Brain Injury Diagnosis: Chiropractic and Nurse Practitioner

 

Integrative chiropractic doctors and nurse practitioners work together to diagnose brain injuries in a careful, step-by-step way. They combine hands-on exams, neurological testing, computer-based brain tests, advanced imaging, and lab work to build a clear picture of how the brain, spine, and nervous system are working. This kind of team approach is especially important after car accidents, sports injuries, falls, or work accidents, where head and neck trauma are common.

Clinicians like Dr. Alexander Jimenez, DC, APRN, FNP-BC, in El Paso use this integrative model every day—bringing together chiropractic, nurse practitioner training, imaging, and neurological scans to detect hidden injuries and guide safe, personalized treatment plans. dralexjimenez.com

Below is a simple guide to the main diagnostic methods used by integrative chiropractors and nurse practitioners when evaluating possible brain damage.

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Why accurate brain injury diagnosis matters

Brain injuries are not always obvious. A person can:

• Walk and talk normally

• Have normal basic X-rays

• Still have a concussion or subtle brain dysfunction

If these injuries are missed, they can lead to:

• Chronic headaches and neck pain

• Problems with memory, focus, and mood

• Dizziness, balance problems, and falls

• Worsening musculoskeletal pain because the brain and spine are not coordinating movement correctly

This is why integrative providers use a battery of tests rather than relying on a single tool.

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Detailed history and symptom review

The first diagnostic “tool” is a careful conversation.

Chiropractors and nurse practitioners listen for:

• How the injury happened

  • Car crash? Sports hit? Fall? Work accident?

• What the person felt right away

  • Loss of consciousness, confusion, seeing stars, nausea, ringing in the ears

• Changes in thinking or behavior

  • Trouble concentrating, irritability, sleep problems, anxiety, depression

• Neck, back, or jaw pain that may signal spinal involvement

• Existing conditions like migraines, previous TBIs, or spine problems

Chiropractic consumer guides and clinical blogs on injury care point out that the interview is the first major step toward an accurate diagnosis. flspineandinjury.com+1

Common questions include:

• Where is your pain or discomfort?

• What makes it better or worse?

• Have you had prior concussions or head injuries?

• Do you notice changes in memory, mood, or sleep since the event?

• Are you having dizziness, imbalance, or vision changes? flspineandinjury.com

This history helps the provider decide which physical, neurological, and imaging tests are needed next.

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Physical and neurological examination

After the history, integrative chiropractic doctors and nurse practitioners perform a head-to-toe physical and neurological exam. This helps them see how the brain and the spine work together.

Physical exam

They check:

• Vital signs (blood pressure, heart rate, breathing)

• Posture and alignment of the head, neck, and spine

• Range of motion in the neck and back

• Tender areas around the skull, jaw, neck, shoulders, and spine

• Muscle strength and flexibility

Chiropractic injury practices often use strength, range-of-motion, and functional tests to identify areas of restriction or pain before proceeding to imaging. flspineandinjury.com+1

Neurological exam

The neurological exam focuses on the nervous system’s function. It may include:

• Cranial nerve testing

  • Eye movements, facial muscles, tongue movement, swallowing, hearing, and smell

• Motor testing

  • Muscle strength in arms and legs

• Sensory testing

  • Light touch, vibration, temperature, and pain response

• Reflexes

  • Deep tendon reflexes (like knee and ankle jerks)

• Coordination

  • Finger-to-nose testing, heel-to-shin movements

• Gait and balance

  • Walking pattern, ability to stand heel-to-toe, or on one leg

Nurse practitioners add their medical training to determine whether there may be bleeding, infection, stroke, or other serious conditions that require emergency imaging or referral to the ER or a neurologist.

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Standardized neurological rating scales

To make their findings more objective, nurse practitioners and chiropractors often use standardized scales—structured tools with clear scoring systems.

Common scales used in brain injury diagnosis

• Glasgow Coma Scale (GCS)

  • Measures eye opening, verbal response, and motor response

  • Helps quickly grade brain injury as mild, moderate, or severe in emergency settings

• Balance Error Scoring System (BESS)

  • A structured balance test using several standing positions on firm and foam surfaces

  • Designed to measure static postural stability after mild head injury and guide return-to-play decisions Shirley Ryan AbilityLab

• Symptom scales and concussion checklists

  • Patient rates headache, dizziness, nausea, fatigue, sensitivity to light and noise, etc.

Rehabilitation tools such as BESS are widely recognized as objective measures of balance and postural control in brain-injured populations. Shirley Ryan AbilityLab

These scales help the integrative team:

• Quantify changes over time

• Decide when a patient is improving or getting worse

• Document findings clearly for medical records, insurance, and legal cases

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Neurocognitive assessment (ImPACT and similar tests)

Brain injuries often affect thinking skills, not just physical movement. That is why integrative teams use neurocognitive testing.

One widely used tool is ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). ImPACT Applications

ImPACT is a computerized test that measures:

• Memory (visual and verbal)

• Processing speed

• Reaction time

• Attention and concentration

According to ImPACT Applications, chiropractors can use ImPACT for patients ages 12–80 (and ImPACT Pediatric for younger children) to track concussion symptoms and recovery. It includes multiple test batteries, a concussion symptom scale, and generates a report that guides clinical decisions. ImPACT Applications+1

Why neurocognitive testing matters

• Helps identify “hidden” brain problems when CT or MRI scans are normal

• Provides objective numbers instead of relying only on “I feel foggy.”

• Allows comparison with baseline or normative data

• Supports safe return-to-work, return-to-school, or return-to-sport decisions

In an integrative clinic, the chiropractor may administer the test and interpret functional patterns, while the nurse practitioner integrates the results with medical findings, medications, and overall health.

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Balance, vestibular, and eye-movement testing

Brain injuries frequently disrupt balance and the inner ear (vestibular system), as well as eye-tracking and visual reflexes. This can show up as:

• Dizziness

• Motion sensitivity

• Blurry vision

• Trouble reading or focusing

• Feeling “off” when walking in a busy environment

Chiropractors and nurse practitioners may use:

• BESS for static balance and postural stability Shirley Ryan AbilityLab

• Dynamic balance tasks (walking while turning the head, tandem gait, etc.)

• Simple eye-movement tests

  • Smooth pursuit (tracking a moving target)

  • Saccades (quick eye jumps)

  • Convergence (eyes moving together for near focus)

Audiology and concussion resources emphasize that combining balance and cognitive tests improves the detection of brain and vestibular involvement after trauma. Shirley Ryan AbilityLab+1

If balance or eye problems are more severe, the nurse practitioner may refer to:

• Vestibular therapists

• Neuro-optometrists

• Neurologists

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Imaging – X-rays, CT scans, MRIs, and Digital Motion X-ray (DMX)

Conventional imaging ordered or used by integrative teams

Nurse practitioners and chiropractors use or refer for several types of imaging:

• X-rays

  • Show fractures, gross alignment problems, and degenerative changes in the spine

  • Common first-line imaging study in chiropractic practice Invalid URL+1

• CT scans (Computed Tomography)

  • Used in emergency settings to quickly detect brain bleeding, skull fractures, and major structural damage

  • Recommended when there are red-flag symptoms after a head injury NYU Langone Health

• MRI (Magnetic Resonance Imaging)

  • Provides detailed images of the brain and soft tissues

  • Helpful when symptoms persist but CT is normal, or when there is concern for brain bleeding, bruising, or subtle structural damage NYU Langone Health+1

Chiropractic diagnostic guides and accident-injury resources explain that chiropractors often start with a patient interview and physical exam and then order imaging such as X-rays, MRI, CT, or ultrasound when indicated. flspineandinjury.com+1

Advanced chiropractic imaging: Digital Motion X-ray (DMX)

Some integrative clinics use Digital Motion X-ray (DMX), also known as videofluoroscopy, to detect injuries that static imaging may miss. DMX captures real-time X-ray images while the patient moves through specific ranges of motion. Modern Chiropractic Center

DMX can help identify:

• Cervical instability after whiplash or head trauma

• Ligament damage in the neck or spine

• Abnormal motion at the skull–neck junction that may be related to brain injury symptoms

Modern Chiropractic Center, for example, describes DMX as valuable for uncovering subtle spinal injuries, documenting ligament damage, and supporting both treatment planning and medicolegal documentation after car crashes. Modern Chiropractic Center

Dr. Jimenez’s practice similarly highlights the use of advanced imaging—including motion-based X-ray studies—to better understand how head and neck trauma affects the spine and nervous system, especially in personal-injury cases. dralexjimenez.com+1

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Functional neurological scanning and non-invasive diagnostics

Beyond structural imaging, integrative chiropractors increasingly use non-invasive neurological scanning technologies to study nerve function and autonomic balance.

INSiGHT scanning systems, as described by chiropractic technology experts, commonly include: INSiGHT CLA+1

• Surface EMG (sEMG)

  • Measures electrical activity in spinal muscles

  • Reveals areas of tension and overwork linked to nerve irritation

• Thermal (neuroTHERMAL) scans

  • Detect temperature differences along the spine

  • These asymmetries can suggest nerve stress or inflammation affecting organs and glands

• Heart rate variability (HRV)

  • Measures beat-to-beat changes in heart rate

  • Gives insight into the autonomic nervous system’s balance (stress vs. recovery).

These tools do not diagnose brain injury on their own. Instead, they:

• Show how the nervous system is adapting (or failing to adapt) after trauma

• Provide objective, visual reports that help track progress over time

• Help chiropractors and nurse practitioners see connections between spinal stress, autonomic imbalance, and symptoms like headaches, dizziness, and fatigue

The World Health Organization notes that diagnostics include in vitro tests (such as lab tests) and in vivo monitoring tools, such as blood pressure cuffs, imaging devices, and other technologies that detect, monitor, or treat health conditions. World Health Organization Functional neurological scanning fits into this broader family of non-invasive diagnostic tools.

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Laboratory and blood tests ordered by nurse practitioners

Nurse practitioners expand the diagnostic picture by ordering lab tests when needed, especially in more complex or high-risk cases.

Examples include:

• Basic blood work

  • Complete blood count (CBC) to check for infection or anemia

  • Electrolytes and a metabolic panel to monitor organ function

• Coagulation studies

  • To assess bleeding risk, especially if there is concern for intracranial hemorrhage or the patient is on blood thinners

• Inflammatory markers

  • Sometimes used to monitor systemic inflammation

• Endocrine and metabolic tests

  • Pituitary and adrenal function, if there are symptoms of post-TBI hormonal changes

While many blood tests do not directly “show” a concussion, they help rule out other dangerous conditions and support safe medication and imaging decisions. Nurse practitioners follow broader diagnostic principles, such as those described by the WHO, to select appropriate tests and interpret them within the larger clinical picture. World Health Organization+1

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Integrating findings into a working brain injury diagnosis

Once history, exam, testing, and imaging are completed, the integrative team pulls the data together.

They consider:

• Mechanism of injury (how the trauma happened)

• Immediate and delayed symptoms

• Neurological exam results

• GCS or other scale scores

• Neurocognitive test results (ImPACT, symptom scales) ImPACT Applications+1

• Balance and vestibular testing outcomes (BESS, gait tests) Shirley Ryan AbilityLab

• Imaging findings (X-ray, CT, MRI, DMX) Modern Chiropractic Center+1

• Neurological scan data (sEMG, HRV, thermal scans) INSiGHT CLA+1

• Lab results and overall medical status World Health Organization+1

From this, they may arrive at diagnoses such as:

• Mild traumatic brain injury (concussion)

• Moderate or severe TBI (usually managed in hospitals)

• Post-concussion syndrome

• Co-existing cervical or thoracic spine injuries

• Vestibular dysfunction

• Headaches related to craniocervical or TMJ dysfunction

This integrated approach allows targeted treatment and clear communication with surgeons, neurologists, physical therapists, and legal teams when needed.

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Dr. Alexander Jimenez’s integrative diagnostic approach

Dr. Alexander Jimenez, DC, APRN, FNP-BC, is a strong example of how integrative chiropractic and nurse practitioner care can work in a real-world clinic.

From his published materials and clinical descriptions, his team typically: dralexjimenez.com+1

• Takes a detailed trauma history focused on car accidents, sports injuries, and work-related head and neck trauma

• Performs layered neurological and musculoskeletal exams to check the spine, nerves, and brain-related functions

• Uses advanced imaging, including digital motion X-ray and other structural studies, to detect instability and ligament damage that may worsen brain symptoms

• Incorporates non-invasive neurological scanning to measure muscle activity, autonomic balance, and thermal patterns along the spine

• Orders or coordinates MRI, CT, and lab tests when red flags appear or when symptoms do not improve as expected

• Works within a team model—coordinating with neurologists, orthopedic surgeons, physical therapists, and personal-injury attorneys when documentation and expert testimony are needed

This dual-scope (chiropractic and nurse practitioner) role allows him to look at both the mechanical side (spine, joints, posture) and the medical-neurological side (brain, vascular, metabolic health) of complex injuries, especially those related to motor vehicle accidents.

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When urgent care or emergency evaluation is needed

Even in an integrative clinic, providers are trained to look for red-flag signs that require immediate emergency care, such as:

• Sudden worsening headache

• Repeated vomiting

• Slurred speech

• Weakness or numbness on one side of the body

• Seizures

• Unequal pupils

• Confusion that is getting worse, not better

In these situations, nurse practitioners and chiropractors do not rely solely on office-based tools. They send patients directly to the emergency department for urgent CT or MRI scans and higher-level monitoring. NYU Langone Health+1

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Putting it all together

Diagnosing brain damage is not about one magic test. It is about combining:

• Careful history and symptom tracking

• Physical and neurological examinations

• Standardized scales like GCS and BESS

• Neurocognitive tools like ImPACT

• Balance and eye-movement testing

• Structural imaging (X-ray, CT, MRI, DMX)

• Functional neurological scans (sEMG, HRV, thermography)

• Lab work and medical screening

Integrative chiropractic doctors and nurse practitioners use all of these pieces to see how the brain, spine, and nervous system are working together after trauma. Clinics like Dr. Jimenez’s show how powerful this approach can be for patients recovering from car accidents, sports injuries, and other high-impact events.

If you or someone you care about has had a head or neck injury and is dealing with brain-related symptoms, an integrative team that understands both chiropractic biomechanics and medical neurology can provide a thorough, evidence-based evaluation and a safer, more personalized path forward.

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References

• Florida Spine and Injury. (2018). How do chiropractors diagnose injuries? Ethos Health Group Blog. https://www.flspineandinjury.com/blog/how-do-chiropractors-diagnose-injuries flspineandinjury.com

• ImPACT Applications, Inc. (2025). Chiropractor’s role in concussion management. https://impacttest.com/chiropractors-role-in-concussion-management/ ImPACT Applications

• Injury 2 Wellness Centers. (n.d.). Revolutionizing injury diagnosis: Advanced chiropractic tools explained. https://injury2wellness.com/revolutionizing-injury-diagnosis-advanced-chiropractic-tools-explained/ injury2wellness.com

• Modern Chiropractic Center. (2025). The crucial role of digital motion X-ray (DMX) in accurate post-car crash injury diagnosis. https://modernchiropracticcenter.com/blog/accurate-post-car-crash-injury-diagnosis/ Modern Chiropractic Center

• Shirley Ryan AbilityLab. (2013). Balance Error Scoring System (BESS). Rehabilitation Measures Database. https://www.sralab.org/rehabilitation-measures/balance-error-scoring-system Shirley Ryan AbilityLab

• Insight CLA. (n.d.). The role of neurological scanning tech in modern chiropractic care. https://insightcla.com/blog/the-role-of-neurological-scanning-tech-in-modern-chiropractic-care/ INSiGHT CLA+1

• NYU Langone Health. (n.d.). Concussion: Diagnosis. https://nyulangone.org/conditions/concussion/diagnosis NYU Langone Health

• World Health Organization. (n.d.). Diagnostics. https://www.who.int/health-topics/diagnostics World Health Organization

• California Board of Chiropractic Examiners. (n.d.). Consumer guide to chiropractic care. https://www.chiro.ca.gov/publications/chiro_consumer_guide.pdf Invalid URL

• Jimenez, A. (n.d.). Dr. Alex Jimenez – Injury Medical & Chiropractic Clinic [Clinic overview and articles]. https://dralexjimenez.com/ dralexjimenez.com