Diagnostic Testing

Functional Neurology Physical

Diagnostic assessment by Dr. Michalopoulos begins with a extensive physical examination to determine how the patient is processing their immediate physical environment. Whenever indicated by the physical exam, and based upon the judgment of our Board Certified Chiropractic Neurologist, we may order additional lab work and medical imaging tests as part of the assessment. We then complete the assessment utilizing cutting-edge diagnostic techniques and technologies to measure postural control, reaction times, motor accuracy and neurological endurance, all in a concerted effort to pinpoint specific areas of brain and central nervous system problems. The initial diagnostic testing results serve as benchmarks against which therapy results are measured. Available in-office testing includes:

  • Videonystagmography (VNG)
  • Computerized Dynamic Posturography (CDP)
  • Saccadometry
  • Gait Analysis

Videonystagmography (VNG)

Balance problems, dizziness and other issues associated with the vestibular system can be assessed through videonystagmography (VNG) testing. VNG consists of a series of tests to evaluate how well the eyes respond to information from the vestibular system. During the tests, the patient wears a set of infrared goggles that record eye movements as the eyes follow moving targets. In addition to enabling the care team to detect signs of central nervous or neurological problems, VNG can indicate whether the vestibular system is responding correctly to stimulation. VNG testing is considered the standard for testing vestibular function, because it tracks eye movements directly, rather than measuring movements based on the muscles surrounding the eyes, as other testing does.

Computerized Dynamic Posturography (CDP)

Posturography is a general term that covers all the techniques used to quantify postural control in an upright stance, in either static or dynamic conditions.

Among those techniques is computerized dynamic posturography (CDP), also called test of balance (TOB). CDP is a non-invasive specialized clinical assessment technique used to quantify the central nervous system adaptive mechanisms (sensory, motor and central) involved in the control of posture and balance, both in normal (such as in physical education and sports training) and abnormal conditions (particularly in the diagnosis of balance disorders and in physical therapy and postural re- education).

Due to the complex interactions among the sensory, motor, and central processes involved in posture and balance, CDP requires different protocols to differentiate among the many defects and impairments, which may affect a subject’s postural control system. CDP challenges that system by using several different combinations of visual and support surface stimuli and parameters and has been proven effective in assessing vestibular, as well as, some neuromuscular disorders affecting balance.

How it works

Static posturography is carried out by placing a subject in a standing posture on a fixed instrumented platform (force plate) connected to sensitive detectors (force and movement transducers), which are able to detect the tiny oscillations of the body.

Dynamic posturography differentiates from static posturography in that it usually involves perturbing the subject’s posture by means of a foam cushion or a special apparatus with a movable horizontal and tilting platform. As the subject makes small movements, the sensitive detectors transmit this time-varying information in real time to a computer. Thus, the dynamic posturography test protocols can quantify the ability of a subject to maintain balance in non-static conditions. Usually coupled with the ability to test the subject either with or without visual references (eyes open or closed) or with a moving environment that gives conflicting visual information, dynamic posturography makes it possible to quantify a subject’s vestibular functions. This is because, in certain testing conditions, the visual and proprioceptive systems cannot be used, and the subject must rely only on the vestibular system to maintain balance.

  • Saccadometry: 
  • Saccadometry is one of the most recent technologies in measuring the movement of the eyes. Research has shown that the movements of the eyes are intimately related and correlated to the degree of integrity of the brain. By analyzing this area of the brain closely, the doctor can identify an athlete’s accuracy, reaction time, speed, and performance potential.

Intensive therapy

Some patients due to the complexity of their health condition may qualify for intensive care programs where they perform in office rehabilitation 3-5 times per day for up to 5 days.

Main Neurotransmitters:

  • Serotonin: Low serotonin is associated with depression, PMS, seasonal affective disorder, inner rage, and a general loss of enthusiasm.
  • Dopamine: Low dopamine is associated with a short temper, low self-esteem, poor focus and concentration, and addictive behavior.
  • GABA: Low GABA is associated with stress, anxiety, panic, feeling overwhelmed, chronic worry, restlessness, and feelings of dread.
  • Acetylcholine: Low acetylcholine is associated with memory loss, difficulty learning, difficulty calculating numbers, slow mental response, and poor visual memory (trouble remembering faces or where you parked your car).

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