I have seen magic at work in human beings in the form of paying attention to all serious thinking by evaluating and interpreting bodily signals as the clues they are intended to be. They may be the forerunner of what may be the more serious symptoms that slowly prevent the body from functioning at its most productive level.
We need to be careful to look in the proper direction instead of being drawn away by a slight of hand movement (assuming a wrong conclusion). Take the time to notice and chart what is really taking place in your body. Nature is usually more honest than magic.
Friday, October 8, 2010
Tuesday, September 14, 2010
final details re end of N.F.L.players foorball injury
Headline, article dated, NY TIMES, Concussions tied to Depression in N.F.L. players story, that states "The rate of diagnosed clinical depression among Natl. Football players is strongly correlated with the number of concussions they sustained according to a published study, by University of North Carolina's
Center for the Study of Retired Athletics on a general health survey of 2550 retired N.F.L. players.
It confirms other findings regarding brain trauma and later life depression, but runs counter to long time assertions by the N.F.L. that concussions in football have no long term effect. (N.Y.Times, 6-1-07)
Dr. Ira Casson, Co-Chairman of committee, stated "Survey studies are the weakest type of research study, "... subject to all kind of error and interpretation and miscalculation," although they are using them by taking people's words without verifying them. On the other hand, Dr. John White, Director of the Moss Rehabilitation Institute in Philadelphia disagreed with this criticism. "Do I think this one study proves the point beyond doubt? No.
Does it contribute in a meaningful way? You bet."
This report that 600 players, in a formal, anonymous peer review, before putlication, reported approximately 600 players recalled sustaining three or more concussions on the football field, of which the physician found they had depression.
This formal, anonymous peer review, underwent formal review before publication. (Respondents were on average 54 years old having played almost seven season, and a minimum of two seasons.
Center for the Study of Retired Athletics on a general health survey of 2550 retired N.F.L. players.
It confirms other findings regarding brain trauma and later life depression, but runs counter to long time assertions by the N.F.L. that concussions in football have no long term effect. (N.Y.Times, 6-1-07)
Dr. Ira Casson, Co-Chairman of committee, stated "Survey studies are the weakest type of research study, "... subject to all kind of error and interpretation and miscalculation," although they are using them by taking people's words without verifying them. On the other hand, Dr. John White, Director of the Moss Rehabilitation Institute in Philadelphia disagreed with this criticism. "Do I think this one study proves the point beyond doubt? No.
Does it contribute in a meaningful way? You bet."
This report that 600 players, in a formal, anonymous peer review, before putlication, reported approximately 600 players recalled sustaining three or more concussions on the football field, of which the physician found they had depression.
This formal, anonymous peer review, underwent formal review before publication. (Respondents were on average 54 years old having played almost seven season, and a minimum of two seasons.
Friday, June 4, 2010
WU gets $60 million gift - STLtoday.com
WU gets $60 million gift - STLtoday.com
This article was written last year, but the project is to be completed this year, so here we are...
What effect will 60 MILLION dollars have on the way young people handle religion and politics? Let's hope it all works out well.
This article was written last year, but the project is to be completed this year, so here we are...
What effect will 60 MILLION dollars have on the way young people handle religion and politics? Let's hope it all works out well.
Sunday, May 23, 2010
Friday, May 14, 2010
A New View on Customer Service
I recently had a new pair of glasses made which I was not happy with. I wore my new glasses almost six weeks before I went back to have them checked. I thought I needed a new pair because they were not only uncomfortable to wear they did not improve my vision.
At the time of my first fitting, the man who was helping me wasn’t really all that much help. You would have thought I was a Meineke Car Care, “In – Up – Out.” I told the man the glasses were not comfortable and they didn’t seem to improve my vision. His response was, “You will get used to them.”
Not wanting to be “a pain,” I went along with his advice. After six weeks my glasses didn’t get better, so I decided to have them checked. It turned out that he had not adjusted them to my eyes and face correctly. The new person who took care of me on this return visit knew immediately that was the case and corrected the problem without having to change the prescription.
This experience happens all too often these days. For some reason people don’t feel they need to do a good job at what they are hired to do, if they don’t make LOTS of money for their time. Thank goodness there are other types of people also – the ones that do their job no matter what.
There is an unfair balance that happens in the work place when this attitude prevails – slackers screw things up and the workers have to fix their problems on top of doing their own work. What is one to do in such situations, criticize the one who made the error or just allow the knowledgeable person to correct it?
My belief is that a “complaint” should be made to the person who made the mistake. This way they can learn from their error. I see two benefits that could come from this, the next patient doesn’t have to go through the same experience, and co-workers don’t have to pull dead weight at work.
Moral of the story – speak up. You may be able to teach and help others while improving your own life.
At the time of my first fitting, the man who was helping me wasn’t really all that much help. You would have thought I was a Meineke Car Care, “In – Up – Out.” I told the man the glasses were not comfortable and they didn’t seem to improve my vision. His response was, “You will get used to them.”
Not wanting to be “a pain,” I went along with his advice. After six weeks my glasses didn’t get better, so I decided to have them checked. It turned out that he had not adjusted them to my eyes and face correctly. The new person who took care of me on this return visit knew immediately that was the case and corrected the problem without having to change the prescription.
This experience happens all too often these days. For some reason people don’t feel they need to do a good job at what they are hired to do, if they don’t make LOTS of money for their time. Thank goodness there are other types of people also – the ones that do their job no matter what.
There is an unfair balance that happens in the work place when this attitude prevails – slackers screw things up and the workers have to fix their problems on top of doing their own work. What is one to do in such situations, criticize the one who made the error or just allow the knowledgeable person to correct it?
My belief is that a “complaint” should be made to the person who made the mistake. This way they can learn from their error. I see two benefits that could come from this, the next patient doesn’t have to go through the same experience, and co-workers don’t have to pull dead weight at work.
Moral of the story – speak up. You may be able to teach and help others while improving your own life.
Thursday, May 13, 2010
ideas slip away fast if not recorded
A new idea comes on momentarily and we assume we can recall it at the appropriate time as needed.
This is a major error our brain imposes on us.
It neglects telling us how fast the idea will get lost in the brain and only a strong reminder might bring it back when we need it.
This is another habit we take for granted without realizing how many wonderful ideas are filed in the brain that we never get back to applying.
How to avoid this functioning or malfunctioning of the brain is just as important as the error the brain imposes on us when it disregards the games the brain plays on us without letting it continue to do so no matter how much important information falls by the wayside without our realizing it.
Can this be avoided? Yes, with a little effort at the time it is happening. How?
Keep a notebook handy and jot the thought down when it occurs. If one thinks this is too much trouble think of the loss of positive thoughts if one avoids this minor effort to make life more pleasant by saving our positive thoughts instead of letting them float away as if they were not important.
MAKE A PERSONAL LIST OF POSITIVE THOUGHTS AND KEEP ADDING TO IT. IT WILL HELP YOU RETAIN THE MANY POSITIVE IDEAS THAT MAKE LIFE INTERESTING, STIMULATING, AND PRODUCTIVE RATHER THAN HAVE THEM CLUTTERING YOUR MIND WITHOUT YOUR EVEN REALIZING THEY ARE THERE.
This may seem a burden but it really is not. It relieves burdens we ignore or do so because they seem to require more time than our superficial view of them makes then appear so.
This is a major error our brain imposes on us.
It neglects telling us how fast the idea will get lost in the brain and only a strong reminder might bring it back when we need it.
This is another habit we take for granted without realizing how many wonderful ideas are filed in the brain that we never get back to applying.
How to avoid this functioning or malfunctioning of the brain is just as important as the error the brain imposes on us when it disregards the games the brain plays on us without letting it continue to do so no matter how much important information falls by the wayside without our realizing it.
Can this be avoided? Yes, with a little effort at the time it is happening. How?
Keep a notebook handy and jot the thought down when it occurs. If one thinks this is too much trouble think of the loss of positive thoughts if one avoids this minor effort to make life more pleasant by saving our positive thoughts instead of letting them float away as if they were not important.
MAKE A PERSONAL LIST OF POSITIVE THOUGHTS AND KEEP ADDING TO IT. IT WILL HELP YOU RETAIN THE MANY POSITIVE IDEAS THAT MAKE LIFE INTERESTING, STIMULATING, AND PRODUCTIVE RATHER THAN HAVE THEM CLUTTERING YOUR MIND WITHOUT YOUR EVEN REALIZING THEY ARE THERE.
This may seem a burden but it really is not. It relieves burdens we ignore or do so because they seem to require more time than our superficial view of them makes then appear so.
Friday, April 23, 2010
What's in a habit?
Habits good and bad are created through repetition. Repetition is kind of boring unless it has value added, like a healthy body, a good relationship or a good handle on your money.
Check out why you do what you do, and either continue doing what you do or start a new boring repetitious behavior with value added.
Where has Common Sense Gone?
I live in a retirement home where many of the residents use walkers. One day I was watching a lady walk bent over her walker, as if it was trying to pull her under the floor. I suggested that she raise the handles on her walker, but she informed me that her doctor had not told her to do so and on that note, she was only going to do as her doctor instructed her to do!OK, I can understand following doctor’s orders, but what if her doctor didn’t watch her using that short walker? Think about it – the nurse brings us into the room and we sit waiting for that doctor to arrive. And, the doctor usually leaves the room before us, so when would he have seen this dear little lady use her walker? When do we become responsible for some of our own care?
You would think if people are suggesting improvements we can make to our lives, that we would at least stop to think, “I wonder why they would say that?” Most of the time people make suggestions because they want to see us doing, being or feeling better. Why would I care if her back hurt from bending over too far if it wasn’t for her benefit?
The scary thing in all of this is - we treat our doctors as if they are God – knowing everything we need before we ask for it. Well, the fact is doctors aren’t God or even a good facsimile of God, so why wouldn’t we ask more questions of our doctors if it would make our lives easier?
Do we think so little of ourselves that we don’t dare question those who are the “authority” or have we been programmed not to ask questions, because it wouldn’t be polite? Either way, it’s time to take a little responsibility for our own well-being.
Raise the handles on your walker! Your back will thank you!
Friday, March 12, 2010
Biased Decisions – Costly Business
If only we knew how costly decisions based on biased beliefs can be, we might stop making them. For example Jews, God and History, published in the mid-1960s, had sold more than 2.5 million copies by the year 2000. It is now considered a classic continuing to sell close to 3,000 copies per month. The reason for the many rejections of Jews, God and History by prominent publishers was, “There are so many books on Jewish history now we see no point in adding another one.” But, after sales of 3 million plus copies, the error of their thinking has shown them how much money they have lost.
One wonders if there has been any change in their rejection policy. Think of how the brave person who took the time to actually read the unpublished manuscript and sent it on for review feels. I for one would feel quite confident in the ability to know good writing when I saw it. It would be interesting to read the minds of who passed on the opportunity to publish yet “another book on Jewish history.”
This wonderful classic can be ordered on-line at http://tinyurl.com/yldbagb or purchased at any major bookstore.
Friday, February 26, 2010
To Treat or Not to Treat
I endured a traumatic brain injury in a car accident and for 35 years I was unable to cry. Then I heard about cranial manipulation treatment. It was presented to me as a cure for what ailed me. To see what it would do, I tried it. It did make me cry, but for no reason and no cause. Was my choice a good one or not? We all live with the intense desire to make right decisions regarding our health, but when we learn we made the wrong decision, it upsets us and leave us with an unpleasant feeling.
Whether to listen to our bodies or the advice we get from “those who know” is not a simple decision to make. We hear, “Listen to your doctor,” or “Ask your health care provider,” but when should we listen to our daily symptoms instead of asking those who think they know what’s best for us?
Another example of following the advice of health care providers instead of listening to symptoms was when I was being treated for my adrenal gland damage. The physician knew this is the one gland of the body that cannot be repaired or cured since the adrenal gland cannot regenerate itself, but this negative fact was not conveyed when this treatment was applied. I didn’t know what was harder to deal with, my hope of getting better being dashed or having a damaged adrenal gland.
During the years of “mending,” I have learned to listen to my body and choose the best medical decision I can.
Whether to listen to our bodies or the advice we get from “those who know” is not a simple decision to make. We hear, “Listen to your doctor,” or “Ask your health care provider,” but when should we listen to our daily symptoms instead of asking those who think they know what’s best for us?
Another example of following the advice of health care providers instead of listening to symptoms was when I was being treated for my adrenal gland damage. The physician knew this is the one gland of the body that cannot be repaired or cured since the adrenal gland cannot regenerate itself, but this negative fact was not conveyed when this treatment was applied. I didn’t know what was harder to deal with, my hope of getting better being dashed or having a damaged adrenal gland.
During the years of “mending,” I have learned to listen to my body and choose the best medical decision I can.
Longevity
At 93, I feel I have lived long enough to have a personal opinion on longevity. I read an article that says your personality may be the key to a very long life. They examined the personality traits of 246 children of people who lived to be at least 100. The study showed that those who live the longest are more outgoing, more active and less neurotic than other people.
(Time/CNN – The Year in Health 2009)
If this is true, they didn’t interview the offspring of the people who live in my building. I was under the opinion that the crabby, nit picking and somewhat neurotic lived the longest, or maybe that’s just how it feels. But then again, I have been active, outgoing and interested in everything around me –so I guess the study is true.
(Time/CNN – The Year in Health 2009)
If this is true, they didn’t interview the offspring of the people who live in my building. I was under the opinion that the crabby, nit picking and somewhat neurotic lived the longest, or maybe that’s just how it feels. But then again, I have been active, outgoing and interested in everything around me –so I guess the study is true.
Doctors -vs- Patients
I had a disagreement against a physician and I wrote to the State Board of Registration for the Healing Arts. My complaint was rejected by them, without ever giving me a reason for doing so.
A routine visit to my doctor was the start to a long drawn out misunderstanding. He prescribe Amox-Clav, and gave me exercises for my round shoulders, which I explained to him I had lived with my round shoulders since I was six years old. I refused to believe that any pharmaceutical could correct this at my age, which at the time I was 80 years of age.
I took the medication as prescribe, only after one dose I experience bleeding, so I stopped taking the drug and called my doctor. He suggested I go to the emergency room because of the bleeding. I was leery about going myself so I called a friend who came immediately to take me to the hospital. I wasn’t hemorrhaging, but having your doctor tell you to go to the emergency room makes you wonder if he knows something you don’t and doesn’t want to scare you by telling you.
I was admitted for observation, and I ended up spending three days in the hospital before this doctor even showed up to see what might be wrong with me. In the end, the medical staff didn’t find any reason for me to be there. On the third day, he arrived too late to issue a discharge order that would have permitted the hospital to discharge me. If I stayed another day, I would have had to pay for it myself as my insurance would not cover it. Because of this I insisted on leaving without his discharge authorization and did.
Now back to my complaint. Not only did I feel neglected by my doctor, but there was no one that seemed to care about my plight. I doubt if this is an only experience of this type. We need a patient listening ear for patients not just for doctors.
A routine visit to my doctor was the start to a long drawn out misunderstanding. He prescribe Amox-Clav, and gave me exercises for my round shoulders, which I explained to him I had lived with my round shoulders since I was six years old. I refused to believe that any pharmaceutical could correct this at my age, which at the time I was 80 years of age.
I took the medication as prescribe, only after one dose I experience bleeding, so I stopped taking the drug and called my doctor. He suggested I go to the emergency room because of the bleeding. I was leery about going myself so I called a friend who came immediately to take me to the hospital. I wasn’t hemorrhaging, but having your doctor tell you to go to the emergency room makes you wonder if he knows something you don’t and doesn’t want to scare you by telling you.
I was admitted for observation, and I ended up spending three days in the hospital before this doctor even showed up to see what might be wrong with me. In the end, the medical staff didn’t find any reason for me to be there. On the third day, he arrived too late to issue a discharge order that would have permitted the hospital to discharge me. If I stayed another day, I would have had to pay for it myself as my insurance would not cover it. Because of this I insisted on leaving without his discharge authorization and did.
Now back to my complaint. Not only did I feel neglected by my doctor, but there was no one that seemed to care about my plight. I doubt if this is an only experience of this type. We need a patient listening ear for patients not just for doctors.
Friday, February 19, 2010
The Concussion Puzzle
ALTERNATIVE METHODS OF CONCUSSION ASSESSMENT
Piecing Together the Concussion Puzzle
By: Kevin M. Guskiewicz, Ph.D.
Condensed suggestions for article to be included in
THE HIDDEN INJURY
By Ethel Dimont
Reports of the cumulative effects of multiple head injuries, as well as multiple head impacts, on long-term cognitive functioning are causing clinicians to rethink their approach to managing concussions. The literature has revealed deficiencies in neurocognitive functions such as attention span, memory, concentration and information processing as a result of cerebral concussions. Alternative testing as well as historical perspective of postural stability and neurocognitive testing are essential.
A variety of assessment tools are available for detecting a mild traumatic brain injury following a concussion or blow to the head. However, their practicality is often questions, especially in sport settings. Assessment of mild traumatic brain injury can be likened to piecing together a very complex puzzle. There are several pieces to this concussion puzzle, and it is the clinician’s job to place as many pieces together as possible before making a diagnosis. Some of these pieces may include, but are not limited to:
1. Assessing cognitive abilities
2. Motor functioning (including balance and reaction time)
3. Symptoms such as headaches, dizziness, blurred vision, memory deficits, etc.
4. History of prior MTBI
Though this chapter is geared primarily to head injuries sustained in sport activities, the same problems and difficulties apply to most head injuries, especially where injuries are invisible.
It is essential for physicians to keep clear records of the patient’s symptoms for future decisions pertaining to severity of injury and possible future need for rehabilitation. Many methods of assessing the severity of head and brain injury have already been developed. Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) have enhanced the capability of diagnosticians to identify certain types of brain injuries and their severity. Two widely accepted methods to assess the severity of brain injury are the Glasgow Coma Scale (GSC) and the Abbreviated Injury Scale (AIS). However, their usefulness is questioned in many instances, especially in managing sport-related head injury. [Because these injuries are often hidden, or considered a closed head injury, which often are not even confirmed by the CT or MRI.]
The (GCS) requires observation of the patient while their eyes are open, verbal performance, and motor response, but several problems limit its applicability in certain cases. For example, having the patient’s eyes open may be impossible with facial swelling, and verbal response may be compromised by endotracheal tube.
The AIS is designed to assess overall bodily injury along with severity of injury to specific body parts. The AIS avoids some of the problems of the GCS administration, but according to Sorenson and Kraus, in the book Physical Management in Neurological Rehabilitation, by Maria Stokes, AIS has some of its own limitation. The scale depends on a valid physician diagnosis, and a clear enumeration of symptoms in the medical record to allow assignment of an injury score.
If we view the body as a computer, sending signals from the brain to tell the body what is required of it, or if there is a problem, it becomes a bit easier to understand some of the complicated systems the human body uses to enable it to function on the level it does.
POSTURAL CONTROL SYSTEM:
The postural control system is responsible for the maintenance of upright posture and balance. This system operates as a feedback control circuit between the brain and the musculoskeletal system.
VESTIBULAR AND VISUAL SYSTEM
The vestibular and visual systems work very closely in attempting to retain upright balance. The vestibular apparatus is the organ responsible for detecting sensations concerned with equilibrium. It mainly contributes to posture by maintaining reflexes associated with keeping the head and neck in a vertical position and allowing the vestibular apparatus to control eye movement.
PROPRIOCEPTIVE SYSTEM:
The proprioceptive system is best described through the tactile senses, and the sense of position, which determines the relative actions and rate of movements of the different part of the body.
A complex network of neural connections and centers are related by peripheral and central feedback mechanisms. A hierarchy integrating the cerebral cortex, cerebellum, basal ganglia, brainstem, and spinal cord is primarily responsible for controlling voluntary movements.
PATHOLOGICAL BALANCE ASSESSMENT:
Disorders of orientation and balance can be very debilitating, especially in an athletic environment. The complexity of the balance system makes localization of the problem difficult, since the abnormality may occur in one or more of the sensory modalities (vision, vestibular, somatosensory) or in the motor system involved in carrying out a particular movement.
Contrary to clinical belief, studies have demonstrated that motor deficits are present in mild head injury patients one year after injury, suggesting that motor skills should be routinely assessed after a concussion.
Symptoms in persons with cerebella damage generally include the following:
1. Cannot perform movements smoothly
2. Walk awkwardly, with the feet well apart. Difficulty in maintaining balancing causes unsteadiness of gait.
3. Cannot start or stop movements quickly or easily. Motions are slow and irregular.
4. Cannot easily combine the movements of several joints into a smooth, coordinated motion. i.e.: To move the arm, they must first move the shoulder, then the elbow, and finally the wrist.
PATHOLOGICAL NEUROCOGNITIVE ASSESSMENT
Neuropsychological techniques have been developed to reliably assess the extent of neurocognitive deficits following cerebral concussion in athletes. Due to the variability of neurocognitive abilities of athletes, acquisition of baseline (pre-injury) measurements for comparison with post-injury measurements is a necessity when instituting a neuropsychological testing program for athletes. This model is not realistic for use in a clinic or hospital setting, but has endless potential when used in the sports medicine where baseline testing is possible for athletes who have a higher risk for injury.
Neuropsychological testing has revealed cognitive declines in as little as 24 hours post injury from the pre-season levels in areas of attention, concentration, and rapid-complex problem solving. These mild deficits were directly correlated with reported symptoms of increased headaches, dizziness, and memory problems. Most test include 5-8 sub tests which assess the various domains of cognitive functioning (re: working memory, mental processing speed, and attention: concentration, procedural reaction time, and visual scanning abilities.)
RECOMMENDED PROTOCOLS FOR ASSESSMENT OF CONCUSSION
This can best be accomplished through the use of a symptom checklist. An on-line check list can be obtained from The Brain Injury Resource Center, http://www.headinjury.com/checktbi.htm. Using the total symptom score and the total number of symptoms reported takes some of the guesswork out of determining an athletes readiness to return to activity. The additional use of objective measures such as postural stability assessment and neuropsychological evaluation can be invaluable to the sport medicine clinician.
These three measure (symptom checklist, postural stability assessment, and neuropsychological evaluation), combined with a thorough clinical examination provide the best resources for making a sound clinical diagnosis and a safe return to participation. The certified athletic trainer and team physician can therefore more easily detect lingering symptoms such as irritability, sadness, concentration deficits, etc.
The athlete should always be referred to a neurosurgeon if post-concussion symptoms worsen within the first few hours post-injury. Neuropsychologists can also play an important role if the symptoms persist during the first several days post-injury. They have advanced training in the administration and interpretation of neuropsychological tests. It is recommended that all sports medicine teams include a neurosurgeon and neuropsychologist, at the very least, for referral purposes.
Understanding that no two head injuries are created equal will help one to realize that this is a complex problem. Some injuries will resolve quickly, and never present any recurrent complications. Others, even those that may appear to be very mild, can result in persistent symptoms that lasts for weeks, months, or even years.
Future research will inevitably develop additional concepts that will aid those with head injuries. Until then, with present knowledge, everyone should be able to agree that no athlete should be permitted to return to competition while still symptomatic, nor should any person suffering from post-concussion syndrome attempt a quick entry back into activities that may predispose them to complicate or interrupt the healing process. Admittedly, though these signs and symptoms are often difficult to assess objectively, erring on the side of caution is the most logical way to deal with piecing together the concussion puzzle.
Piecing Together the Concussion Puzzle
By: Kevin M. Guskiewicz, Ph.D.
Condensed suggestions for article to be included in
THE HIDDEN INJURY
By Ethel Dimont
Reports of the cumulative effects of multiple head injuries, as well as multiple head impacts, on long-term cognitive functioning are causing clinicians to rethink their approach to managing concussions. The literature has revealed deficiencies in neurocognitive functions such as attention span, memory, concentration and information processing as a result of cerebral concussions. Alternative testing as well as historical perspective of postural stability and neurocognitive testing are essential.
A variety of assessment tools are available for detecting a mild traumatic brain injury following a concussion or blow to the head. However, their practicality is often questions, especially in sport settings. Assessment of mild traumatic brain injury can be likened to piecing together a very complex puzzle. There are several pieces to this concussion puzzle, and it is the clinician’s job to place as many pieces together as possible before making a diagnosis. Some of these pieces may include, but are not limited to:
1. Assessing cognitive abilities
2. Motor functioning (including balance and reaction time)
3. Symptoms such as headaches, dizziness, blurred vision, memory deficits, etc.
4. History of prior MTBI
Though this chapter is geared primarily to head injuries sustained in sport activities, the same problems and difficulties apply to most head injuries, especially where injuries are invisible.
It is essential for physicians to keep clear records of the patient’s symptoms for future decisions pertaining to severity of injury and possible future need for rehabilitation. Many methods of assessing the severity of head and brain injury have already been developed. Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) have enhanced the capability of diagnosticians to identify certain types of brain injuries and their severity. Two widely accepted methods to assess the severity of brain injury are the Glasgow Coma Scale (GSC) and the Abbreviated Injury Scale (AIS). However, their usefulness is questioned in many instances, especially in managing sport-related head injury. [Because these injuries are often hidden, or considered a closed head injury, which often are not even confirmed by the CT or MRI.]
The (GCS) requires observation of the patient while their eyes are open, verbal performance, and motor response, but several problems limit its applicability in certain cases. For example, having the patient’s eyes open may be impossible with facial swelling, and verbal response may be compromised by endotracheal tube.
The AIS is designed to assess overall bodily injury along with severity of injury to specific body parts. The AIS avoids some of the problems of the GCS administration, but according to Sorenson and Kraus, in the book Physical Management in Neurological Rehabilitation, by Maria Stokes, AIS has some of its own limitation. The scale depends on a valid physician diagnosis, and a clear enumeration of symptoms in the medical record to allow assignment of an injury score.
If we view the body as a computer, sending signals from the brain to tell the body what is required of it, or if there is a problem, it becomes a bit easier to understand some of the complicated systems the human body uses to enable it to function on the level it does.
POSTURAL CONTROL SYSTEM:
The postural control system is responsible for the maintenance of upright posture and balance. This system operates as a feedback control circuit between the brain and the musculoskeletal system.
VESTIBULAR AND VISUAL SYSTEM
The vestibular and visual systems work very closely in attempting to retain upright balance. The vestibular apparatus is the organ responsible for detecting sensations concerned with equilibrium. It mainly contributes to posture by maintaining reflexes associated with keeping the head and neck in a vertical position and allowing the vestibular apparatus to control eye movement.
PROPRIOCEPTIVE SYSTEM:
The proprioceptive system is best described through the tactile senses, and the sense of position, which determines the relative actions and rate of movements of the different part of the body.
A complex network of neural connections and centers are related by peripheral and central feedback mechanisms. A hierarchy integrating the cerebral cortex, cerebellum, basal ganglia, brainstem, and spinal cord is primarily responsible for controlling voluntary movements.
PATHOLOGICAL BALANCE ASSESSMENT:
Disorders of orientation and balance can be very debilitating, especially in an athletic environment. The complexity of the balance system makes localization of the problem difficult, since the abnormality may occur in one or more of the sensory modalities (vision, vestibular, somatosensory) or in the motor system involved in carrying out a particular movement.
Contrary to clinical belief, studies have demonstrated that motor deficits are present in mild head injury patients one year after injury, suggesting that motor skills should be routinely assessed after a concussion.
Symptoms in persons with cerebella damage generally include the following:
1. Cannot perform movements smoothly
2. Walk awkwardly, with the feet well apart. Difficulty in maintaining balancing causes unsteadiness of gait.
3. Cannot start or stop movements quickly or easily. Motions are slow and irregular.
4. Cannot easily combine the movements of several joints into a smooth, coordinated motion. i.e.: To move the arm, they must first move the shoulder, then the elbow, and finally the wrist.
PATHOLOGICAL NEUROCOGNITIVE ASSESSMENT
Neuropsychological techniques have been developed to reliably assess the extent of neurocognitive deficits following cerebral concussion in athletes. Due to the variability of neurocognitive abilities of athletes, acquisition of baseline (pre-injury) measurements for comparison with post-injury measurements is a necessity when instituting a neuropsychological testing program for athletes. This model is not realistic for use in a clinic or hospital setting, but has endless potential when used in the sports medicine where baseline testing is possible for athletes who have a higher risk for injury.
Neuropsychological testing has revealed cognitive declines in as little as 24 hours post injury from the pre-season levels in areas of attention, concentration, and rapid-complex problem solving. These mild deficits were directly correlated with reported symptoms of increased headaches, dizziness, and memory problems. Most test include 5-8 sub tests which assess the various domains of cognitive functioning (re: working memory, mental processing speed, and attention: concentration, procedural reaction time, and visual scanning abilities.)
RECOMMENDED PROTOCOLS FOR ASSESSMENT OF CONCUSSION
This can best be accomplished through the use of a symptom checklist. An on-line check list can be obtained from The Brain Injury Resource Center, http://www.headinjury.com/checktbi.htm. Using the total symptom score and the total number of symptoms reported takes some of the guesswork out of determining an athletes readiness to return to activity. The additional use of objective measures such as postural stability assessment and neuropsychological evaluation can be invaluable to the sport medicine clinician.
These three measure (symptom checklist, postural stability assessment, and neuropsychological evaluation), combined with a thorough clinical examination provide the best resources for making a sound clinical diagnosis and a safe return to participation. The certified athletic trainer and team physician can therefore more easily detect lingering symptoms such as irritability, sadness, concentration deficits, etc.
The athlete should always be referred to a neurosurgeon if post-concussion symptoms worsen within the first few hours post-injury. Neuropsychologists can also play an important role if the symptoms persist during the first several days post-injury. They have advanced training in the administration and interpretation of neuropsychological tests. It is recommended that all sports medicine teams include a neurosurgeon and neuropsychologist, at the very least, for referral purposes.
Understanding that no two head injuries are created equal will help one to realize that this is a complex problem. Some injuries will resolve quickly, and never present any recurrent complications. Others, even those that may appear to be very mild, can result in persistent symptoms that lasts for weeks, months, or even years.
Future research will inevitably develop additional concepts that will aid those with head injuries. Until then, with present knowledge, everyone should be able to agree that no athlete should be permitted to return to competition while still symptomatic, nor should any person suffering from post-concussion syndrome attempt a quick entry back into activities that may predispose them to complicate or interrupt the healing process. Admittedly, though these signs and symptoms are often difficult to assess objectively, erring on the side of caution is the most logical way to deal with piecing together the concussion puzzle.
Friday, February 12, 2010
Max Dimont's books on Kindle
If you loved Max Dimont's book in paper form - you will love them in e-form too. Here's a link to E-Reads where you can find many of Max's books.
http://www.ereads.com/author.asp?authorid=145
If you like paper books - try this.
http://tinyurl.com/yhlphua
Enjoy!
Friday, February 5, 2010
Washington University in St. Louis to establish religion and politics center | Newsroom | Washington University in St. Louis
Washington University in St. Louis to establish religion and politics center Newsroom Washington University in St. Louis
Religion and politics have been hot topics for thousands of years. The Greeks had taken the idea of discussion to great heights at Mars Hill, and the world has been influenced by their brilliant minds ever since.
How wonderful to think we may again have brilliant minds tossing around the pros and cons of ideas and philosophies here in St. Louis. As we will know, religion and politics have infuenced one another since the beginning of time.
Religion and politics have been hot topics for thousands of years. The Greeks had taken the idea of discussion to great heights at Mars Hill, and the world has been influenced by their brilliant minds ever since.
How wonderful to think we may again have brilliant minds tossing around the pros and cons of ideas and philosophies here in St. Louis. As we will know, religion and politics have infuenced one another since the beginning of time.
Saturday, January 23, 2010
Friday, January 15, 2010
Head Injuries and War
Back during the first Golf War, I had written this observation and now...
FINALLY RECOGNIZED AS ACCURATE YEARS LATER
Visible or invisible brain injuries affect different areas of the brain in each individual, yet there is no distinction made even years later when a new correct or incorrect diagnosis is made.
We have specific medical names for different types of digestive, psychological, ethical, political health problems, even cancer. The various names indicate the differences and degrees of each, including even for physically, visible brain injuries.
But, with invisible brain changes, although the titles are different, until recently, all represented the same problem. We have finally begun to recognize acknowledge there are differences between PTSS (POST TRAUMATIC Stress syndrome, and Post Concussion syndrome? Traumatic indicated something happened, but what?
Is there a distinction between TBI and PTSS? (Traumatic Brain Injury and post traumatic stress syndrome?)
Has anyone explained what they specifically refer to or have we accepted them as “psychological causes for invisible symptoms,” fueling the assumptive belief the patient is responsible for the symptom or symptoms, and leaving the patient with the same impression.
Soldiers returning from the First Gulf War were told for years it was their attitude was the cause responsible for their symptoms. This was finally negated by the same federal agency that perpetuated it for more than 20 years. This new approach which had been forced on the federal agency since the latest Iraq War was finally acknowledged by that same agency this interpretation was inaccurate.
The symptoms, almost identical in so many of the returning Iraq War veterans, has finally forced the federal agency to reevaluate that conclusion when it became obvious that it was not logical for more than 22,000 GI’s to have identical reactions to the same symptoms.
FINALLY RECOGNIZED AS ACCURATE YEARS LATER
Visible or invisible brain injuries affect different areas of the brain in each individual, yet there is no distinction made even years later when a new correct or incorrect diagnosis is made.
We have specific medical names for different types of digestive, psychological, ethical, political health problems, even cancer. The various names indicate the differences and degrees of each, including even for physically, visible brain injuries.
But, with invisible brain changes, although the titles are different, until recently, all represented the same problem. We have finally begun to recognize acknowledge there are differences between PTSS (POST TRAUMATIC Stress syndrome, and Post Concussion syndrome? Traumatic indicated something happened, but what?
Is there a distinction between TBI and PTSS? (Traumatic Brain Injury and post traumatic stress syndrome?)
Has anyone explained what they specifically refer to or have we accepted them as “psychological causes for invisible symptoms,” fueling the assumptive belief the patient is responsible for the symptom or symptoms, and leaving the patient with the same impression.
Soldiers returning from the First Gulf War were told for years it was their attitude was the cause responsible for their symptoms. This was finally negated by the same federal agency that perpetuated it for more than 20 years. This new approach which had been forced on the federal agency since the latest Iraq War was finally acknowledged by that same agency this interpretation was inaccurate.
The symptoms, almost identical in so many of the returning Iraq War veterans, has finally forced the federal agency to reevaluate that conclusion when it became obvious that it was not logical for more than 22,000 GI’s to have identical reactions to the same symptoms.
HAVE YOU SEEN STARS?
With cars, sports, wars, a blow to the head has become a major incident, overlooked physical injury for a million and a half people yearly. Society and routine medical care divisions categorize and treat it as temporary. If it is, the patient is lucky. If it is not, it becomes permanent and takes years before this injury may be acknowledged by routine medical care physicians, because there are not adequate test for such an injury to alert the medical staff that there is a problem. Medical staff needs to do it the old fashioned way – by observing.
IF YOU RECEIVE A BLOW TO THE HEAD
1. Do not assume symptoms are not important when the blow to the head was only slight.
2. Minor symptoms are potential clues to a possible serious physical problem.
3. Will probably continue to increase in spite of diagnosis that says “they will go away.”
4. Don’t wait too long to learn about head injuries, doing so often causes compounded problems which will delay the healing process or may cause the injury to become permanent.
5. It is the patient’s responsibility to question any diagnoses that doesn’t feel right – do not “live with it” if it isn’t getting better – head injuries can become permanent if ignored.
6. Head Injury victims are also doing their own research, along with other support groups, research clinic and brain injury activist groups who are searching for explanations and evaluating beliefs, concepts, and potential advances.
7. Answers are complicated, human bodies are all different, their healing processes are not identical, finding the proper approach and treatment for each body is vital and the reason why finding the right answer is so difficult.
Moral of the story - keep asking questions, keep seeking answers, never accept advice that doesn't have your best interest at heart.
IF YOU RECEIVE A BLOW TO THE HEAD
1. Do not assume symptoms are not important when the blow to the head was only slight.
2. Minor symptoms are potential clues to a possible serious physical problem.
3. Will probably continue to increase in spite of diagnosis that says “they will go away.”
4. Don’t wait too long to learn about head injuries, doing so often causes compounded problems which will delay the healing process or may cause the injury to become permanent.
5. It is the patient’s responsibility to question any diagnoses that doesn’t feel right – do not “live with it” if it isn’t getting better – head injuries can become permanent if ignored.
6. Head Injury victims are also doing their own research, along with other support groups, research clinic and brain injury activist groups who are searching for explanations and evaluating beliefs, concepts, and potential advances.
7. Answers are complicated, human bodies are all different, their healing processes are not identical, finding the proper approach and treatment for each body is vital and the reason why finding the right answer is so difficult.
Moral of the story - keep asking questions, keep seeking answers, never accept advice that doesn't have your best interest at heart.
Strange World - DECISIONS ON ERRORS OF FACTS
I have been in the “unknown” (strange world ) for nearly 30 years always believing it was “routine” after an auto accident and the symptoms were not unusual. But I may be one of the very few to search for answers during all those years hoping to be able to return to normal, which I saw as the original me.
Contrary to everyone’s opinion and belief, what I found was so unusual it left me no other possible choice but to accept my situation. All others thought I was making a wrong decision when I decided to try it…a situation that my body was actually telling me it could not be changed. When I did try, small, invisible change began to appear indicating something slightly different and subtle was happening to my body, I decided to stick with it. It was the wisest decision I ever made. My bodily memory lasted long enough to help me remember how long I had not been able to use my muscles, which resulted in their loss of the use of their active ability to function normally, and became stratified. I was not smart enough to know this was the reason why they couldn’t function nor was I aware enough of the importance of finding out why at this point)
Stimulating this and all the bodily functions, in the end took more than two years of stimulation – to help them try to function normally, again.
Or, so it seemed. But it was not so. It had by now been so depleted that whatever energy had not yet been completely exhausted, made it appear as though it was still functioning normally But one day, it exhausted itself It stopped functioning entirely, for more than a year. No one in the health care personnel field seemed to know the reason why. But, did they or had they just gone on assuring themselves their treatments were helping me, knowing full well they weren’t. When I finally called to find out why I was no longer being helped to my utter disgust, I was told by the person who had been giving those treatments for so many years, actually CONFESSED he, and others, had known all along that neither his or any other treatment was capable of curing or relieving it but was only capable of slowly continuing to delay any progress he had told me I was making.
It was just another ‘Health care treatment” that was known could only slow down the deterioration, but never telling me or the public or letting me know that was all it was capable of doing.
Would I, and other patients, be better off knowing the truth and learning to live with it rather than camouflaging the correct information to let us think we were actually being on the road to normalcy? Or was it money which seems to be more important these days than humanities health care?
Just another disillusionment of a health care professional we are told we are getting but are we?
It is almost frightening to think of what we are leaving our children to correct for themselves and their children and the future health care for all of us, including the world. What it will eventually do to our reputation is beyond the stretch or our imaginations.
Contrary to everyone’s opinion and belief, what I found was so unusual it left me no other possible choice but to accept my situation. All others thought I was making a wrong decision when I decided to try it…a situation that my body was actually telling me it could not be changed. When I did try, small, invisible change began to appear indicating something slightly different and subtle was happening to my body, I decided to stick with it. It was the wisest decision I ever made. My bodily memory lasted long enough to help me remember how long I had not been able to use my muscles, which resulted in their loss of the use of their active ability to function normally, and became stratified. I was not smart enough to know this was the reason why they couldn’t function nor was I aware enough of the importance of finding out why at this point)
Stimulating this and all the bodily functions, in the end took more than two years of stimulation – to help them try to function normally, again.
Or, so it seemed. But it was not so. It had by now been so depleted that whatever energy had not yet been completely exhausted, made it appear as though it was still functioning normally But one day, it exhausted itself It stopped functioning entirely, for more than a year. No one in the health care personnel field seemed to know the reason why. But, did they or had they just gone on assuring themselves their treatments were helping me, knowing full well they weren’t. When I finally called to find out why I was no longer being helped to my utter disgust, I was told by the person who had been giving those treatments for so many years, actually CONFESSED he, and others, had known all along that neither his or any other treatment was capable of curing or relieving it but was only capable of slowly continuing to delay any progress he had told me I was making.
It was just another ‘Health care treatment” that was known could only slow down the deterioration, but never telling me or the public or letting me know that was all it was capable of doing.
Would I, and other patients, be better off knowing the truth and learning to live with it rather than camouflaging the correct information to let us think we were actually being on the road to normalcy? Or was it money which seems to be more important these days than humanities health care?
Just another disillusionment of a health care professional we are told we are getting but are we?
It is almost frightening to think of what we are leaving our children to correct for themselves and their children and the future health care for all of us, including the world. What it will eventually do to our reputation is beyond the stretch or our imaginations.
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