ICE-2 neurology at Bridgepoint
Welcome!
ICE-2 neurology sessions at Bridgepoint will be held over 3 sessions in Oct. This website will help orientate you to location, expectations, additional learning resources and educational technology tools we will be using.
Expectations
It is expected that:
1. Learners will come to sessions prepared (readings done and videos observed) so that active learning can occur in the sessions.
2. Learners will be respectful of patient spaces (please speak respectfully when in public spaces in the hospital)
3. Learners will provide both positive and specific constructive feedback that fosters everyone's learning. Use observations to test your own skills- try to find constructive feedback tips in every colleagues performance you observe. Remember, feedback is about your PERFORMANCE (to be a better physician) not about if you are a good or bad person.
4. We will be using technology in our teaching. During our in class sessions, please feel free to look up associated websites or resources (as long as you share your findings with the group!), but refrain from emails or other tasks that will distract your and other group members learning.
4. If you are going to be late or absent, be sure to contact Dr. Heather MacNeill at Heather.MacNeill@sinaihealth.ca
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How to get to Bridgepoint/ Contact Us
1 Bridgepoint Dr
Toronto, M4M 2B5
Canada
Additional Information
Additional Educational tools
We will be using poll everywhere for polling/quizzing for CN session.
Please go to PollEv.com/heatherm985 or text Heatherm985 to 37607
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We'll be using this random generator for:
Additional Resources
Click on the links below for additional resources that we will be discussing in class
GENERAL NEURO EXAM
University of Toronto neuro exam
University of Utah (videos of normal and abnormal CN findings)
The Hub (neurology exam links) University of Toronto
VIRTUAL NEUROLOGY EXAM
The Virtual Neurologic Exam (CJNS/ UofT)-
(including supplemental videos for virtual neuro exam)
Canadian Physical Medicine and Rehabiliation (CaPMR) webinar on virtual neurological and MSK exam
COGNITIVE ASSESSMENT
(Pubmed article for non UofT learners)
CRANIAL NERVES
Video of RAPD and video of patient with RAPD (CN 2 defect)
visual fields diagram
MOTOR & SENSORY
Key Sensory Points _Dermatomes
American Spinal Cord Injury Association (ASIA) eLearning Centre
CEREBELLAR
"Head to Foot" cerebellar exam-Stanford
Eye findings in cerebellar stroke
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GENERAL NEURO RESOURCES
University of Toronto-Hub-Neurology
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Your Teachers
Dr. Heather is a staff physiatrist at Sinai Health System, Bridgepoint Site. Her main area of clinical practice is in stroke rehabilitation and academic interest is in educational technologies for health professional education (Edutech HPE).
If you would like to learn more about Physiatry or how to apply for an elective, please contact her below.
Click HERE for further learning on stroke rehabilitation.
Click HERE for further learning on educational technology in health professional education.
Click HERE to learn more about WHO commitment to rehabilitation care by 2030.
Motor Exam
The motor exam can seem tricky to memorize. Remember our "indecisive" mnemonic for the UE myotomes and UPX4, down X1 (or 4 weddings and a funeral) for the LE.
Remember these principles:
Strength and power testing: Long lever, Use gravity, stabilize proximally
Reflexes: RELAXATION is the key, swing through (Not to) and down (not up)
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ADL's and iADL's
In session 3, we will be touching on the importance of function (including ADL's and iADL's) as part of the neurological history and physical exam. Although the mnemonic below isnt the best, it can be helpful for remembering these functions.
ADL's (activities of daily living)
C-cognition
D-dressing
E-eating
A- ambulating
T- transferring (to bed, toilet, shower, etc)
H- hygiene
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iADL's (instrumental iADL's)
S-shopping
H-housekeeping
A- accounting
F-food prep
T- transportation
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Although mnemonics can help with remembering the category, dont forget that there are many things to consider in each category. Take for example ambulation- do they use a gait aid, and if so, what one? do they need supervision or assistance of one or two people? how far can they walk? what limits their walking? Have they fallen? Can they mobilize independently at the wheelchair level?
Being able to discern someone's current and past functional level can mean the difference between a safe and unsafe discharge and a meaningful (vs. medical) recovery for your patient. Therefore, the importance of a good functional history taking cannot be underestimated.
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Sensory and Cerebellar Exam
Sensory exam- remember the importance of primary vs secondary sensory modalities, and how the primary sensory modalities travel in the spinal cord:
dorsal: LT, proprioception, vibration
lateral: sharp/dull, pain and temp
secondary: steriognosis, graphesthesia, 2 point descrimination, extinction/neglect
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Cerebellar exam: remember the importance of feedback (eg. NASA reaching the moon) and how it affects many movements beyond our arms and legs (eg. voice, eyes)