Integrative Head-Injury Diagnostics for Better Care

Integrative head-injury diagnostics: how chiropractors and nurse practitioners test the brain

When someone hits their head in a car crash, sports game, fall, or work accident, the biggest question is, “How serious is it?”

Integrative chiropractors and nurse practitioners work together to answer that question using a layered diagnostic process. They combine:

• Careful interviews and physical exams

• Standardized neurological and balance tests

• Neurocognitive tools like ImPACT

• Imaging such as X-rays, CT scans, and MRIs

• Non-invasive neurological scanning and, for nurse practitioners, blood and lab tests

By blending these tools, they can identify dangerous red flags, pick up “hidden” concussions, and build a safe, step-by-step treatment plan instead of guessing.

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Why accurate diagnostic testing after a head injury matters

Head injuries and concussions can be tricky:

• Symptoms may be mild at first and get worse over hours or days.

• CT or MRI scans can be normal even when the brain is not working correctly. NYU Langone Health

• Neck, jaw, ear, and balance problems can copy or hide concussion symptoms. impacttest.com+1

Because of this, integrative chiropractors and nurse practitioners don’t rely on one single test. They use multiple tools to look at:

• Brain function (thinking, memory, reaction time)

• Balance, vision, and coordination

• Structural damage to the skull, neck, and spine

• Nerve function, muscle activity, and inflammation

• Overall body health through blood and lab tests

The World Health Organization (WHO) explains that diagnostics include both in vitro tests (such as blood tests) and in vivo tests, such as imaging (X-ray, CT, ultrasound) and monitoring devices (blood pressure, ECG, pulse oximeter). World Health Organization Nurse practitioners and chiropractors draw from this full toolbox to see the whole picture.

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History and symptom screening

The first “diagnostic test” is a conversation.

Most integrative providers start with a structured interview:

• What happened? (Mechanism of injury)

• Did you lose consciousness or feel dazed?

• Are you nauseated, dizzy, confused, or unusually sleepy?

• Do you have neck pain, jaw pain, ringing in the ears, or visual problems?

• Have you had concussions before?

• What medications and medical conditions do you have?

Chiropractic and spine-injury clinics describe this data as the foundation of diagnosis, followed by physical tests and, if needed, imaging such as X-ray, MRI, CT, or ultrasound to confirm findings. flspineandinjury.com+1

What providers are looking for in the interview

• Red-flag symptoms

  • Worsening headache

  • Repeated vomiting

  • Seizures

  • Slurred speech

  • Weakness, numbness, or trouble walking

  • Inability to wake up or rapidly worsening confusion NYU Langone Health

• Concussion-type symptoms

  • Headache, dizziness, and sensitivity to light/noise

  • Foggy thinking, memory gaps, slowed reactions

  • Sleep changes, irritability, or anxiety

• Associated problems

  • Neck whiplash and spinal pain

  • Jaw/TMJ issues

  • Hearing loss, tinnitus, or balance problems from inner ear injury audiologyassociates-sr.com+1

An integrative chiropractor will also connect the story to spinal mechanics—how the head, neck, and mid-back moved at impact—while a nurse practitioner (NP) is simultaneously thinking about brain bleeding risk, stroke risk, and whether emergency imaging or referral is needed.

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Neurological and physical examination

After the history, both the chiropractor and nurse practitioner perform a hands-on exam.

Neurologic screening

This usually includes:

• Checking level of alertness and orientation (person, place, time, situation)

• Eye movements and pupils

• Facial strength and sensation (cranial nerves)

• Strength and sensation in arms and legs

• Reflexes and coordination (finger-to-nose, heel-to-shin)

• Simple walking and balance tests

Providers often use a standardized Glasgow Coma Scale (GCS) score to rate eye opening, verbal response, and motor response. This helps decide whether the injury is likely mild, moderate, or severe and whether emergency transport or immediate imaging is needed.

Cervical spine and musculoskeletal exam

Because many head injuries involve sudden acceleration–deceleration (whiplash), integrative chiropractors pay close attention to:

• Neck range of motion

• Spasms and tenderness in neck muscles

• Alignment of cervical vertebrae

• Signs of ligament instability or nerve root irritation

Imaging and concussion guidelines stress that cervical spine injuries can mimic concussion symptoms and must be ruled out, especially in car crashes and sports impacts. impacttest.com+1

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Standardized concussion, balance, and symptom tools

On top of the physical exam, integrative providers use standardized assessment tools developed for concussion and mild traumatic brain injury (mTBI).

Common tools used by chiropractors and nurse practitioners

• BESS (Balance Error Scoring System) – a simple balance test that tracks errors (stumbles, foot lifts) while a person stands in different positions. It helps identify balance deficits linked to concussion. audiologyassociates-sr.com

• Standardized Assessment of Concussion (SAC) – a brief paper-and-pencil test that checks orientation, memory, and concentration. audiologyassociates-sr.com+1

• ACE (Acute Concussion Evaluation) – a structured tool that guides clinicians through symptom checklists, injury details, and red flags to support diagnosis and management of mild TBI. audiologyassociates-sr.com+1

• SCAT5 / Child SCAT5 – sideline and clinic tools used widely in sports to assess symptoms, cognitive function, and balance after head trauma (often included in multidisciplinary concussion protocols).

• VOMS (Vestibular/Ocular Motor Screening) – checks eye tracking and vestibular (inner ear) function, which is often disturbed after a concussion. impacttest.com

These tools help make concussion assessment more objective and allow chiropractors, nurse practitioners, and other providers (like audiologists, physical therapists, and neuropsychologists) to speak the same language about severity and progress over time. audiologyassociates-sr.com+1

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Neurocognitive testing with ImPACT

One of the best-known computerized concussion tests is ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing).

ImPACT and ImPACT Quick Test are FDA-cleared medical devices designed to help assess and manage concussions. impacttest.com+1

What ImPACT measures

According to ImPACT Applications, the test:impacttest.com+1

• Includes eight neurocognitive subtests

• Measures:

  • Visual and verbal memory

  • Reaction time

  • Processing speed

• Includes a 21-item symptom scale that tracks headaches, dizziness, sleep changes, emotional changes, and more

How integrative chiropractors use ImPACT

Chiropractors can use ImPACT for patients ages 12–80 (with ImPACT Pediatric available for ages 5–11). The test can be done in-office or remotely:

• Provides baseline testing before a season or high-risk activity

• Gives post-injury scores that can be compared to baseline or to normative data

• Helps guide return-to-play, return-to-school, and return-to-work decisions

• Offers objective data that complements physical exam and balance tests

Nurse practitioners working in integrative settings often review ImPACT or similar neurocognitive results while also considering:

• Overall medical risk

• Medication interactions (for example, sedatives that affect test scores)

• Mental health factors like anxiety or depression

• The need for referral to neuropsychology for deeper testing

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Imaging – X-ray, CT, MRI, ultrasound, and more

Imaging is not always needed for every concussion, but when used appropriately, it is critical for catching serious problems.

X-rays and digital X-rays

Chiropractors commonly use X-rays to evaluate:

• Skull fractures or cervical spine fractures

• Obvious misalignments or degenerative changes

• Postural shifts following trauma

Traditional chiropractic and spine-injury guides describe X-rays as among the most common diagnostic tests, especially for bone and joint problems. flspineandinjury.com

More recently, digital X-rays have become standard in many chiropractic clinics. Injury-diagnosis articles describe how digital systems like injury2wellness.com

• Provide high-resolution images of the spine

• Use lower radiation than older film X-rays

• Help detect ligament injury, vertebral misalignment, and subtle trauma

CT scans

When a more serious brain injury is suspected, nurse practitioners often order CT scans (usually in the emergency or urgent care setting). CT is especially useful to detect:

• Bleeding inside the brain (intracranial hemorrhage)

• Brain swelling

• Depressed skull fractures

Concussion guidelines from major academic centers emphasize that CT is the first-line imaging test in acute moderate-to-severe head injury or when red-flag symptoms are present. NYU Langone Health+1

MRI scans

MRI provides a deeper view of the brain and soft tissues. It:

• Uses strong magnets and radio waves (no radiation)

• Shows subtle bruises, small bleeds, or stretching of nerve fibers

• Helps evaluate chronic symptoms like headaches, dizziness, or cognitive changes if they continue beyond the expected recovery window NYU Langone Health+1

MRI is also useful for:

• Detecting ligament and disc injuries in the neck and upper back

• Evaluating soft-tissue damage after high-impact crashes or sports injuries injury2wellness.com

Ultrasound and thermography

Ultrasound is a non-invasive imaging tool that helps visualize soft tissues, muscles, and nerves. Chiropractic injury-diagnosis resources describe its use in: injury2wellness.com+1

• Assessing soft-tissue strains in the neck and shoulder

• Detecting inflammation or fluid collections

• Guiding rehabilitation and manual therapy

Thermography uses infrared cameras to map skin temperature. Articles on advanced chiropractic tools note that thermography can: injury2wellness.com+2INSiGHT CLA+2

• Highlight areas of inflammation

• Suggest regions of nerve stress or dysregulation

• Provide non-radiation, non-invasive data that complements X-rays and MRIs.

Surface EMG and digital motion analysis

Chiropractors increasingly rely on surface electromyography (sEMG) and digital motion analysis:

• sEMG measures electrical activity in muscles to detect overactive or weak muscle groups, especially around the neck and spine after whiplash or concussion. injury2wellness.com+1

• Digital motion analysis tracks how the head, neck, and body move in real time, revealing hidden compensation patterns that may contribute to headaches, dizziness, or imbalance after head trauma. injury2wellness.com+1

These tools are particularly helpful for personal injury and sports cases, where documenting objective changes in movement and muscle control can support both treatment and medico-legal documentation.

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Non-invasive neurological scanning (INSiGHT neuroTECH)

Some integrative chiropractic clinics, including advanced practices like Dr. Alexander Jimenez’s, use INSiGHT neuroTECH scanners to capture a more complete picture of nervous system function. INSiGHT CLA+1

According to INSiGHT’s own clinical education materials, the system combines three major tools: INSiGHT CLA+1

• neuroPULSE (HRV)

  • Measures heart rate variability

  • Reflects how well the autonomic nervous system adapts to stress and recovery

• neuroCORE (sEMG)

  • Uses surface EMG along the spine

  • Shows areas of muscle over-activity or fatigue related to nerve interference

• neuroTHERMAL (thermal scanning)

  • Detects temperature changes along the spine

  • Helps identify nerve stress and deeper system imbalances

Why this matters for head injuries

After a concussion or head/neck trauma, patients often show:

• Autonomic dysregulation (heart-rate changes, poor stress tolerance)

• Abnormal muscle patterns in the neck and upper back

• Areas of inflammation or nerve irritation along the spine

INSiGHT scanners translate these changes into clear, visual reports. Chiropractors and nurse practitioners can then:

• Track objective progress over weeks and months

• Show patients how the spinal and nervous system function improves with care

• Adjust treatment plans based on real-time data, not just symptoms INSiGHT CLA+1

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Blood tests and in vitro diagnostics (nurse practitioner role)

While chiropractors generally focus on physical and neurological exams plus imaging, nurse practitioners can order laboratory testing to rule out systemic problems that may complicate head injuries.

Using the WHO framework, these are in vitro diagnostics, such as World Health Organization

• Complete blood count (CBC) – looks for anemia, infection, or clotting problems

• Coagulation studies – important when bleeding risk or blood-thinning medications are involved

• Electrolytes and metabolic panels – check for dehydration, low sodium, or other issues that can worsen confusion

• Inflammatory markers – may be used in complex or multi-system trauma

• Toxicology screens – help distinguish brain injury from substance-related changes in consciousness

Nurse practitioners may also coordinate specialty labs—such as hormonal, nutritional, or autoimmune panels—if a patient has lingering symptoms that do not match standard concussion recovery patterns. Integrative practices like Dr. Jimenez’s use partnered labs (for example, Vibrant America, Genova, and others) to explore broader metabolic and inflammatory contributors to symptoms. El Paso, TX Doctor Of Chiropractic

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Hearing, vestibular, and audiology testing

Head injury can damage both the brain and the inner ear. Audiology literature notes that TBI can lead to: audiologyassociates-sr.com

• Hearing loss

• Tinnitus

• Difficulty understanding speech in noise

• Balance problems related to vestibular damage

To evaluate these, patients may undergo:

• Comprehensive hearing tests

• Vestibular tests such as videonystagmography (VNG) and posturography

• Balance Error Scoring System (BESS) for postural stability

• Cognitive-linguistic evaluations are used when memory or attention issues complicate listening

Audiologists emphasize the use of the ACE and other concussion tools to track recovery over time and coordinate with other providers. audiologyassociates-sr.com

In an integrative clinic, chiropractors and nurse practitioners use these results to refine spinal, vestibular, and neurological care plans, especially when neck and head injuries overlap.

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Integrative collaboration: chiropractors + nurse practitioners + Dr. Jimenez’s example

In many modern clinics, chiropractors and nurse practitioners work side by side. A common workflow after a head injury might look like this:

1. Initial triage and red-flag screening

• Either provider can perform basic neurological and physical exams, screen for emergency signs, and determine whether the patient needs immediate transfer to the ER.

• Glasgow Coma Scale scoring, red-flag symptom checklists, and vital signs guide these decisions.

2. Early diagnostic testing

• Chiropractor

  • Focuses on the mechanism of injury, cervical spine alignment, posture, and neuromusculoskeletal function.

  • Uses tools such as SCAT, BESS, VOMS, ImPACT, sEMG, digital motion analysis, and X-rays where appropriate. impacttest.com+2injury2wellness.com+2

• Nurse practitioner

  • Reviews medical history, medications, and risk factors.

  • Orders CT, MRI, and lab work when clinically indicated. NYU Langone Health+1

  • Screens for mood disorders, sleep disturbances, and systemic issues that can slow brain healing.

3. Advanced and non-invasive diagnostics

In a clinic like Dr. Alexander Jimenez, DC, APRN, FNP-BC’s in El Paso, the diagnostic pathway may also include: El Paso, TX Doctor Of Chiropractic+1

• INSiGHT neuroTECH scanning (HRV, sEMG, thermal)

• Ultrasound for soft-tissue evaluation

• Digital X-ray and MRI via partnered imaging centers

• Functional and metabolic lab panels coordinated through integrative medicine labs

Dr. Jimenez’s practice emphasizes:

• Clinical neurology and neurophysiology for nerve injuries and TBI

• Imaging and diagnostics for personal injury cases (auto accidents, work injuries, and sports trauma)

• Medical–legal documentation, where objective test results help attorneys and insurers understand causation, timing, and severity of injuries El Paso, TX Doctor Of Chiropractic+2injury2wellness.com+2

4. Ongoing monitoring and re-testing

As patients progress, integrative teams use repeat testing to track recovery:

• Follow-up ImPACT or other neurocognitive tests

• Repeat BESS and balance exams

• Updated sEMG, motion analysis, or INSiGHT scans to show changes in muscle tone, autonomic function, and spinal balance

• Updated imaging only when indicated, not routinely, to limit unnecessary radiation

This allows the team to adjust exercise programs, manual therapies, medications, and lifestyle recommendations based on real data instead of guesswork.

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When should a patient seek emergency vs. integrative care?

Even with advanced diagnostics, some situations need immediate emergency evaluation, not a scheduled clinic visit. Seek emergency help right away for:

• Worsening or severe headache

• Repeated vomiting

• Seizures

• Trouble waking up, or growing confusion

• Weakness, numbness, or trouble walking

• Slurred speech or facial droop

Once life-threatening problems are ruled out, integrative chiropractors and nurse practitioners are well-positioned to:

• Continue detailed diagnostic evaluation

• Treat neck and spine injuries linked to head trauma

• Address vestibular, balance, and visual issues

• Monitor neurocognitive recovery

• Coordinate care with neurology, neuropsychology, audiology, physical therapy, and legal professionals when needed

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Putting it all together

Head injuries are complex, and no single test tells the whole story. That is why integrative chiropractors and nurse practitioners rely on a diagnostic ecosystem rather than just one scan or questionnaire.

Key parts of that system include:

• Thorough history and red-flag screening

• Neurological and musculoskeletal exams, including cervical spine evaluation

• Standardized tools like BESS, SAC, SCAT, ACE, VOMS

• Neurocognitive testing, especially ImPACT

• Imaging: X-ray, CT, MRI, ultrasound, and sometimes thermography

• Non-invasive neurological scanning (INSiGHT HRV, sEMG, neurothermal)

• Blood and lab tests to address the whole body and rule out systemic causes

• Specialty hearing and vestibular testing where needed

In practices like Dr. Alexander Jimenez’s, these tools are combined into a coordinated, patient-centered approach that respects both structural (spine and joints) and functional (brain, nerves, metabolism) aspects of head injuries. The goal is always the same: identify problems early, treat safely, monitor objectively, and support long-term recovery—not just symptom suppression.

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References

American Audiology Associates. (n.d.). Hearing loss & TBI — Recognizing and evaluating head injury. Retrieved from www.audiologyassociates-sr.com/hearing-loss/hearing-loss-tbi audiologyassociates-sr.com

Florida Spine and Injury. (2024). How do chiropractors diagnose injuries? Retrieved from www.flspineandinjury.com/blog/how-do-chiropractors-diagnose-injuries flspineandinjury.com

ImPACT Applications, Inc. (2022). Chiropractor’s role in concussion management [PDF]. Retrieved from impacttest.com/wp-content/uploads/chiropractors-role-in-concussion-management.pdf impacttest.com

ImPACT Applications, Inc. (2025). Chiropractor’s role in concussion management [Web article]. Retrieved from impacttest.com/chiropractors-role-in-concussion-management impacttest.com

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

Injury 2 Wellness Centers. (n.d.). Revolutionizing injury diagnosis: Advanced chiropractic tools explained. Retrieved from injury2wellness.com/revolutionizing-injury-diagnosis-advanced-chiropractic-tools-explained injury2wellness.com+1

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

NYU Langone Health. (n.d.). Diagnosing concussion. Retrieved from nyulangone.org/conditions/concussion/diagnosis NYU Langone Health

World Health Organization. (2025). Diagnostics – Global. Retrieved from www.who.int/health-topics/diagnostics World Health Organization