Assessment Document Specifications

Written Blueprint

Case Topics

Tools and Modalities

Written Exam Case Template

References

Practical Blueprint

ACNB Practical Examination Case Template

Sample Case History Flow Chart

Written Blueprint

Introduction

This is an exam blueprint, also referred to as, exam specification for American Chiropractic Neurology Board’s certification exam in functional neurology. The skills and knowledge certified by this examination represent a postdoctoral chiropractic level of expertise where a certified individual can:

1. Examine individuals with a thorough functional neurological examination
2. Diagnose neurological and associated problems after examination
3. Treat through chiropractic methodologies neurological and associated problems
4. Treat through functional and environmental modalities neurological and associated problems
5. Educate patients with respect to minimizing chronic neurologically related problems

Exam Purpose

This examination is based upon the most critical job activities a Chiropractic Neurologist performs. The skills and knowledge certified by this examination represent entry level into the postdoctoral chiropractic neurological professional level of expertise for a certified individual. The critical job activities derived from the 2002 job analysis of Chiropractic Neurologists include the following patient care areas:

1. Examination
2. Diagnosis
3. Treatment
4. Follow-up

Additionally, ethics and techniques were identified by our Subject Matter Expert (SME) Panel as important components not included on the 2002 job analysis. Questions asked of the Board by the public and Diplomates were also brought to the SME panel and this data supported the inclusion of ethics and techniques on the exam. The panel divided the neuraxis into the twelve domains sited below and identified as critical in the job analysis.

Background and Experience

The test is intended to address the knowledge and skill areas that demonstrate proficiency as a Chiropractic Neurologist. Eligibility requirements are:

1. The applicant must hold the degree of Doctor of Chiropractic from a CCE accredited college (USA) or its equivalent.

2. The applicant must show evidence of having successfully completed a post doctoral program in neurology of three hundred (300) credit hours from a chiropractic college, university, institution, foundation or agency whose program is approved by the continuing education committee of the Commission for the Accreditation of Graduate Education in Neurology (CAGEN). The Chiropractic College, organization, institution, foundation, or agency from which the applicant has completed his/her course of study must certify to the Board that the applicant has satisfactorily completed three hundred (300) credit hours of postdoctoral instruction in neurology.

3. The applicant must possess a license or registration to practice chiropractic and be in good standing with the respective licensing/registration agency.

The skills and knowledge measured by this examination are derived from current course content and from an understanding of the jobs of current Chiropractic Neurologists. A team of highly qualified Chiropractic Neurologists defined the test content and determined the categories for case submission for the exam.

Exam Structure

The knowledge domains measured by this examination are shown in the table below along with the percentages of the exam that are applied to each domain.  This is in accord with the job analysis update from the Subject Matter Experts performed in 2007.

Objectives:

The objectives for the examination as determined from the job analysis and its update are as follows:

According to the job analysis update, diagnosis and differential diagnosis are the most significant portions of the job of the chiropractic neurologist.  Treatment, of course, follows those.  The reason that diagnosis is weighed so heavily is because each patient receives three types of diagnosis:  clinical/medical, level of the lesion, and functional.  In this way, the chiropractic neurologist differs from other diagnostic professions because the level of the lesion and the functional diagnoses are the ones that dictate the treatment and rehabilitation modalities and the mechanisms for measuring success of treatment.

All questions on the written examination are multiple-choice.  Some are complex or multiple-multiple choice questions.  A Scantron sheet is used for the recording of answers.

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Case Topics

Domain 1.0 Brain & Its Environment
Kennedy Syndrome Kennedy
Aneurysm (Berry Aneurysm) Aneurysm
Cortical Neoplasm
Pseudotumor Cerebrii
Middle Cerebral Artery stroke (lenticulostriate branch)
Bacterial Meningitis / Viral Meningitis
Epidural Hematoma
Parasagittal Meningioma
Cavernous Sinus Thrombosis
Senile Dementia / Alzheimer's
Cluster headache
Migraine
Anterior Cerebral Artery Stroke
Posterior Cerebral Artery Stroke
Pituitary Adenoma
Middle Cerebral Artery stroke (Main trunk occlusion)
Capsular CVA
CVA to the dominant or the non-dominant hemisphere
Pineal Tumor with hydrocephalus P

Domain 2.0 Lobes of the Brain Lobes
Traumatic Head Injury
Carotid Artery Occlusion
Schizophrenia
Auditory Processing for Language (Different Aphasia's)
Multiple Sclerosis
Addiction
ADHD / ADD: frontal lobe-cingulate gyrus
Subarachnoid haemorrhage
Temporal Lobe Automatism
Dysphasic Confusion
Anxiety / Panic Attacks
Depression (Various types)
Complex Partial Seizures
Autism
Dyslexia
Nocturnal Enuresis
Hemsiphericity
Cerebral Palsy
Coma

Domain 3.0 Brain Stem & Cranial Nerves
Brainstem Ischemia (TIA)
IVth ventricle tumor -Bell's palsy & lat rectus palsy IVth
Dysphagia
Bell's Palsy (Facial Paresis) (Upper verses Lower)
Acoustic Neuroma
Dysarthria
Foville's/Parinaud's syndrome
Post comm art aneurysm
Benedikt's Syndrome
Weber's syndrome
Millard-Gubler Syndrome
Locked In Syndrome
Nothnagel's Syndrome
Trigeminal Neuralgia

Domain 4.0 Spinal Cord
Cervical Myelopathy
ALS
Anterior Spinal Artery Syndrome
Ventral Cord Pathology
Poliomyelitis
Cervical Stenosis
Cauda Equiina Syndrome
Syringomyelia / Syringobulbia
Tabes Dorsalis
Acute Transverse Myelitis
Friedreich's Ataxia
Sub acute Combined Degeneration
Caudication of the Cauda Equina
Lumbar disc hernation at T12 affecting the conus from within
Progressive Muscular Atrophy
Facet Syndrome
Ankylosing Spondylitis
Tension Headache
Familial Spastic Paraplegia

Domain 5.0 Peripheral Nerve
Upper Brachial Plexus (Erbs palsy)
Lower Brachial Plexus (Pancoast's tumor)
Radial Entrapment (Spiral groove lesion)
C6 Radiculopathy (Due to neural foraminal stenosis,
spondylosis)
Diabetic Neuropathy (Stocking glove, sensory > motor)
Median Nerve Entrapment (Pronator Teres)
Cubital Tunnel
L5 Radiculopathy (Due to a disc herniation)
Charcot Marie Tooth (Inherited neuropathies)
Arthritic related neuropathy (Rheumatoid Arthritis)
Thyroid Related Peripheral Neuropathy
Autoimmune Related Neuropathy (Sulfatide / MAG / GM1 /
Gallop)
CIDP (Chronic demyelinating disorder)
Neuralgic Amyotrophy
Peroneal Nerve Lesion at the Fibular Head
Peripheral Nerve Pathology due to Vasculitis
Anterior Interosseus Lesion
Ulnar Nerve lesion at Guyons Canal
Sciatic Nerve lesion due to Injection Depo
Amyloid Neuropathy
Lead / Arsenic Induced Neuropathies
Alcohol Induced Neuropathy
Tarsal Tunnel Syndrome

Domain 6.0 Autonomic Nervous System ANS
Migraine (Trigeminal Mechanism)
Cardiac Arythmias/rate anomalies
Horner's Syndrome
Sympathetic Hypertonia
Excess Mesencephalic Depolarization
Vasovagal Response
Raynauds
Bergers
Chronic Regional Pain syndrome (RSD)
Postural Hypotension
Autonomous Bladder (subsacral Lesion)
Uninhibited Bladder
Erectile Dysfunction
Hypertension

Domain 7.0 Cerebellum & Vestibular System C&VS
Benign Positional Vertigo
Vermal Lesions
Cerebellar Ataxia
Meniere's
Cerebellar Atrophy/malacia
Vertebral Artery Syndrome
Cervicogenic Vertigo
Fistula
Vestibular epilepsy
INO
Wallenberg Syndrome
Basilar Ischemia
Cupulolithiasis
TND Cerebellum
Intention Tremor
Skew Deviation
Exotropia
Peripheral Vestibular Neuronitis

Domain 8.0 Basal Ganglia & Limbic System BG-LS
Parkinson's
Tourettes
Hemiballism
Panic Disorder
Anxiety
Dystonia/Essential tremors
Insomnia
Medication Induced Physiological Tremor
Wilson's Disease (Copper induced athetosis)
Sydenham's Chorea (Rheumatic fever induced movement
disorder)
Narcolepsy
OCD
Manic Depression

Domain 9.0 Muscles/NMJ and Receptor Disease
Hypertonicity (Spastic Gait) UMN lesion
LMN lesion vs. UPN
Duchenne's muscular dystrophy
Myotonia Congenita
Polymyositis
Myesthenia Gravis
Myotonic Dystrophy
Radiculopathy vs nerve compression
Limb Girdle Dystrophy
Facioscapulohumeral Dsytrophy
Botulism
Tick Paralysis
Sprain / Strain Injury
Subluxation
Whiplash
Fibromyalgia
Chromic Fatigue Syndrome
Lambert Eaton Syndrome

Domain 10.0 Sensory
Conductive Hearing Loss
Cortical Blindness
Visual Distortion: superior temporal orbital tumor resulting in
astigmatism
Tinnitus
Sensory Radiculopathy
Guillian Barre syndrome
Allodynia
SNHL (Sensory Neural Hearing loss)
Hyperalgesia
Scotoma

Domain 11.0 Neuro Endocrine
Pituitary Adrenal Cortico Axis
Hypothyroidism and neurological symptoms
Hyperthyroidism and neurological symptoms
Acromegaly (Growth Hormone Related Problems)
sleep disorders (Sleep apnea) (Pineal and Melatonin)
Eating Disorders (Anorexia Nervosa / Bolemia / Obesity)
Irritable Bowel Syndrome
Insulin Resistance / Hypoglycemia
PMS

Domain 12.0 Neuroanatomy & Physiology
Diplopia & Ptosis - DDx myasthenia from III nerve palsy
L5 radiculopathy -denervation mechanism (Acute verses
Chronic)
mild dementia 2o to hip fracture
Sat night palsy - ischemic radial palsy
Carpal tunnel in Type 2 Diabetic - mechanisms
Otitis media induced Bell's palsy
Diabetic lumbar (ischemic) plexopathy
Vertigo/anosmia 2o to basal skull Fracture (possibly 2 cases)
Hypocalcemia (carpal pedal spasms due to kidney disease
Hypokalaemia
Hyperkalaemia
Parathyroid Disease
Oxidative Stress
Antioxidants / CoQ10
Glutathione and Degenrative Neurological Disease
Heavy Metal Exposure
Hyponatremia
Hypernatremia
Mechanism of manipulation
Slow stretch verses fast stretch

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Tools and Modalities

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Written Exam Case Template

HISTORY:

Chief Complaint/Present Illness: 
Pain History: 
Family History: 
Social History: 
Past Medical History/Review of Systems: 

PHYSICAL EXAM:

General Appearance: 
Vitals: 
Height/WT; Temp; HR & Rhythm; Respiratory; B/P  L and R. Ausculatory Exam:    (Bruits, Lung Sounds, Abdominal Sounds); Pulses:  (Brachial, radial, femoral, popliteal, dorsalis pedis); Rib Excursion: 
Mental Status: 
Cranial Nerves: 
Sensation: 
Motor:  
Tone: Strength: Reflexes: 
Coordination/Balance: 
Imaging/Special Studies: 

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References

The following is a list of references used in preparation of the examination and to determine model answers.

Recent Additions:

Author                                     Book/Article/Presentation                                     ISBN/Journal

Blume, Warren T.Atlas of Adult Electroencephalography                         3-936817-15-4

Brock, JB Board Review Presentation (found in Carrick Course Companion)

CarrickClinical Neuroscience Course                                     Companion Guide I & II

DeMyerTechnique of the Neurologic Examination, 5th Ed. 71405682

Kandel, Schwartz & Jessel.Principles of Neural Science, 4th Ed                               838577016

NolteThe Human Brain                                                               323013201
(An Introduction to It's Functional
Anatomy) 5th Ed.

Patten                                     Neurological Differential Diagnosis, 2nd Ed.                         3540199373

Preston & Shapiro                        Electromyography & Neuromuscular                              075067492X
Disorders, 2nd Ed.

Theodore, William                        Epilepsy: 100 elementary principles. (3rd Ed.)             702018139
(ed) et.al.

Yatsu, Frank M.,                         Stroke (100 Maxims in Neurology Series)                           BMJ
et. al.                                                                                                                                                1995;311:69
(1 July)

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Practical Blueprint

Introduction:

This is an exam specification for the Practical Exam in Chiropractic Neurology.  The skills and knowledge and abilities certified by this examination represent a professional level of expertise where the certified individual can:

• Demonstrate the interview and psychomotor skills necessary in history taking and patient examination
• Identify normal and abnormal findings from a physical/neurological examination

Exam Purpose:

This examination is based upon the most crucial job analysis activities a chiropractic neurologist performs.  The psychomotor skills, knowledge and abilities certified by this examination represent a professional level of expertise for a certified individual.  The critical job activities of a chiropractic neurologist are:

• Demonstrate the capability of taking a patient history through the use of interview techniques
• Demonstrate the psychomotor skills of performing a physical/neurological examination on a patient
• Demonstrate the ability to accurately identify the findings of a physical/neurological examination through the use of video clips of examination results

Background and Experience:

The test is intended to address the knowledge and skill areas that demonstrate proficiency as a Chiropractic Neurologist.  Eligibility requirements are:

• The applicant must hold the degree of Doctor of Chiropractic from a CCE accredited college (USA) or its equivalent.

• The applicant must show evidence of having successfully completed a post doctoral program in neurology of three hundred (300) credit hours from a chiropractic college, university, institution, foundation or agency whose program is approved by the continuing education committee of the Commission for the Accreditation of Graduate Education in Neurology (CAGEN). The Chiropractic College, university, organization, institution, foundation, or agency from which the applicant has completed his/her course of study must certify to the Board that the applicant has satisfactorily completed three hundred (300) credit hours of postdoctoral instruction in neurology.

• The applicant must possess a license or registration to practice chiropractic and be in good standing with the respective licensing/registration agency.

The skills and knowledge measured by this examination are derived from current course content and from an understanding of the jobs of current Chiropractic Neurologists.  A team of highly qualified Chiropractic Neurologists defined the test content and determined the categories and videoed examination findings for the video clips for the exam.

Exam Structure:

The knowledge domains measured by this examination are shown in the table below.

Within the domains, the following table identifies the test objectives.  Test items will relate to a specific objective within a domain.

The answers to the questions on the video simulations are oral.  The candidate will hear and read the questions, then respond orally.  This section is also videotaped.

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ACNB Practical Examination Case Template

The candidate must be able to conduct a thorough history:

OPQRST
Past History-thorough
Social History
Family History-1st and 2nd degree relatives
ROS-Every System

The candidate must be able to demonstrate the psychomotor skills and the knowledge to perform a complete head-to-toe Neurological Physical Examination:

Vital Signs:  Ht/wt, Temperature, Pulse, Respirations, Blood Pressures (Bilateral)
Cranial Nerves:  ALL and all aspects of testing each one

Sensory:  Pain & Temperature, Vibration and Light Touch, Joint Position Sense of ALL extremities

Motor:  Reflexes, Tone, All extremities

Coordination/Balance:  Romberg, Finger-Nose, Rapid alternating movements, pronation/supination, Gait & Tandem, Heel-Shin test.  Be certain to perform all tests correctly and safely.

Heart/Lung:  Auscultation of all heart sounds and areas, auscultation for bruits, auscultation of six (6) lung fields and apex, Palpation of pulses-upper and lower extremities

Abdomen:  Auscultation of each quadrant and abdominal aorta; percussion of each quadrant, palpation of each quadrant (in this order)

Correctly perform special neurological and orthopedic tests such as:  Optokinetics, Eply’s, Hall Pike, Homan, Lhermitte’s, Hoffman’s, Tromner’s, TOS, Mill’s, Cozen’s, S.I. Joint ortho tests, A.C. joint pathology, ACL, Hip capsule, Tinel’s, Kemp’s, O’Donohues, and others.  This is NOT an exhaustive list.

Video Clips:

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Sample Case History Flow Chart

Patient Name: _____________________________________________________
Home Address: _____________________________________________________
Home Phone: _____________________________________________________
Work Phone: _____________________________________________________
Date of Birth: _____________________________________________________
Age: ___________
Male: ___ Female: ___
Marital Status: Single: ___ Married: ___ Separated: ___ Divorced: ___ Widowed: ___
Occupation: _____________________________________________________
Referring Physician’s Name: _____________________________________________________
Type of doctor who referred you: _____________________________________________________
State your major problem/pain: _____________________________________________________
Describe your symptoms in detail. _____________________________________________________
How long have you had this condition? _____________________________________________________
Have you had similar conditions in the past?
No: ___
Yes: ___ If Yes, please specify: _____________________________________________________
What activities aggravate your condition? _____________________________________________________
Is this condition interfering with: Work: ___ Sleep: ___ Daily Routine: ___
Other: _____
Please specify: _____________________________________________________
What other health care have you received for this problem, i.e. what other doctors have treated this condition? _____________________________________________________
Other complaints: _____________________________________________________
Do you presently take any medication/over the counter/homeopathic or recreational drugs? No: ___ Yes: ___ If Yes, please specify: _____________________________________________________
_____________________________________________________
List previous injuries/major illnesses/accidents _____________________________________________________
_____________________________________________________
List fractures/dislocations/concussions past and present: _____________________________________________________
_____________________________________________________
List previous surgeries/hospitalizations: _____________________________________________________
_____________________________________________________
_____________________________________________________
Have you had changes in bowel/bladder/sexual function? If so, please specify.
_____________________________________________________
_____________________________________________________
Do you have any condition involving your heart/lungs/thyroid/or other internal organs? If yes, please specify: _____________________________________________________
_____________________________________________________
Are you a: Non-smoker: ___ Smoker: ___ (# of Packs per day _____ for ____ years) Ex-smoker: ___ (for how long ____).
Regarding alcohol use, are you a: Never Drank: ___ Drinker: ___ Ex-drinker: ___
If you drink alcohol, enter the average number of drinks per weeks:
Bottles of beer: ____ Mixed drinks: ______ Glasses of wine: ____
Shots of liquor: _____
How would you rate the amount of physical activity you perform?
Very little: ___ Little: ___ Moderate: ___ Active: ___ Very Active: ___
List activities in which you participate on the average of two times per week:
_____________________________________________________
Please specify any conditions or illnesses in your family medical history (i.e. diabetes, cancer, etc.) (parents, grandparents, siblings, and children) _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Females Only:
Date your last menstrual period began: _____________________________________________________
Number and ages of your children: _____________________________________________________
Are you pregnant now? No: ___ Yes: ___ Not sure: ___
Date of last pelvic/breast (PAP test) examination: _____________________________________________________
_____________________________________________________
Doctor’s Comments from the interview:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

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