Paul D. Larsen, Alejandro Stern and Suzanne Stensaas
University of Nebraska Medical Center, Omaha, NE, Fundación Stern, Buenos Aires, Argentina and University of Utah, Salt Lake City, USA

ABSTRACT:

The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the 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?" Benarroch, et al, formalizes this approach to the neurological examination in their medical neuroscience textbook from the Mayo Medical School (Medical Neurosciences, 4th edition, 1999). The purpose of our computer-based tutorial is not only to teach the elements of the exam, but more importantly, how the parts of the exam are organized. (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. These learning principles shape the structure of the NeuroExam, a web-based tutorial.

The tutorial is divided into 7 modules:

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

Each module is organized in the following format:

1. A schematic review of the anatomical pathway(s) being examined.
2. A video demonstration of that portion of the exam using a normal patient.
3. Video of patients with lesions of structures being tested in the module. During this part, the method of anatomical localization will be demonstrated using several video clips from the Fundación Stern collection.
4. Self-evaluation quiz for each module in a multiple choice question format.

At the end of the tutorial there will be clinical cases that include history (text), video of patient and series of self-evaluation questions organized to yield answers that will result in localization. This exercise will help the student develop skills in using the NeuroExam to answer the questions of "Where is the lesion?" Two modules will be demonstrated. The program, when complete, will be evaluated with students at the University of Nebraska Medical Center. It will then be free on the Web. NeuroExam has been supported by a grant from the National Library of Medicine to the Knowledge Weavers at the Eccles Health Sciences Library, the Slice of Life Development Fund at the University of Utah, the Department of Pediatrics and the Office of Education at the University of Nebraska Medical Center as well as the Fundación Stern in Buenos Aires.

This demo 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 tutorial as well as being available for use on demand.

Paul D. Larsen, M.D.
Dept. of Pediatrics
University of Nebraska Medical Center
985165 Nebraska Medical Center
Omaha, Nebraska 68198-5165
Phone: 402-559-9539
Fax: 402-559- 5763
Email: pdlarsen@unmc.edu

CO-AUTHORS:

Alejandro Stern, Fundación Stern
Av. Cordoba 2033 - Box 87 - (Zip 1453) - Buenos Aires, Argentina
Tel (5411) 4304-3243
Fax (5411) 4304-3243
Cellular phone (5411) 4989-0332
Email: stern@movi.com.ar

Suzanne S. Stensaas, Ph.D.
Eccles Health Sciences Library
University Of Utah
10 North 1900 East
Salt Lake City, Utah 84112-5890
801-585-1281
801-581-3632
suzanne.stensaas@hsc.utah.edu