Introduction to Neurological Examination/Introduction to Neuropathic Pain. (Videotapes).
Misha-Miroslav Backonja, MD, CRC Press LLC, 2000 Corporate Boulevard, NW, Boca Raton, FL 33431, 1999, $209.95 per video, ISBN 08493-1645-6 and 0-8493-1139-3
Both of these videotapes provide close-up views of examination techniques not captured by similar instructional videotapes. Clear visualization is especially effective in the demonstration of pupillary constriction in the first videotape. The diagnostic slant to both videotapes is a variation from those typically shown to nursing students, with the second having a more advanced-practice focus.
The first videotape begins with an overview of the nervous system appropriate for nursing students or newcomers to a neuroscience setting. Lasting 20 minutes, it presents a clear, systematic examination addressing normal parameters, related terminology, and the rationale for focusing the examination on patient history. Think "systems," the narrator encourages, when trying to identify the source of a neurological deficit. This videotape further engages the viewer by covering some of the resulting signs and symptoms of deficits. Examination of cranial nerves, specifically extraocular eye movements, includes the statement that diplopia is maximal in the area of the neurological deficit. Other examples include the fact that the uvula will deviate away from the side of the lesion and that, in the assessment of movement, rigidity is a sign of basal ganglia disease. Terminology is not consistently provided. For example, in the discussion of a position sense of a digit, the term proprioception is omitted, yet allodynia, pain from a nonpainful stimulus, is used during the somatosensory examination and immediately defined.
All practitioners know that a new pin must always be used for the pin prick test, yet this important point is not always specified in other instructional tapes. This may prompt nurses to offer a safer option if a break in technique is observed.
The second videotape, Neuropathic Pain Assessment and Examination, opens with Nick Ut's 1972 Pulitzer Prize-winning image of terrified children, as they runaway from their village after an aerial attack. With napalm bums, they cried in pain all the way to the hospital. This videotape, sensitive to the fact that pain is subjective, reviews the research published in 1965 on the Gate Control Theory of Pain. While the significance of this theory to practice is obvious, few sources actually describe the emergency room study that established the concept. This three-part, 40-minute videotape introduces the challenge of assessing chronic, especially neuropathic, pain. Part I provides definitions and concepts of sensory symptoms and phenomena. Explanations are given for terms that are used throughout the rest of the videotape: allodynia, hyperalgesia, paresthesia, numbness, and summation.
Part II demonstrates signs and symptoms through the examination of three interesting patients with neuropathic disorders. Actual patients share their histories, while the viewer/learner becomes involved in the approaches and the techniques used. Emphasis is placed on demonstrating common symptoms and signs of neuropathic pain syndrome and summarizing findings. Part III discusses elements of pain and symptom assessment. The examiner summarizes that it is crucial to acknowledge the patient's pain, with a complete review of the chief complaint and of systems. Finally, the videotape relates these processes to the diagnostic decision-making process, making it perhaps the best suited overall for advanced-practice nurses.
Reviewed by Sherry Hendrickson, PhD RN CNS Assistant Professor of Clinical Nursing The University of Texas at Austin School of Nursing