posted on Nov. 13th, 2025

🧠 Neurological vs. Neuropsychological DME: Key Differences

While both exams assess the nervous system, they are performed by different specialists, have distinct focus areas, and vary significantly in structure and duration.

The Examiners and Their Focus

Neurological DME > Neurologist (MD or DO) > Disorders of the brain and nervous system (e.g., stroke, epilepsy, concussion). Focuses on physical/organic aspects. > Physical exam (cranial nerves, reflexes, motor/sensory testing)

Neuropsychological DME > Neuropsychologist (PhD or PsyD) > Relationship between the brain and behavior (cognition, emotion). Focuses on mental, cognitive, and behavioral effects. > Battery of standardized tests (pencil/paper, computer, verbal)

The Exam Components

Neurological DME

This exam typically takes about one hour and is a systemic and quick evaluation of the nervous system.

• History: The neurologist will take a medical history, often with a focus on the traumatic injury and its immediate effects.
• Cranial Nerve Testing: This is a vital part of the exam, assessing all twelve cranial nerves to check sensory and motor function in the head and neck.
• CN I (Olfactory): Smell (e.g., coffee, soap).
• CN II (Optic): Vision (Snellen chart, color vision).
• CN III, IV, VI (Oculomotor, Trochlear, Abducens): Eye movements, pupil reactions.
• CN V (Trigeminal): Facial sensation (pin/cotton), chewing strength.
• CN VII (Facial): Facial movements (smile, grimace), taste.
• CN VIII (Acoustic/Vestibulocochlear): Hearing and balance (whispering, nystagmus).
• CN IX, X (Glossopharyngeal, Vagus): Gag reflex, swallow, voice (say "ah").
• CN XI (Accessory): Shoulder shrug against resistance.
• CN XII (Hypoglossal): Tongue movement/strength.
• Motor and Sensory Testing: Testing muscle strength, tone, and reflexes.
• Sensory Testing: Unlike an orthopedic exam that may stop with a basic "Do you feel this?", a neurological exam is more detailed, testing light touch, pain (pinwheel), temperature, vibration (tuning fork), position sense, stereognosis (identifying objects in the hand), and graphesthesia (identifying writing on the skin). This is a crucial area to observe for inconsistencies!
• Cognitive Status: A brief check of alertness, orientation (x 4) - name, date, location, events.

Neuropsychological DME

These exams are far more extensive, often lasting six to eight hours or longer for a comprehensive assessment.

• History/Interview: Very lengthy, covering the client's history from birth to present. LNC observers often audio-record this initial part.
• Testing Battery: The core of the exam. A large set of standardized, validated tests designed to evaluate specific brain functions like:
• Attention and Concentration
• Learning and Memory (e.g., Rey Auditory Verbal Learning Test)
• Language
• Problem-Solving/Executive Function (e.g., Wisconsin Card Sorting Test)
• Visuospatial Skills (e.g., Rey Figure Copy)
• Mood and Personality (e.g., MMPI, Trauma Symptom Inventory)
• Symptom Validity Tests (SVTs): To assess effort (e.g., TOMM, Word Choice Test).
• LNC Observer Access: The testing portion is often considered "protected" and may require the LNC to wait outside, or only be present for the history/interview. The rules for LNC presence can vary by state or judicial ruling.
• Physical Exam: A very brief physical exam often concludes the day.

The Observer's Role 👩‍💼

The LNC's role evolves based on the exam type.

• Neurological DME: Your focus is on the consistency and completeness of the exam. Did the neurologist test all 12 cranial nerves? Were reflexes tested correctly with a hammer? Did they adequately document sensory deficits?
• Neuropsychological DME: Your role is more focused on behavioral observation during the history and managing the client's stamina/comfort throughout the long day. You need to know which tests might trigger an emotional response or fatigue and be prepared to support your client. The ability to manage a potential medical emergency (like a seizure, as in my own experience) is invaluable. The client's energy level, frustration, and attention should be meticulously noted.

Understanding these distinctions ensures you and your retaining attorney are prepared for the scope, duration, and specific challenges of each type of DME.