Abstract
BACKGROUND: The assessment of any patient or examinee with neurological
impairment, whether acquired or congenital, provides a key set of data points in the
context of developing accurate diagnostic impressions and implementing an appropriate
neurorehabilitation program. As part of that assessment, the neurological physical exam is
an extremely important component of the overall neurological assessment.
PURPOSE: In the aforementioned context, clinicians often are confounded by
unusual, atypical or unexplainable physical exam findings that bring into question the
organicity, veracity, and/or underlying cause of the observed clinical presentation. The
purpose of this review is to provide readers with general directions and specific caveats
regarding validity assessment in the context of the neurological physical exam.
CONCLUSIONS: It is of utmost importance for health care practitioners to be
aware of assessment methodologies that may assist in determining the validity of the
neurological physical exam and differentiating organic from non-organic/functional
impairments. Maybe more importantly, the limitations of many commonly used strategies for
assessment of non-organicity should be recognized and consider prior to labeling observed
physical findings on neurological exam as non-organic or functional.
