Brain Injury Testing: How Nurse Practitioners and Integrative Chiropractors Find Hidden Damage

 

When someone hits their head in a car crash, sports game, fall, or work accident, the most important question is simple: “Is there a brain injury?”

Nurse practitioners (NPs) and integrative chiropractors often work together to answer that question. They do much more than “look at the neck” or “order a scan.” They use a layered testing process that checks:

• How the brain is working (thinking, memory, reaction time)

• How the nervous system is firing (muscles, reflexes, balance, eye movements)

• How the structure looks (X-rays, CT, MRI, sometimes ultrasound)

• How the body and blood look on lab tests

This article explains, in simple language, the key tests these providers use to spot concussion and other traumatic brain injuries (TBIs) and how they combine those results into a safe treatment plan.

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Why accurate brain injury testing matters

A mild traumatic brain injury can be easy to miss. A person might:

• Walk and talk normally

• Have a normal CT scan

• Still feel “off” for weeks or months

Without proper testing, subtle brain injuries can turn into long-term problems like headaches, dizziness, poor focus, mood changes, and chronic neck or back pain. Early diagnosis gives providers a chance to:

• Remove the patient from unsafe work, sports, or driving

• Protect the brain while it heals

• Track recovery with repeat tests

• Decide when it’s safe to go back to normal life

Modern chiropractic clinics and NP-led practices now use structured interviews, neurological exams, concussion tools, computer tests like ImPACT, non-invasive neurological scanners, and imaging to guide care. flspineandinjury.com+2INSiGHT CLA+2

In El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, uses this kind of integrated approach. His clinic combines chiropractic, medical, neurological, imaging, and laboratory testing to evaluate complex spinal and brain injuries following accidents. El Paso, TX Doctor Of Chiropractic

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Detailed history and symptom interview

Before any fancy test, both NPs and integrative chiropractors start with a guided conversation. This is more than “Where does it hurt?”

They ask about:

• How the injury happened

  • Type of accident (car crash, sports impact, fall, work injury)

  • Speed, direction of force, head position

• Immediate symptoms

  • Loss of consciousness or not

  • Confusion, amnesia, “seeing stars,” or feeling dazed

• Current symptoms

  • Headache, neck pain, dizziness, nausea, vision changes

  • Trouble thinking, concentrating, or remembering

  • Sleep problems, mood swings, anxiety, or irritability

• Past history

  • Previous concussions or TBIs

  • Migraine, seizure, ADHD, mental health issues

  • Medications, blood thinners, or medical conditions

Many clinics use structured symptom checklists (e.g., those included in SCAT5 or ImPACT) to rate the severity of each symptom over time. Physiopedia+2concussioninsportgroup.com+2

Why it matters:
A careful story often gives the first big clue that brain injury is likely, even before imaging or computer testing.

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Neurological and physical examination

Next, the NP or integrative chiropractor performs a hands-on neurological exam. Florida Spine and Injury, for example, describes a process that moves from history to physical tests to imaging when needed. flspineandinjury.com

Typical checks include:

• Mental status

  • Alertness, orientation (person, place, time, situation)

  • Ability to follow simple and complex commands

• Cranial nerves

  • Eye movements

  • Pupil size and reaction to light

  • Facial strength and sensation

  • Hearing, swallowing, and tongue movement

• Motor system

  • Muscle strength in arms and legs

  • Muscle tone and any abnormal movements

• Reflexes

  • Deep tendon reflexes (knee, ankle, elbow)

  • Abnormal reflexes that may suggest spinal cord or brain damage

• Coordination

  • Finger-to-nose testing

  • Heel-to-shin testing

• Sensation

  • Light touch, pinprick, and vibration

Simple bullet summary of bedside neuro tests:

• Check alertness and orientation

• Test eye movements and pupils

• Look at the face, tongue, and swallowing

• Measure strength, reflexes, and coordination

• Test sensation in arms, legs, and trunk

Integrative chiropractors focus strongly on how these findings relate to the spine, posture, and joint motion, while NPs connect them to overall medical and neurological status.

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Glasgow Coma Scale (GCS) for early severity

The Glasgow Coma Scale (GCS) is one of the most widely used tools for classifying the severity of a head injury. It scores three things:

• Eye-opening (E)

• Verbal response (V)

• Motor response (M)

Scores range from 3 to 15:

• 13–15 = Mild TBI / concussion

• 9–12 = Moderate TBI

• 3–8 = Severe TBI / coma Cleveland Clinic+1

Nurse practitioners and integrative chiropractors trained in emergency triage may:

• Use GCS at the scene or early visit to decide whether the patient needs immediate ER care

• Track changes over time (for example, from 15 ? 13) that suggest worsening brain swelling or bleeding

• Document severity for medical and legal purposes

Important: Any person with a low or falling GCS, repeated vomiting, worsening headache, or unequal pupils needs emergency medical attention, not just office-based care.

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Balance and gait testing—BESS and more

Brain injuries often disrupt the vestibular system (balance in the inner ear) and proprioception (body awareness). That’s why balance testing is a key part of concussion care.

Balance Error Scoring System (BESS)

The Balance Error Scoring System (BESS) is a low-cost, portable test of static balance widely used for athletes with concussion or mild TBI. Physiopedia+2Shirley Ryan AbilityLab+2

In BESS, patients stand in several positions (feet together, single leg, tandem stance) on firm and foam surfaces while the examiner counts “errors” such as:

• Opening eyes when they should be closed

• Stepping or stumbling

• Lifting hands off the hips

• Moving out of the test position

A higher error score suggests poorer balance and possible lingering effects on the brain. Research shows BESS can detect balance changes in concussed athletes, especially when the differences are large. PMC+1

Other common balance and gait checks

Along with BESS, NPs and chiropractors may use:

• Tandem gait (heel-to-toe walking)

• Single-leg stance

• Romberg and sharpened Romberg (feet together, eyes closed)

• Head-turn or vestibular tests that combine head movement with walking

An audiology review on TBI also notes that BESS and the Standardized Assessment of Concussion (SAC) are commonly used in concussion evaluation, as they assess balance, hearing, and brain function. Audiology Associates

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Sport concussion tools—SCAT5 and related forms

In sports and accident settings, many providers use standardized concussion tools such as SCAT5 (Sport Concussion Assessment Tool 5).

SCAT5 is designed for healthcare professionals to evaluate suspected concussion in people aged 13 and older. It:

• Combines symptom checklists

• Includes brief cognitive tests

• Screens balance and neurological function

• Can be compared to baseline or normative data CATT Online+2Physiopedia+2

Key SCAT-style elements include:

• Symptom rating (headache, nausea, fogginess, etc.)

• Orientation questions (date, place, situation)

• Immediate and delayed memory tasks

• Concentration tests (digits backward, months in reverse)

• Balance tests similar to BESS

For younger patients, providers may use Child SCAT5, which is adapted for ages 5–12.British Journal of Sports Medicine+1

Nurse practitioners often use SCAT tools on the sideline, in urgent care, or in primary care. Integrative chiropractors may use them in sports clinics and personal injury settings, especially when working with athletes, weekend warriors, or car-crash survivors with concussion-like symptoms.

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Computerized neurocognitive testing – ImPACT

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is a widely used computer test that measures several brain functions after head injury. According to ImPACT Applications, chiropractors and other providers use it for patients ages 12–80 (with a pediatric version for younger children). impacttest.com

ImPACT typically evaluates:

• Verbal memory

• Visual memory

• Processing speed

• Reaction time

• Attention and concentration

It also includes a concussion symptom scale that lets patients rate how they feel. After testing, a report compares scores to baseline or normative data and helps guide:

• Return-to-play decisions for athletes

• Return-to-work planning after accidents

• Progress over time with repeated testing

In Dr. Jimenez’s kind of integrated setting, ImPACT results are often combined with:

• GCS and SCAT/BESS findings

• Spinal and posture exams

• Imaging and lab data

This helps create a picture of both brain function and body function together.

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Non-invasive neurological scanning in integrative chiropractic

Modern integrative chiropractic practices increasingly use non-invasive neurological scanning to measure how the nervous system is functioning along the spine. Insight CLA describes a suite of tools (INSiGHT neuroTECH) that includes: INSiGHT CLA+1

• Heart Rate Variability (HRV) – measures how well the nervous system manages stress and recovery

• Surface electromyography (sEMG) – tracks muscle tension and fatigue along the spine

• Thermal scanning – maps skin temperature changes that may show nerve stress or inflammation

These tools can help:

• Detect hidden nervous-system stress that might follow whiplash or concussion

• Guide where adjustments or rehab exercises should focus

• Track changes over time as the brain and spine recover

In cases of trauma, Dr. Jimenez’s clinic uses brain scans along with regular check-ups, detailed imaging, and movement tests to see how a traumatic brain injury (TBI) has affected posture, muscle control, and spine Injury 2 Wellness Centers+1

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Imaging—X-rays, CT, MRI, ultrasound, and motion studies

When imaging is needed

Not every concussion needs a scan, but certain red flags push NPs and chiropractors to send patients for imaging, such as:

• Worsening headache

• Repeated vomiting

• Seizures

• Very drowsy or hard to wake

• Weakness or numbness in arms or legs

• Unequal pupils

Common imaging tests

1. X-rays

• Show skull and spinal bones

• Can reveal fractures or major alignment issues

• Often used by chiropractors to evaluate spinal alignment, disc spaces, and posture flspineandinjury.com+1

2. CT scans

• Often, the first test in the ER for a serious head injury

• Good at finding bleeding, skull fractures, and large brain swelling

• Used when there is concern for life-threatening injury NYU Langone Health

3. MRI scans

• Provide more details of the brain than the CT

• Can show bruising, small bleeds, and diffuse axonal injury (microscopic damage to brain fibers)

• Used in ongoing symptoms, complex cases, or when CT is normal but problems persist NYU Langone Health+1

4. Ultrasound

• More often used to look at soft tissues, blood vessels, or neck structures

• May be used in chiropractic settings for soft-tissue injuries around the neck and shoulders flspineandinjury.com+1

5. Advanced digital imaging and motion analysis
Modern chiropractic centers and integrative clinics also use:

• Digital radiography for detailed spinal images

• Motion analysis systems to see how joints and the spine move after injury

• Thermal imaging, as discussed above

These tools give objective data on how an accident has changed movement, posture, and nervous system load. Injury 2 Wellness Centers+2Injury 2 Wellness Centers+2

Dr. Jimenez’s practice, for example, includes access to imaging studies and diagnostic centers to support complex injury evaluation, especially after motor vehicle accidents. El Paso, TX Doctor Of Chiropractic

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Laboratory and blood testing—the nurse practitioner’s role

While chiropractors focus on mechanical and neurological problems, nurse practitioners can also order laboratory tests to look for medical issues that may worsen brain injury or mimic its symptoms.

According to the World Health Organization and other health agencies, in vitro diagnostics (IVDs) include blood and urine tests performed outside the body to detect diseases and monitor health. World Health Organization+2World Health Organization+2

After a head injury, an NP might order:

• Basic blood work

  • Complete blood count (CBC)

  • Electrolytes and kidney function

  • Liver function tests

• Coagulation tests

  • To see if someone on blood thinners is at a higher risk for bleeding

• Inflammation or infection markers, if symptoms suggest another problem

• Metabolic or endocrine tests, if there is fatigue, mood changes, or long-term recovery problems

In an integrative clinic like Dr. Jimenez’s, more advanced labs may look at:

• Nutrient status (e.g., B-vitamins, vitamin D, omega-3s)

• Inflammation and oxidative stress markers

• Hormone balance and metabolic health El Paso, TX Doctor Of Chiropractic

These tests don’t “diagnose concussion” directly, but they help build a whole-body picture so the care plan supports both brain and body healing.

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Hearing, vision, and vestibular testing

Head injuries can also damage the systems that handle hearing, balance, and eye movement.

An audiology review on TBI notes that:

• Hearing loss and ringing in the ears (tinnitus) are common after TBI

• Tools such as BESS and SAC help assess balance and concussion status in patients with head injury Audiology Associates

Nurse practitioners and integrative chiropractors may:

• Screen for hearing changes, sound sensitivity, or sound fullness

• Perform simple eye-movement tests for nystagmus (jerky eye movements) or tracking problems

• Refer to audiologists, neuro-optometrists, or vestibular therapists for deeper testing

This is especially important in patients who report:

• Dizziness or vertigo when turning the head

• Motion sickness in cars

• Blurry vision, double vision, or trouble focusing

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How Dr. Jimenez’s integrated approach brings it all together

In a clinic that blends chiropractic and nurse practitioner care, like Dr. Alex Jimenez’s practice in El Paso, the testing pathway for a suspected brain injury often looks like this: El Paso, TX Doctor Of Chiropractic+2Injury 2 Wellness Centers+2

1. Initial triage and safety check

   • Use GCS and red-flag questions to decide if ER referral is needed

   • Rule out major emergencies first

2. Detailed history and symptom scoring

   • Mechanism of injury, past history, current symptoms

   • Symptom scales, SCAT-style forms, and concussion checklists

3. Spine, posture, and neurological exam

   • Full neuro exam, spinal alignment, range of motion

   • Check for whiplash, joint restriction, muscle spasm

4. Balance and cognitive testing

   • BESS or similar balance tools

   • Computerized tests like ImPACT to measure memory, reaction time, and processing speed

5. Non-invasive neurological scanning

   • HRV, sEMG, thermal scans to find nervous system stress along the spine

6. Imaging and labs as needed

   • X-rays, CT, or MRI to look for structural damage

   • Ultrasound or motion analysis for soft tissue and joint problems

   • Lab testing to support whole-body healing and rule out other problems

7. Personalized treatment and follow-up testing

   • Chiropractic adjustments, soft-tissue work, and posture rehab

   • Medication, lifestyle counseling, and referrals managed by the NP

   • Repeat ImPACT, balance tests, or scans to track recovery and guide return-to-play or return-to-work decisions

This layered testing strategy helps catch both obvious and subtle brain injuries and supports patients through the full recovery journey.

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When to seek emergency care instead of office testing

Even the best integrative clinic is not a substitute for the ER. Anyone with a head injury should seek emergency help immediately if they have:

• Loss of consciousness that lasts more than a few seconds

• Repeated vomiting

• Slurred speech or confusion that gets worse

• Weakness, numbness, or trouble walking

• Seizures

• Very severe or rapidly worsening headache

• Unequal pupils or new vision loss

Office-based testing is meant for stable patients or for follow-up after emergency care.

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Conclusion: Brain injury testing is a team effort

Testing for brain injury is not about one single perfect test. It is about layers of information:

• Story + symptoms

• Neurological and physical exam

• GCS, SCAT-type tools, BESS

• Computerized tests like ImPACT

• Non-invasive neurological scanning

• Imaging and lab work

Nurse practitioners and integrative chiropractors each bring a unique skill set. When they work together—like in Dr. Jimenez’s integrated practice—they can detect subtle changes in brain function, spinal mechanics, and whole-body health that might otherwise go unnoticed.

For patients, this means:

• Safer decisions about sports, work, and driving

• Better tracking of recovery over weeks and months

• A care plan that supports both brain healing and overall wellness

If you or someone you love has had a head injury, it is worth finding a team that understands both neurology and spine-body mechanics and that uses modern, evidence-based testing to guide every step.

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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. (2025). Chiropractor’s role in concussion management. https://impacttest.com/chiropractors-role-in-concussion-management/ impacttest.com

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

Concussion in Sport Group. (n.d.). CISG tools – SCAT®. https://www.concussioninsportgroup.com/scat-tools/ concussioninsportgroup.com

Cattonline. (n.d.). Sport Concussion Assessment Tool (SCAT5). https://cattonline.com/scat CATT Online

Physio-pedia. (n.d.). Balance Error Scoring System. https://www.physio-pedia.com/Balance_Error_Scoring_System Physiopedia

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

TeksScan. (n.d.). BESS test for balance assessment. https://www.tekscan.com/blog/medical/bess-test-balance-assessment tekscan.com

Cleveland Clinic. (2023). Glasgow Coma Scale (GCS): What it is, interpretation & chart. https://my.clevelandclinic.org/health/diagnostics/24848-glasgow-coma-scale-gcs Cleveland Clinic

Brain Injury Association of America. (n.d.). Glasgow Coma Scale. https://biausa.org/brain-injury/about-brain-injury/diagnosis/hospital-assessments/glasgow-coma-scale Brain Injury Association of America

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

U.S. Food and Drug Administration. (2024). In vitro diagnostics. https://www.fda.gov/medical-devices/products-and-medical-procedures/in-vitro-diagnostics U.S. Food and Drug Administration

World Health Organization – Western Pacific Region. (n.d.). In vitro diagnostics. https://www.who.int/westernpacific/health-topics/in-vitro-diagnostics World Health Organization

Audiology Associates of Santa Rosa. (n.d.). Hearing loss & TBI – recognizing and evaluating head injury. https://www.audiologyassociates-sr.com/hearing-loss/hearing-loss-tbi/ Audiology Associates

Insight CLA. (2022). The future of non-invasive diagnostics in chiropractic practices. https://insightcla.com/blog/the-future-of-non-invasive-diagnostics-in-chiropractic-practices/ INSiGHT CLA

Insight CLA. (n.d.). Neurological scanning technology for chiropractic diagnosis. https://insightcla.com/blog/neurological-scanning-technology-for-chiropractic-diagnosis/ INSiGHT CLA

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

Injury 2 Wellness Centers. (n.d.). Innovative injury assessment techniques in modern chiropractic care. https://injury2wellness.com/innovative-injury-assessment-techniques-in-modern-chiropractic-care/ Injury 2 Wellness Centers

Jimenez, A. (n.d.). El Paso’s premier chiropractic clinic – Injury Medical & Pain Treatment Clinic. https://dralexjimenez.com El Paso, TX Doctor Of Chiropractic