Neurological Assessment in Physiotherapy: A Guide to Evaluation and Treatment

Introduction

Neurological conditions affect millions of people worldwide, significantly impacting daily functioning and quality of life. Whether stemming from stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis, or other conditions affecting the nervous system, the path to recovery often involves specialized neurological physiotherapy. At the heart of effective neurological rehabilitation lies a thorough and precise neurological assessment – the crucial first step in developing a personalized treatment plan tailored to each patient’s specific needs.

At Physio at your Doorstep, we understand that a comprehensive neurological assessment forms the foundation of successful rehabilitation outcomes. This detailed evaluation process allows our physiotherapists to identify specific impairments, establish baseline measurements, set realistic goals, and create evidence-based treatment strategies that address the root causes of functional limitations.

In this comprehensive guide, we’ll explore the critical components of neurological assessment physiotherapy, demonstrating why this systematic approach is essential for patients with neurological conditions. We’ll examine the scientific principles behind these assessments, the various techniques employed, and how the results inform targeted treatment plans that maximize recovery potential and improve quality of life.

Understanding Neurological Assessment in Physiotherapy

What is Neurological Assessment Physiotherapy?

Neurological assessment physiotherapy is a specialized form of evaluation performed by physiotherapists with expertise in neurological conditions. This systematic process examines the impact of neurological disorders on various body systems and functions, providing crucial information to guide rehabilitation strategies.

Unlike general physical examinations, neurological assessments specifically focus on how neurological conditions affect:

• Motor function and movement patterns
• Sensory perception and processing
• Balance and coordination
• Reflexes and muscle tone
• Cognitive and perceptual abilities
• Functional mobility and activities of daily living

The primary goal of neurological assessment physiotherapy is to identify specific impairments and their impact on function, establishing baseline measurements that will be used to develop personalized treatment plans and track progress throughout rehabilitation.

The Importance of Specialized Neurological Assessment

Neurological conditions present unique challenges that require specialized assessment approaches. The complexity of the nervous system means that damage or dysfunction can manifest in diverse ways, affecting multiple body systems simultaneously. A comprehensive neurological assessment by a trained physiotherapist is essential because:

1. It provides objective data: Standardized assessment tools offer quantifiable measurements of neurological function, allowing for precise tracking of improvement over time.
2. It reveals underlying causes: Rather than just identifying symptoms, a thorough assessment helps determine the neurological mechanisms behind functional limitations.
3. It guides personalized treatment: Each patient’s neurological presentation is unique, requiring individualized therapeutic approaches based on specific assessment findings.
4. It establishes realistic expectations: By understanding the nature and extent of neurological impairment, physiotherapists can set achievable goals and provide realistic timelines for recovery.
5. It facilitates interdisciplinary communication: Comprehensive assessment results provide valuable information to share with other healthcare professionals involved in the patient’s care.

At Physio at your Doorstep, our specialized neurological assessments form the cornerstone of our evidence-based approach to neurological rehabilitation, ensuring that each patient receives care tailored to their specific needs and recovery potential.

The Neurological Assessment Process

The Subjective Assessment Component

The neurological assessment begins with a thorough subjective evaluation, which involves gathering detailed information about the patient’s condition, history, and personal circumstances. This crucial first step provides context for the objective findings that will follow and helps establish rapport between the physiotherapist and patient.

Key Elements of the Subjective Assessment:

1. Demographic Information: Basic data including age, gender, occupation, and living situation, which may influence treatment approaches.
2. Chief Complaint: The main issues the patient is experiencing in their own words, such as weakness, balance problems, difficulty walking, or problems with daily activities.
3. History of Present Condition:
   • Onset and duration of symptoms
   • Progression pattern (improving, worsening, or stable)
   • Factors that aggravate or relieve symptoms
   • Previous treatments and their effectiveness
4. Past Medical History:
   • Previous neurological conditions
   • Other relevant medical conditions (e.g., diabetes, hypertension)
   • Surgical history, especially neurological or orthopedic surgeries
   • Medications and their effects
5. Personal and Family History:
   • Family history of neurological conditions
   • Lifestyle factors (activity level, exercise habits)
   • Alcohol or tobacco use
   • Impact of condition on work, relationships, and quality of life
6. Patient Goals and Expectations:
   • Understanding what matters most to the patient
   • Identifying specific activities they wish to resume or improve

This detailed subjective assessment allows our physiotherapists at Physio at your Doorstep to understand the full context of the patient’s condition, ensuring that the subsequent objective assessment and treatment plan align with their specific needs, circumstances, and goals.

The Objective Assessment Component

Following the subjective assessment, the physiotherapist conducts a comprehensive objective evaluation to assess various aspects of neurological function. This systematic examination provides measurable data about the patient’s current status and identifies specific impairments that will be targeted during treatment.

Higher Mental Function Assessment:

1. Level of Consciousness: Evaluated using the Glasgow Coma Scale or other standardized measures.
2. Communication: Assessment of speech, language comprehension, and expression.
3. Cognition: Evaluation of orientation, memory, attention, problem-solving, and judgment.
4. Perception: Assessment of body scheme awareness, spatial relations, and recognition of objects and people.

Cranial Nerve Examination:

Systematic evaluation of all 12 cranial nerves to identify specific deficits affecting facial expressions, eye movements, swallowing, speech, and other functions.

Sensory Assessment:

1. Superficial Sensation: Testing light touch, pain, and temperature perception across dermatomes.
2. Deep Sensation: Evaluating proprioception (position sense), kinesthesia (movement sense), and vibration sense.
3. Cortical Sensation: Assessing discriminative sensations like two-point discrimination, stereognosis (object recognition by touch), and graphesthesia (recognition of numbers/letters traced on skin).

Motor Function Assessment:

1. Muscle Tone: Evaluation for hypotonia, hypertonia, spasticity, or rigidity.
2. Range of Motion: Assessment of active and passive movement at all joints.
3. Muscle Strength: Manual muscle testing using the Medical Research Council (MRC) scale or other standardized measures.
4. Coordination: Testing fine and gross motor coordination through specialized tests like finger-to-nose, heel-to-shin, and rapid alternating movements.

Reflex Testing:

1. Deep Tendon Reflexes: Assessment of biceps, triceps, patellar, and Achilles reflexes.
2. Superficial Reflexes: Testing abdominal, cremasteric, and plantar reflexes.
3. Pathological Reflexes: Checking for abnormal reflexes such as Babinski, Hoffman’s, and clonus.

Balance and Gait Assessment:

1. Static Balance: Evaluation of balance in sitting and standing positions.
2. Dynamic Balance: Assessment of balance during movement and in response to perturbations.
3. Gait Analysis: Comprehensive evaluation of all phases of the walking cycle, noting deviations and compensatory strategies.

Functional Mobility Assessment:

1. Bed Mobility: Ability to roll, sit up, and reposition in bed.
2. Transfers: Evaluation of sit-to-stand, bed-to-chair, and other essential transfers.
3. Ambulation: Assessment of walking capacity, including distance, speed, and use of assistive devices.
4. Activities of Daily Living: Evaluation of self-care activities such as dressing, bathing, and eating.

This detailed objective assessment provides a comprehensive picture of the patient’s neurological status and functional capabilities, serving as the foundation for developing targeted and effective rehabilitation strategies.

Specialized Assessment Tools and Measures

Standardized Assessment Scales and Outcome Measures

Reliable and validated assessment scales provide objective measurements that help quantify impairments, track progress, and demonstrate treatment effectiveness. These standardized tools are essential for evidence-based neurological physiotherapy practice.

Common Standardized Measures Used in Neurological Assessment:

1. For Motor Function and Strength:
   • Fugl-Meyer Assessment for post-stroke motor recovery
   • Motricity Index for limb movement after stroke
   • Medical Research Council (MRC) Scale for muscle strength
2. For Balance and Fall Risk:
   • Berg Balance Scale
   • Timed Up and Go Test (TUG)
   • Functional Reach Test
   • Balance Evaluation Systems Test (BESTest)
3. For Mobility and Gait:
   • 10-Meter Walk Test for gait speed
   • 6-Minute Walk Test for endurance
   • Dynamic Gait Index
   • Functional Gait Assessment
4. For Functional Independence:
   • Functional Independence Measure (FIM)
   • Barthel Index for activities of daily living
   • Performance Assessment of Self-Care Skills (PASS)
5. For Specific Neurological Conditions:
   • Unified Parkinson’s Disease Rating Scale (UPDRS)
   • Multiple Sclerosis Functional Composite (MSFC)
   • Stroke Impact Scale (SIS)
   • Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS)

Advanced Assessment Technologies

Modern neurological assessment increasingly incorporates advanced technologies that provide more precise measurements and insights into neurological function.

Technological Assessment Tools:

1. Computerized Gait Analysis: Using sensor-based systems to capture detailed data about gait patterns, joint angles, and weight distribution during walking.
2. Force Plate Testing: Measuring ground reaction forces and center of pressure to analyze balance and weight-bearing patterns.
3. Surface Electromyography (sEMG): Recording electrical activity of muscles to assess recruitment patterns, timing, and fatigue.
4. Inertial Sensors and Accelerometry: Wearable devices that provide objective data about movement patterns, activity levels, and fall events.
5. Virtual Reality Assessment Tools: Interactive environments that challenge and measure specific aspects of balance, coordination, and functional performance.
6. Smartphone Applications: Increasingly sophisticated apps that can capture and analyze aspects of neurological function like tremor, coordination, and reaction time.

At Physio at your Doorstep, we combine traditional clinical expertise with appropriate technology-assisted assessments to obtain the most comprehensive understanding of each patient’s neurological status, enabling us to develop precisely targeted rehabilitation programs.

Clinical Reasoning in Neurological Assessment

Interpreting Assessment Findings

The value of neurological assessment lies not just in collecting data, but in the skilled interpretation of findings to understand the underlying neurological mechanisms and their functional impact. This interpretive process requires advanced clinical reasoning skills and neurological expertise.

Key Aspects of Clinical Reasoning in Neurological Assessment:

1. Pattern Recognition: Identifying characteristic clusters of symptoms and signs that suggest specific neurological conditions or lesion locations.
2. Differential Diagnosis: Distinguishing between different possible causes of observed impairments.
3. Localization: Determining the site(s) of neurological damage or dysfunction based on assessment findings.
4. Severity Determination: Gauging the extent of neurological impairment and its functional impact.
5. Prognosis Estimation: Using assessment findings to predict potential for recovery and likely timelines.
6. Treatment Selection: Matching therapeutic approaches to the specific neurological deficits identified.

From Assessment to Treatment Planning

The ultimate purpose of neurological assessment is to inform a comprehensive, individualized treatment plan. This critical transition from assessment to intervention requires synthesizing all findings into a coherent strategy that addresses the patient’s needs and goals.

The Treatment Planning Process:

1. Problem Identification: Clearly defining the specific neurological impairments and resulting functional limitations.
2. Prioritization: Determining which problems to address first, based on their impact on function, safety concerns, and rehabilitation potential.
3. Goal Setting: Establishing specific, measurable, achievable, relevant, and time-bound (SMART) goals in collaboration with the patient.
4. Intervention Selection: Choosing evidence-based therapeutic approaches specifically targeted to the identified problems.
5. Outcome Measurement Plan: Determining which assessment tools will be used to track progress and evaluate treatment effectiveness.

At Physio at your Doorstep, our experienced neurological physiotherapists excel in this clinical reasoning process, ensuring that assessment findings are translated into meaningful treatment plans that address each patient’s unique neurological presentation and personal goals.

Specific Neurological Conditions and Their Assessment

Stroke Assessment

Stroke (cerebrovascular accident) is one of the most common neurological conditions requiring specialized physiotherapy assessment. The location and extent of brain damage determine the specific impairments, which may include hemiparesis, sensory deficits, aphasia, and balance problems.

Key Elements in Stroke Assessment:

1. Motor Assessment:
   • Evaluation of movement patterns and synergies
   • Assessment of selective movement control
   • Identification of spasticity or flaccidity
2. Sensory Evaluation:
   • Testing for sensory loss or altered sensation
   • Assessment of neglect or inattention
   • Evaluation of proprioceptive deficits
3. Functional Mobility:
   • Analyzing compensatory movement strategies
   • Assessing safety during transfers and ambulation
   • Evaluating balance in various positions
4. Specific Tools:
   • National Institutes of Health Stroke Scale (NIHSS)
   • Fugl-Meyer Assessment
   • Chedoke-McMaster Stroke Assessment
   • Motor Assessment Scale (MAS)

Traumatic Brain Injury (TBI) Assessment

TBI presents unique assessment challenges due to the potential combination of physical, cognitive, and behavioral impairments. The nature and location of brain damage determine the specific presentation, which may evolve over time.

Key Elements in TBI Assessment:

1. Cognitive-Motor Integration:
   • Assessment of dual-task performance
   • Evaluation of attention during movement tasks
   • Testing of executive function during mobility
2. Motor Control and Coordination:
   • Detailed assessment of postural control
   • Evaluation of movement planning and execution
   • Testing of balance reactions and equilibrium
3. Behavioral Aspects:
   • Assessment of impulsivity and safety awareness
   • Evaluation of frustration tolerance during tasks
   • Observation of initiation and motivation
4. Specific Tools:
   • Rancho Los Amigos Scale
   • High-Level Mobility Assessment Tool (HiMAT)
   • Community Integration Questionnaire
   • Glasgow Outcome Scale Extended (GOS-E)

Parkinson’s Disease Assessment

Parkinson’s disease assessment focuses on the cardinal motor symptoms of bradykinesia, rigidity, tremor, and postural instability, as well as the impact of these symptoms on functional mobility and daily activities.

Key Elements in Parkinson’s Disease Assessment:

1. Movement Quality:
   • Assessment of initiation difficulties
   • Evaluation of freezing episodes
   • Measurement of step length and walking speed
2. Motor Fluctuations:
   • Tracking of “on” and “off” medication states
   • Assessment of dyskinesias and their impact
   • Documentation of timing of motor symptoms
3. Functional Impact:
   • Evaluation of handwriting and fine motor tasks
   • Assessment of bed mobility and turning
   • Testing of balance during challenging tasks
4. Specific Tools:
   • Unified Parkinson’s Disease Rating Scale (UPDRS)
   • Parkinson’s Disease Questionnaire (PDQ-39)
   • Freezing of Gait Questionnaire
   • Modified Hoehn and Yahr Staging

Multiple Sclerosis Assessment

Multiple sclerosis (MS) assessment must account for the variable and often fluctuating nature of symptoms, which may include fatigue, weakness, spasticity, ataxia, sensory disturbances, and balance problems.

Key Elements in MS Assessment:

1. Fatigue Evaluation:
   • Assessment of impact on functional activities
   • Measurement of endurance during tasks
   • Documentation of fatigue patterns
2. Motor Function:
   • Testing of strength with consideration of fatigue
   • Evaluation of spasticity and its functional impact
   • Assessment of ataxia and tremor
3. Temperature Sensitivity:
   • Documentation of symptom changes with temperature
   • Assessment in controlled temperature environments
   • Evaluation of heat-induced fatigue
4. Specific Tools:
   • Expanded Disability Status Scale (EDSS)
   • Multiple Sclerosis Functional Composite (MSFC)
   • Modified Fatigue Impact Scale (MFIS)
   • Multiple Sclerosis Quality of Life Inventory

Spinal Cord Injury Assessment

Spinal cord injury (SCI) assessment focuses on determining the neurological level and completeness of injury, as well as the resulting functional capabilities and limitations.

Key Elements in SCI Assessment:

1. Neurological Level Determination:
   • Systematic testing of motor and sensory function
   • Identification of complete versus incomplete injury
   • Assessment of zone of partial preservation
2. Functional Capabilities:
   • Evaluation of transfer abilities
   • Assessment of mobility options (wheelchair skills, ambulation potential)
   • Testing of upper extremity function for daily activities
3. Secondary Complications:
   • Screening for pressure areas
   • Assessment of spasticity
   • Evaluation of autonomic dysreflexia risk
4. Specific Tools:
   • International Standards for Neurological Classification of SCI (ISNCSCI)
   • Spinal Cord Independence Measure (SCIM)
   • Walking Index for Spinal Cord Injury (WISCI)
   • Capabilities of Upper Extremity Test (CUE-T)

At Physio at your Doorstep, our physiotherapists are trained in the specialized assessment approaches for each of these neurological conditions, ensuring accurate evaluation and effective treatment planning tailored to each specific condition.

The Patient Experience During Neurological Assessment

Creating a Supportive Environment

A neurological assessment can be physically and emotionally challenging for patients. Creating a supportive, comfortable environment is essential for obtaining accurate assessment data and establishing a therapeutic relationship.

Key Considerations for Patient Comfort:

1. Physical Environment:
   • Ensuring privacy and minimizing distractions
   • Maintaining comfortable room temperature
   • Providing appropriate support surfaces and positioning
2. Emotional Support:
   • Acknowledging anxiety or frustration
   • Offering encouragement and positive reinforcement
   • Allowing rest periods when needed
3. Communication Adaptations:
   • Adjusting explanation style for cognitive or language impairments
   • Using clear, concise instructions
   • Confirming understanding before proceeding

At Physio at your Doorstep, our home-based service naturally creates a comfortable, familiar environment for neurological assessment, reducing anxiety and allowing for more accurate evaluation.

Patient and Family Education

Education is a vital component of the assessment process. Helping patients and their families understand the purpose of each assessment component and the overall findings enhances engagement and sets realistic expectations for rehabilitation.

Key Educational Elements:

1. Assessment Purpose:
   • Explaining why specific tests are being performed
   • Clarifying how the information will guide treatment
2. Findings Interpretation:
   • Using clear, non-technical language to explain results
   • Relating findings to daily functional activities
3. Recovery Expectations:
   • Providing honest but hopeful information about prognosis
   • Explaining the concept of neuroplasticity and its implications
4. Treatment Planning Participation:
   • Involving patients and families in goal setting
   • Incorporating personal priorities into the rehabilitation plan

Our physiotherapists at Physio at your Doorstep excel in communicating complex neurological concepts in accessible ways, ensuring patients and families become informed partners in the rehabilitation process.

From Assessment to Treatment: Neurological Rehabilitation Approaches

Evidence-Based Treatment Techniques

Comprehensive neurological assessment informs the selection of specific treatment techniques tailored to each patient’s unique presentation. Modern neurological rehabilitation draws on a variety of evidence-based approaches.

Key Neurological Treatment Approaches:

1. Neurodevelopmental Techniques:
   • Bobath Concept/Neurodevelopmental Treatment (NDT)
   • Proprioceptive Neuromuscular Facilitation (PNF)
   • Sensory Integration approaches
2. Task-Oriented Training:
   • Constraint-Induced Movement Therapy (CIMT)
   • Task-specific practice
   • Functional electrical stimulation with task practice
3. Motor Learning Strategies:
   • Implicit versus explicit learning approaches
   • Feedback optimization
   • Practice scheduling for skill acquisition
4. Balance and Gait Retraining:
   • Body-weight supported treadmill training
   • External cueing strategies
   • Perturbation training for reactive balance
5. Technology-Assisted Approaches:
   • Robotics-assisted therapy
   • Virtual reality rehabilitation
   • Biofeedback systems

At Physio at your Doorstep, our treatment approach is firmly grounded in the latest evidence, with techniques specifically selected based on detailed assessment findings to target the underlying neurological mechanisms of each patient’s functional limitations.

Measuring Progress and Treatment Effectiveness

Ongoing reassessment is essential in neurological rehabilitation to track progress, adjust treatment approaches, and document outcomes. The initial comprehensive assessment provides baseline measures against which progress can be evaluated.

Key Elements of Progress Measurement:

1. Regular Reassessment:
   • Systematic retesting using standardized measures
   • Comparison to baseline and previous assessments
   • Documentation of changes in impairment and function
2. Goal Attainment Scaling:
   • Rating progress toward specific functional goals
   • Involving patients in self-assessment of achievement
   • Adjusting goals based on progress patterns
3. Patient-Reported Outcome Measures:
   • Capturing the patient’s perception of improvement
   • Assessing changes in quality of life and participation
   • Evaluating satisfaction with treatment process and outcomes
4. Treatment Plan Modification:
   • Using reassessment findings to guide treatment adjustments
   • Progressing or modifying interventions based on response
   • Adding new treatment components as needs evolve

Our commitment at Physio at your Doorstep includes rigorous ongoing assessment to ensure treatment effectiveness, with transparent communication about progress and collaborative decision-making about treatment modifications.

The Future of Neurological Assessment in Physiotherapy

Technological Advances

The field of neurological assessment is rapidly evolving, with technological innovations offering new possibilities for more precise, objective, and comprehensive evaluation.

Emerging Assessment Technologies:

1. Wearable Sensor Systems:
   • Continuous monitoring of movement in real-world environments
   • Quantification of activity levels and patterns throughout the day
   • Detection of subtle changes in movement quality over time
2. Telerehabilitation Assessment Platforms:
   • Remote assessment capabilities for patients in distant locations
   • AI-assisted analysis of video-captured movement
   • Integration of home-based sensor data with clinical assessments
3. Brain-Computer Interfaces:
   • Direct measurement of neural activity during motor planning
   • Assessment of neural plasticity and reorganization
   • Evaluation of cognitive-motor integration
4. Virtual Reality Assessment Environments:
   • Standardized, immersive testing of functional abilities
   • Manipulation of environmental challenges for comprehensive assessment
   • Engagement of multiple sensory systems simultaneously

Toward Precision Neurorehabilitation

The future of neurological assessment points toward increasingly personalized, precise approaches that match specific neurological deficits with targeted interventions.

Emerging Directions:

1. Biomarker Integration:
   • Incorporating neuroimaging findings into clinical assessment
   • Using genetic information to predict treatment response
   • Integrating blood biomarkers with functional assessment
2. Predictive Modeling:
   • Using assessment data to predict recovery trajectories
   • Identifying responders to specific intervention types
   • Optimizing treatment selection based on assessment profiles
3. Patient-Specific Digital Twins:
   • Creating computational models of individual patients
   • Simulating responses to different treatment approaches
   • Personalizing interventions based on predicted outcomes

At Physio at your Doorstep, we stay at the forefront of these developments, incorporating appropriate technological advances into our assessment process while maintaining the essential human connection that is vital to neurological rehabilitation.

Conclusion: 

A thorough neurological assessment is not merely a preliminary step in the rehabilitation process—it is the foundation upon which all effective neurological physiotherapy is built. It provides the essential insights needed to understand each patient’s unique neurological presentation, functional limitations, and rehabilitation potential.

The benefits of comprehensive neurological assessment include:

1. Personalized Treatment Planning: Tailoring interventions to address specific neurological deficits identified during assessment.
2. Objective Progress Tracking: Establishing baseline measurements against which improvement can be measured.
3. Informed Goal Setting: Creating realistic rehabilitation goals based on accurate understanding of neurological status.
4. Enhanced Patient Understanding: Helping patients comprehend the nature of their condition and the purpose of treatment approaches.
5. Interprofessional Communication: Providing detailed information to facilitate coordination among all healthcare providers involved in the patient’s care.

At Physio at your Doorstep, our experienced neurological physiotherapists excel in the art and science of comprehensive neurological assessment. We understand that time invested in thorough initial and ongoing assessment leads to more efficient, effective rehabilitation outcomes and improved quality of life for our patients with neurological conditions.

If you or a loved one is experiencing neurological challenges, contact our team to learn how our detailed assessment approach can form the foundation for a successful rehabilitation journey.

Resources and References

1. World Health Organization. (2022). Neurological disorders: Public health challenges. Geneva: WHO Press.
2. Shumway-Cook, A., & Woollacott, M. H. (2017). Motor control: Translating research into clinical practice (5th ed.). Philadelphia: Wolters Kluwer.
3. O’Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2019). Physical rehabilitation (7th ed.). Philadelphia: F.A. Davis Company.
4. Lennon, S., & Stokes, M. (2008). Pocketbook of neurological physiotherapy. Edinburgh: Churchill Livingstone Elsevier.
5. Carr, J. H., & Shepherd, R. B. (2010). Neurological rehabilitation: Optimizing motor performance (2nd ed.). Edinburgh: Churchill Livingstone Elsevier.
6. Umphred, D. A., Lazaro, R. T., Roller, M. L., & Burton, G. U. (2019). Umphred’s neurological rehabilitation (7th ed.). St. Louis: Elsevier.
7. Physiopedia. (2021). Neurological Assessment. Retrieved from https://www.physio-pedia.com/Neurological_Assessment
8. Shahrokhi, M., et al. (2023). Neurologic Exam. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557589/

For more information about our neurological physiotherapy services, please visit Physio at your Doorstep or contact our team directly to schedule a comprehensive neurological assessment.

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