Geriatric Neurological Exam and Differential Diagnosis

presented by Myles Quiben, PT, PhD, DPT, MS, GCS, NCS

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Financial: Myles Quiben is an employee of the University of North Texas Health Science Center. Dr. Quiben receives compensation from MedBridge for this course.

NonFinancial: Myles Quiben is on the Board of Directors of APTA Geriatrics.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 47 Minutes, Learning Assessments: 36 Minutes

In the older adult, a thorough examination is critical to determine the nature of the presenting symptoms. Age-related changes, combined with other determinants of health and the presence of multimorbidities, complicate the evaluation process, particularly for older adults presenting with neurologic symptoms. This course will present a comprehensive overview of differential diagnosis and clinical decision-making for the physical therapist providing care for geriatric patients across multiple neurologic diagnoses. Typical age-related changes in the neurologic system will be reviewed and distinguished from neurologic signs and symptoms related to neurological pathology.

Discussion combined with demonstration will take the clinician through strategies for medical screening, upper and lower quarter screening, and movement observation for individuals with neurologic deficits. Neurological examination strategies, including discussion of common activity limitations and impairments based on the ICF Disablement Model, will be discussed. Contributions of the history and physical examination findings, the social determinants of health, and the movement system to the clinical decision-making process will be evaluated to determine if neurologic presentation is within the physical therapist's scope of practice or requires referral/communication to another healthcare professional.

The course is designed for beginner to intermediate clinicians to hone their screening and clinical decision-making skills specific to the care of individuals with neurologic deficits in multiple clinical settings, including home health, outpatient, hospital-based, and rehabilitation.

Meet Your Instructor

Myles Quiben, PT, PhD, DPT, MS, GCS, NCS

Myles Quiben, PT, PhD, DPT, MS, is a professor and chair of the department of physical therapy at the University of North Texas Health Science Center, teaching clinical medicine and cardiopulmonary, geriatric, and neurologic physical therapy. She is a board-certified clinical specialist in both neurologic and geriatric physical therapy (NCS, GCS) by the American Board…

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1. The Older Adult With Neurologic Deficits

The chapter introduces the need for medical screening in the aging population with consideration for typical age-related changes, determinants of health, and the presence of multimorbidities and complex diagnoses. Multiple considerations for neurological examination for aging adults will be discussed, including challenges of working with older adults with neurologic deficits.

2. Differential Diagnosis Principles for Neurologic Diagnoses

This chapter presents the principles of differential diagnosis, including challenges with medical screening. The patient/client management model is discussed in the context of differential diagnosis, with an emphasis on communicating with healthcare professionals for referral or consultation. Distinguishing typical age-related changes in the neurologic system from neurologic signs and symptoms related to neurologic pathology is discussed.

3. Flags for Neurological Signs and Symptoms

Critical to the differential diagnosis process is determining if neurologic presentation is within the physical therapist's scope of practice or if referral to and communication with another healthcare professional is needed. Several factors are considered when determining the need for communication with other healthcare professionals, including onset, symmetry, additional signs and symptoms, medical diagnosis, movement observations, and patterns and/or clusters of neurologic symptoms.

4. Components of the Neurologic Exam

In this chapter, we discuss the components of the neurologic examination for older adults, including an overview of cerebral and cerebellar function, motor examination, sensation, and reflexes. Screening strategies during the physical examination, including the upper quarter screening, lower quarter screening, and movement screening will be presented.

5. Let’s Practice

The contributions of the history and physical examination findings, the social determinants of health, and the movement system to the clinical decision-making process are evaluated in this chapter. We conclude with a case study that allows the therapist to apply the principles of differential screening and diagnosis. The participant will evaluate history and physical examination findings in the clinical decision-making process and determine the need for communication and/or referral.

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