The difference between a Neurological and a Neuropsychological Defense Medical Examination.
Is there a difference? ………YES, this is two vastly different medical exams.
There are distinct differences between the examiner, the nurse observer needed, the exam, and the time limit.
Differences between the two examiners.
The examiner for a Neurological defense exam is a specialty called a Neurologist. A neurologist is a medical provider with training in diagnosing, treating, and managing disorders of the brain and nervous system. Examples of these are Alzheimer’s disease, concussion, epilepsy, migraine, and stroke, just to name a few diagnoses. During a Neurological Defense Medical Exam their services are retained as legal opinion and not as a treating provider
The Neuropsychology Defense Medical exam needs an examiner that specializes in the science of Neurology and Psychology. A Neuropsychologist is concerned with the relationship between the brain and your behavior. These professionals can help with adaptation to these mental changes and remediation of these symptoms. During a Neuropsychological Defense Medical Exam their services are retained as legal opinion and not as a treating provider.
Differences between the nurses needed for these two exams.
The neurological defense medical exam needs a Legal Nurse Consultant that is well versed in observing your client. The legal nurse consultant needs knowledge about Montreal (MoCa) and two separate depression screening assessments. The nurse should be knowledgeable about the cranial nerves.
Her observation skills can warn the plaintiff attorney about possible deficits the clients suffered during her incident or accident that can have life altering issues in her/his life. Example: the examiner did not assess for smell during the cranial nerve assessment. Your client can’t smell her food burning, can’t smell a fire in her house.
Neuropsychological defense medical examinations need legal nurse consultants with extensive experience with brain injuries.
The nurse observer needs to know which area of the brain was impacted. Example: when the client has a temporal lobe injury, he/she will have trouble with memory. During testing of memory, the client might feel pressures or embarrassment which brings out feelings of worthlessness. Your nurse observer should know the reactions that either of the 21 plus tests that will be administered to this injured individual can “wake up/ trigger.” The legal nurse consultant needs to know how to handle their behavior, attitude, and to set a pace throughout the day to make sure the individual does not have early onset of his/her more severe symptoms like a seizure.
Our nurse observer, Bettie de Bruyn, RN LNC specializes in traumatic brain injury and was observing a Neuropsychological defense medical exam. The client developed a seizure. The Plaintiff attorney and the examiner valued the nurse observer’s presence, experience, and rapid action to deal with this medical emergency.
The difference between the two exams.
Neurological defense medical exam consists of a medical history (sometimes extremely limited by the Response letter), Neurological testing (the Montreal (MoCa) and separate depression screening assessments), and a physical assessment of the body parts that was injured in the accident.
The neuropsychological defense medical exam consists of a very lengthy medical history that includes all your history from birth to present. Usually, the nurse audio tapes this part of the exam.
The second part of the exam is a battery of tests, these tests are usually administered by pencil and paper, computer, and verbal administration. These tests evaluated the functioning of the different areas in the brain, like attention, memory, language, perception, mood state, etc. The second part is considered “protected” so only the client and the examiner are present during the second phase and no audiotape allowed.
The third part consists of a very brief physical exam.
These tests include.
- Delis-Kaplan Executive functioning system
- Wechsler adult intelligence scale
- Wechsler memory scale
- Wide range assessment of memory and learning
- B-test
- Visuospatial test
- Brown location test
- Conners continuous performance test
- Dot counting
- Boston naming test
- NAB naming test.
- Controlled oral test.
- Animal naming test
- Repetition of phrases test
- Victoria symptom validity test.
- Rey auditory learning test or California verbal learning test.
- Letter-digit substitution test
- Victoria Stroop test
- Word choice test
- TOMM
- Ruff figural fluency test
- Rey figure copy
- Wisconsin card scoring test (several versions)
- Grooved peg board test
- Wide range achievement test
- Woodcock Johnson test of achievement
- Minnesota multiphasic personality inventory
- Trauma symptom inventory
- Word memory test.
Time limit for these exams.
A Neurological defense medical exam lasts about two hours, while a Neuropsychological exam lasts eight hours.
