Podcasts about spinal

New episodes of Living The Full Life with Dr. Juan post every Saturday.

In today's episode, we will be looking at the biomechanics of spinal fusions focusing primarily on anterior fusions. 

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Ronen Soffer – Chief Product Guy – Intuition Robotics Find out more: intuitionrobotics.com elliq.com —————————— If you have an AT question, leave us a […]

We'll look at the new movies out this weekend and Borderlands 4! Hear about everything in the #MikeJonesMinuteCon.

"Long before American Idol and Americas Got Talent, there was Star Search. It was pretty schmaltzy but looking back, some of the biggest singers, actors and comedians got their big break on Star Search. We have grabbed as many examples as we could."

Ataxia is a neurologic symptom that refers to incoordination of voluntary movement, typically causing gait dysfunction and imbalance. Genetic testing and counseling can be used to identify the type of ataxia and to assess the risk for unaffected family members. In this episode, Katie Grouse, MD, FAAN, speaks with Theresa A. Zesiewicz, MD, FAAN, author of the article “Ataxia” in the Continuum® August 2025 Movement Disorders issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Zesiewicz is a professor of neurology and director at the University of South Florida Ataxia Research Center, and the medical director at the University of South Florida Movement Disorders Neuromodulation Center at the University of South Florida and at the James A. Haley Veteran's Hospital in Tampa, Florida. Additional Resources Read the article: Ataxia Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Theresa Zesiewicz about her article on ataxia, which appears in the August 2025 Continuum issue on movement disorders. Welcome to the podcast, and please introduce yourself to our audience.  Dr Zesiewicz: Well, thank you, Dr Grouse. I'm Dr Theresa Zesiewicz, otherwise known as Dr Z, and I'm happy to be here. Dr Grouse: I have to say, I really enjoyed reading your article. It was a really great refresher for myself as a general neurologist on the topic of ataxia and a really great reminder on a great framework to approach diagnosis and management. But I wanted to start off by asking what you feel is the key message that you hope our listeners will take away from reading your article. Dr Zesiewicz: Yes, so, thanks. I think one of the key messages is that there has been an explosion and renaissance of genetic testing in the past 10 years that has really revolutionized the field of ataxia and has made diagnosis easier for us, more manageable, and hopefully will lead to treatments in the future. So, I think that's a major step forward for our field in terms of genetic techniques over the last 10 years, and even over the last 30 years. There's just been so many diseases that have been identified genetically. So, I think that's a really important take-home message. The other take-home message is that the first drug to treat Friedreich's ataxia, called omaveloxolone, came about about two years ago. This was also a really landmark discovery. As you know, a lot of these ataxias are very difficult to treat. Dr Grouse: Now pivoting back to thinking about the approach to diagnosis of ataxia, how does the timeline of the onset of ataxia symptoms inform your approach? Dr Zesiewicz: The timeline is important because ataxia can be acute, subacute or chronic in nature. And the timeline is important because, if it's acute, it may mean that the ataxia took place over seconds to hours. This may mean a toxic problem or a hypoxic problem. Whereas a chronic ataxia can occur over many years, and that can inform more of a neurodegenerative or more of a genetic etiology. So, taking a very detailed history on the patient is very important. Sometimes I ask them, what is the last time you remember that you walked normal? And that can be a wedding, that can be a graduation. Just some timeline, some point, that the patient actually walked correctly before they remember having to hold onto a railing or taking extra steps to make sure that they didn't fall down, that they didn't have imbalance. That sometimes that's a good way to ask the patient when is the last time they had a problem. And they can help you to try to figure out how long these symptoms have been going on. Dr Grouse: I really appreciate that advice. I will say that I agree, it can sometimes be really hard to get patients to really think back to when they really started to notice something was different. So, I like the idea of referencing back to a big event that may be more memorable to them. Now, given that framework of, you know, thinking through the timeline, could you walk us through your approach to the evaluation of a patient who presents to your clinic with that balance difficulties once you've established that? Dr Zesiewicz: Sure. So, the first thing is to determine whether the patient truly has ataxia. So, do they have imbalance? Do they have a wide base gait? That's very important because patients come in frequently to your clinic and they'll have balance problems, but they can have knee issues or hip issues, neuropathy, something like that. And sometimes what we say to the residents and the students is, usually ataxia or cerebellar symptoms go together with other problems, like ocular problems are really common in cerebellar syndromes. Or dysmetria, pass pointing, speech disorder like dysarthria. So, not only do you need to look at the gait, but you should look at the other symptoms surrounding the gait to see if you think that the patient actually has a cerebellar syndrome. Or do they have something like a vestibular ataxia which would have more vertigo? Or do they have a sensory ataxia, which would occur if a person closes his eyes or has more ataxia when he or she is in the dark? So, you have to think about what you're looking at is the cerebellar syndrome. And then once we look to see if the patient truly has a cerebellar syndrome, then we look at the age, we look at---as you said before, the timeline. Is this acute, subacute, or chronic? And usually I think of ataxia as falling into three categories. It's either acquired, it's either hereditary, or it's neurodegenerative. It can be hereditary. And if it's not hereditary, is it acquired, or is it something like a multiple system atrophy or a parkinsonism or something like that? So, we try to put that together and start to narrow down on the diagnosis, thinking about those parameters. Dr Grouse: That's really a helpful way to think through it. And it is true, it can get very complex when patients come in with balance difficulties. There's so many things you need to think about, but that is a great way to think about it. Of course, we know that most people who come in to the Movements Disorders clinic are getting MRI scans of their brains. But I'm curious, in which cases of patients with cerebellar ataxia do you find the MRI to be particularly helpful in the diagnosis? Dr Zesiewicz: So, an MRI can be very important. Not always, but- so, something like multiple system atrophy type C where you may see a hot cross bun sign or a pontine hyperintensity on the T2-weighted image, that would be helpful. But of course, that doesn't make the diagnosis. It's something that may help you with the diagnosis. In FXTAS, which is fragile X tremor/ataxia syndrome, the patient may have the middle cerebellar peduncle sign or the symmetric hyperintensity in the middle cerebellar peduncles, which is often visible but not always. Something like Wernicke's, where you see an abnormality of the mammillary bodies. Wilson's disease, which is quite rare, T2-weighted image may show hyperintensities in the putamen in something like Wilson's disease. Those are the main MRI abnormalities, I think, with ataxia. And then we look at the cerebellum itself. I mean, that seems self-evident, but if you look at a sagittal section of the MRI and you see just a really significant atrophy of the cerebellum, that's going to help you determine whether you really have a cerebellar syndrome. Dr Grouse: That's really encouraging to hear a good message for all of us who sometimes feel like maybe we're missing something. It's good to know that information can always come up down the line to make things more clear. Your article does a great review of spinal cerebellar ataxia, but I found it interesting learning about the more recently described syndrome of SCA 27B. Would you mind telling us more about that and other really common forms of SCA that's good to keep in mind? Dr Zesiewicz: Sure. So, there are now 49 types of spinal cerebellar ataxia that have been identified. The most common are the polyglutamine repeat diseases: so, spinocerebellar ataxia type 3 or type 2, type 6, are probably the most common. One of the most recent spinocerebellar ataxias to be genetically identified and clinically identified is spinocerebellar ataxia 27B. This is caused by a GAA expansion repeat in the first intron of the fibroblast growth factor on chromosome 13. And the symptoms do include ataxia, eye problems, downbeat nystagmus, other nystagmus, vertical, and diplopia. It appears to be a more common form of adult-onset ataxia, and probably more common than was originally thought. It may account for a substantial number of ataxias, like, a substantial percentage of ataxias that we didn't know about. So, this was really a amazing discovery on SCA 27B. Dr Grouse: Now a lot of us I think feel a little anxious when we think about genetic testing for ataxia simply because there's so many forms, things are changing quickly. Do you have a rule of thumb or a kind of a framework that we can think of as we approach how we should be thinking about getting genetic testing for the subset of patients? Dr Zesiewicz: Sure. And I think that this is where age comes into play a lot. So, if you have a child who's 10, 11, or 12 who's having balance problems in the schoolyard, does not have a history of ataxia in the family, the teachers are telling you that the child is not running correctly, they're having problems with physical education, that is someone who you would think about testing for Friedreich's ataxia. A preteen or a child, that would be one thing that would be important to test. When you talk to your patient, it's important to really take a detailed family history. Not just mom or dad, but ethnicity, grandparents, etc. And sometimes, once in a while, you come up with a known spinal cerebellar ataxia. Then you can just test for that. So, if a person is from Portugal or has Portugal background and they have ataxia and the parents had ataxia, you would think of spinal cerebellar ataxia type 3. Or if they're Brazilian, or if the person is from a certain area of Cuba and mom and dad had ataxia and that person has ataxia, you would think of spinal cerebellar ataxia type 2. Or if a person has ataxia and their parent had blindness or visual problems, you may be more likely to think of spinal cerebellar ataxia type 7, for example. If they have that---either they have a known genetic cause in in the family, first degree family, or they come from an area of the world in which we can pinpoint what type we think it is---you can go ahead and get those tests. If not, you can take an ataxia comprehensive panel. Many times now, if you take the panel and the panel is negative, it will reflex to the whole exome gene sequencing, where we're finding really unusual and more rare types of ataxia, which are very interesting. Spinal cerebellar ataxia type 32, spinal cerebellar ataxia type 36, I had a spinal cerebellar ataxia type 15. So, I think you should start with the age, then the family history, then where the person is from. And then, if none of those work out, you can get a comprehensive panel, and then go on to whole exome gene sequencing. Dr Grouse: That's really, really useful. Thank you so much for breaking that down in a really simple way that a lot of us can take with us. Pivoting a little bit now back towards different types of acquired ataxias, what are some typical lab tests that you recommend for that type of workup? Dr Zesiewicz: Again, if there's no genetic history and the person does not appear to have a neurodegenerative disease, we do test for acquired ataxias. Acquired ataxias can be complex. Many times, they are in the autoimmune family. So, what we start with are just basic labs like a CBC or a CMP, but then we tried to look at some of the other abnormalities that could cause ataxia. So, celiac disease, stiff person syndrome. So, you would look at anti-glutamic acid decarboxylase antibodies, Hashimoto's---so, antithyroglobulin antibodies or antithyroperoxidase antibodies would be helpful. You know, in a case of where the patients may have an underlying neoplasm, maybe even a paraneoplastic workup, such as an anti-Hu, anti-Yo, anti-Ri. A person has breast cancer, for example, you may want to take a paraneoplastic panel. I've been getting more of the anti-autoimmune encephalitis panels in some cases, that were- that are very interesting. And then, you know, things that sometimes we forget now like the syphilis test, thyroid-stimulating test, take a B12 and folate, for example. That would be important. Those are some of the labs. We just have on our electronic chart a group of acquired labs for ataxia. If we can't find any other reason, we just go ahead and try to get those. Dr Grouse: Now, I'm curious what you think is the most challenging aspect of diagnosing a patient with cerebellar ataxia? Dr Zesiewicz: So, for those of us who see many of these patients a day, some of the hardest patients are the ones that---regardless of the workup that we do, we've narrowed it down, it's not hereditary. You know, they've been through the whole exome gene sequencing and we've done the acquired ataxia workup. It doesn't appear to be that. And then we've looked for parkinsonism and neurodegenerative diseases, and it doesn't appear to be that either; like, the alpha-synuclein will be negative. Those are the toughest patients, where we think we've done everything and we still don't have the answer. So, I've had patients in whom I've taken care of family members years and years ago, they had a presumed diagnosis, and later on I've seen their children or other family members. And with the advent of the genetic tests that we have, like whole exome gene sequencing, we have now been able to give the patient and the family a definitive diagnosis that they didn't have 25 years ago. So, I would say don't give up hope. Retesting is important, and as science continues and we get more information and we make more landmark discoveries in genetics, you may be better able to diagnose the patient. Dr Grouse: I was wondering if you had any recommendations regarding either some tips and tricks, some pearls of wisdom you can impart to us regarding the work of ataxia, or conversely, any big pitfalls that you can help us avoid? I would love to hear about it. Dr Zesiewicz: Yeah, there's no easy way to treat or diagnose ataxia patients. I've always felt that the more patients you see- and sounds easy, but the more patients you see, the better you're going to become at it, and eventually things are going to fall into place. You'll begin to see similarities in patients, etc. I think it's important not only to make sure that a person has ataxia, but again, look at the other signs and symptoms that may point to ataxia that you'll see in a cerebellar syndrome. I think it's important to do a full neuroexam. If a person has spasticity, that may point you more towards a certain type of ataxia than if a person has no reflexes, for example, that we see in Friedreich's ataxia. Some of the ocular findings are very interesting as well. It's important to know if a person has a tremor. I've seen several Wilson's disease cases in my life with ataxia. They're very important. I think a full neuroexam and also a very detailed history would be very helpful. Dr Grouse: Tell us about some promising developments in the diagnosis and management of ataxia that we should be on the lookout for. Dr Zesiewicz: The first drug for Friedreich's ataxia was FDA-approved two years ago, which was an NRF2 activator, which was extremely exciting and promising. There are also several medications that are now in front of the FDA that may also be very promising and have gone through long clinical trials. There's a medication that's related to riluzole, which is a medication used for amyotrophic lateral sclerosis, that has been through about seven years of testing. That is before the FDA as well for spinal cerebellar ataxia. Friedreich's ataxia has now completed the first cardiac gene therapy program with AAV vectors, which- we're waiting for full results, but that's a cardiac test. But I would assume that in the future, neurological gene therapy is not far behind if we've already done cardiac gene therapy and Friedreich's ataxia. So, you know, some of these AAV vector-based genetic therapies may be very helpful, as well as ASO, antisense oligonucleotides, for example. And I think in the future, other things to think about are the CRISPR/Cas9 technology for potential treatment of ataxia. It is a very exciting time, and some major promising therapies have been realized in the past 2 to 3 years. Dr Grouse: Well, that's really exciting, and we'll all look forward to seeing these becoming more clinically applicable in the future. So, thank you so much for coming to talk with us today. Dr Zesiewicz: Thank you. Dr Grouse: Again, today I've been interviewing Dr Theresa Zesiewicz about her article on ataxia, which appears in the August 2025 Continuum issue on movement disorders. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

New episodes of Living The Full Life with Dr. Juan post every Saturday.

En este episodio exploramos a fondo el mutismo acinético, una de las manifestaciones más desconcertantes tras un daño cerebral grave. Hablamos de su base neurofisiológica, su relación con el sistema dopaminérgico y los circuitos prefronto-subcorticales, y cómo se diferencia clínicamente de otros estados de conciencia alterada. Recorremos también las opciones terapéuticas más prometedoras, desde la estimulación multisensorial y la verticalización robótica hasta técnicas de neuromodulación como la estimulación cerebral profunda, la estimulación medular o la tDCS. Un episodio técnico, narrativo y lleno de preguntas clínicas clave, pensado para quienes trabajan día a día con pacientes que aún no responden... pero que podrían hacerlo. Referencias del episodio: 1. Arnts, H., van Erp, W. S., Lavrijsen, J. C. M., van Gaal, S., Groenewegen, H. J., & van den Munckhof, P. (2020). On the pathophysiology and treatment of akinetic mutism. Neuroscience and biobehavioral reviews, 112, 270–278. https://doi.org/10.1016/j.neubiorev.2020.02.006 8 https://pubmed.ncbi.nlm.nih.gov/32044373/). 2. Arnts, H., Tewarie, P., van Erp, W. S., Overbeek, B. U., Stam, C. J., Lavrijsen, J. C. M., Booij, J., Vandertop, W. P., Schuurman, R., Hillebrand, A., & van den Munckhof, P. (2022). Clinical and neurophysiological effects of central thalamic deep brain stimulation in the minimally conscious state after severe brain injury. Scientific reports, 12(1), 12932. https://doi.org/10.1038/s41598-022-16470-2 (https://pubmed.ncbi.nlm.nih.gov/35902627/). 3. Arnts, H., Tewarie, P., van Erp, W., Schuurman, R., Boon, L. I., Pennartz, C. M. A., Stam, C. J., Hillebrand, A., & van den Munckhof, P. (2024). Deep brain stimulation of the central thalamus restores arousal and motivation in a zolpidem-responsive patient with akinetic mutism after severe brain injury. Scientific reports, 14(1), 2950. https://doi.org/10.1038/s41598-024-52267-1 (https://pubmed.ncbi.nlm.nih.gov/38316863/). 4. Bai, Y., Xia, X., Li, X., Wang, Y., Yang, Y., Liu, Y., Liang, Z., & He, J. (2017). Spinal cord stimulation modulates frontal delta and gamma in patients of minimally consciousness state. Neuroscience, 346, 247–254. https://doi.org/10.1016/j.neuroscience.2017.01.036 (https://pubmed.ncbi.nlm.nih.gov/28147246/). 5. Bai, Y., Xia, X., Liang, Z., Wang, Y., Yang, Y., He, J., & Li, X. (2017). Corrigendum: Frontal Connectivity in EEG Gamma (30-45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients. Frontiers in cellular neuroscience, 11, 251. https://doi.org/10.3389/fncel.2017.00251 (https://pubmed.ncbi.nlm.nih.gov/28828002/). 6. Bai, Y., Lin, Y., & Ziemann, U. (2021). Managing disorders of consciousness: the role of electroencephalography. 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Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness. Brain stimulation, 13(2), 427–429. https://doi.org/10.1016/j.brs.2019.12.005 (https://pubmed.ncbi.nlm.nih.gov/31866491/). 21. Norwood, M. F., Lakhani, A., Watling, D. P., Marsh, C. H., & Zeeman, H. (2023). Efficacy of Multimodal Sensory Therapy in Adult Acquired Brain Injury: A Systematic Review. Neuropsychology review, 33(4), 693–713. https://doi.org/10.1007/s11065-022-09560-5 (https://pubmed.ncbi.nlm.nih.gov/36056243/). 22. O'Neal, C. M., Schroeder, L. N., Wells, A. A., Chen, S., Stephens, T. M., Glenn, C. A., & Conner, A. K. (2021). Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data. Frontiers in neurology, 12, 694970. https://doi.org/10.3389/fneur.2021.694970 (https://pubmed.ncbi.nlm.nih.gov/34475848/). 23. Schiff, N. D., Giacino, J. T., Kalmar, K., Victor, J. D., Baker, K., Gerber, M., Fritz, B., Eisenberg, B., Biondi, T., O'Connor, J., Kobylarz, E. J., Farris, S., Machado, A., McCagg, C., Plum, F., Fins, J. J., & Rezai, A. R. (2007). Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature, 448(7153), 600–603. https://doi.org/10.1038/nature06041 (https://pubmed.ncbi.nlm.nih.gov/17671503/). 24. Schiff N. D. (2016). Central thalamic deep brain stimulation to support anterior forebrain mesocircuit function in the severely injured brain. Journal of neural transmission (Vienna, Austria : 1996), 123(7), 797–806. https://doi.org/10.1007/s00702-016-1547-0 (https://pubmed.ncbi.nlm.nih.gov/27113938/). 25. Schiff N. D. (2023). Mesocircuit mechanisms in the diagnosis and treatment of disorders of consciousness. Presse medicale (Paris, France : 1983), 52(2), 104161. https://doi.org/10.1016/j.lpm.2022.104161 (https://pubmed.ncbi.nlm.nih.gov/36563999/). 26. Shimojo, S., & Shams, L. (2001). Sensory modalities are not separate modalities: plasticity and interactions. Current opinion in neurobiology, 11(4), 505–509. https://doi.org/10.1016/s0959-4388(00)00241-5 (https://pubmed.ncbi.nlm.nih.gov/11502399/). 27. Stephens, T. M., Young, I. M., O'Neal, C. M., Dadario, N. B., Briggs, R. G., Teo, C., & Sughrue, M. E. (2021). Akinetic mutism reversed by inferior parietal lobule repetitive theta burst stimulation: Can we restore default mode network function for therapeutic benefit?. Brain and behavior, 11(8), e02180. https://doi.org/10.1002/brb3.2180 (https://pubmed.ncbi.nlm.nih.gov/34145791/). 28. Piedade, G. S., Assumpcao de Monaco, B., Guest, J. D., & Cordeiro, J. G. (2023). Review of spinal cord stimulation for disorders of consciousness. Current opinion in neurology, 36(6), 507–515. https://doi.org/10.1097/WCO.0000000000001222 (https://pubmed.ncbi.nlm.nih.gov/37889524/). 29. Rosenfelder, M. J., Helmschrott, V. C., Willacker, L., Einhäupl, B., Raiser, T. M., & Bender, A. (2023). Effect of robotic tilt table verticalization on recovery in patients with disorders of consciousness: a randomized controlled trial. Journal of neurology, 270(3), 1721–1734. https://doi.org/10.1007/s00415-022-11508-x (https://pubmed.ncbi.nlm.nih.gov/36536249/). 30. Thibaut, A., Bruno, M. A., Ledoux, D., Demertzi, A., & Laureys, S. (2014). tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology, 82(13), 1112–1118. https://doi.org/10.1212/WNL.0000000000000260 (https://pubmed.ncbi.nlm.nih.gov/24574549/). 31. Visocchi, M., Della Pepa, G. M., Esposito, G., Tufo, T., Zhang, W., Li, S., & Zhong, J. (2011). Spinal cord stimulation and cerebral hemodynamics: updated mechanism and therapeutic implications. Stereotactic and functional neurosurgery, 89(5), 263–274. https://doi.org/10.1159/000329357 (https://pubmed.ncbi.nlm.nih.gov/21860253/). 32. Yang, Y., He, Q., Xia, X., Dang, Y., Chen, X., He, J., & Zhao, J. (2022). Long-term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness. CNS neuroscience & therapeutics, 28(8), 1249–1258. https://doi.org/10.1111/cns.13870 (https://pubmed.ncbi.nlm.nih.gov/35619213/). 33. Yang, Y., He, Q., Dang, Y., Xia, X., Xu, X., Chen, X., Zhao, J., & He, J. (2023). Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness. Stroke and vascular neurology, 8(5), 368–378. https://doi.org/10.1136/svn-2022-001998 (https://pubmed.ncbi.nlm.nih.gov/36882201/). 34. Yu, Y. T., Yang, Y., Wang, L. B., Fang, J. L., Chen, Y. Y., He, J. H., & Rong, P. J. (2017). Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: The first case report. Brain stimulation, 10(2), 328–330. https://doi.org/10.1016/j.brs.2016.12.004 (https://pubmed.ncbi.nlm.nih.gov/28017322/). 35. Zhou, Y. F., Kang, J. W., Xiong, Q., Feng, Z., & Dong, X. Y. (2023). Transauricular vagus nerve stimulation for patients with disorders of consciousness: A randomized controlled clinical trial. Frontiers in neurology, 14, 1133893. https://doi.org/10.3389/fneur.2023.1133893 (https://pubmed.ncbi.nlm.nih.gov/36937511/). 36. Zhuang, Y., Yang, Y., Xu, L., Chen, X., Geng, X., Zhao, J., & He, J. (2022). Effects of short-term spinal cord stimulation on patients with prolonged disorder of consciousness: A pilot study. Frontiers in neurology, 13, 1026221. https://doi.org/10.3389/fneur.2022.1026221 (https://pubmed.ncbi.nlm.nih.gov/36313512/). 37. Zuo, J., Tao, Y., Liu, M., Feng, L., Yang, Y., & Liao, L. (2021). The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis. International journal of nursing studies, 115, 103846. https://doi.org/10.1016/j.ijnurstu.2020.103846 (https://pubmed.ncbi.nlm.nih.gov/33485101/).

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Karthik Kannan – Chief Technology Officer and Co-Founder – Envision Ally Website: ally.me Ally Glasses Website: ally.me/glasses Find Ally on the app and play […]

"Here is a game to play. Name as many two minute songs as you can following these rules. Only one song per group and you cannot name just punk songs. We then go one step farther and change the game to as many one minute songs as you can."

Gyzele Brown is a proud native of Greenville, MS, now residing in Cleveland, MS.  She is the owner and operator of Gyzele's Salon and Spa, where she's dedicated to not only transforming looks but also impacting lives through her work.  A graduate of Delta State University and Goshen Cosmetology School, Gyzele's journey began with a background in speech and hearing science — yet her passion for hair and beauty took center stage.  Beyond her career, Gyzele is a proud mother of three amazing children who all have spinal muscular atrophy, a rare genetic disease. Her journey is filled with both challenges and blessings, and she's here to encourage others, remind them of the power of faith, and show that even in tough times, you can keep going for your family and yourself.  Join us as Gyzele shares her inspiring journey, full of hope, and powerful life lessons about strength, faith, and the importance of never giving up. ​Spinal muscular atrophy (SMA) is a genetic disease that causes muscle weakness and wasting due to the degeneration of motor neurons. It's a progressive disease that can be fatal in severe forms. SMA is typically caused by mutations in the SMN1 gene, which is responsible for producing a protein vital for motor neuron health. The severity and age of onset vary, with different types of SMA categorized based on symptom onset and severity.   ​ Key aspects of SMA: Progressive Nature: SMA is a progressive disease, meaning the symptoms worsen over time.  Varied Severity: SMA is classified into types based on the age of onset and severity of symptoms.  Types of SMA: Type 1 (Infantile-onset): Most severe, symptoms appear at birth or within the first six months, and many affected individuals don't survive past early childhood.  Type 2 (Intermediate): Symptoms appear between 6 and 18 months, individuals can sit but not walk unaided, and life expectancy varies.  Type 3 (Juvenile-onset): Symptoms appear later in childhood, individuals can walk but may have difficulty, and life expectancy is generally normal.  Type 4 (Adult-onset): Rare, with symptoms appearing in adulthood and causing mild motor impairment.  Symptoms: Symptoms include muscle weakness, difficulty with movement (sitting, crawling, walking), breathing and swallowing problems, and skeletal abnormalities like scoliosis.  Diagnosis: Diagnosis often involves clinical evaluation, genetic testing, and sometimes neurological examinations.  Treatment: While there is no cure, treatments like gene therapy and medications can help manage symptoms, improve motor function, and increase survival time. Physical therapy, occupational therapy, and assistive devices are also important.  Genetic Basis: SMA is primarily caused by mutations or deletions in the SMN1 gene.  Motor Neuron Degeneration: The disease affects motor neurons, which control muscle movement, leading to muscle weakness and atrophy.   

Living The Full Life with Dr. Juan

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Catwoman [vol 2] #39 (1996)Catwoman is a busy lady this issue, between the planned theft of an Egyptian dollhouse and fending off Two-Face's crew of Bob Seger fanatics. Even Batman has his hands full with the Joker laugh-gassing the GCPD and expertly defacing the Bat-Signal. Will these two ever know a moment of peace?!?Topics include:Catwoman sleeps in the nudeBatman pilfers office suppliesMike from AMERICAN MOVIE takes a mercenary gigPenguin makes a sensible decisionAlfred's breakfast for nocturnal crusaderslame security guard humorAlso, Jen and Shawn read some of YOUR podcast reviews and reflect on a recent trip to Casa Bonita.*** PROPER COMIC BOOK DISCUSSION STARTS AT 00:13:59 ***Promo: BATMAN KNIGHTCAST (https://fireandwaterpodcast.com/show/batman-knightcast-2/)Continue the conversation with Shawn and Jen on Twitter / Instagram / Facebook / Threads / Bluesky or email the show at worstcollectionever@gmail.comAlso, get hip to all of our episodes on YouTube in its own playlist! https://bit.ly/WorstCollectionEverYTDownload the podcast on Spotify, Apple Podcasts and wherever you get your favorite shows. Please rate, review, subscribe and tell a friend!

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Craig Misrach – President and CEO – UpLyft UpLyft Website: https://myuplyft.com/ UpLyft Customer Testimonials: https://youtu.be/ntzJIwXPSnY Self-Transfer at Home – Bed to Wheelchair: https://youtu.be/6FX3RltH-D0 Assisted Transfer at Home […]

"A band named The Velvet Sundown had a hit a short while ago. The concern was that the band and the music were all fake. They were both fully AI generated. It is easier than you think. We have the story and some examples of when I did the same thing for an audience just to prove how easy it is to do."

In this episode of The Health Commute, we explore a new study in Scientific Reports that reveals how spinal posture can predict cognitive health in older adults. Researchers studied over 400 participants aged 50–90 and found that those with a forward-leaning posture (SVA > 70 mm) were much more likely to experience cognitive decline, regardless of age. Balanced posture was linked to better quality of life, while severe forward lean showed strong associations with poor brain health. The discussion highlights why posture affects the brain—from reduced mobility and activity to altered spinal input to the nervous system. Listeners will walk away with practical tips: get your posture checked, keep moving, and use chiropractic care and exercises to maintain spinal alignment. Good posture doesn't just keep you standing tall—it helps keep your mind sharp too.

Backboards, cervical collars... first we used them, then we didn't, now we're bringing them back! Why, and how to use them is the subject of today's discussion. 

It's time for a Path of Exile 2 patch/update! The Third Edict has officially been revealed and GGG loaded 0.3.0 with updates and content that PoE 2 lovers will...love! In this episode we go through as much as we can without reading the Patch Notes word for word (which we know you'd love). We can't wait for next Friday's release! Hopefully you enjoyed the reveal, and our opinions regarding it! Thanks, as always, for your time each and every week. We love your faces!(00:00:00) Welcome to Forever Exiled(00:03:45) Patreon banter and After Dark chatter(00:09:12) Discord community shout-outs(00:14:25) Xbox release anniversary(00:19:40) Weekly life updates and MCU movie marathons(00:28:55) Spinal injections and missed live events(00:34:22) Path of Exile 1 patch notes and mass identification(00:42:08) First reactions to PoE2 announcement(00:49:15) Sprinting mechanics and campaign pacing(00:57:34) Act Four and interludes explained(01:05:22) Support gems overhaul and lineage supports(01:13:40) Currency tiers, essences, and crafting changes(01:19:45) New trade system and stash tab conversionForever Exiled Info:www.foreverexiled.comPatreonTwitter @ForeverExiled82Path of Exile WebsiteWrecker of Days Builds ListDiscord...FE Merch StoreFE Nexus Store

In this episode of Selfdom, I sit down with Dr. Sarah Jane, the visionary creator of Spinal Energetics - a groundbreaking healing modality that blends Eastern wisdom and Western science to help the body release stress and trauma. With her work going viral on TikTok and reaching over 2.4 billion views, Dr. Sarah Jane has captivated the world with powerful transformations that unfold on the treatment table.We explore the mind-body connection, the role of the spine in our overall well-being, and how trauma can remain stored in the body until it's released. Dr. Sarah Jane shares the philosophy behind Spinal Energetics, her own healing journey, and practical ways we can all begin to release everyday stresses before they build up.If you've ever been curious about the link between stress, trauma, and health - or wondered how energy-based healing really works - this episode will open your eyes to what's possible.Produced by Talkback Mediainfo@talkbackmedia.com.au

Living The Full Life with Dr. Juan

EP. 227: Grab my FREE 4 Part Video Series: GLP1s Uncovered: https://bit.ly/GLP1uncovered In this episode, I open up about something deeply personal that I know many of you can relate to. Over the summer, I found myself trapped in one of the worst pain cycles I've ever experienced, what I call the “pain trap.” It consumed my life and left me questioning how I was even going to keep going. I'll share the passive and active care approaches that finally helped me break free, along with the lessons I learned about my health, hormones, and resilience. Topics Discussed: → What is a pain trap? → How does passive vs active care help pain? → Can hormones affect chronic pain? → Does pilates ease pain? → Can burnout worsen physical pain? Sponsored By: → Nutrisense | Head over to nutrisense.io/drtyna and use the code TYNA to save 33% on your Nutrisense Program. → Sundays | As a Listener of The Dr Tyna Show, you can Get 40% off your first order of Sundays. Go to sundaysfordogs.com/DRTYNA and use code DRTYNA at checkout. → Qualia | Go to qualialife.com/DRTYNA for up to 50% off your purchase and use code DRTYNA for an additional 15% → Manukora | Head to manukora.com/DRTYNA to save up to 31% & $25 worth of free gifts in Starter Kit, which comes with an MGO 850+ Manuka Honey jar. → BIOptimizers | For 15% off go to bioptimizers.com/drtyna and use promo code DRTYNA → Liver Love | Go to https://store.drtyna.com/products/liverlove Use code LIVER20 for 20% off On This Episode We Cover:  → 00:00:00 - Introduction  → 00:02:40 - Dr. Tyna's back pain  → 00:09:41 - Fighting burnout & chronic pain  → 00:15:05 - Seeking treatment  → 00:22:27 - Back adjustment  → 00:28:26 - Feet pain & worse  → 00:30:52 - What helped  → 00:41:32 - Pilates & back pain  → 00:46:06 - Spinal pain is different  → 00:49:26 - Supplement routine  → 00:53:26 - Estrogen and sleep  → 00:57:37 - Current routine  → 01:03:55 - Mid-career crisis  Affiliate links to save on the items I discussed on this week's episode: → Red Light, PEMF and Superhuman Protocol: https://davincimedicalusa.com/?ref=DRTYNAMOORE → Powerplate: https://powerplate.com/drtyna → Sunlighten: https://www.sunlighten.com/drtyna/ → Sauna Space: https://sauna.space/drtyna → Dr. Tyna's Supplement Store: www.store.drtyna.com  → Puori :Go to Puori.com/drtyna and use code DRTYNA to get 20% off Further Listening:  → EP. 221 | The GLP-1 Microdosing Lie: It's NOT a Weight Loss Strategy | Solo → EP. 187 | The 5 Hazardous Signs of Low Estrogen Most Doctors Overlook | Solo Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Vicki Mayo – Founder and CEO – The Touchpoint Solution Website: ilovetouchpoint.com Discount code – assist For more about Bridging Apps: www.bridgingapps.org —————————— If […]

"This is a fun parlor game. Name a band, a song by that band and then an album from that band that are all named exactly the same. Here is an example. Bad Company by Bad Company on the album Bad Company. There are many that are close but a true Trilogy is all three exactly the same."

"The Rock School show is now a part of the Library of Congress through their American Archive of Public Broadcasting. I know. I can barely believe it myself. Here is the story of the Library of Congress and how this all came to be. Check the calendar. It is not April and I am not fooling."

In the era of fast-tracked surgery and same-day discharge, anesthesiologists are looking for strategies to optimize recovery without compromising safety or pain control. A long-standing debate centers around whether low-dose bupivacaine or mepivacaine is the better spinal agent to promote early ambulation after total knee arthroplasty. In this episode of RAPM Focus, RAPM Editor-in-Chief, Brian Sites, MD, explores this debate with Clinton Pillow, MD, following the May 2025 publication of “Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial.” This episode explores a topic faced by every anesthesiologist that manages joint replacements, especially total knee arthroplasty, has grappled with—what is the ideal spinal anesthetic when time is money and same-day discharge is the goal? Dr. Pillow is an assistant professor in the department of anesthesiology and perioperative medicine at the Medical University of South Carolina. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

CardioNerds (Drs. Rick Ferraro and Georgia Vasilakis Tsatiris) discuss ATTR cardiac amyloidosis with expert Dr. Justin Grodin. This episode is a must-listen for all who want to know how to diagnose and treat ATTR with current available therapies, as well as management of concomitant diseases through a multidisciplinary approach. We take a deep dive into the importance of genetic testing, not only for patients and families, but also for gene-specific therapies on the horizon. Dr. Grodin draws us a roadmap, guiding us through new experimental therapies that may reverse the amyloidosis disease process once and for all.  Audio editing by CardioNerds academy intern, Christiana Dangas. This episode was developed in collaboration with the American Society of Preventive Cardiology and supported by an educational grant from BridgeBio.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here.  CardioNerds Cardiac Amyloid PageCardioNerds Episode Page Pearls: You must THINK about your patient having amyloid to recognize the pattern and make the diagnosis. Start with a routine ECG and TTE, and look for a disproportionately large heart muscle with relatively low voltages on the ECG.  Before you diagnose ATTR amyloidosis, AL amyloidosis must be ruled out (or ruled in) with serum light chains, serum/urine immunofixation, and/or tissue biopsy.  Genetic testing is standard of care for all patients and families with ATTR amyloidosis, and the future is promising for gene-specific treatments. Current FDA-approved treatments for TTR amyloidosis are TTR stabilizers and TTR silencers, but TTR fibril-depleting agents are on their way.  Early diagnosis of ATTR affords patients maximal benefit from current amyloidosis therapies.   TTR amyloidosis patients require a multidisciplinary approach for success, given the high number of concomitant diseases with cardiomyopathy.  Notes: Notes: Notes drafted by Dr. Georgia Vasilakis Tsatiris.  What makes you most suspicious of a diagnosis of cardiac amyloidosis from the typical heart failure patient?  You must have a strong index of suspicion, meaning you THINK that the patient could have cardiac amyloidosis, to consider it diagnostically. Some characteristics or “red flags” to not miss:   Disproportionately thick heart muscle with a relatively low voltages on EKG   Bilateral carpal tunnel syndrome – estimated that 1 in 10 people >65 years old will have amyloidosis   Previously tolerated antihypertensive medications  Atraumatic biceps tendon rupture   Bilateral carpal tunnel syndrome  Spinal stenosis   Concomitant with other diseases: HFpEF, low-flow low-gradient aortic stenosis  How would you work up a patient for cardiac amyloidosis?   Start with a routine ECG (looking for disproportionally low voltage) and routine TTE (looking for thick heart muscle)  CBC, serum chemistries, hepatic function panel, NT proBNP, and troponin levels  NOTE: It is critical to differentiate between amyloid light chain (AL amyloidosis) and transthyretin ATTR amyloidosis, as both make up 95-99% of amyloidosis cases.   Obtain serum free light chains, serum & urine electrophoresis, and serum & urine immunofixation to rule out AL amyloidosis. (See table below)  AL Amyloidosis ATTR Amyloidosis  → Positive serum free light chains and immunofixation (Abnormal M protein) → Tissue biopsy (endomyocardial, fat pad) to confirm diagnosis → Negative serum free light chains and immunofixation (ruled out AL amyloidosis) → Cardiac scintigraphy (Technetium pyrophosphate with SPECT imaging)  What treatment options do we have to offer now for ATTR CM, and how has this compared to prior years?   Before 2019, treatment options were limited outside of cardiac tr...

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Mike Hazlewood – CEO & Co-Founder – SensePilot For More on SensePilot: Website: https://sensepilot.tech/ Email: info@sensepilot.tech Youtube: https://www.youtube.com/@SensePilotTech IG: @sensepilot https://www.instagram.com/sensepilot?igsh=cmQ4Y21teG14aDR3&utm_source=qr FB: @sensepilot https://www.facebook.com/share/19AYKBW3zV/?mibextid=wwXIfr TikTok: […]

"Naming a band can be quite difficult. The list of bands we will discuss today went back into history to grab a name or an event to come up with a moniker. You know a good many of them. "

This week the boys sit down again and talk about: 4th of July, Stone Ipa, Dobrian, Dogs and Burgs, Mt Dew Seltzers, Bobs Burgers, Fall out 4, Dodger, Angels, Tiger, Mr Beast, Spinal tap, and much much more. Legal High: legalhigh.co/?ref=bktwdqyt

In this episode, we dive into the latest chiropractic research, focusing on a brand new systematic review that examines the biomechanical effects of high velocity, low amplitude spinal manipulation. Whether you've ever wondered what really changes in the body after an adjustment or you're looking for better ways to communicate those benefits to your patients, Dr. Langmaid breaks down the findings in clear, straightforward language. From increased range of motion in the cervical spine to the surprising impact of thoracic adjustments on neck mobility, this episode looks under the hood at the real, measurable effects of chiropractic care.Episode Notes: Systematic review on biomechanical effects of high-velocity, low amplitude spinal manipulationLeander Tables- Save $1,000 on the Series 950 Table using the code EBC2025 — their most advanced flexion-distraction tableTurncloud EHR- Minimalist design, without being sparse. Practical, yet elegant. Turncloud's design was to find the most efficient path in a day in the life of a chiropractic office. Connect with their team at www.turncloud.com Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Brady Dowling – Founder – Neurture Neurture App is available in Apple App and Google Play Story – Search neurture Code for one free […]

This week, I talked about my experience with having a lumbar spinal cortisone shot at UConn. Spoiler alert: it was a great experience! Just waiting for it to take full effect, but I already have a lot less overall nerve pain. It’s exciting! Maybe I’ll be back on the bike next weekend!  I talked about the […]

Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Michael Jewell – VP of Sales and Marketing – Cayenne Apps Download the app: Say It 4 Me – Apple App Store and Google […]

"The K Pop band EXO claimed that one of their concerts in South Korea sold out in less than two seconds. It sounds impossible because you are not being told the entire story. It is a badge of honor for bands to sell out quickly. Other than EXO, who did legitimately sell out the fastest. We will tell you our pick."