What is a Clinical Examination?
A clinical examination is usually triggered when someone is referred by a neurologist, neurosurgeon, psychiatrist, or some other type of medical professional. However, sometimes a patient, a concerned family member or even a friend of the patient’s may approach us directly. We also see patients who are inpatients at the Netcare Rehabilitation Hospital, where Ormond Neuroscience is based.
Due to the complexity of the human brain, a clinical examination can take anywhere from a few hours to a few weeks to complete. The process is usually moves through the following phases:
- Defining the patient’s brain dysfunction
- Relating the patient’s brain dysfunction to the real world
- Making recommendations regarding treatment and further referrals.
Defining Brain Dysfunction
Defining brain dysfunction is the first component of a clinical examination. This involves assessing, defining, and describing the brain-related problems affecting a patient. This part of the examination is often called neuropsychological assessment, and involves probing signs and symptoms of brain disease by means of a detailed clinical interview, inspecting brain scans, EEG reports and any other medical information that is available and which sheds light on brain dysfunction, and by the administration of neuropsychological tests that are sensitive to brain impairment. These are psychometric tests that tell us about low-level and high-level brain functions. Low-level brain functions are sensory and motor in nature and include fine sensorimotor coordination, vision, hearing, olfaction and so on. High-level brain functions are affective (emotional) and cognitive in nature and are very complex. High-level brain functions include memory, concentration, reasoning, judgement and planning, and happiness, depression, temper-control, social insight, and interpersonal skills, to name a few.
Relating Brain Dysfunction to the Real World
The second important component of a clinical examination is to provide extensive feedback, relating the clinical findings to the patient’s functioning in the real world. In other words, spelling out how the identified difficulties will impact on the patient’s functioning in daily life. Specifically, it is usually important to describe how the identified problems will affect the patient’s functioning in the workplace. For children, it is important to understand how the shortcomings that have been described will influence their performance at school. When dealing with a geriatric patient who is developing dementia, it is important to know if they are capable of safely living independently or if care-giving is appropriate.
Referrals and Treatment
Depending on the diagnosis that is made and the nature of the problems that have been identified, further investigations may be appropriate by other disciplines. For example, some visual problems warrant further investigation by an ophthalmologist, or hearing difficulties may indicate referral to an ear, nose and throat surgeon for further tests and fitment of a hearing aid.
Treatment of the problems that have been identified is usually appropriate. The brain is complex and needs to heal and reshape itself if it has been damaged or injured. Ormond Neuroscience is able to assist in that process. One important component of our intervention is to provide information that enables the patient and their family to maximise the recovery process. Knowledge is power, especially when dealing with the brain. We do not medicate but will refer to the relevant specialists, if appropriate. Treatment is usually drawn out and involves subtle interventions. Our treatments reflect our belief that the brain is delicate and highly complex; we do not blast the brain.