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Neuroscience Diagnostics

The key to success in treating neurological disorders and diseases is accurate diagnosis of the problem.  McLaren’s Neurodiagnostics department is a sophisticated diagnostic resource for all of mid-Michigan.

Skilled physicians and technologists perform diagnostic testing in a professional, caring environment.

Diagnostic Procedures

Ambulatory EEG

If you have seizures or other suspected events that have not been detected by a routine EEG, your doctor may request that you have an ambulatory EEG. An ambulatory EEG is a continuous recording of your brain's function. You will wear the EEG monitor 24-72 hours while you go about your usual daily activities.

To prepare for this test, wash and dry your hair and wear a shirt that opens in the front. Bring a hood or scarf to wear home.

During the ambulatory EEG, the technologist will measure and scrub your scalp, and electrodes will be placed as was done during your routine EEG. A small receiver will also be placed on your scalp and your head will be wrapped to hold everything securely in place. You will also wear a light-weight monitor around your waist or over your shoulder. You will be asked to keep a diary of any symptoms that occur during the test and to return to have the monitor removed after the prescribed period of time. Your ambulatory EEG will be scanned onsite by a registered technologist and a neurologist will generate a report, which will be sent to your physician.

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Electroencephalogram (EEG)

The EEG is a safe and painless test that evaluates the function of your brain. If you have experienced seizures, fainting, memory loss, headaches, dizziness, stroke or head injury, your doctor may request that you have an EEG. These studies evaluate brain wave and electrical function.  Physicians refer patients for evaluation of seizures, epilepsy, attention deficit disorders, headaches, dizziness, fainting, and memory disorders. All studies are performed by trained technologists and reviewed by the Center’s neuologists.  Results are sent to the referring physician.

In preparation of the test you will be asked to sleep less than five hours the night before the test. You should also wash and dry your hair prior to your test.

During the EEG, you will sit in a  comfortable reclining chair in a quiet room. The technologist will measure your head and scrub the areas where electrodes will be placed. The electrodes will be dipped in cool cream and placed on your scalp. The lights will be dimmed and you will be allowed to lie back in the chair. The technologist will monitor the activity of your brain as you rest with your eyes closed. During the test, a strobe light will flash for about two minutes and you will be asked to open and close your eyes. You may also be asked to breathe rapidly and deeply for a few minutes. Many people fall asleep during this relaxing procedure. 

The test lasts about one hour and you will be able to resume your normal daily activities after it is completed.

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Electromyography

Conducted by physicians with specialty training, this is a needle examination of selected muscles of the arms, legs and small muscles along the spinal regions of the neck and back.  This test is primarily used to evaluate cervical or lumbar (neck or back) nerve root compression.  The needle examination is also used for diagnosis of ALS and other motor neuron disorders (polio, for example).

The needle is inserted just under the skin into the underlying muscle.  Specific waveforms, indicating the presence or absence of nerve injury and its effect on muscle function, are observed on a computer screen. 

For patients with specific pain concerns, referring physicians may prescribe pre-test pain or anti-anxiety medications.

The test is usually well tolerated by patients, who are advised by the examining physician about each step of the procedure.

Preliminary test results are reviewed with patients.  A follow-up appointment with your referring physician is suggested to discuss treatment recommendations.

Please plan on 2 hours for your EMG appointment.

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Evoked Potentials (EP)

This test evaluates how long it takes for a stimulus to reach the brain from a point of stimulation.  Stimulation points may be on the arms and legs.  Visual and auditory impulses are also used.  Your surgeon may request this test prior to surgery to establish baseline information that will be available to your surgeon during your surgical procedure.

Specialized EP tests also evaluate Multiple Sclerosis and other conditions affecting brain or spinal cord function.

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Head Injury Rehabilitation

A head injury occurs when there is a blow or jolt to the head resulting in injury to the brain. The head injury can result in mild, moderate to severe brain damage. Mild head injuries are also known as concussions Moderate to Severe head injuries cause a major loss in a person’s ability to function throughout his/her day.

Our Rehab Goal: To maximize a person's functional mobility, minimize a person's deficits, enhance his/her quality of life and regain his/her independence after a head injury has occurred.

Treatment can include:

  • Muscle Re-education is used to improve your ability to move and use your affected arm and/or leg.
  • Therapeutic exercises can improve a patient's overall strength and improve overall cardiovascular fitness/endurance
  • Activities of Daily Living (ADL) and Mobility Training can improve each patient’s ability to transfer, walk and manage all daily activities like dressing and bathing.
  • Bracing may be used in order to protect joints and positioning in an affected arm and/or leg, either by physical and occupational therapist or orthotist.
  • Speech Therapy will be provided as appropriate to assist with cognitive issues, along with any swallow problems that may have occurred as a result of the head injury.
  • Modification of Leisure activities will by provided by the recreational therapist to assist with alternatives or modifications to current or new leisure interests.
  • Patient education is given to understand and prevent further head injuries, joint protection of the affected arm and/or leg, family education to assist with care at home, and safe, proper use of assisted devices.

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Inpatient Neurosurgical Rehab at McLaren Bay Region

Interdisciplinary approach among many therapies makes inpatient neurosurgical rehab-- 'a marathon'

Rehabilitation for patients with neurological deficits may feel they've signed up for the Boston Marathon. It's a run for recovery: Challenging physical conditioning. Difficult dexterity and balance programs. Repetitive speech and language practice. Recreational activities to stimulate the brain and the body.

inpatient neur rehab

Typically, patients are recovering from strokes, traumatic brain injury, surgery to remove brain or lumbar tumors, or other debilitating neurological diseases.

Depending on severity, patients have a limited inpatient time frame to re-build life skills, and are urged to make the most of every minute. Patients must be able to spend three hours in therapy every day for the 2-3 week inpatient stay. Each patient has his/her room, and a schedule that starts early.

All patients are initially evaluated by medical director Ravi Lakkaraju, M.D. A team conference of all nursing and therapy disciplines distills a comprehensive treatment regimen, designed to achieve the patient's and family's goals for rehabilitation. Nurses and therapists know each patient's goals, and take every opportunity to reinforce skills the patient's need to overcome limitations.

Inpatient Rehab has a fully equipped apartment that some patients, nearing discharge, use to practice skills they've been learning.

Inpatient Nursing Care

Each day starts with re-learning day- to-day living activities -- getting out of bed, using the commode, taking a shower or bath, and getting dressed. Nurses monitor each patient's vital signs, noting any physical, mental, or language deficits that have changed. Nurses play a key role in evaluating patient reactions to stimulation, medications, and ambulation. "They are the 24/7 caregivers that know the needs and personalities of each patient," says Kimberly Ligney, BSN, Inpatient Rehab Nursing Manager.

Physical Therapy

inpatient neuro rehab

 

One--'marathon' trainer is Jacqueline Irvine, PT. The interdisciplinary team meeting sets a baseline for each patient's various therapeutic goals. Like all therapists, Jacqueline does her own patient evaluations, specifically evaluating functional and cognitive (understanding) abilities.

"I want to see where we need to start: Can the patient get out of bed? What level of mobility, coordination, and flexibility does the patient have? Does the patient understand what I am asking them to do, when I ask them to move a certain way physically?

"Often, we begin with my moving a leg, for example, for the patient. From there, we use verbal and touch prompts to remind the patient how to move the leg. The body has an amazing ability to compensate for physical deficits. Regaining muscle strength is something a patient must work on, not just during therapy, but throughout the day.

"Sometimes electrical stimulation can help to stimulate nerve impulses to make new connections. Patients may be excited about regaining a particular function, but we put safety over independence while they are in our care.

"Family support is very important, so they can understand what to expect in function and mobility for the short-term, and after the patient leaves inpatient rehab. That first year after a neuro injury is the window for regaining the greatest degree of independence and mobility. Family and friends can make a huge difference in encouraging patients to continue with therapy.

"We encourage patients to work toward physical stability and balance. Progress comes gradually, and with constant repetition. Their dedication determines how life will be for them -- their physical independence and emotional self-esteem."

Occupational Therapy

Occupational therapist Sandra Lauria works with neurological patients with varying degrees of losses, depending on where the injury occurred and its severity.

"In Occupational Therapy, we evaluate the strengths and weaknesses the patient has, and how these affect their activities of daily living. We may need to re-educate and improve muscle control for bathing, dressing and cooking activities. At times, the patient may need to use equipment for tasks, and learn new ways to do something that they have always done. If a patient has weakness in one hand and is unable to button their shirt, we may use a buttonhook or teach them to do it one-handed.

"When a patient has some sensory loss or vision problem, we educate the patient and their family on how this may affect their participation in some activities such as cooking, driving or money management. The patient may need to find new ways to perform these tasks that are personally and financially safe.

"At times, we may need to go to a patient's home to observe the patient moving around their own house or apartment. We have the patient get in and out of their bed, on and off the toilet, in and out of the tub, walk around or use a wheelchair in their own home. One of the biggest obstacles in returning home may be how they will get inside. We may recommend a ramp or other changes to accommodate the patient in their home.

In Occupational Therapy, we want to help the patient (with the help of family and friends) return to living as independently as possible, engaging in tasks and activities they once performed and enjoyed".

Speech Pathology and Swallowing Disorders

Most stroke and brain injury patients are certain to encounter speech pathologist Mary Grant. "One of the first things we check for is dysphasia, or a swallowing disorder. They may have weakness with the lips and tongue, and it can be difficult to transfer food from the front to the back of their throat. Damage to the cranial nerves may have compromised coordination and strength, so they cannot swallow safely.

"This may require diet modification and helping them re-learn how to swallow food. Individuals with swallowing disorders are re-introduced to food by taking very small bites of food, small sips of liquids, and with laryngeal exercises and oral strengthening, to name a few.

"Patients whose language and understanding skills have been affected may need to learn to read and speak all over again. By using their strengths we can develop a program specific to their needs."

Recreational Therapy

If there's one therapist patients want to see, it's the recreational therapist Annmarie Sitkewicz. "I want patients to recapture skills, so activities are fun and stimulating. So, I want to find out what they enjoy doing in their spare time, and how they interact with others.

"We engage patients in favorite activities.. It might be chess or backgammon, or Scrabble. Individuals can re-learn almost any recreational skill, from knitting and jigsaw puzzles, to woodworking and golf. The key is adapting activities within the limitations they have.

"We may focus on strength building, coordination, word and speech recognition, or problem-solving. I like to see patients leave with three activities they enjoy and will practice after discharge.

"We organize weekly outings, so they can practice social skills and be comfortable out in the community. We work on skills they will use during the outing beforehand, which includes a restaurant meal. The whole team emphasizes the importance of--¿giving back'.

"Maybe it's getting re-involved in church or other volunteer activities. It could be joining an activity club that meets on a regular basis. What we stress is not to stay at home, but to learn how to get out and about where you live. Do as much as you can for yourself, and ask for help as needed.

"We tell patients that everything they do is about improving their quality of life. The late Christopher Reeve, paralyzed from the neck down, never gave up. The word that describes him and our patients is--¿courage.' We suggest they take some of their courage and--¿pass it on'."

Discharge Planning

The plan for discharge starts the day the patient arrives. "We observe their emotional adjustment and support system," says social worker Karen Pabalis. "Most patients are here a short time, so we closely monitor their progress and work with family on what adaptations will allow the patient to go home. It usually involves some continuing outpatient rehabilitation, so they may need help with mobility and transportation.

"We may do a home visit to see if adaptations are required for the patient's safety. We encourage caregivers to let their loved ones do as much as they can on their own. This gives the patient permission to practice skills they've learned, and become as independent as possible."

For more information about neuro-lumbar inpatient rehabilitation, call (989) 667-6600.

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Interoperative Monitoring

Intraoperative monitoring during surgery evaluates peripheral and central nervous system function at the surgical site.  This is particularly helpful during back and spinal cord surgery.  This service is provided upon the request of your surgeon.

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Nerve Conduction Studies

This study is used to diagnose common conditions such as carpal tunnel syndrome, ulnar neuropathy, and peripheral neuropathy.

Small electrical impulses are used to evaluate nerve integrity.  Nerves in the arm and leg have both sensory and motor function.  This study will evaluate whether conduction pathways are transmitting information appropriately.

Very specialized studies may be used to evaluate diseases, such as Myasthenia Gravis, which affects the junction where nerves connect with muscle fibers.

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Neurological Rehab

Our Rehab Goal: To maximize a person’s functional mobility, minimize a person’s deficits, enhance his/her quality of life and regain his/her independence when suffering from a neurological disease.

Common injuries / diseases treated include:

  • Stroke (CVA or TIA)
  • Spinal Cord injury
  • Traumatic Brain injury
  • Amputation (Upper or Lower Extremity)
  • Multiple Sclerosis
  • Parkinson’s Disease

Treatment can include:

  • Muscle Re-education is used to improve your ability to move and use your affected arm and/or leg, by a physical, occupational, recreational and speech therapist.
  • Therapeutic exercises can improve a patient’s overall strength and improve overall cardiovascular fitness/endurance
  • Activities of Daily Living (ADL) and Mobility Trainingis provided by physical and occupational therapists, in order to improve each patient’s ability to transfer, walk and manage all daily activities like dressing and bathing.
  • Bracing may be used in order to protect joints and positioning in an affected arm and/or leg, either by physical and occupational therapist or orthotist.
  • Speech Therapy will be provided as appropriate to assist with cognitive issues, along with any swallow problems that may have occurred as a result of the neurological disease.
  • Modification of Leisure activities will assist with alternatives or modifications to current or new leisure interests.
  • Patient education is given to understand disease process and disease progression, reduce complications, joint protection, family education to assist with care at home, and safe, proper use of assisted devices.

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Neurology

Neurological Disorders: Diagnostic Puzzles requiring extensive exam, tests to find healing pieces

Patients are referred to neurologists by their physicians, neurosurgeons or other specialists. Neurologists diagnose, treat and manage disorders of the brain and nervous system for children and adults. Many neurological disorders can be treated with medication. Other interventions can include sleep studies, cognitive-behavioral therapy, physical therapy, relaxation techniques, biofeedback training, and implantable neuro-stimulators.

The inner workings of the brain and nervous system differ with each individual and his or her condition. For each patient, the 'healing pieces' for their neurological puzzle may require long-term intervention and therapy. Neurologists do not perform surgery but can refer patients to neurosurgeons or other specialists.

Common neurological conditions include:

  • ALS (Lou Gehrig's disease)
  • Alzheimer's disease
  • Autism
  • Bell's Palsy
  • Brain and Nerve Tremors
  • Brain tumors
  • Epilepsy
  • Migraine headaches
  • Multiple sclerosis
  • Parkinson's disease
  • Peripheral nerve disorders
  • Sleep Disorders
  • Some learning disabilities
  • Stroke
  • Tourette Syndrome

Click here to learn more about a neurological exam....

The Neurological Puzzle: Finding the Locking Pieces

"As more of the gene code is unraveled, and we do more stem cell research, we will find the basis for many autoimmune diseases. Our treatments will be more effective, and in some cases, we may be able to cure some neurological conditions. New medications and treatments allow us to extend quality of life for patients far beyond what would have been true even two or three years ago.

"I think patients and physicians finally understand that health is best achieved when the patient takes note of changes in their body and mind, and seeks appropriate medical attention as needed. Early diagnosis and treatment is key. And quite frankly, good nutrition, daily exercise, and adequate sleep, a positive attitude, and stress reduction have a significant impact on healing."

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Neurology Exam

The Seven Stages of a Neurological Exam

The neurological exam is a critical evaluation of different aspects of the brain and central nervous system. When completed, the neurologist compares the patient's medical history with results from the neurological exam to arrive at a diagnosis. The seven stages include:

1. Mental Status

    • How aware and responsive is the patient to the environment and his/her senses?
    • Evaluation of appearance and general behavior
    • Evaluation of mood
    • How does the individual process information?
    • Is the patient oriented to time, place and person?
    • Can they pay attention?
    • Can they remember objects after a period of time?
    • Can they repeat sentences?
    • Can they copy a three-dimensional drawing?
    • Tests for speech and language function.
    • Can they think abstractly, make correct judgments, and reveal their thoughts when asked a question?

2. Cranial Nerves (Set of 12 nerves that relay messages between the brain, head and neck, and control motor and sensory functions, including vision, smell, and movement of the tongue and vocal cords). Evaluation of:

    • Eyelid strength and function
    • Visual function
    • Peripheral vision
    • Pupil's response to light
    • Ability for the eye muscle to move
    • Strength of face muscles
    • Gag reflex
    • Tongue and lip movements
    • Ability to smell, taste and hear
    • Sensations in the face, head, and neck

3. Motor System (brain and spinal cord motor pathways)

    • Examination of muscles for atrophy, twitching, abnormal movements
    • Strength evaluation in all major muscle groups
    • Scratch heel to toe. Normally, patients' toes curl downward.

4. Sensory System (Tests sensation by stimulating receptors in the skin, muscles and tendons)

    • Evaluate sensations for pain, temperature, pressure, position, with eyes open and eyes closed.

5. Deep Tendon Reflexes (tests involuntary actions in response to stimuli sent to the central nervous system)

    • Specific muscle tendons tapped with soft rubber hammer to see if muscle fibers contract.

6. Brain coordination for voluntary movement, coordination and posture

    • Patient will be asked to move fingers from nose to neurologist's finger, going back and forth
    • Tap fingers together quickly in coordination, or move hands one on top of the other, back and forth.
    • Patient is asked to rub one heel up and down smoothly over opposite shinbone.

7. Gait

    • Orientation to posture
    • Ability to walk heel to toe, turn quickly
    • Ability to walk on toes, heels, run

Source: www.neurologychannel.com

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