S. Stensaas, PhD (University of Utah School of Medicine); Alejandro Stern (Fundación Stern, Buenos Aires, Argentina)
URL: http://library.med.utah.edu/neurologicexam/html/home_exam.html
Lead Designers: Paul E. Burrows and Eric Carlson