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This week on That Tech Pod, we sit down with Sebastian Wernicke, a globally recognized expert on data and AI strategy whose TED Talks have been viewed more than five million times. Sebastian argues that successful AI adoption has far less to do with choosing the right tools and far more to do with building the right culture.We explore why "data-driven" organizations often struggle to make better decisions, and why Sebastian prefers the idea of being "data-inspired" instead. He explains how leaders can create cultures built on evidence, curiosity, and better questions rather than dashboards and reports. The conversation also takes a fresh look at Shadow AI. Rather than treating employees' use of unauthorized AI tools as simply a security problem, Sebastian explains why it can be a signal that workers are frustrated by broken processes, inefficient workflows, and organizational bottlenecks. We also tackle the growing debate around whether AI is entering bubble territory, what executives misunderstand about AI demand, and how massive investments like Kirkland & Ellis's reported $500 million AI initiative could reshape competition across industries. Will AI become a game where only the largest organizations can afford to compete, or will smaller companies find new ways to stay ahead? Finally, Sebastian shares examples from his book Data Inspired that show how organizations can unlock the value of data not through technology purchases, but through culture, leadership, and better decision-making habits. If you're trying to separate AI hype from business reality, this episode offers a practical roadmap for what actually drives transformation.A leading expert in data and AI strategy, Sebastian Wernicke believes that the key to unlocking data's power lies not in technology, but in leaders fostering a culture of evidence and inquiry. For over 20 years, Sebastian has guided organizations around the world to harness the power of data and AI to achieve breakthrough transformation. Sebastian's ability to make complex topics around data accessible, engaging, and actionable has made him a sought-after speaker and workshop facilitator. His three acclaimed TED Talks have reached over 5 million viewers.
Charlene Li makes the case that AI is a leadership and strategy test, not a tech rollout — and that most organizations stall because they hand AI to IT instead of owning it as a CEO-level priority. She explains why leaders should kill their pilots, why speed has become the real competitive moat, and why the smartest companies are using AI for value reclamation — building new capabilities and services — instead of just cutting headcount. She also lays out the four building blocks of AI fluency: mindset, skill set, tool set, and decision set, and makes the case for a dedicated AI value owner who keeps the whole organization moving at the same tempo. Sebastian Wernicke shifts the conversation to the foundation underneath all of this: data. He argues that most data initiatives fail not because of bad tools, but because organizations misunderstand data's actual purpose — which is change, not dashboards. He debunks three persistent myths — that data is objective, that it speaks for itself, and that it provides clean, definitive answers — and explains why psychological safety, not better software, is what actually lets data change minds inside an organization. Together, Li and Wernicke offer a practical, unified roadmap: clarify your strategy, empower real ownership, invest in fluency, and build a culture where data — and leaders — can be wrong in public without consequence.
How can HR use data to drive change?Why is being “data driven” no longer a nice to have, but rather an expectation for HR leadersMy guest on this episode is Sebastian Wernicke, author of “Data Inspired”During our conversation Sebastian and I discuss the following: How the best data work starts by trying to prove yourself wrongWhy HR leaders must become critical consumers of dataHow to start with the business problem, not the available dataWhy data-inspired organizations rest on three foundations: data literacy, a digital mindset, and a data cultureConnecting with Sebastian: Connect with Sebastian on LinkedInLearn more about Sebastian's new book, Data Inspired Episode Sponsor: Next-Gen HR Accelerator - Learn more about this best-in-class leadership development program for next-gen HR leadersHR Leader's Blueprint - 18 pages of real-world advice from 100+ HR thought leaders. Simple, actionable, and proven strategies to advance your career.Succession Planning Playbook: In this focused 1-page resource, I cut through the noise to give you the vital elements that define what “great” succession planning looks like.
Sebastian Wernicke is a leading expert in data and AI strategy who has spent more than 20 years helping organizations—from startups to Fortune 500 companies—turn data into real-world transformation. Sebastian's work stands out because of his core belief that the power of data isn't unlocked through better technology—it's unlocked through better thinking. Through his consulting, speaking, and three TED Talks with over 5 million views, he's helped leaders rethink how they use data to drive meaningful change. His new book, Data Inspired, makes the case that the future belongs not to organizations that are merely data-driven, but to those that build a true culture of inquiry. In this episode we discuss the following: Data doesn't convince people. People convince people. Sebastian's fuel savings example captures this perfectly. A 20% improvement felt like a win to Sebastian, but like an accusation to the employee. So Sebastian repositioned it—not as a “big fix,” but as a gradual, step-by-step pilot—making it feel natural and allowing everyone to save face. And an underappreciate tool Sebastian uses to systematically think through motivations and constraints is checklist. What especially helps companies make the best use of data is psychological safety. Without it, the highest-paid opinion wins, and the data gets ignored. Data is more like an MRI than a clear cut verdict, so it's important to get people's perspectives because we can all look at the same data and see a different truth. If we want to use data more, we have to understand people better.
In this episode, we review the high-yield topic of Wernicke Korsakoff Syndrome from the Neurology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Jay Gunkelman has read more than half a million brain scans. In this episode he and host Pete Jansons open a real before-and-after case and walk it frame by frame — eyes open and eyes closed, pre-treatment and post-treatment — so you can watch what changed. Going in: fast alpha racing at 11.5 Hz, 23 Hz beta spindling at the vertex driving insomnia, a slow edge of alpha buried in the left temporal lobe pointing at local ischemia and possible old head injury, and right-frontal beta carrying a depressive signature. Coming out: alpha stabilized toward 10 Hz, frontal beta down, left-temporal function dramatically improved. Then the bigger story — the refractory-psychiatry work Jay did with Ron Swatzyna and Nash Boutros, where roughly half of medication failures turned out to have a focal EEG biomarker that no pill could fix. As Jay puts it: you can't give soup to the whole brain.
You've invested in the dashboards. You've declared data a top priority. So why does transformation still feel out of reach? In this episode, Brandon Laws sits down with Dr. Sebastian Wernicke, author of Data Inspired: Building an Organizational Culture of Inquiry for Lasting Transformation, to unpack one of business's most frustrating paradoxes: companies that succeed at data... and still don't change. Sebastian challenges the conventional wisdom around data-driven organizations, reveals why human psychology is working against your data strategy, and introduces a more powerful mindset: becoming data inspired. From Goodhart's Law to Netflix's bold decision-making model, this conversation is loaded with ideas that will fundamentally change how you think about data, leadership, and organizational transformation. Don't miss it. Key Timestamps [00:00] — Welcome & Introduction to Data Inspired [00:39] — The bold opening argument: data initiatives don't fail; they succeed at keeping organizations the same. Sebastian unpacks the difference between getting modest value from data and achieving true transformation, and why only ~10% of companies ever get there. [07:38] — Are organizations paralyzed by too much data? Sebastian explains why collecting more data is often a way of avoiding the harder, more courageous work of challenging your own assumptions. [09:39] — What "data-driven" actually means in practice and why it's harder than it sounds. Sebastian introduces the "data deficit theory" and draws on 50 years of psychological research showing that data often hardens our existing beliefs rather than changing them. [13:45] — The Charles Barkley moment: what a legendary NBA star's skepticism about data analysts gets right and wrong about using data in sports and business. [16:03] — How data is collected and used in modern organizations, and why the real challenge isn't gathering data; it's organizing it. (Yes, there's a "data swamp" warning here.) [18:00] — Why the classic 8-step decision-making model is a myth. Sebastian explains what monkey brain research and animal herds reveal about how decisions are actually made and what that means for how you introduce data into the process. [22:36] — Goodhart's Law and the GE cautionary tale: the dangerous difference between steering metrics and success metrics, and what happens when leaders confuse the two. [25:38] — The decision-making spectrum: from fully automated machine-learning decisions to pure gut instinct and how Netflix found the sweet spot between data and human judgment. [30:17] — AI vs. machine learning: why we're wired to trust the type of automated decision-making that's actually less reliable and what that means for your organization right now. [33:34] — Data fatigue is real. Sebastian introduces two archetypes, the Dashboard Director and the Data Diver, and explains why you need both to build a truly innovative organization. [36:31] — A peek into Part 5: The Toolbox, with practical checklists, workshop formats, and tried-and-tested methods developed over 20 years of real-world data projects. [39:03] — Closing wisdom: why copying what successful companies did is a trap, and what it really takes to lead transformative change with data, including the courage to slow down before you speed up. A QUICK GLIMPSE INTO OUR PODCAST Podcast: Transform Your Workplace, sponsored by Xenium HR Host: Brandon Laws In Brandon's own words: "The Transform Your Workplace podcast is your go-to source for the latest workplace trends, big ideas, and time-tested methods straight from the mouths of industry experts and respected thought-leaders." About Xenium HR Xenium HR is on a mission to transform workplaces by providing expert outsourced HR and payroll services for small and medium-sized businesses. With a people-first approach, Xenium helps organizations create thriving work environments where employees feel valued and supported. From navigating compliance to enhancing workplace culture, Xenium offers tailored solutions that empower growth and simplify HR. Whether managing employee relations, payroll processing, or implementing impactful training programs, Xenium is the trusted partner businesses rely on to elevate their workplace experience. Discover how Xenium can transform your workplace: Learn more Connect with Brandon Laws: LinkedIn | Instagram | About Connect with Xenium HR: Website | LinkedIn | Facebook | Twitter | Instagram | YouTube
Send us Fan MailEvery company today says it's data-driven.Billions are spent on analytics. AI pilots are everywhere. Dashboards glow with real-time metrics.And yet, only a small fraction of organizations actually transform.In this episode of FUTUREPROOF., I sit down with Sebastian Wernicke — author of DATA INSPIRED: Building an Organizational Culture of Inquiry for Lasting Transformation—to unpack why.Sebastian argues that the problem isn't a lack of data. It's a lack of inquiry.Most companies use data to optimize what already exists. Few use it to question assumptions, rethink business models, or challenge leadership narratives. That's the difference between being data-driven and being data-inspired.We explore: Why data doesn't “speak for itself” How organizations become excellent at staying the same The dangers of data-resistant minds Why psychological safety is foundational for real AI success What “radical data integrity” actually requires And how to navigate AI's “jagged frontier,” where human judgment still matters This isn't a conversation about tools; it's about whether your culture is equipped to learn — especially when the evidence is uncomfortable.Because AI won't transform your company. It will amplify whatever culture you already have.
Jay Gunkelman goes in BLIND on Case 8 — a 30-year-old whose eyes-open EEG looks like eyes-closed. Alpha at 150 microvolts. Widespread. Anteriorized. Not responding to eye opening. After half a million EEGs, Jay calls the phenotype on sight: vigilance regulation problem, not attention. Left-side mu disconnect. Right-parietal alpha persistence. Frontal alpha hyper-coherence climbing from 0.5 eyes-open to 0.6+ eyes-closed — affect regulation flag. Plus a treatment map more granular than the room expected: FC beta for salience activation, C3 for language, C4 for affect, C4-to-PZ for the parietal alpha that won't quit. And a history segment most listeners have never heard — the first transmitted EEG in 1974, phase-lock loops over voice-grade phone lines, Trudy and Eric Gibbs, Larry Wood's engineering. Stay for the inter-rater reliability number that should end the classical-EEG debate: 90% on phenotypes vs 30-40% on traditional reads.
Welcome back to the Jack Westin MCAT Podcast with Mike and Molly! Last episode we broke down the neurobiology of language; Broca's, Wernicke's, split-brain patients. This episode we zoom all the way out and ask a question that's fascinated scientists for centuries:Does the language you speak actually shape the way you think?This is one of the most debated topics in MCAT psychology and one of the most fascinating. Mike and Molly break it all down, name by name, theory by theory.
Welcome back to the Jack Westin MCAT Podcast with Mike and Molly! In this episode, we're breaking down one of the most high-yield neuroscience topics on the MCAT, the biology of language and the brain areas behind it.Ever wonder why some people lose the ability to speak clearly after a stroke, while others speak fluently but make zero sense? That's not random, it comes down to specific brain regions, and the MCAT loves to test exactly this.
In this episode, we review the high-yield topic of Wernicke-Korsakoff Syndrome from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Neurologic complications of substance use may be the first symptoms that lead patients with substance use disorders to seek care. Neurologists have a key role in identifying patients with substance use disorders and connecting them to treatment. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Adeline L. Goss, MD, author of the article "Neurologic Complications of Drug and Alcohol Use" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Goss is a neurohospitalist and associate chief of neurology for Highland Hospital in Oakland, California. Additional Resources Read the article: Neurologic Complications of Drug and Alcohol Use 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 Host: @LyellJ Full episode transcript available here Dr Jones: A big part of neurology is solving mysteries. Patients can show up with all kinds of mysterious symptoms. Sometimes the diagnosis comes from within, some internal disruption of neurophysiology. But sometimes the problem is a complication of drug or alcohol use. Today we have the pleasure of speaking with Dr Adeline Goss, who recently authored an article for Continuum on this exact problem, a topic all neurologists need to be familiar with. 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 Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Adeline Goss, who recently authored an article on the neurologic complications of drug and alcohol use for our latest issue of Continuum on the neurology of systemic disease. Dr Goss is a neurohospitalist and the associate chief of neurology at Highland Hospital in Oakland, California. She's also an accomplished writer, broadcaster and podcaster. Dr Goss, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Goss: Great to speak with you, Dr Jones. Yes, I'm Adeline. I also go by Addie Goss. Dr Jones: So, before we get into the discussion, we're going to start off today with something fairly new to the podcast, the Continuum Audio trivia question. So, we all know that alcohol and other substances have many potential complications in that use of these substances fluctuates over time. But this one stood out to me from your article, Dr Goss, just for the sheer size of the change. So, for our listeners, here's the question. Accidental exposures to what substance increased a whopping 1,375% between 2017 and 2021? I'll read that again. Accidental exposures to what substance increased 1,375% between 2017 and 2021? So, stick around to the end of our interview for the answer. And let's get right to it, Dr Goss. If you had a single most important message to our listeners from your article, what would it be? Dr Goss: Well, I mean, many of us went into neurology because of the way that neurologic illnesses can be life-changing for patients. And I work as a neurohospitalist at a public hospital in Oakland, California. Many of my patients are admitted for neurologic conditions related to substance use. And when I see my patients later in the discharge clinic, many tell me that the last day that they used meth or the last day they used cocaine, the last day they smoked, was the day they had their stroke or whatever they came into the hospital for. I think the most important message is that hospitalization for a neurologic condition related to substance use can interrupt use patterns, can motivate change. And therefore, as neurologists, we really have an opportunity to connect to our patients and connect our patients to substance use treatment and make a dramatic difference in people's lives in this regard. Dr Jones: I think that's a fantastic point. I enjoyed a point you made in your article---and I can't remember exactly how you phrased it, I won't say it as well---that you think of the syndromes through which alcohol and drug exposures can present. Those syndromes almost always could end up of other primary neurologic disorders. So, put a different way, when a patient presents with a neurologic problem, most of the time an exposure could be on the differential. And so, we really do have a responsibility as neurologists to be familiar with these. Dr Goss: To be familiar with these and to know how to connect patients to resources to try to get treatment. Dr Jones: Totally agree. And you touched on the public health aspect of this. It's really hard to talk about drug or alcohol use without acknowledging the public health impact particularly of opioids, which has been a crisis for most of this century. Right? And I think most of our listeners will be familiar with the rapid rise in opioid-related deaths. But there might be a glimmer of optimism there. Is what I've seen true, that opioid-related deaths may have plateaued? Dr Goss: So, yes, it's true that opioid-related deaths, overdose deaths in general, have begun to decline, actually, since 2023. And that's in part because overdose deaths really surged early on in the Covid-19 pandemic, in the setting of all of the social disruption, reduced access to services, and social isolation that occurred with the pandemic. But there were really multiple factors there. So, as you mentioned, there was this really rapid rise in illicitly manufactured fentanyl. Fentanyl became a major driver in overdose deaths starting in the mid-2010s. And by the late 2010s, it overtook heroin and prescription opioids as drivers of overdose deaths. And then this just collided with the pandemic in 2020, causing skyrocketing deaths. So, as we know as neurologists, fentanyl is more potent, it's shorter-acting, and it's also cheaper than heroin. It can cost as little as 50 cents or a dollar a pill. Thankfully, as services have rebooted and also as naloxone has become more widely distributed, there has begun to be a decline in opioid overdose-related deaths. So, we're relying on provisional data from the CDC for the most recent years, but that shows about a 24% decline in annual overdose deaths, comparing late 2023 to late 2024. And that's real. That comes out to 70 lives saved per day. Unfortunately, deaths still remain above prepandemic levels, and we're still talking about 87,000 drug overdoses per year. So, I would agree, a glimmer of hope. But we're still seeing overdose as the leading cause of death among young Americans aged 18 to 44. And there's a very long way to go. Dr Jones: 23% is a big number, and that is certainly exciting to think about, but we're still above that long-term secular trend. So, hopefully whatever is happening to bring that down, hopefully it continues. And we talk a lot about- appropriately, we talk a lot about opioid exposures and some of the neurologic presentations of opioid use and toxicity, but alcohol use disorder is the most common substance use disorder, correct? I learned that from your article. And it has been for some time, and it has well-known acute and chronic toxicities. But I think many of us have been taught something of a myth in the acute treatment of patients who may have thiamin deficiency or Wernicke's encephalopathy. Can you tell us a little more about that? Dr Goss: Yeah, sure. So, boy, what is my favorite vitamin? As a neurologist, I think thiamin is my favorite vitamin. Thiamin is a cofactor in- for several enzymes that are involved in glucose catabolism. And it's necessary to synthesize myelin and several neurotransmitters. And as we know, alcohol use disorder leads to reduced nutritional intake and impaired digestion and absorption of nutrients. And this can lead to deficiencies in water-soluble B vitamins, including thiamin, as well as trace elements. The thing about thiamin is that thiamin deficiency often appears first, because the body's stores of thiamin deplete in about 4 to 6 weeks. You know, we're traditionally taught if a patient presents with symptoms concerning for Wernicke's encephalopathy, that if they're also hypoglycemic or just in general, we have to get glucose into them first, because we don't want to tax these thiamin-dependent glucose catabolism pathways. But really, there's no reported case of a single glucose bolus precipitating some dramatic symptomatic thiamin deficiency. It's thought that harm would come potentially from prolonged carbohydrate administration without thiamin. And so, if a patient in front of you is both thiamin deficient and hypoglycemic, you just treat both. You treat both emergently. But it doesn't really matter in what order you do so. Dr Jones: That's good to know that doing the right thing for the patient can involve using either of those in whatever order. And I agree with you, I don't think I've ever hurt anybody by giving them thiamin. It's an easy one to miss and an important one to remember in the right context. And speaking of, and I think a lot about in your article, Dr Goss, I can see a neurologist seeing a patient in the emergency department or in the hospital or even in the clinic thinking about the wonderful points in your article. But we know that when alcohol or substance use enters our mind on the differential, the next impulse is to test for it. And we also know there are pitfalls of drug screening, doing urine drug screens, etc. How do you approach testing when you think about a potential drug-related complication in their differential? Dr Goss: So, like most people, I would start with a urine drug screen for any patient who's presenting with a possible toxidrome or some substance-related neurological presentation. These urine drug screens, they're rapid, they're inexpensive, they're immunoassays for traditional drugs and their metabolites. So, usually amphetamines, cocaine, opiates, plus/minus cannabis. But I think the first thing to note is that they miss entire categories of drugs, and not just drugs that are not in that list. They miss synthetic opioids, including fentanyl. One group is keeping track of this number. So, I have an update for mid-2025. And that's that 30% of U.S. ED overdose encounters as of mid-2025 included fentanyl testing. Only 30% for patients who are presenting with an overdose syndrome. Dr Jones: And that's for one of the most widely used synthetic opioids. So that's really a striking number. Dr Goss: Yeah, one of the most widely used and one with the greatest rate of complications. So, states can make a difference here. In 2022, California passed a law requiring fentanyl testing on hospital urine drug screens and several states have followed. And so that number is rising, the rate of testing for fentanyl. But that's just a really key thing to know, that that one is often missed. Other just important pitfalls, the timing of the urine drug screen matters because for most substances, it only picks up the drug within 24 to 72 hours after the last use. With amphetamines and cocaine going out a couple more days after that, especially in patients who use repeatedly. And then also, notably, there's a risk of false positives. This is especially true with amphetamine use, and beta blockers are one of the drugs that can lead to false positives on an amphetamine test, on a urine drug screen. So, I'll share that I've had several patients who have presented with intracerebral hemorrhage and who tested positive on the emergency department's urine drug screen and who adamantly stated that they do not use amphetamines, they've never used amphetamines, and they didn't ingest anything that could have contained amphetamines. And when we did serum confirmatory testing, in fact, their amphetamine testing was negative, and all those patients had received esmelol or the labetalol in the ED to treat their blood pressure related to their ICH. So false positives can occur with, you know, other medications like decongestants and certain antidepressants. But beta blockers are a key one to know. And then finally, there are just a number of things outside of that short list of substances that I mentioned, including a huge range of novel psychoactive substances that would not be tested for on a standard urine drug screen. And for those, you'd require serum testing, or at some large academic centers or specialty toxicology labs, you can actually do liquid chromatography high-resolution mass spectrometry, with- which is basically unbiased testing for any substance that's present in the patient sample. So, I guess, you know, you asked about my approach. Start with the urine drug screen, but there's no substitute for good history-taking and close examination of your patient's general examination, not just their neurologic presentation. And if patients are presenting with a toxidrome that I would expect would show up on a urine drug screen but it's negative, there are other confirmatory tests that can be sent, although they're often send-out labs and come back in a very delayed fashion. Dr Jones: So, in other words, it's complicated, which usually means it's humbling. And if I'm understanding it correctly, there's the risk of the false positive on the urine drug screen. And then there's the risk of the false negative if we think we're screening for something that might not even be on that initial screen. So, that's a wonderful reminder that these are clinical diagnoses and we have to keep our clinician hats on while we're thinking about how to establish these diagnoses or exclude them. So, back to opioids, Dr Gross. There are some really peculiar neurologic syndromes associated with opioid overdose. Tell us a little about those. Dr Goss: Well, I mean, some of these were described first with heroin. So, we can start with the one that almost anybody has heard of, heroin-associated spongiform leukoencephalopathy, which we know is associated with a practice known as "chasing the dragon," which is inhaling vapors of heroin heated on foil. But we know now that this syndrome can occur with other opioids, including fentanyl. The clinical features are, you know, apathy, cerebellar signs, quadriparesis, parkinsonism, myoclonus, and some patients progress to coma or even death. But on MRI you're seeing, you know, these confluence symmetric white matter diffusion restriction and T2 hyperintensities in the cerebellar white matter and the posterior limb of the internal capsule that spare the subcortical U-fibers. So, you know, I think this is kind of the classic example of something that's symmetric, that has a very obvious and interesting MRI pattern. But as time is passing, we're seeing more and more similar types of syndromes of leukoencephalopathies, but with different clinical presentations and MRI characteristics. So, another of these is CHANTER syndrome. This is an opioid overdose-related presentation where people have stupor and coma. And on the MRI there, you see bilateral symmetric diffusion restriction in the cerebellar cortex, in the hippocampi, in the basal ganglia. And it spares the cerebral cortex. And notably in these cases, patients can progress to cerebellar edema, to obstructive hydrocephalus. And some require suboccipital craniotomy. I had a week recently at Highland Hospital, where I work, where we had two of these cases in the same week, in just a community hospital. And there's a similar syndrome in children known as POUNCE syndrome with profound cerebellar edema, and many patients require posterior decompression. So that's another different distribution of findings with a different outcome. Fortunately, there's a milder sort of phenotype of opioid-associated amnestic syndrome, is what it's been described, where there's primarily DWI changes in the hippocampi and the globus pallidus. So, patients primarily present with an amnestic syndrome, mostly anterograde amnesia. Seeing these in practice, I'm not sure that patients always fall into one bucket or another. But in general, you'll see some degree of symmetric diffusion restriction or symmetric white matter changes that clearly point to a toxic presentation, a toxic syndrome, as opposed to pure anoxia, for example. And it's important to know that because from a prognostic standpoint, anoxic brain injury, which can occur after cardiac arrest and after opioid overdose, can look different than some of these syndromes. Finally, heroin has been associated with myelopathy, but also that's been reported on with fentanyl. So, I think some of these conditions got their reputation from heroin. But as fentanyl has proliferated---and prior to that as prescription opioid, you know, misuse had proliferated---we're seeing similar syndromes with all of the opiates. Dr Jones: And I think it's a good case in point that you can have multifocal disease and it be a manifestation of an intoxication, and I think that's a really good reminder that we have to have many of these syndromes in our differential, we have to be aware of them, otherwise we might miss them or attribute them to another mechanism. Dr Goss, our last issue of Continuum that was dedicated to the neurology of systemic disease came out in 2023, and here we are in 2026 publishing our latest issue, including your article and this podcast. Since 2023, have there been any emerging patterns or novel agents of abuse or misuse out there? Dr Goss: The short answer is yes, and I would say the reason is just the supply is moving at more and more rapid speed. The relationship between the internet and drug supply has really informed what's out there at any given moment. So, the turnover in the market can change in weeks, not in years. And there's all of this distribution through social media and encrypted apps. And then manufacturers are kind of continuously tweaking chemical structures to evade law enforcement. In the process of researching this article, I came across some, I mean, really wild examples. To be clear, these are not- not all these are common substances, but I think the general phenomenon should be known that people can walk into a vape shop or walk into a gas station or meander around online and buy some really weird stuff. So, in 2024, there was this nationwide recall of a product called Diamond Shrooms that was sold online and in smoke and vape shops, and this was billed as, like, a hemp and mushroom mixture. But it led to multiple- I mean, over 100 cases of seizures and agitation and depressed consciousness and a few possible deaths. And when the contents were analyzed, they included psilocybin analogs and pregabalin. I mean, some weird stuff. And so, those have been pulled. But people are constantly inventing and marketing these different substances. I think another example… we all know about nitrous oxide and its association with B12 myopathy. But the use of nitrous oxide has really changed. Companies are selling large canisters online and in vape shops, and they're flavored, like, in blue raspberry flavor. And unfortunately, there's been a rise of nitrous among youth. So, we're seeing not just increased cases of myelopathy, but also a 2025 study in JAMA found a spike in deaths attributed to actual nitrous oxide overdose. And so nitrous, I think, had not been that commonly used a few years ago, but has become more common in the last couple of years. A final one I'll just mention is ketamine. So, ketamine has certainly appeared in reviews of neurological syndromes related to substance use for a long time, and it's also been studied and used off-label for mood disorders in outpatient infusion clinics for some time. But in the pandemic, there was an expansion in telemedicine, as we know, and an associated proliferation of teleclinics that were prescribing very frequent, even daily oral and lozenge and nasal formulations of ketamine, which has led to increased rates of misuse. So, you know, acutely, the syndrome associated with ketamine intoxication is very brief. And often by the time people come to the emergency department, their symptoms have already worn off. But long-term, frequent use of ketamine is really still being studied. There seems to be an association with persistent neuropsychiatric effects like cognitive impairment, psychosis, persistent depressive symptoms. And so, you know, I think it's just important to realize that while the list of substances may look pretty similar to 2023, the use patterns, the distribution patterns are continuing to change. It's hard to keep up. And while alcohol and opioids and stimulants are by far the most common substances that a neurologist is going to encounter in daily practice, there's this ever-expanding range of possible substances that can trigger neurologic syndromes, both acute and chronic. Dr Jones: And I think that might be the best possible plug to read your article, because it is evolving and we have to stay on top of it. And we really can't be complacent with it. So, thank you for that update. Okay, back to our trivia question. Accidental exposures to what substance increased a whopping 1,375% between 2017 and 2021? Dr Goss, what do you think? Dr Goss: That was THC-infused edibles. Specifically, these would be THC-infused substances that are often marketed as looking like candy or snacks or cereal. Exactly what a kid might want to get their hands on. And unfortunately, accidental cannabis exposures in children under age five went up by 1,375% between 2017 and 2021, and 600 of those patients required critical care admission. Dr Jones: Yeah. So, just a mind-blowing number, and obviously something for us to be on the lookout for, especially if you see children in your practice and someone comes in with CNS depression or stupor, it's one to not miss. So that was something I learned in reading your article, among many other things. And Dr Goss, I want to thank you for joining us. I want to thank you for such a great discussion. I learned a lot from reading your article, I learned a lot just from our conversation today, and I suspect our readers and our listeners will too. Dr Goss: What a pleasure. Thank you so much, Dr Jones. Dr Jones: Again, we've been speaking with Dr Adeline Gross, author of a fantastic article on neurologic complications of drug and alcohol use in our latest issue of Continuum on the neurology of systemic disease. Please check it out, and thank you to our listeners for joining us 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.
Interviewer info Lyssa Rome is a speech-language pathologist in the San Francisco Bay Area. She is on staff at the Aphasia Center of California, where she facilitates groups for people with aphasia and their care partners. She owns an LPAA-focused private practice and specializes in working with people with neurogenic communication disorders. She has worked in acute hospital, skilled nursing, and continuum of care settings. Prior to becoming an SLP, Lyssa was a public radio journalist, editor, and podcast producer. In this episode, Lyssa Rome interviews Jessica Obermeyer about group treatment for aphasia. Guest info Jessica Obermeyer, PhD, CCC-SLP, is an Assistant Professor in the Department of Communication Sciences and Disorders at the University of North Carolina at Greensboro. Her area of specialization is acquired adult neurogenic language disorders. Dr. Obermeyer's research interests include discourse production in aphasia, treatment efficacy, and the cognitive requirements of language production. Prior to earning her doctorate, she worked in a variety of clinical settings where she specialized in assessment and treatment of adult neurogenic populations. Listener Take-aways In today's episode you will: ● Recognize the role of written communication in clients' daily activities, including texting, email, and online tasks. ● Adapt ARCS-W treatment components to match each client's preferred writing modality (handwriting vs. typing). ● Identify candidates with aphasia who are well-suited for discourse-level writing treatment. Lyssa Rome Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Lyssa Rome. I'm a speech language pathologist on staff at the Aphasia Center of California, and I see clients with aphasia and other neurogenic communication disorders in my LPAA-focused private practice. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Jessica Obermeyer, who was selected as a 2024 Tavistock Trust for Aphasia, Distinguished Scholar, USA and Canada. Dr. Obermeyer is an assistant professor in the Department of Communication Sciences and Disorders at the University of North Carolina at Greensboro. Her area of specialization is acquired adult neurogenic language disorders. Dr Obermeyer's research interests include discourse production and aphasia treatment efficacy and the cognitive requirements of language production. Prior to earning her doctorate, she worked in a variety of clinical settings, where she specialized in assessment and treatment of adult neurogenic populations. Jessica Obermeyer, welcome to the podcast, and thanks for being here. Jessica Obermeyer Thank you. It's a pleasure. Lyssa Rome So I wanted to get started with a question we often ask, which is: How did you get into this? Was there an aha moment for you and what led you to research aphasia? Jessica Obermeyer That's a great question. I think it was more of a slow awakening and journey to realizing that this is how I wanted to spend my days. When I started studying speech language pathology, I knew I wanted to work in adult rehab with people with traumatic brain injury, stroke, and aphasia. But as an undergraduate and a masters student, I worked on a lot of research related to traumatic brain injury and cognition. But then I had some exposure to aphasia research, and as a clinician, I just loved working with people that had aphasia. I loved running aphasia groups. I started aphasia groups, and when I decided to go back for my PhD, that is what I wanted to focus on. I also had the opportunity to work in adult outpatient, so I got to see a lot of people that had aphasia and were at different points in their rehabilitation journey. And those experiences just made me want to continue and especially do research that could develop and evaluate different treatment approaches for people that had aphasia. Lyssa Rome One of the sort of through lines in your research has been discourse. And I'm curious about how you landed on that as the focus of your work, why discourse? Jessica Obermeyer It's how we talk. It was always, you know, something I was interested in. I think, as a clinician, I felt really daunted by discourse, because it is laborious, you know, it takes a lot of time to think about how you're going to analyze it. But I was always so fascinated by all the linguistic components that make up discourse as a clinician. And then I think as a researcher, I really appreciate how important it is. Everything we do in our day to day lives is often at a discourse level, and that looks so different depending on the type of discourse. So your text exchange is discourse, your emails, your conversations, the interaction with a barista. You know, every kind of functional way that we communicate is often at a discourse level. But it's so different depending on what that interaction looks like, and that's just endlessly fascinating to me as a researcher… challenging but fascinating. Lyssa Rome Challenging both to evaluate and, I guess, to some extent, to treat. One of the things that I really appreciate is that it's how we communicate in our daily lives, and so if we're thinking about life participation and sort of functional approaches to treatment, to my mind, discourse is kind of where it's at. So I'm really excited to get to talk to you more about it. So speaking of discourse, I thought we could talk about your work on ARCS. Maybe we could start by telling us a little bit about the origins and how you became involved in researching. Jessica Obermeyer Yes, I'd be happy to. I started doing research with ARCS as a doctoral student. So it's been a long time, but the origin of ARCS, or Attentive Reading with Constrained Summarization, started with Yvonne Rogalski and Lisa Edmonds, and they published the first paper, I think, in 2009, but someone should go back to check that, and it was originally for someone that had primary progressive aphasia. And then there was another paper published for two people with Wernicke's aphasia. So in the original version, it's based on constrained summarization, and constrained only in that you're giving someone guidelines for how to summarize so they have to read through a segment of text. Usually it's a current event article, but clinically, you could use pretty much any written text. And I've actually done it with someone listening as well. Typically with ARCS, you would have someone read a segment of written text and then summarize it with the constraint or guideline to be specific. So avoid words like it, stuff, thing, he, she. So use that really intentional word retrieval. That's not what we typically do. We often use non-specific words, but it's that therapeutic, like try to go for the really precise and specific word exercise that retrieval and to also stay on topic, so try not to add a tangent, or, you know, additional information that's not related to what you're reading. And then in my work, I've added an additional guideline that's just based on what that person needs. So if they're repeating a lot, then that might be part of the guideline. Often, the guideline is to try to include the essential information that you've identified already. So that's the origin of ARCS. And as a doctoral student, I really wanted to do treatment research. I became really interested in cooperative learning theory, in how people can work together in their learning, collaborate to improve learning. And when I was doing that, reading and thinking about cooperative learning, writing seemed like such an excellent tool for that, because I think one of the hard things about spoken language is that it's just gone. You say it, it's gone. It's very hard to monitor, which I'm acutely aware of right now in this recording. But with written text, you have this wonderful record of what you've produced, and that can be really helpful for thinking about language and planning, especially in an approach like ARCS or ARCS-W that emphasizes this planning, process-driven component, where you're thinking about, "What do I need to include in this discourse? What's important? What's not important? And what have I actually produced? Does that meet, you know, the guidelines I've tried to meet?" So that's how writing actually got pulled into it. And I wanted to keep the spoken language because, I don't know that I've ever met someone with aphasia who told me they didn't want to continue exercising their spoken language, but the writing was just I think, an important addition, because there are so few written discourse treatment options. And it allowed for this emphasis on monitoring and planning and some of the cognitive components of discourse that can be hard to address. Lyssa Rome And maybe you could say a little bit about what you found when you've studied ARCS-W, so the Attentive Reading and Constrained Summarization-Written. Jessica Obermeyer Well, people have improved, which is great. So the one of the things about ARCS and ARCS-W that's maybe unique when we think about aphasia treatment as a whole, is that it's not a treatment with trained items, so no items are repeated. You're working on the process of discourse production, this process of monitoring and trying to be specific, be efficient, you know. In written discourse, people have made improvements in correct information units or CIUs. So at the word level in discourse, the amount of informative and correct information that they're producing, people have made improvements at the utterance level, where they're producing more relevant utterances and more utterances that have a basic sentence structure, and then this hasn't been looked at in all of the studies, but for some of the participants, where we've measured things like main concepts, the amount that the person is conveying the main ideas or concepts in the discourse has improved for some people as well. And then at this spoken discourse. So ARCS-W, it's half spoken, half written. Basically, people have also made similar improvements. So it's been encouraging so far, ARCS-W I would say, compared to ARCS is for people in the more mild aphasia end of the spectrum, especially with the writing component. Any clinician who's worked with people with aphasia will know that writing is often a stressful thing for people with aphasia. So it's for people that are writing at a phrase level already. It doesn't mean that their spelling is perfect, but if they're really struggling to get out a single word, this is probably not the ideal you know treatment for them, but for folks that are more on the mild end who want to work on spoken and written discourse, we have seen some positive results in their spoken and written discourse production. Another thing that I think is really important for this treatment is that it is so multi-modality. When we write normally, we're reading as well. You know, we're not just writing in a vacuum. A lot of the time. We're rereading our text, we are reading that text message and then responding to it. So I like that. I like multi-modality treatments. I like that this is a treatment that allows people to address multiple types of language goals, while, you know, keeping it pretty simple and low tech. Lyssa Rome I think that that really hits on one of the reasons that I like using ARCS-W in my work with people is that It can be used with so many different kinds of texts. So I've used both, you know, work emails, if their goal is to get back to work, newspaper articles that interest them, simplified newspaper articles that interest there's so many possibilities. And anyway, it's exciting to hear you talk about that. Jessica Obermeyer Yeah, I think that as a clinician, that's why I liked ARCS. It was so flexible, so easy to implement. And that's definitely one of the things I like about ARCS-W as well. Make treatment work hard for you. Lyssa Rome So that is interesting to people as well. Where are you going next with your ARCS research? Jessica Obermeyer Great question. I'm writing up results from about six people we ran over the last couple years, so that, I hope, gets submitted for publication soon. And I would really like to adapt this treatment a little further to use more assistive technology for folks that are really wanting to write, but aren't wedded to handwriting or typing in a traditional sense. So can we use speech-to-text? I always mix it up. And can we use methods to support people producing written language that are, you know, different than just typing it? Because people have really different needs in their life. So if that is a way to meet their writing needs, excellent, and I'd like to do that in the future. Lyssa Rome I think that gets back to this idea that it's so flexible, right? You could adapt it in so many different ways. I think that that's really exciting, because it sort of further underscores the flexibility of this approach. And we were talking earlier, before we started recording, about using the same ARCS framework, or ARCS-W framework for material that clients have listened to, things like podcasts or TED Talks. So it seems like it's so adaptable, which is part of what I think makes it really exciting. Jessica Obermeyer I think that's a great idea. We actually did use listening and then summarization for one of the participants in the first arc study, because that met their profile. That's how they wanted to interact with the treatment, and it worked out really well for them, and it's a great way to incorporate people's different interests. Not everyone wants to read, so being able to listen is a great option. And in the treatment for everybody, they always select their writing modality so they can either hand write or type, depending on what's relevant for them. In the population of people that have aphasia now, and I know that this will change over time, people have really different comfort levels with technology and with typing. So if someone says, "No, I never typed. I want to handwrite," then we can do that. And if, if it's the other, we can type. So I think listening is just another way to make it meet someone's needs better. Lyssa Rome I was hoping that you could talk a little bit more about the similarities and differences between different types of discourse. So spoken and written discourse, typed and versus handwritten discourse. Tell us a little bit more about that. Jessica Obermeyer Yeah, of course. Well, I should, I guess, start off by saying, working on the ARCS-W treatment research, I recognized just how little information is out there on written discourse and the majority of discourse measures that we use in aphasiology are based on spoken discourse production. But there are differences in how we speak versus how we write. So in spoken language, we've already talked a little bit about this, it's temporal, it's just gone. So writing is tangible. You have a record of your writing, and that can be really beneficial for people with aphasia. But of course, there's there's other things that can make writing more challenging as well. With spoken language, of course, we have the suprasegmental components of what we're saying. So we have our tone and our facial expression and things that allow us to impart meaning without actually saying it, and we don't have that in writing. Although things are shifting with text messaging technologies, we can add emojis and memes that help us communicate information. But I think when we're thinking about traditional writing, it doesn't have those additional components, and therefore people have to be more explicit with their word choice and a little more clear in what they're trying to say. People are often more efficient in writing. They use fewer words than they would in speaking. So those are some of the differences. We can't automatically correct our written output because we see that our partner doesn't understand. Because in writing, there's this distance between when we're writing versus when we think someone's reading it. Even in more instant platforms like text messaging, we don't know exactly when someone's reading something or how their face looks when they read it, in the way we know with speaking. So those differences do impact how we complete the task. And of course, the context of writing changes it dramatically. So you write notes to yourself really differently than you write a research paper or a work email. And that's not so different from speaking, right? The context is still going to impact how we speak or write, very much. So in my work, I've looked at how writing and typing are the same or different. And this is a pretty new area. There's a couple papers out there on it now, and I think it's gaining traction, which is great, because most people write through typing in their daily life now. What I found is that at a group level, it's pretty similar. Writing and typing look pretty similar for people that have aphasia. But individually it can be very different. So an individual person with aphasia might have a strength or weakness in handwriting versus typing for lots of different possible reasons, like their experience, or hemiparesis, their desire to do one or the other. But it's not, the patterns aren't completely clear. I think clinicians are probably really used to hearing that every individual with aphasia has the potential to be different. So I think that keeps with written and typed language output, handwritten and typed. Some of my recent work has been related to looking at different writing modalities for people with aphasia. So are there differences in their handwritten versus typed discourse production. There's a couple papers out on this now, and hopefully there'll be even more as it gains traction. And I think it's getting more attention in the research literature because of how important writing is in our daily lives now. I mean, most activities of daily living are now completed through, you know, the virtual world, so banking, shopping, lots of messaging are completed through reading and writing now. So that's kind of why I became interested in also working with ARCS-W and having people handwrite versus type, depending on their interest and comfort level. It was always interesting to me why certain people picked one or the other, and kind of what I was seeing. There is some research out there that shows that handwriting is advantageous for learning. So the specificity of how we're moving our fingers to create letters is helpful for retention and learning items, but when we're thinking at the discourse level, when we're not using the same items necessarily, things could potentially be a little different. So I was interested in just exploring some of those differences and patterns that might emerge, and if there was anything I could figure out that might be driving a pattern. So if someone's better at typing than handwriting, is there a reason that they're better? So what I have found so far, and it's it's pretty preliminary, is that at the group level, handwriting and typing look very similar for people with aphasia, so oftentimes, there's not a big difference in the total words that they produce, and that's been confirmed by a larger study as well from Jaime Lee and colleagues. But then when we look at the individual level, that's when you can start to see differences. And I don't think any clinician would be surprised to hear that people with Aphasia are variable or different. So we know that that is common, but it's been pretty interesting and striking in my own work to see how at the group level, these differences just totally even out. But then when we look at individuals, you do see that, you know, someone is more proficient with typing, someone else is more proficient with handwriting. So in a study I did, I think from 2024, we had people fill out this historical information about their typing experience and exposure, we knew about if they had a hemiparesis or not, and so were they able to use both hands or one hand for handwriting or typing? And like I said, we did find these individual differences for some people, but there wasn't a really clear pattern in what was driving those differences? Was it that they hadn't worked with a keyboard a lot? Was it that they only had the use of one hand? And we just didn't have enough data potentially to discern any specific patterns? Lyssa Rome We've talked a little bit about different types of discourse, written, spoken for written, typed versus handwritten. But I wanted to kind of come back to how we measure and analyze discourse, and wanted to ask about a more recent paper and have you describe a little bit about your work on discourse measurement and training clinicians to measure discourse? Jessica Obermeyer That paper is a perceptual rating paper. We've talked a lot about discourse in this chat, and I think probably one of the first things I might have mentioned was how daunting discourse analysis can be. So researchers are aware of that, and always kind of thinking that discourse is so rich, it provides us so much information about someone's linguistic ability, but also their success with communication in a way that other levels of language don't necessarily tell us. So how can we benefit from that rich information in a way that clinicians can do. Because with discourse analysis, you know, in the clinical session, it might not take that long. You're having someone participate in 10 minutes of conversation—that is not a lot of time in your session. The time is all backlogged. The time is after the session is over, and you're trying to transcribe what they've said and then identify discourse measures that you're interested in. And another thing that makes discourse just complex and dynamic is that there's not one measure, you know, there's not a measure of word retrieval and discourse. There are lots of measures that can give you insight into word retrieval and discourse. So this project I did with my collaborator, Marion Lehman, who also works on discourse, and especially conversation. We wanted to see if it was possible to train people to rate conversation samples from people with aphasia on linguistic measures, so measures of language ability. So there are other perceptual rating scales, but a lot of them might be looking at speech acts like initiation or presence or absence of errors. And we were really interested in if these, if perceptual ratings, could map on to the things we're doing in our labs, so you know, correct information units or the degree of informativeness, utterances that have basic structure, coherence, you know, these measures that we are spending many hours, you know, coding line by line, or even word by word, for some. So she and I developed this training and introduced—so the paper that's published, we used research assistants in our research labs, and we exposed them to the linguistic measures that we were interested in. Had them watch some practice videos, and then told them how we had coded them. So what was the value based on our lab coding? And then we did five test samples, so there were four linguistic measures. The training lasted about three hours, and I did five test samples. And we got some really good feedback from the RAs who did the training and rating samples. We had some promising results for especially two of the measures that we used in their training, and now we're really interested in extending that work with clinicians. So the people that were in the study before had very limited experience listening to people that had aphasia. They hadn't worked with people that had aphasia, they hadn't done extensive clinical training. We're hopeful that if we can use their feedback to fine tune the training and rating procedures and recruit some clinicians to participate, that hopefully we could get even better results and hopefully provide a tool to clinicians where they can be thinking about linguistic components of conversation in a way that's more feasible to their schedule and their workload, because we recognize how much time it takes. And I think it's, it's just a barrier to entry, even, because if someone is feeling like, "I can't do this, I don't have time to do this," then it's hard to even learn about or get started. Lyssa Rome Yeah, I'm so happy to hear that you're that you're focused on the feasibility for clinicians who have productivity requirements, who don't necessarily have a lot of time at the end of the day to do that kind of really in depth analysis. I think it's exciting. Jessica Obermeyer Oh, for sure, and clinicians, I think, work a lot of extra hours, but they have a whole caseload, you know, so balancing everybody's needs and being able to to provide excellent care to everybody is, is always a challenge, and hopefully, hopefully we'll, we'll be able to continue this work. We're trying to get some funding for the project because we want to be able to pay SLPs who participate in the research. Lyssa Rome As we start to wrap up, I'm wondering what you would like clinicians who are listening to this podcast to take away from what we've talked about today, from your work. Jessica Obermeyer I think one takeaway would be for clinicians to think about incorporating handwriting and typing into their existing treatment practice. So I've talked a lot about ARCS-W. ARCS-W is not for everybody. It is a very specific treatment approach for people that have mild aphasia who want to work on discourse-level writing. But there are so many ways to have people engage with handwriting and typing that will serve them in their daily life. So we've talked a lot about how literacy is just such a big—it's a bigger part of our lives than it was 20 years ago. People can achieve a lot of independence and autonomy if they're able to interact with reading and writing and complete it successfully. So I would really encourage clinicians to think about how they can incorporate reading and writing into their existing treatment. A study I was involved with— Liz Madden surveyed SLPs on their practices assessing and treating reading and writing, and one of the take-homes from that project was that clinicians evaluate writing more than treating it. And especially handwriting, versus typing. But I think that given the way society is moving, asking people like, "What's important for you, handwriting or typing?" and let's make that our practice. Lyssa Rome I appreciate how person centered and flexible that advice is right. We're trying to meet people where they're at and recognizing that our treatment can be tailored to the person who's sitting in front of us. I'm curious to hear what is coming next for you. What are you excited about in your work? Jessica Obermeyer That's actually a great segue about how we can tailor treatment, because that is one of the projects that I'm working on now, how we can think about treatment in terms of what are the things that make it work, versus things that maybe aren't essential components of the treatment? With the last study I did with ARCS-W of the things that we were really trying to understand better was: Did it matter if people hand wrote or typed? Did they have the same kind of level of generalization to the other writing modality? And in that study, it doesn't seem that they did. And I think there's really specific reasons for that, because we're working at this discourse level without repeated items. And so you might not see the same impact of that handwriting learning boost, because we're not repeating things as often. That's one of my real interests is thinking about how we work on treatment, how we deliver treatment, how clinicians can deliver treatment. Because I am very guilty of this. Working on writing takes a long time. It takes a long time for people with aphasia to produce written discourse level text. So in the ARCS W studies, it's an hour-and-a-half treatment session where we only work on ARCS-W. But I know I recognize that that's like not most clinicians' daily life, and it doesn't mirror what therapy many people with aphasia receive. So thinking about treatment in a more component-based and mechanistic way that makes it easier for clinicians to adapt to their their practice is is one of the things I would like to flesh out in the future. And then continuing to work on this training and perceptual rating protocol. One of the things my colleagues and I would like to do is create a training that can be shared freely, where clinicians can easily get access to it, and then collect more robust data. I mean, only if we get good results, of course. If we don't, we will not be sharing it. But those are the big things I'm thinking about in the next couple of years, and then beyond that, even more. Lyssa Rome Well, I look forward to reading more of your work and to seeing what comes next as well. Dr. Jessica Obermeyer, thanks so much for talking with us. I really appreciate it. Jessica Obermeyer It's been a pleasure. Thank you. Lyssa Rome And thanks also to our listeners for the references and resources mentioned in today's show. Please see our show notes. They're available on our website, www.aphasiaaccess.org. There, you can also become a member of our organization, browse our growing library of materials and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access. For Aphasia Access Conversations, I'm Lyssa Rome. Resources Obermeyer, J. (2024). Using and modifying standardized restorative treatments in aphasia: Clinician perspectives. American Journal of Speech‑Language Pathology. Advance online publication. https://doi.org/10.1044/2024_AJSLP-23-00349 Obermeyer, J., Leaman, M., & Oleson, J. (2025). Feasibility and preliminary data for a training protocol and perceptual rating scale of linguistic conversation measures in aphasia. American Journal of Speech‑Language Pathology. Advance online publication. https://doi.org/10.1044/2025_AJSLP-24-00420 Obermeyer, J. A., Rogalski, Y., & Edmonds, L. A. (2021). Attentive reading with constrained summarization-written, a multi-modality discourse-level treatment for mild aphasia. Aphasiology, 35(1), 100-125. Obermeyer, J. A., & Edmonds, L. A. (2018). Attentive reading with constrained summarization adapted to address written discourse in people with mild aphasia. American Journal of Speech‑Language Pathology, 27(1S), 392–405. https://doi.org/10.1044/2017_AJSLP-16-0200 Obermeyer, J. A., Leaman, M. C., & Edmonds, L. A. (2020). Evaluating change in the conversation of a person with mild aphasia after Attentive Reading with Constrained Summarization–Written treatment. American Journal of Speech‑Language Pathology, 29(3), 1618–1628. https://doi.org/10.1044/2020_AJSLP-19-00078 Obermeyer, J., Edmonds, L., & Morgan, J. (2024). Handwritten and typed discourse in people with aphasia: Reference data for sequential picture description and comparison of performance across modality. American Journal of Speech-Language Pathology, 33(6S), 3170-3185
Humans excel at transmitting ideas, skills, and knowledge across generations, and at building on those competencies in a cumulative manner. James Rilling, Professor of Psychology at Emory University, explores how the transmission of our cumulative culture is assumed to depend on both language and mental perspective-taking, or theory of mind. If humans have specialized abilities in these domains, we must have neurobiological specializations to support them. Our research has used comparative primate neuroimaging to attempt to identify such specializations. The arcuate fasciculus is a white matter fiber tract that links Wernicke's and Broca's language areas. It is known to be involved in multiple, high level linguistic functions such as lexical semantics, complex syntax, and speech fluency. Using diffusion weighted imaging and tractography, we have demonstrated human specializations in the size and trajectory of the arcuate fasciculus that may partially explain human linguistic abilities. Theory of Mind depends on a set of cortical regions that belong to a neural network known as the default mode network that is functionally connected, highly active at rest, and deactivated by attention-demanding cognitive tasks. We and others have used functional neuroimaging to show that chimpanzees and other primates appear to have a default mode network that is similar to that of humans. However, the non-human primate default mode network seems to have weaker connectivity between certain key nodes, suggesting that these connections could play a role in human theory of mind specializations. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41329]
Humans excel at transmitting ideas, skills, and knowledge across generations, and at building on those competencies in a cumulative manner. James Rilling, Professor of Psychology at Emory University, explores how the transmission of our cumulative culture is assumed to depend on both language and mental perspective-taking, or theory of mind. If humans have specialized abilities in these domains, we must have neurobiological specializations to support them. Our research has used comparative primate neuroimaging to attempt to identify such specializations. The arcuate fasciculus is a white matter fiber tract that links Wernicke's and Broca's language areas. It is known to be involved in multiple, high level linguistic functions such as lexical semantics, complex syntax, and speech fluency. Using diffusion weighted imaging and tractography, we have demonstrated human specializations in the size and trajectory of the arcuate fasciculus that may partially explain human linguistic abilities. Theory of Mind depends on a set of cortical regions that belong to a neural network known as the default mode network that is functionally connected, highly active at rest, and deactivated by attention-demanding cognitive tasks. We and others have used functional neuroimaging to show that chimpanzees and other primates appear to have a default mode network that is similar to that of humans. However, the non-human primate default mode network seems to have weaker connectivity between certain key nodes, suggesting that these connections could play a role in human theory of mind specializations. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41329]
CARTA - Center for Academic Research and Training in Anthropogeny (Video)
Humans excel at transmitting ideas, skills, and knowledge across generations, and at building on those competencies in a cumulative manner. James Rilling, Professor of Psychology at Emory University, explores how the transmission of our cumulative culture is assumed to depend on both language and mental perspective-taking, or theory of mind. If humans have specialized abilities in these domains, we must have neurobiological specializations to support them. Our research has used comparative primate neuroimaging to attempt to identify such specializations. The arcuate fasciculus is a white matter fiber tract that links Wernicke's and Broca's language areas. It is known to be involved in multiple, high level linguistic functions such as lexical semantics, complex syntax, and speech fluency. Using diffusion weighted imaging and tractography, we have demonstrated human specializations in the size and trajectory of the arcuate fasciculus that may partially explain human linguistic abilities. Theory of Mind depends on a set of cortical regions that belong to a neural network known as the default mode network that is functionally connected, highly active at rest, and deactivated by attention-demanding cognitive tasks. We and others have used functional neuroimaging to show that chimpanzees and other primates appear to have a default mode network that is similar to that of humans. However, the non-human primate default mode network seems to have weaker connectivity between certain key nodes, suggesting that these connections could play a role in human theory of mind specializations. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41329]
Humans excel at transmitting ideas, skills, and knowledge across generations, and at building on those competencies in a cumulative manner. James Rilling, Professor of Psychology at Emory University, explores how the transmission of our cumulative culture is assumed to depend on both language and mental perspective-taking, or theory of mind. If humans have specialized abilities in these domains, we must have neurobiological specializations to support them. Our research has used comparative primate neuroimaging to attempt to identify such specializations. The arcuate fasciculus is a white matter fiber tract that links Wernicke's and Broca's language areas. It is known to be involved in multiple, high level linguistic functions such as lexical semantics, complex syntax, and speech fluency. Using diffusion weighted imaging and tractography, we have demonstrated human specializations in the size and trajectory of the arcuate fasciculus that may partially explain human linguistic abilities. Theory of Mind depends on a set of cortical regions that belong to a neural network known as the default mode network that is functionally connected, highly active at rest, and deactivated by attention-demanding cognitive tasks. We and others have used functional neuroimaging to show that chimpanzees and other primates appear to have a default mode network that is similar to that of humans. However, the non-human primate default mode network seems to have weaker connectivity between certain key nodes, suggesting that these connections could play a role in human theory of mind specializations. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41329]
Humans excel at transmitting ideas, skills, and knowledge across generations, and at building on those competencies in a cumulative manner. James Rilling, Professor of Psychology at Emory University, explores how the transmission of our cumulative culture is assumed to depend on both language and mental perspective-taking, or theory of mind. If humans have specialized abilities in these domains, we must have neurobiological specializations to support them. Our research has used comparative primate neuroimaging to attempt to identify such specializations. The arcuate fasciculus is a white matter fiber tract that links Wernicke's and Broca's language areas. It is known to be involved in multiple, high level linguistic functions such as lexical semantics, complex syntax, and speech fluency. Using diffusion weighted imaging and tractography, we have demonstrated human specializations in the size and trajectory of the arcuate fasciculus that may partially explain human linguistic abilities. Theory of Mind depends on a set of cortical regions that belong to a neural network known as the default mode network that is functionally connected, highly active at rest, and deactivated by attention-demanding cognitive tasks. We and others have used functional neuroimaging to show that chimpanzees and other primates appear to have a default mode network that is similar to that of humans. However, the non-human primate default mode network seems to have weaker connectivity between certain key nodes, suggesting that these connections could play a role in human theory of mind specializations. Series: "CARTA - Center for Academic Research and Training in Anthropogeny" [Science] [Show ID: 41329]
Paul Wernicke hört genau hin im Wald. Um ihn herum erwacht das Leben in einem wilden Konzert: Der Specht trommelt, während die Misteldrossel singt. Der Wildnispädagoge bringt den Menschen bei, die Rufe der Vögel im Wald besser zu verstehen. Korneli, Caro www.deutschlandfunkkultur.de, Plus Eins
According to the World Health Organisation, harmful use of alcohol accounts for 3 million deaths each year. Indeed, it's the third leading cause of preventable death, and causes a large burden for societies across the world. Of course regular alcohol consumption doesn't always kill, but it can lead to other health problems, including neurological disorders. Wernicke-Korsakoff Syndrome is one such example. It's the combination of Wernicke encephalopathy and Korsakoff Syndrome. Both are linked to vitamin B1 deficiency. Alcohol has a direct toxic effect on the brain, which can lead to a lack of certain substances, such as vitamin B1, which is also known as thiamine. What are the symptoms of this syndrome? How does it develop? Are there any forms of treatment? In under 3 minutes, we answer your questions! To listen to more episodes, click here: Are baths or showers better for our health? Can this budgeting method help us save better? Is microwaving food bad for you? A Bababam Originals podcast. Written and produced by Joseph Chance. First Broadcast: 24/1/2023 Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Refky Nicola speaks with Dr. Sudhakar Venkatesh from Mayo Clinic about the imaging manifestations of alcohol use disorder and its widespread impact on the brain, liver, heart, lungs, and musculoskeletal system. The discussion highlights key radiologic findings, from Wernicke's encephalopathy to hepatic fibrosis, and explores how advanced MRI techniques aid in diagnosis and management. Imaging Manifestations of AlcoholUse–associated Disorders and Diseases. Venkatesh et al. RadioGraphics 2025; 45(7):e240189.
Wernicke-Korsakoff Syndrome, linked to alcohol abuse and malnutrition, presents neurological and oral health risks. Dental hygienists can play a role in recognition and intervention. Robyn Lynn Hack, RDH Read by Jackie Sanders https://www.rdhmag.com/patient-care/article/55317603/what-is-wernicke-korsakoff-syndrome-and-its-oral-manifestations
Today's episode is all about Autism and its associated communication disorders, as outlined in the DSM-5-TR, focusing on social communication disorder (SCD), childhood onset fluency disorder (stuttering), speech sound disorder, and developmental language disorder (DLD), which affect 50-70%, 4-22%, 20-30%, and up to 50% of Autistic individuals, respectively. We explore neural underpinnings, highlighting hypoactivation in brain regions and brain waves are discussed that are critical for social cognition, alongside disrupted connectivity in networks like the arcuate and superior longitudinal fasciculi. Two genes- FOXP2 and CNTNAP2 are also discussed.Other relevant episodes:Decoding the Brain: How Reading works in Autism and Dyslexia https://youtu.be/s1-7HZchy84?si=-r9foWP8Gmw-Wsx2Autism and Speech & Language https://youtu.be/jhAA-UWduKg?si=TfVWi9AfbFZgv8XVAutism and Sensory Processing part 2 https://youtu.be/iWy9Rligzic?si=2LATDK0bPl6jjat9Daylight Computer Companyuse "autism" for $50 off athttps://buy.daylightcomputer.com/autismChroma Light Devicesuse "autism" for 10% discount athttps://getchroma.co/?ref=autismCognity AI for Autistic Social Skillsuse "autism" for 10% discount athttps://thecognity.com00:00 - Introduction to Autism and Communication Disorders; DSM-5-TR, social communication, pragmatic deficits, stuttering, speech sound disorder, developmental language disorder04:02 - Brain Regions and Social Cognition; medial prefrontal cortex, temporal parietal junction, superior temporal sulcus, "theory of mind", hypoactivation06:01 - Autistic Phenotype and Neural Connectivity; Mirror neurons, sensory processing, under-connectivity, arcuate fasciculus, superior longitudinal fasciculus11:38 - Brainwave Patterns and Measurement Techniques; EEG, MEG, gamma band, alpha band suppression, fMRI, DTI & Factional Anisotropy16:27 - Genetic Contributions to Communication; FOXP2, CNTNAP2, neural circuits, synaptic plasticity, language processing19:56 - Social Communication Disorder (SCD); Overview pragmatic language, non-verbal cues, autism differentiation24:45 - Childhood Onset Fluency Disorder (Stuttering); basal ganglia, motor planning, rTMS, dopamine signaling, Go-Stop, Go-Stop, Go-Stop...30:05 - Speech Sound Disorder Speech; Broca's area, superior temporal gyrus, articulation errors, PROMPT therapy35:25 - Developmental Language Disorder (DLD); Broca's area, Wernicke's area, language comprehension, early intervention40:56 - Importance of Early Intervention; speech therapy, neural connectivity, personalized interventions, neurofeedback.X: https://x.com/rps47586YT: https://www.youtube.com/channel/UCGxEzLKXkjppo3nqmpXpzuAemail: info.fromthespectrum@gmail.com
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.
Have you ever had a word on the tip of your tongue? Imagine that feeling magnified, a constant state of being. That is the reality for millions living with aphasia. In this episode of English Plus, we journey into one of the most fascinating and misunderstood topics in human psychology: aphasia and language deficits. We're asking the burning questions: What is aphasia and what happens in the brain to cause it? What's the startling difference between Broca's (expressive) and Wernicke's (receptive) aphasia? What is the profound psychological toll on a person's identity and relationships? How does the brain's amazing ability for neuroplasticity offer hope for recovery? Beyond the science, we'll also focus on elevating your English. We'll break down 10 advanced vocabulary words and phrases like "neuroplasticity," "inextricably linked," and "cognitive dissonance" so you can use them with confidence. Plus, stick around for a practical speaking lesson on "scaffolding" to make you a more resilient and fluid communicator. This isn't just a lesson; it's an exploration of identity, connection, and the incredible power of the human spirit. To unlock full access to all our episodes, consider becoming a premium subscriber on Apple Podcasts or Patreon. And don't forget to visit englishpluspodcast.com for even more content, including articles, in-depth studies, and our brand-new audio series and courses now available in our Patreon Shop!
Es gibt ja diese Menschen, mit denen man durch Wälder oder sogar durch die Stadt geht und plötzlich sagen sie: "Oh, ein Buchfink. Toll." oder "hier muss irgendwo ein Fuchs wohnen". Wenn Sie in der Lage sind, eine Meise von einer Amsel und einen Steinpilz von einer Marone unterscheiden zu können: Glückwunsch, immerhin etwas. Aber Hand auf’s Herz: die wenigsten Menschen kennen sich in der Natur noch aus. Dabei ist das Leben mit einer direkten Verbindung zur Natur so viel schöner, selbst und gerade für Städter. Der 1978 in Berlin Pankow zur Welt gekommene Paul Wernicke ist angetreten, um Kindern und Erwachsenen genau das zu vermitteln. Der Wildnispädagoge ist selbst Vater von sechs Kindern und er kennt sich aus mit den Vögeln, den Füchsen und Wölfen, Käfern und Schlangen, den Bäumen und Pflanzen. Und noch schafft er es, Tiktok-Besessenheit und Online-Overkills durch echte Abenteuer zu ersetzen. Wie sowas gelingen kann und überhaupt, wie sein Leben bislang so verlief, das erzählt Paul Wernicke in der Hörbar Rust. Playlist: Sergej Prokoview - Peter und der Wolf (Erzähler: Elmar Gunsch) Motiv von der Ente & dem kleinen Vogel Die Ärzte - Zu spät Bob Marley - Redemption Song George Jones - Just one more Shaban & Käpt’n Peng - Werbistich Snotty Nose Rez Kids - Clash of the Clans Ben E. King - Stand by me Cosmo Sheldrake - Cuckoo Song Diese Podcast-Episode steht unter der Creative Commons Lizenz CC BY-NC-ND 4.0.
Es gibt ja diese Menschen, mit denen man durch Wälder oder sogar durch die Stadt geht und plötzlich sagen sie: "Oh, ein Buchfink. Toll." oder "hier muss irgendwo ein Fuchs wohnen". Wenn Sie in der Lage sind, eine Meise von einer Amsel und einen Steinpilz von einer Marone unterscheiden zu können: Glückwunsch, immerhin etwas. Aber Hand auf’s Herz: die wenigsten Menschen kennen sich in der Natur noch aus. Dabei ist das Leben mit einer direkten Verbindung zur Natur so viel schöner, selbst und gerade für Städter. Der 1978 in Berlin Pankow zur Welt gekommene Paul Wernicke ist angetreten, um Kindern und Erwachsenen genau das zu vermitteln. Der Wildnispädagoge ist selbst Vater von sechs Kindern und er kennt sich aus mit den Vögeln, den Füchsen und Wölfen, Käfern und Schlangen, den Bäumen und Pflanzen. Und noch schafft er es, Tiktok-Besessenheit und Online-Overkills durch echte Abenteuer zu ersetzen. Wie sowas gelingen kann und überhaupt, wie sein Leben bislang so verlief, das erzählt Paul Wernicke in der Hörbar Rust. Playlist: Sergej Prokoview - Peter und der Wolf (Erzähler: Elmar Gunsch) Motiv von der Ente & dem kleinen Vogel Die Ärzte - Zu spät Bob Marley - Redemption Song George Jones - Just one more Shaban & Käpt’n Peng - Werbistich Snotty Nose Rez Kids - Clash of the Clans Ben E. King - Stand by me Cosmo Sheldrake - Cuckoo Song Diese Podcast-Episode steht unter der Creative Commons Lizenz CC BY-NC-ND 4.0.
L'histoire de cet adolescent néerlandais de 17 ans qui s'est réveillé d'une anesthésie en parlant uniquement anglais — incapable de comprendre sa langue maternelle — relève d'un phénomène neurologique rare, souvent appelé syndrome de la langue étrangère (Foreign Language Syndrome), à ne pas confondre avec le syndrome de l'accent étranger (Foreign Accent Syndrome). Voici comment une intervention chirurgicale pourrait provoquer une telle transformation linguistique.1. Un phénomène neurologique extrêmement rareLe syndrome de la langue étrangère survient parfois après des traumatismes cérébraux, des AVC, des crises d'épilepsie, ou — plus rarement — des anesthésies générales. Le cerveau, à la suite d'un déséquilibre chimique ou d'une micro-lésion temporaire, semble réorganiser l'accès aux structures du langage, favorisant une langue étrangère apprise mais jusque-là secondaire. Dans le cas du jeune néerlandais, il avait étudié l'anglais à l'école, ce qui laisse penser que la mémoire de cette langue s'est temporairement imposée sur celle du néerlandais.2. Les zones cérébrales impliquéesLe langage est principalement traité dans deux régions du cerveau :• L'aire de Broca (production du langage) dans le lobe frontal gauche.• L'aire de Wernicke (compréhension du langage) dans le lobe temporal gauche.Lors d'une anesthésie, certains déséquilibres métaboliques, une hypoperfusion temporaire (baisse de l'oxygénation dans des zones précises), ou même de minuscules lésions invisibles à l'IRM peuvent désorganiser ces zones ou leurs connexions. Résultat : la langue maternelle devient inaccessible, alors que la langue étrangère — stockée dans des circuits partiellement distincts — reste activée.3. Une forme de plasticité cérébrale inversée ?Ce phénomène pourrait être vu comme une démonstration extrême de la plasticité cérébrale. Le cerveau, confronté à une contrainte (traumatisme, anesthésie, inflammation), tente de recréer un schéma linguistique cohérent avec ce qu'il peut encore mobiliser. Il se "rabat" alors sur une langue étrangère, souvent mieux structurée scolairement, avec des règles syntaxiques plus rigides, parfois plus faciles à reconstruire que la langue maternelle parlée plus intuitivement.4. Récupération et temporalitéDans la majorité des cas documentés, les effets sont transitoires. Le néerlandais du patient est généralement revenu progressivement, parfois en quelques heures ou quelques jours. Le phénomène semble davantage lié à un "réglage" temporaire des connexions neuronales qu'à un effacement profond de la mémoire linguistique.5. Une construction partiellement psychosomatique ?Certains neurologues considèrent que ce syndrome peut avoir une composante psychogène. Un choc émotionnel lié à l'intervention, à l'anesthésie ou à l'environnement médical peut désinhiber certaines fonctions, provoquant un accès anormal à une langue apprise. C'est pourquoi ce syndrome est parfois observé chez des polyglottes ou dans des contextes de stress extrême.En résumé, une intervention chirurgicale peut, dans des circonstances rares mais réelles, désorganiser temporairement les circuits cérébraux du langage, faisant "ressortir" une langue étrangère apprise, au détriment de la langue maternelle. Ce phénomène étonnant reste peu compris, mais fascine les neuroscientifiques pour ce qu'il révèle sur les mystères de la mémoire linguistique et la souplesse du cerveau humain. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.
Lyssa Rome is a speech-language pathologist in the San Francisco Bay Area. She is on staff at the Aphasia Center of California, where she facilitates groups for people with aphasia and their care partners. She owns an LPAA-focused private practice and specializes in working with people with aphasia, dysarthria, and other neurogenic conditions. She has worked in acute hospital, skilled nursing, and continuum of care settings. Prior to becoming an SLP, Lyssa was a public radio journalist, editor, and podcast producer. In this episode, Lyssa Rome interviews Dr. Suma Devanga about collaborative referencing, gesture, and building rich communicative environments for people with aphasia. Guest info Dr. Suma Devanga is an assistant professor in the Department of Communication Disorders and Sciences at Rush University Medical Center, Chicago, where she also serves as the director of the Aphasia Research Lab. She completed her PhD in Speech and Hearing science from the University of Illinois. Urbana Champaign in 2017. Dr. Devanga is interested in studying aphasia interventions and their impacts on people's everyday communication. Her recent work includes investigating a novel treatment called the Collaborative Referencing Intervention for Individuals with aphasia, using discourse analysis methods and patient reported outcome measures, studying group-based treatments for aphasia, and studying the use of gestures in aphasia. Additionally, she is involved in teaching courses on aphasia and cognitive communication disorders to graduate SLP students at Rush. She also provides direct patient care and graduate clinical supervision at Rush outpatient clinics. Listener Take-aways In today's episode you will: Understand the role of collaborative referencing in everyday communication. Learn about Collaborative Referencing Intervention. Describe how speech-language pathologists can create rich communicative environments. Edited transcript Lyssa Rome Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Lyssa Rome. I'm a speech language pathologist on staff at the Aphasia Center of California, and I see clients with aphasia and other neurogenic communication disorders in my LPAA-focused private practice. I'm also a member of the Aphasia Access podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Suma Devanga, who is selected as a 2024 Tavistock Trust for Aphasia Distinguished Scholar, USA and Canada. In this episode, we'll be discussing Dr. Devanga's research on collaborative referencing, gesture, and building rich communicative environments for people with aphasia. Suma Devanga is an assistant professor in the Department of Communication Disorders and Sciences at Rush University Medical Center, Chicago, where she also serves as the director of the Aphasia Research Lab. She completed her PhD in Speech and Hearing science from the University of Illinois. Urbana Champaign in 2017. Dr. Devanga is interested in studying aphasia interventions and their impacts on people's everyday communication. Her recent work includes investigating a novel treatment called the Collaborative Referencing Intervention for Individuals with aphasia, using discourse analysis methods and patient reported outcome measures, studying group-based treatments for aphasia, and studying the use of gestures in aphasia. Additionally, she is involved in teaching courses on aphasia and cognitive communication disorders to graduate SLP students at Rush. She also provides direct patient care and graduate clinical supervision at Rush outpatient clinics. Suma Devanga, thank you so much for joining us today. I'm really happy to be talking with you. Suma Devanga Thank you, Lyssa, thank you for having me. And I would also like to thank Aphasia Access for this wonderful opportunity, and the Tavistock Trust for Aphasia and the Duchess of Bedford for recognizing my research through the Distinguished Scholar Award. Lyssa Rome So I wanted to start by asking you how you became interested in aphasia treatment. Suma Devanga I became interested in aphasia during my undergraduate and graduate programs, which was in speech language pathology in Mysore in India. I was really drawn to this population because of how severe the consequences were for these individuals and their families after the onset of aphasia. So I met hundreds of patients and families with aphasia who were really devastated by this sudden condition, and they were typically left with no job and little means to communicate with family and friends. So as a student clinician, I was very, very motivated to help these individuals in therapy, but when I started implementing the treatment methods that I had learned, what I discovered was that my patients were showing improvements on the tasks that we worked on in therapy. Their scores on clinical tasks also were improving, but none of that really mattered to them. What they really wanted was to be able to easily communicate with family, but they continued to struggle on that, and none of the cutting-edge treatment methods that I learned from this highly reputable program in India were impacting my patients' lives. So I really felt lost, and that is when I knew that I wanted to do a PhD and study this topic more closely, and I was drawn to Dr. Julie Hengst's work, which looked at the bigger picture in aphasia. She used novel theoretical frameworks and used discourse analysis methods for tracking patient performance, as opposed to clinical tests. So I applied to the University of Illinois PhD program, and I'm so glad that she took me on as her doctoral student. And so that is how I ended up moving from India to the US and started my work in aphasia. Lyssa Rome I think that a lot of us can probably relate to what you're describing—that just that feeling of frustration when a patient might improve on some sort of clinical tasks, but still says this is not helping me in my life, and I know that for me, and I think for others, that is what has drawn us to the LPAA. I wanted to sort of dive into your research by asking you a little bit more about rich communicative environments, and what you mean by that, and what you mean when you talk about or write about distributed communication frameworks. Suma Devanga So since I started my PhD, I have been interested in understanding how we can positively impact everyday communication for our patients with aphasia. As a doctoral student, I delved more deeply into the aphasia literature and realized that what I observed clinically with my patients in India was consistent with what was documented in the literature, and that was called the clinical-functional gap. And this really refers to the fact that we have many evidence-based aphasia treatments that do show improvements on clinical tasks or standardized tests, but there is very limited evidence on these treatments improving the functional use of language or the everyday communication, and this remains to be true even today. So I think it becomes pretty important to understand what we are dealing with, like what is everyday communication? And I think many aphasia treatments have been studying everyday communication or conversational interactions by decontextualizing them or reducing them into component parts, like single words or phrases, and then we work our way up to sentence structures. Right? So this approach has been criticized by some researchers like Clark, who is an experimental psychologist, and he called such tasks as in vacuo, meaning that they are not really capturing the complexity of conversational interactions. So basically, even though we are clinicians, our ultimate goal is improving everyday communication, which is rich and emergent and complex, we somehow seem to be using tasks that are simplified and that removes all of these complexities and focuses more on simple or specific linguistic structures. So to understand the complexities of everyday communication, we have shifted to the distributed communication framework, which really originates from the cultural historical activity theories and theories from linguistic anthropology. Dr. Julie Hengst actually proposed the distributed communication theory in her article in the Journal of Communication Disorders in 2015, which highlights that communication is not just an individual skill or a discrete concept, but it is rather distributed. And it is distributed in three ways: One is that it is distributed across various resources. We communicate using multiple resources, not just language. We sign, we use gestures, or facial expressions. We also interpret messages using such resources like dialects and eye gaze and posture, the social context, cultural backgrounds, the emotional states that we are in, and all of that matters. And we all know this, right? This is not new, and yet, we often give credit to language alone for communication, when in reality, we constantly use multiple resources. And the other key concept of distributed communication theory is that communication is embedded in socio- cultural activities. So depending on the activity, which can be a routine family dinnertime conversation or managing relationships with your co workers, the communicative resources that you use, their motives, and the way you would organize it, all of that would vary. And finally, communication is distributed across time. And by that we mean that people interpret and understand present interactions through the histories that they have experienced over time. For example, if you're at work and your manager says you might want to double check your reports before submitting them based on prior interactions with the manager and the histories you've shared with them, you could interpret that message either as a simple suggestion or that there is a lack of trust in your work. So all in all, communication, I think, is a joint activity, and I think we should view it as a joint activity, and it depends on people's ability to build common ground with one another and draw from that common ground to interpret each other's messages. Lyssa Rome I feel like that framework is really helpful, and it makes a lot of sense, especially as a way of thinking about the complexity of language and the complexity of what we're trying to do when we are taking a more top-down approach. So that's the distributed communication theory. And it sounds like the other framework that has really guided your research is rich communicative environments. And I'm wondering if you could say a little bit more about that. Suma Devanga Absolutely. So this work originates from about 80 years of research in neuroscience, where rodents and other animals with acquired brain injuries showed greater neuroplastic changes and improved functions when they were housed in complex environments. In fact, complex environments are considered to be the most well replicated approach to improve function in animal models of acquired brain injury. So Dr. Julie Hengst, Dr. Melissa Duff, and Dr. Theresa Jones translated these findings to support communication for humans with acquired brain injuries. And they called it the rich communicative environments. The main goal of this is to enrich the clinical environments. And how we achieve that is by ensuring that there is meaningful complexity in our clinical environments, and that you do that by ensuring that our patients, families, and clinicians use multimodal resources, and also to aim for having multiple communication partners within your sessions who can fluidly shift between various communicative roles, and to not just stay in that clinician role, for example. Another way to think about enriching clinical environments is to think about ensuring that there is voluntary engagement from our patients, and you do that by essentially designing personally meaningful activities, rather than focusing on rehearsing fixed linguistic form or having some predetermined goals. And the other piece of the enrichment is, how do we ensure there is a positive experiential quality for our patients within our sessions. And for this rather than using clinician-controlled activities with rigid interactional roles, providing opportunities for the patients to share stories and humor would really, you know, ensure that they are also engaging with the tasks with you and having some fun. So all of this put together would lead to a rich communicative environment. Lyssa Rome It sounds like what you're describing is the kind of speech therapy environment and relationship that is very much person-centered and focused on natural communication, or natural communicative contexts and the kinds of conversations that people have in their everyday lives, rather than more sort of strict speech therapy protocol that might have been more traditional. I also want to ask you to describe collaborative referencing and collaborative referencing intervention. Suma Devanga Yes, absolutely. So traditionally, our discipline has viewed word-finding or naming as a neurolinguistic process where you access semantic meanings from a lexicon, which you use to generate verbal references. And that theoretical account conceptualizes referencing as an isolated process, where one individual has the skill of retrieving target references from their stores of linguistic forms and meanings, right? So in contrast to that, the distributed communication perspective views referencing as a process where speakers' meanings are constructed within each interaction, and that is based on the shared histories of experiences with specific communication partners and also depending on the social and physical contexts of the interaction as well. Now this process of collaborative referencing is something that we all do every single day. It is not just a part of our everyday communication, but without collaborative referencing, you cannot really have a conversation with anyone. You need to have some alignment, some common ground for communicating with others. This is a fundamental feature of human communication, and this is not new. You know, there is lots of work being done on this, even in childhood language literature as well. Collaborative referencing was formally studied by Clark, who is the experimental psychologist. And he studied this in healthy college students, and he used a barrier task experiment for it. So a pair of students sat across from each other with a full barrier that separated them so they could not see each other at all, and each student had a board that was numbered one through 12, and they were given matching sets of 12 pictures of abstract shapes called tangrams. One participant was assigned as the director, who arranged the cards on their playing board and described their locations to the other, who served as the matcher and matched the pictures to their locations on their own board. So the pair completed six trials with alternating turns, and they use the same cards with new locations for each trial. And what they found was that the pairs had to really collaborate with each other to get those descriptions correct so that they are placed correctly on the boards. So in the initial trials, the pairs had multiple turns of back and forth trying to describe these abstract shapes. For example, one of the pictures was initially described as “This picture that looks like an angel or something with its arms wide open.” And there had to be several clarifying questions from the partner, and then eventually, after playing with this picture several times, the player just had to say “It's the angel,” and the partner would be able to know which picture that was so as the pairs built their common ground, the collaborative effort, or the time taken to complete each trial, and the number of words they used and the number of turns they took to communicate about those pictures declined over time, and the labels itself, or the descriptions of pictures, also became more streamlined as the as time went by. So Hengst and colleagues wanted to study this experiment in aphasia, TBI, amnesia, and Alzheimer's disease as well. So they adapted this task to better serve this population and also to align with the distributed communication framework. And surprisingly, they found consistent results that despite aphasia or other neurological conditions, people were still able to successfully reference, decrease collaborative effort over time and even streamline their references. But more surprisingly, people were engaged with one another. They were having really rich conversations about these pictures. They were sharing jokes, and really seemed to be enjoying the task itself. So Hengst and colleagues realized that this has a lot of potential, and they redesigned the barrier task experiment as a clinical treatment using the principles of the distributed communication framework and the rich communicative environment. So that redesign included replacing the full barrier with a partial barrier to allow multimodal communication, and using personal photos of the patients instead of the abstract shapes to make it more engaging for the patients, and also asking participants to treat this as a friendly game and to have fun. So that is the referencing itself and the research on collaborative referencing, and that is how it was adapted as a treatment as well. And in order to help clinicians easily implement this treatment, I have used the RTSS framework, which is the rehabilitation treatment specification system, to explain how CRI works and how it can be implemented. And this is actually published, and it just came out in the most recent issue in the American Journal of Speech Language Pathology, which I'm happy to share. Lyssa Rome And we'll put that link into the show notes. Suma Devanga Perfect. So CRI is designed around meaningful activities like the game that authentically provides repeated opportunities for the client and the clinician to engage in the collaborative referencing process around targets that they really want to be talking about, things that are relevant to patients, everyday communication goals, it could be things, objects of interest, and not really specific words or referencing forms. So the implementation of the CRI involves three key ingredients. One is jointly developing the referencing targets and compiling the images so clinicians would sit down with the patients and the families to identify at least 30 targets that are meaningful and important to be included in the treatment. And we need two perspectives, or two views, or two pictures related to the same target that needs to be included in the treatment. So we will have 60 pictures overall. An example is two pictures from their wedding might be an important target for patients to be able to talk about. Two pictures from a Christmas party, you know, things like that. So this process of compilation of photos is also a part of the treatment itself, because it gives the patients an opportunity to engage with the targets. The second ingredient is engaging in the friendly gameplay itself. And the key really here is the gameplay and to treat it as a gameplay. And this includes 15 sessions with six trials in each session, where you, as the clinician and the client will both have matching sets of 12 pictures, and there is a low barrier in between, so you cannot see each other's boards, but you can still see the other person. So you will both take turns being the director and the matcher six times, and describe and match the pictures to their locations, and that is just the game. The only rule of the game is that you cannot look over the barrier. You are encouraged to talk as much as you like about the pictures. In fact, you are encouraged to talk a lot about the pictures and communicate in any way. The third ingredient is discussing and reflecting on referencing. And this happens at the end of each session where patients are asked to think back and reflect and say what the agreed upon label was for each card. And this, again, gives one more opportunity for the patients to engage with the target. The therapeutic mechanism, or the mechanism of action, as RTSS likes to call it, is the rich communicative environment itself, you know, and how complex the task is, and how meaningful and engaging the task has to be, as well as the repeated engagement in the gameplay, because we are doing this six times in each session, and we are repeatedly engaging with those targets when describing them and placing them. So what we are really targeting with CRI is collaborative referencing and again, this does not refer to the patient's abilities to access or retrieve those words from their stores. Instead, we are targeting people's joint efforts in communicating about these targets, their efforts in building situated common ground. That's what we are targeting. We are targeting their alignment with one another, and so that is how we define referencing. And again, we are targeting this, because that is how you communicate every day. Lyssa Rome That sounds like a really fascinating and very rich intervention. And I'm wondering if you can tell us a little bit about the research that you've done on it so far. Suma Devanga Absolutely. So in terms of research on CRI thus far, we have completed phase one with small case studies that were all successful, and my PhD dissertation was the first phase two study, where we introduced an experimental control by using a multiple-probe, single-case experimental design on four people with aphasia, and we found significant results on naming. And since then, I have completed two replication studies in a total of nine participants with aphasia. And we have found consistent results on naming. In terms of impact on everyday interactions, we have found decreased trouble sources, or communicative breakdowns, you can call it, and also decreased repairs, both of which indicated improved communicative success within conversational interactions. So we are positive, and we plan to continue this research to study its efficacy within a clinical trial. Lyssa Rome That's very encouraging. So how can clinicians target collaborative referencing by creating a rich communicative environment? Suma Devanga Yeah, well, CRI is one approach that clinicians can use, and I'm happy to share the evidence we have this far, and there is more to come, hopefully soon, including some clinical implementation studies that clinicians can use. But there are many other ways of creating rich communicative environments and targeting referencing within clinical sessions. I think many skilled clinicians are already doing it in the form of relationship building, by listening closely to their patients, engaging with them in authentic conversations, and also during education and counseling sessions as well. In addition to that, I think group treatment for aphasia is another great opportunity for targeting collaborative referencing within a rich communicative environment. When I was a faculty at Western Michigan University, I was involved in their outpatient aphasia program, where they have aphasia groups, and patients got to select which groups they want to participate in. They had a cooking group, a music group, a technology group, and so on. And I'm guessing you do this too at the Aphasia Center of California. So these groups definitely create rich communicative environments, and people collaborate with each other and do a lot of referencing as well. So I think there is a lot that can be done if you understand the rich communicative environment piece. Lyssa Rome Absolutely. That really rings true to me. So often in these podcast interviews, we ask people about aha moments, and I'm wondering if you have one that you wanted to share with us. Suma Devanga Sure. So you know how I said that getting the pictures for the CRI is a joint activity? Patients typically select things that they really want to talk about, like their kids' graduation pictures, or things that they are really passionate about, like pictures of their sports cars, or vegetable gardens, and so on. And they also come up with really unique names for them as well, while they are playing with those pictures during the treatment. And when we start playing the game, clinicians usually have little knowledge about these images, because they're all really personal to the patients, and they're taken from their personal lives, so they end up being the novices, while the patients become the experts. And my patients have taught me so much about constructing a house and all about engines of cars and things like that that I had no knowledge about. But in one incident, when I was the clinician paired with an individual with anomic aphasia, there was a picture of a building that she could not recognize, and hence she could not tell me much at all. And we went back and forth several times, and we finally ended up calling it the “unknown building.” Later, I checked my notes and realized that it was where she worked, and it was probably a different angle, perhaps, which is why she could not recognize it. But even with that new information, we continue to call it the “unknown building,” because it became sort of an internal joke for us. And later I kept thinking if I had made a mistake and if we should have accurately labeled it. That is when it clicked for me that CRI is not about producing accurate labels, it is about building a common ground with each other, which would help you successfully communicate with that person. So you're targeting the process of referencing and not the reference itself, because you want your patients to get better at the process of referencing in their everyday communication. And so that was my aha moment. Lyssa Rome Yeah, that's an amazing story, because I think that that gets to that question sort of of the why behind what we're doing, right? Is it to say the specific name? I mean, obviously for some people, yes, sometimes it is. But what is underlying that? It's to be able to communicate about the things that are important to people. I also wanted to ask you about another area that you've studied, which is the use of gesture within aphasia interventions. Can you tell us a little bit more about that? Suma Devanga Yes. So this work started with my collaboration with my friend and colleague, Dr. Mili Mathew, who is at Molloy University in New York, and our first work was on examining the role of hand gestures in collaborative referencing in a participant who had severe Wernicke's aphasia, and he frequently used extensive gestures to communicate. So when he started with CRI his descriptions of the images were truly multimodal. For example, when he had to describe a picture of a family vacation in Cancun, he was, you know, he was verbose, and there was very little meaningful content that was relevant in his spoken language utterances. But he used a variety of iconic hand gestures that were very meaningful and helpful to identify what he was referring to. As the sessions went on with him, his gestural references also became streamlined, just like the verbal references do, and that we saw in other studies. And that was fascinating because it indicated that gestures do play a big role in the meaning-making process of referencing. And in another study on the same participant, we explored the use of hand gestures as treatment outcome measures. This time, we specifically analyzed gestures used within conversations at baseline treatment, probe, and maintenance phases of the study. And we found that the frequency of referential gestures, which are gestures that add meaning, that have some kind of iconics associated with them, those frequencies of gestures decreased with the onset of treatment, whereas the correct information units, or CIUS, which indicate the informativeness in the spoken language itself, increased. So this pattern of decrease in hand gestures and increase in CIUS was also a great finding. Even though this was just an exploratory study, it indicates that gestures may be included as outcome measures, in addition to verbal measures, which we usually tend to rely more on. And we have a few more studies coming up that are looking at the synchrony of gestures with spoken language in aphasia, but I think we still have a lot more to learn about gestures in aphasia. Lyssa Rome It seems like there that studying gestures really ties in to CRI and the rich communicative environments that you were describing earlier, where the goal is not just to verbally name one thing, but rather to get your point across, where, obviously, gesture is also quite useful. So I look forward to reading more of your research on that as it comes out. Tell us about what you're currently working on, what's coming next. Suma Devanga Currently, I am wrapping up my clinical research grant from the ASH Foundation, which was a replication study of the phase two CRI so we collected data from six participants with chronic aphasia using a multiple-probe, single-case design, and that showed positive results on naming, and there was improved scores on patient reports of communication confidence, communicative participation, and quality of life as well. We are currently analyzing the conversation samples to study the treatment effects. I also just submitted a grant proposal to extend the study on participants with different severities of aphasia as well. So we are getting all the preliminary data at this point that we need to be able to start a clinical trial, which will be my next step. So apart from that, I was also able to redesign the CRI and adapt it as a group-based treatment with three participants with aphasia and one clinician in a group. I actually completed a feasibility study of it, which was successful, and I presented that at ASHA in 2023. And I'm currently writing it up for publication, and I also just secured an internal grant to launch a pilot study of the group CRI to investigate the effects of group CRI on communication and quality of life. Lyssa Rome Well, that's really exciting. And again, I'm really looking forward to reading additional work as it comes out. As we wrap up. What do you want clinicians to take away from your work and to take away from this conversation we've had today? Suma Devanga Well, I would want clinicians to reflect on how their sessions are going and think about how to incorporate the principles of rich communicative environments so that they can add more meaningful complexity to their treatment activities and also ensure that their patients are truly engaging with the tasks and also having some fun. And I would also tell the clinicians that we have strong findings so far on CRI with both fluent and non-fluent aphasia types. So please stay tuned and reach out to me if you have questions or want to share your experiences about implementing this with your own patients, because I would love to hear that. Lyssa Rome Dr. Suma Devanga, it has been great talking to you and hearing about your work. Thank you so much for sharing it with us. Suma Devanga It was fantastic talking about my work. Thank you for giving me this platform to share my work with you all. And thank you, Lyssa for being a great listener. Lyssa Rome Thanks also to our listeners for the references and resources mentioned in today's show. Please see our show notes. They're available on our website, www.aphasiaaccess.org. There, you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of aphasia. Access. For Aphasia Access Conversations. I'm Lyssa Rome. References Devanga, S. R. (2025). Collaborative Referencing Intervention (CRI) in Aphasia: A replication and extension of the Phase II efficacy study. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2024_AJSLP-24-00226 Devanga, S. R., Sherrill, M., & Hengst, J. A. (2021). The efficacy of collaborative referencing intervention in chronic aphasia: A mixed methods study. American Journal of Speech Language Pathology, 30(1S), 407-424. https://doi.org/10.1044/2020_AJSLP-19-00108 Hengst, J. A., Duff, M. C., & Jones, T. A. (2019). Enriching communicative environments: Leveraging advances in neuroplasticity for improving outcomes in neurogenic communication disorders. American Journal of Speech-Language Pathology, 28(1S), 216–229. https://doi.org/10.1044/2018_AJSLP-17-0157 Hengst, J. A. (2015). Distributed communication: Implications of cultural-historical activity theory (CHAT) for communication disorders. Journal of Communication Disorders, 57, 16–28. Https://doi.org/10.1016/j.jcomdis.2015.09.001 Devanga, S. R., & Mathew, M. (2024). Exploring the use of co-speech hand gestures as treatment outcome measures for aphasia. Aphasiology. Advanced online publication. https://doi.org/10.1080/02687038.2024.2356287 Devanga, S. R., Wilgenhof, R., & Mathew, M. (2022). Collaborative referencing using hand gestures in Wernicke's aphasia: Discourse analysis of a case study. Aphasiology, 36(9), 1072-1095. https://doi.org/10.1080/02687038.2021.1937919
Conditions Covered • Wernicke's Encephalopathy • Hepatic Encephalopathy • Toxic & Metabolic Encephalopathy • Uremic Encephalopathy • Hypertensive Encephalopathy ⸻ Encephalopathy = Global brain dysfunction Encephalitis = Brain inflammation ⸻ Wernicke's Encephalopathy Acute, reversible encephalopathy caused by thiamine (B1) deficiency. Key Differentiator: Confusion + Ataxia + Ophthalmoplegia in a malnourished or alcoholic patient. Essentials: • […] The post 129b: Quick Encephalopathy Review for the PANCE appeared first on Physician Assistant Exam Review.
Wernicke's Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Hepatic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Toxic & Metabolic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Uremic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Hypertensive […] The post Episode 129: Encephalopathic Disorders appeared first on Physician Assistant Exam Review.
Gary talks to our friend Mike Wernicke from West Chester Hardwood Flooring
Gary talks to our friend Mike Wernicke from West Chester Hardwood Flooring
In this episode, we discuss the intricate relationship between Autism and speech & language, emphasizing the critical role of neuroscience in understanding these dynamics. The discussion begins by highlighting how speech and language are foundational to human evolution and social interaction, yet pose unique challenges for individuals with Autism. The episode explores the brain's key regions involved in these processes, such as Broca's area, responsible for speech production, and Wernicke's area, crucial for language comprehension. These regions are connected by the arcuate fasciculus, a white matter tract essential for language processing, repetition, and verbal working memory.The podcast also examines how the basal ganglia, particularly the dorsal striatum, contributes to speech fluency and motor sequencing, including the articulation of words. By integrating neuroscience, we gain insight into the biological underpinnings of communication difficulties in Autism, such as delays in language processing and the phenomenon of "choppy" speech, which are linked to less coherent organization within these neural pathways.The episode further unpacks the concept of neuroplasticity and its implications for Autism, emphasizing the brain's ability to adapt through practice and repetition, leading to habits. The discussion also touches on the role of the dorsal medial striatum in goal-directed learning and the dorsal lateral striatum in habit formation, illustrating how these areas influence speech and language acquisition. Additionally, the podcast explores the phenomenon of echolalia, often observed in Autistic individuals, as a potential mechanism for processing delays or as a result of cyclical loops in the basal ganglia.The interplay of neurotransmitters like GABA and glutamate is highlighted, explaining the excitation-inhibition imbalance often seen in Autism, which affects sensory processing and communication. By framing these challenges through the lens of neuroscience, the episode underscores the complexity of social interaction for Autistic individuals and the importance of understanding the brain's predictive and adaptive mechanisms to better support their needs.00:00 - Introduction to Autism and Speech02:02 - The Speaker-Receiver Dynamic in Autism04:02 - Visual Thinking and Processing in Autism06:18 - Neuroscience of Speech and Language08:20 - The Role of the Basal Ganglia in Speech10:39 - Echolalia and Sensory Processing Delays16:53 - Neuroplasticity and Speech Therapy17:22 - Reflexes, Inhibition, and GABA in Speech and Autism20:02 - Basal Ganglia Circuits, Motivation, and Echolalia from getting "stuck"24:03 - Language Acquisition and Rule-Setting in Autism27:47 - Energy, Learning, and Social Challenges30:15 - Contingency-Based Learning and Outcomes31:46 - Reviews/Ratings and Contact infoX: https://x.com/rps47586Hopp: https://www.hopp.bio/fromthespectrumYT: https://www.youtube.com/channel/UCGxEzLKXkjppo3nqmpXpzuAemail: info.fromthespectrum@gmail.com
It's been a minute since we've had a good old fashioned animal artist segment, so we've remedied that! Julia Wernicke was a fantastic Argentine painter and engraver most known for her painting "Los Toritos" or Little Bulls. So, naturally we also thought we'd do a little bull mythology! If you have another animal artist we should cover, please reach out!
Welcome to episode 675 and happy New Year. First, we finally discover the real reason the chicken crossed the road. Then, a girl fascinated with the spiders in her old home invites a friend over after school.COMING UPGood Evening: 00:01:06Frank Oreto's The Other Side as read by Seth Williams: 00:02:42Bree Wernicke's Spider Kiss as read by Sarah Mehra: 00:08:12PERTINENT LINKSSupport us on Patreon! Spread the darkness.Shop Tales to Terrify MerchOriginal Score by Nebulus EntertainmentNebulus on FacebookNebulus on InstagramSPECIAL THANKS TOAmanda CarrilloLestle BaxterOrion D. HegreSupport this show http://supporter.acast.com/talestoterrify. Hosted on Acast. See acast.com/privacy for more information.
According to the World Health Organisation, harmful use of alcohol accounts for 3 million deaths each year. Indeed, it's the third leading cause of preventable death, and causes a large burden for societies across the world. Of course regular alcohol consumption doesn't always kill, but it can lead to other health problems, including neurological disorders. Wernicke-Korsakoff Syndrome is one such example. It's the combination of Wernicke encephalopathy and Korsakoff Syndrome. Both are linked to vitamin B1 deficiency. Alcohol has a direct toxic effect on the brain, which can lead to a lack of certain substances, such as vitamin B1, which is also known as thiamine. What are the symptoms of this syndrome? How does it develop? Are there any forms of treatment? In under 3 minutes, we answer your questions! To listen to more episodes, click here: Are baths or showers better for our health? Can this budgeting method help us save better? Is microwaving food bad for you? A Bababam Originals podcast. Written and produced by Joseph Chance. First Broadcast: 24/1/2023 Learn more about your ad choices. Visit megaphone.fm/adchoices
Using language is a complex business. Let's say you want to understand a sentence. You first need to parse a sequence of sounds—if the sentence is spoken—or images—if it's signed or written. You need to figure out the meanings of the individual words and then you need to put those meanings together to form a bigger whole. Of course, you also need to think about the larger context—the conversation, the person you're talking to, the kind of situation you're in. So how does the brain do all of this? Is there just one neural system that deals with language or several? Do different parts of the brain care about different aspects of language? And, more basically: What scientific tools and techniques should we be using to try to figure this all out? My guest today is Dr. Ev Fedorenko. Ev is a cognitive neuroscientist at MIT, where she and her research group study how the brains supports language and complex thought. Ev and her colleagues recently wrote a detailed overview of their work on the language network—the specialized system in our brain that underlies our ability to use language. This network has some features you might have expected, and—as we'll see—other features you probably didn't. Here, Ev and I talk about the history of our effort to understand the neurobiology of language. We lay out the current understanding of the language network, and its relationship to the brain areas historically associated with language abilities—especially Broca's area and Wernicke's area. We talk about whether the language network can be partitioned according to the subfields of linguistics, such as syntax and semantics. We discuss the power and limitations of fMRI, and the advantages of the single-subject analyses that Ev and her lab primarily use. We consider how the language network interfaces with other major neural networks—for instance, the theory of mind network and the so-called default network. And we discuss what this all tells us about the longstanding controversial claim that language is primarily for thinking rather than communicating. Along the way, Ev and I touch on: some especially interesting brains; plasticity and redundancy; the puzzle of lateralization; polyglots; aphasia; the localizer method; the decline of certain Chomskyan perspectives; the idea that brain networks are "natural kinds"; the heart of the language network; and the question of what the brain may tell us—if anything—about how language evolved. Alright friends, this is a fun one. On to my conversation with Dr. Ev Fedorenko. Enjoy! A transcript of this episode will be available soon. Notes and links 3:00 – The article by a New York Times reporter who is missing a portion of her temporal lobe. The website for the Interesting Brains project. 5:30 – A recent paper from Dr. Fedorenko's lab on the brains of three siblings, two of whom were missing portions of their brains. 13:00 – Broca's original 1861 report. 18:00 – Many of Noam Chomsky's ideas about the innateness of language and the centrality of syntax are covered in his book Language and Mind, among other publications. 19:30 – For an influential critique of the tradition of localizing functions in the brain, see William R. Uttal's The New Phrenology. 23:00 – The new review paper by Dr. Fedorenko and colleagues on the language network. 26:00 – For more discussion of the different formats or modalities of language, see our earlier episode with Dr. Neil Cohn. 30:00 – A classic paper by Herbert Simon on the “architecture of complexity.” 31:00 – For one example of a naturalistic, “task-free” study that reveals the brain's language network, see here. 33:30 – See the recent paper arguing “against cortical reorganization.” 33:00 – For more on the concept of “natural kind” in philosophy, see here. 38:00 – On the “multiple-demand network,” see a recent study by Dr. Fedorenko and colleagues. 41:00 – For a study from Dr. Fedorenko's lab finding that syntax and semantics are distributed throughout the language network, see here. For an example of work in linguistics that does not make a tidy distinction between syntax and semantics, see here. 53:30 – See Dr. Fedorenko's recent article on the history of individual-subject analyses in neuroscience. 1:01:00 – For an in-depth treatment of one localizer used in Dr. Fedorenko's research, see here. 1:03:30 – A paper by Dr. Stephen Wilson and colleagues, describing recovery of language ability following stroke as a function of the location of the lesion within the language network. 1:04:20 – A paper from Dr. Fedorenko's lab on the small language networks of polyglots. 1:09:00 – For more on the Visual Word Form Area (or VWFA), see here. For discussion of Exner's Area, see here. 1:14:30 – For a discussion of the brain's so-called default network, see here. 1:17:00 – See here for Dr. Fedorenko and colleagues' recent paper on the function of language. For more on the question of what language is for, see our earlier episode with Dr. Nick Enfield. 1:19:00 – A paper by Dr. Fedorenko and Dr. Rosemary Varley arguing for intact thinking ability in patients with aphasia. 1:22:00 – A recent paper on individual differences in the experience of inner speech. Recommendations Dr. Ted Gibson's book on syntax (forthcoming with MIT press) Nancy Kanwisher, ‘Functional specificity in the human brain' Many Minds is a project of the Diverse Intelligences Summer Institute, which is made possible by a generous grant from the John Templeton Foundation to Indiana University. The show is hosted and produced by Kensy Cooperrider, with help from Assistant Producer Urte Laukaityte and with creative support from DISI Directors Erica Cartmill and Jacob Foster. Our artwork is by Ben Oldroyd. Our transcripts are created by Sarah Dopierala. Subscribe to Many Minds on Apple, Stitcher, Spotify, Pocket Casts, Google Play, or wherever you listen to podcasts. You can also now subscribe to the Many Minds newsletter here! We welcome your comments, questions, and suggestions. Feel free to email us at: manymindspodcast@gmail.com. For updates about the show, visit our website or follow us on Twitter (@ManyMindsPod) or Bluesky (@manymindspod.bsky.social).
In this episode I dive into my list of the top five things I would never do as an ophthalmologist, from using Visine to playing with fireworks. I also explores the critical connection between nutrition and eye health, detailing how vitamin deficiencies like B1 and vitamin A can lead to conditions such as Wernicke's encephalopathy and xerophthalmia. Takeaways: Top 5 Things Ophthalmologists Avoid: Dr. Flannery shares his professional no-nos, including using Visine, playing with fireworks, using bungee cords, sleeping in contact lenses, and delaying cataract surgery, all of which carry significant risks to eye health. The Dangers of Vitamin A Deficiency: A lack of vitamin A can lead to night blindness, xerophthalmia, and corneal scarring, underscoring the importance of a vitamin-rich diet. B Vitamins and Eye Health: Dr. Flannery explains how deficiencies in thiamine (B1) and folate (B9) can cause nutritional optic neuropathy and Wernicke's encephalopathy, both of which may result in vision loss. Humor Meets Eye Safety: True to his style, Dr. Flannery uses humor to explain the dangers of fireworks, bungee cords, and other seemingly harmless activities that can cause serious eye injuries. Preventing Nutritional Eye Disorders: Maintaining a balanced diet with leafy greens, carrots, and other nutrient-rich foods can protect against preventable eye conditions and support overall eye health. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: Anatomy Warehouse Plus for 15% off use code: Glaucomflecken15 Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. To learn more about how DAX Copilot can help improve healthcare experiences for both you and your patients visit aka.ms/knockknockhi. Join 6,000 physicians nationwide who trust physician-founded PearsonRavitz with their insurance needs. Give yourself peace of mind and go to PearsonRavitz to schedule your free one-on-one consultation with a disability insurance expert. That's http://ww.pearsonravitz.com/knockknock to get more information and take the first step toward protecting your income and future. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices
Inside Wirtschaft - Der Podcast mit Manuel Koch | Börse und Wirtschaft im Blick
Die Zukunft des Investierens: Wir sprechen über drei Szenarien - und im Detail über digitale Chancen für Anleger. “Durch die Tokenisierung der Wertpapiere sind z.B. kleine Stückzahlen oder niedrige Volumina darstellbar, weil man das Wertpapier direkt an den Anleger vertreiben kann, was die Kosten senken und damit die Rendite steigern kann. Alles gesetzlich geregelt und überwacht durch die BaFin”, so Daniel Wernicke (Co-CEO NYALA Digital Asset AG). Die Lindner Hotel Group nutzt das für sich und gibt so eine Anleihe mit jährlichen Zinsen von 5,5 Prozent heraus. "Das ist ein Quantensprung. Der digitale Weg ist auch ganz einfach für den Anleger und voll reguliert. Und das Geld nutzen wir, um weiter zu expandieren", so Timo Richter (Positionierung-Professional Lindner Hotel Group). Alle Infos im Interview mit Inside Wirtschaft-Chefredakteur Manuel Koch auf lindnerdigitalinvest.de
TRASCRIZIONE E VOCABOLARIOPuoi sostenere il mio lavoro con una donazione su Patreonhttps://www.patreon.com/italianosiPer €2 al mese riceverai le trascrizioni di tutti i PodcastPer €3 al mese riceverai, oltre alle trascrizioni, anche una lista dei vocaboli più difficili, con spiegazione in italiano e traduzione in inglese.L'ARGOMENTO DELLA PUNTATASesto episodio dedicato al tema dello sviluppo del linguaggio.In questa puntata vi parlerò delle aree del cervello dedite al linguaggio, l'area di Broca e di Wernicke. TRASCRIZIONECiao a tutti e ciao a tutte, bentornati o benvenuti nel podcast di Italiano Sì. Siamo ad ottobre ed è iniziato l'autunno, la mia stagione preferita! È tornato... non posso dire il freddo perché non fa freddo, ma è tornato il fresco. Il tempo è bello, il cielo è blu, il sole splende forte, ma l'aria è fresca. Questo è il mio clima ideale. Ok, ora basta parlare di tempo, direi di iniziare con la puntata di oggi. Ormai sapete già di cosa parleremo, quindi preparatevi e mettetevi comodi. Oggi parleremo di linguaggio e affronteremo un argomento forse un po' più difficile, un po' più tecnico del solito. Quindi, prestate attenzione e, se avete difficoltà e volete seguire un testo mentre ascoltate, magari anche con qualche parola spiegata meglio e tradotta in inglese, visitate la mia pagina Patreon.[...]My YouTube channel Support the show
Le ralentissement de la parole peut être un indicateur utile pour prédire le déclin cognitif. Plusieurs études ont démontré que les changements dans le rythme et la vitesse de la parole peuvent refléter des altérations dans les fonctions cognitives. Citons ici celle men&e en mars 2024 par l'Université de Toronto et qui met clairement en lumière une corrélation intrigante entre la vitesse de la parole et la santé cognitive chez les adultes âgés.Voici comment ce phénomène se manifeste et pourquoi il est pertinent :1. Rythme et vitesse de la parole- Diminution de la vitesse : Un ralentissement notable dans la manière de parler peut indiquer des difficultés cognitives. Les personnes en début de déclin cognitif prennent souvent plus de temps pour formuler leurs pensées et trouver les mots appropriés.- Augmentation des pauses : Les pauses fréquentes et prolongées pendant la parole peuvent signaler des problèmes de mémoire et de traitement de l'information.2. Fluidité verbale- Hésitations et répétitions : Les personnes peuvent hésiter davantage et répéter des mots ou des phrases, ce qui indique des difficultés à accéder rapidement à leur vocabulaire et à structurer leurs pensées.- Réductions des expressions spontanées : La spontanéité de la parole peut diminuer, avec des discours plus laborieux et moins fluides.3. Facteurs neurobiologiques- Dysfonctionnement des aires cérébrales : Les régions du cerveau impliquées dans la production et le contrôle de la parole, comme l'aire de Broca et l'aire de Wernicke, peuvent être affectées par des troubles neurodégénératifs, entraînant un ralentissement de la parole.- Problèmes de mémoire de travail : La mémoire de travail est essentielle pour maintenir et manipuler les informations verbales. Les difficultés dans ce domaine peuvent ralentir la capacité à parler couramment.4. Évaluation clinique- Tests standardisés : Des tests neuropsychologiques peuvent mesurer la vitesse de la parole et d'autres aspects du langage pour évaluer le déclin cognitif.- Enregistrements de la parole : L'analyse d'enregistrements de la parole sur une période donnée peut aider à détecter des tendances de ralentissement.5. Technologie et intelligence artificielle- Outils de traitement du langage naturel : Les technologies basées sur l'IA peuvent analyser les échantillons de parole pour détecter des changements subtils dans la vitesse et le rythme. Ces outils peuvent fournir des évaluations précises et en temps réel des capacités cognitives.- Applications mobiles : Il existe des applications qui peuvent surveiller la parole des utilisateurs et fournir des alertes précoces sur le déclin cognitif.6. Importance de l'approche longitudinale- Suivi continu : Une surveillance continue et à long terme de la parole permet de détecter des changements progressifs, offrant une vue plus complète et précise du déclin cognitif potentiel.ConclusionLe ralentissement de la parole est un indicateur prometteur pour la prédiction du déclin cognitif. Il reflète des modifications sous-jacentes dans les fonctions cérébrales et la mémoire. Cependant, comme pour tout indicateur, il est essentiel de l'utiliser en combinaison avec d'autres méthodes de diagnostic pour obtenir une évaluation complète et fiable de la santé cognitive. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.
In this episode of the NeuroNoodle Podcast,
In this original What the Dementia episode, we will discuss Wernicke-Korsakoff Syndrome, a lesser-known form of dementia that is often underrecognized and underdiagnosed. This episode will cover: — An overview of Wernicke-Korsakoff Syndrome and its symptoms. — The connection between alcoholism, thiamine deficiency, and dementia. — The progression from Wernicke Encephalopathy to Korsakoff Syndrome. — Diagnostic challenges and the importance of timely treatment. — Care needs and support for individuals with this syndrome. REFERENCES: Isenberg-Grzeda E, Kutner HE, Nicolson SE. Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics. 2012;53(6):507-516. doi:10.1016/j.psym.2012.04.008 https://www.alz.org/media/documents/alzheimers-dementia-korsakoff-syndrome-ts.pdf https://www.niaaa.nih.gov/sites/default/files/publications/wernicke-korsakoff.pdf Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol. 2009;44(2):148-154. doi:10.1093/alcalc/agn118 J. Clin. Med. 2022, 11(22), 6755; https://doi.org/10.3390/jcm11226755 CONNECT, GET RESOURCES, LEARN MORE, + SIMPLIFY YOUR CARE JOURNEY: LinkTree | https://www.bambu.care MUSIC CREDIT: Listen To SpillageVillage - Tropical Landing Pop Songs At Looperman.com DISCLAIMER: The information contained in Bambu Care LLC's website, blog, emails, programs, services and/or products is for educational and informational purposes only. While we draw on our prior professional expertise and background in other areas, you acknowledge that we are supporting you in our role exclusively as a Dementia Care Consultant. By participating in Bambu Care, LLC's website, blog, emails, programs, services and/or products, you acknowledge that we are not a licensed psychologist, professional counselor, or medical doctor. We in no way, diagnose, treat, or cure any illnesses or diseases. Dementia Care Consulting is in no way to be construed or substituted as psychological counseling or any other type of therapy or medical advice. The information provided by Bambu Care, LLC also does not constitute legal or financial advice nor is intended to be. Dementia Care Consulting is not a substitute for the services of a CPA or attorney. --- Send in a voice message: https://podcasters.spotify.com/pod/show/whatthedementia/message
SEASON 2 EPISODE 134: COUNTDOWN WITH KEITH OLBERMANN A-Block (1:44) Trump appears to be suffering from a condition called "Fluent Aphasia." Victims can verbalize intricate long sentences, and appear to be answering questions or making coherent observations. But frequently all they have is the structure and the cadence of coherence; the rhythm of speech. They do not fully understand what they are hearing, cannot convey what they are trying to through speech, and are almost invariably the victims of strokes or head injuries. All attempts to explain "Fluent Aphasia" (or by its formal name, "Wernicke's Aphasia,") use the phrase "Word Salad." And after a three-day series of speeches in which, on literally dozens of occasions, he said things that SOUNDED like sentences but were not, the evidence is mounting and the problem is accelerating: the Trump word salad is "Fluent Aphasia" and on top of all of Trump's other mental and ethical problems, it is disqualifying. He cannot be president. His brain literally does not work correctly, MEANWHILE: “Course I'm respectable,” says John Huston as Noah Cross in Chinatown to Jack Nicholson as Jake Gittes in Chinatown. “I'm OLD. Politicians, ugly buildings and whores all get respectable, if they LAST long enough.” And then there's what happens when you're all three of those things - as the Supreme Court and its justices are all three of those things: Politicians pretending to be justices, working in an ugly building, and as Trump relied upon and was proved correct – they're all whores. “Because the Constitution makes Congress rather than the states responsible for enforcing Section 3 against federal office holders and candidates, we reverse,” reads the Court's decision to not enforce the 14th Amendment denying insurrectionists the right to become president or hold other offices. 9-nothing. Except it DOESN'T do that. Section 3, as conservative scholar after conservative scholar has repeatedly stated, is SELF-enforcing. It is automatic. If you engaged in insurrection, you're out. If you think you're being ill-treated, Section 3 provides you an override mechanism: you can get the House AND the Senate to each CLEAR you, each by a two-thirds vote. Period. The constitution says NOTHING about an enforcement responsibility. The Court betrayed democracy yesterday – again: this time by going faster to help Trump. On presidential immunity, it's going SLOWER to help Trump. Its members, including Jackson and Kagan and Sotomayor, who before folding, stood up just long enough to wave BYE BYE to representative government, overruled one of the easiest parts of the constitution to understand for the benefit of one corrupt politician. Individually and as an entity they have proved themselves inept at basic reading comprehension. They have proved themselves to be corrupt and illegitimate. Its usefulness and relevance is at an end, and whatever replaces it, the immediate need is obvious: The Supreme Court must be dissolved. The funny part, of course, is that these idiots have inadvertently given the current sitting president (a Mr. Biden, I believe) a kind of qualified, specific immunity from prosecution in case HE wants to illegally overturn an election. B-Block (25:50) POSTSCRIPTS TO THE NEWS: Another reporter claims Trump is about to pivot and Trump promptly makes her look like an idiot. Trump's new vaccine promise: I'm here to kill your kids. Trump shortens his National Abortion Ban plan. Jack Smith says no, the DOJ 60-Day Secret Unwritten Rule does NOT apply to cases already filed against Trump. And farewell to my old friend Chris Mortensen go ESPN. (33:50) THE WORST PERSONS IN THE WORLD: Jesse Watters says Biden "licking ice cream" is unmanly and implies he has Alzheimer's. That's before they found the post from five years ago of Watters... licking ice cream. The would-be Republican nominee for governor of Missouri is suing because, he claims, he was only an HONORARY member of the KKK, and Kristin Welker allegedly wins after allegedly graduating from Harvard and allegedly being a White House correspondent and saying Trump "allegedly" tried to overturn the election. C-Block (41:30) THINGS I PROMISED NOT TO TELL: My oldest enemy - the one I thought was killed off in the '80s - turns out to be alive and well. My half century battle against "The Auto Train" and its stopped-up toilets of 1972.See omnystudio.com/listener for privacy information.
#neurofeedback #barrysterman #SMR #mu #jaygunkelman #mariswingle #lyndathompson In this enlightening episode, we delve into the remarkable life and legacy of Barry Sterman, a true pioneer in the field of neurofeedback. Through engaging discussions and personal reflections, we explore Sterman's groundbreaking contributions, including his research on Sensory Motor Rhythm (SMR) and its profound impact on neurofeedback practices. We also touch upon the significance of Mew in EEG and how Sterman's work has shaped the evolution of neurofeedback. Join us as we honor the memory of Barry Sterman, examining his scientific rigor, his passion for data-driven research, and the enduring influence he has left on the study of the human brain. This episode is not only a tribute to a legendary figure but also an insightful journey into the heart of neurofeedback, offering valuable perspectives for professionals, students, and enthusiasts alike. Show Notes: 0:000:24 pre show chat Pete Jansons and Dr Mari Swingle Author of I Minds 1:26 Jay Gunkelman Appears the Neurofeedback Tech Legend who has read more than 500,000 brain scans 2:06 Jay Gunkelman Screen Share Barry Sterman passing 2:16 Lynda Thompson https://www.addcentre.com/about-us 4:41 Barry Sterman Paper On SMR (rocket fuel, cats and seizure) 6:04 Mexico Pictures 6:47 Lynda Thompson Barry Sterman Picture 8:08 Udine Italy Pic 10:45 San Diego Zoo Pic 12:36 Dr Mari Swingle thoughts On Barry Sterman 14:03 "Show Me The Data" - Barry Sterman 16:10 Mu/Owl Eye Story 19:32 deeper Dive into Mu Jay Gunkelman 21:45 Wernicke area joke 23:40 seizures 26:50 Santiago Brand "Positive Disassociation" Mu in Athletes in the zone 27:44 Artists and Painters 28:14 Barry Story Christmas Mailman 30:55 Barry data story's 31:06 Anna Weiss Story 33:16 Barry Sterman Photo Montage --- Send in a voice message: https://podcasters.spotify.com/pod/show/neuronoodle/message Support this podcast: https://podcasters.spotify.com/pod/show/neuronoodle/support
Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses the efficacy of mobility programs to produce meaningful, function change in range of motion for patients & athletes. Take a listen to the episode or read the episode transcription below. Article referenced If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? Before we get rolling, I'd love to share a bit about Jane, the practice management software that we love and use here at ICE who are also our show sponsor. Jane knows that collecting new patient info, their consent and signatures can be a time consuming process, but with their automated forms, it does not have to be. With Jane, you can assign intake forms to specific treatments or practitioners, and Jane takes care of sending the correct form out to your patients. Save even more time by requesting a credit card on file through your intake forms with the help of Jane Payments, their integrated PCI compliant payment solution. Conveniently, Jane will actually prompt your patients to fill out their intake form 24 hours before their appointment if they have not done so already. If you're looking to streamline your intake form collection, head over to jane.app slash physical therapy, book a one-on-one demo with a member of the Jane team. They'll be able to show you the features I just mentioned and answer any other questions you may have. Don't forget, if you do sign up, use the code ICEPT1MO for a one month grace period applied to your new account. Thanks everybody, enjoy the show. 01:32 ALAN FREDENDALL Good morning everybody, welcome to the PT on ICE Daily Show. Happy Friday morning, I hope your day is off to a great start. My name is Alan, happy to be your host today. Currently have the pleasure of serving as the Chief Operating Officer here at ICE and lead faculty here in our fitness athlete division. It is Fitness Athlete Friday, we would argue it's the best start day of the week. We talk all things CrossFit, functional fitness, powerlifting, Olympic weightlifting, endurance athletes, runners, bikers, swimmers, everything related to the person who's regulationally active here on Fridays. Before we get started with today's topic, we're going to be tackling mobility. We're going to define mobility versus flexibility. We're going to discuss a recently published paper showing the effects of long term stretching on mobility changes and address concerns related to that paper. Before we get started, let's talk about a couple of announcements. It is the CrossFit Games individual and team competitions began yesterday. Age group and adaptive athletes began Tuesday. We have a day competition all week long. You can catch it on ESPN. You can catch it on YouTube. Our very own Kelly Benfee here from the fitness athlete division will be competing with her team. Plus 64 CrossFit Army end game in the team division. So you can check her out. She had a couple of events yesterday and she's got events every day the rest of the weekend. Speaking of fitness festivals, the I Got Your Six Fitness Festival will be June 21st and 23rd down in Charleston, South Carolina with our friends at Warrior WOD. We had the virtual competition this year, but next year it's going to be in person. So it's a ways away, but look forward to that calendar if you want to come down to Charleston and join us for a weekend of approachable fitness courses coming away from us here in the fitness athlete division. Your next chance to catch our live course will be September 9th and 10th. That will be in Bismarck, North Dakota with Mitch Babcock or the end of September, September 30th and October 1st. You can catch Zach Long out on the West Coast. He'll be in Newark, California. That's in the Bay Area. Our online courses, Clinical Management Fitness Athlete Essential Foundations, our eight week entry level online course begins again September 11th and Fitness Athlete Advanced Concepts, our level two online course begins September 17th. So mobility, let's talk about it. How much can we really move the needle? My goal today is to define mobility as it's often talked about in kind of common terms with athletes in the gym, patients in the clinic when they talk about mobility, defining mobility versus defining flexibility. Talking about a paper that was published a couple of weeks ago, looking at the effects of long term stretching specifically at ankle mobility, which is a joint we're always after to improve the range of motion within and then really how to approach mobility from a practical clinical standpoint. 2:01 EFINING MOBILITY VS. FLEXIBILITY So let's start first with defining mobility versus flexibility because they're often used interchangeably and that's not the correct way to use them. Then when we talk about flexibility, we're talking about the capacity of soft tissues of muscles, tendons, ligaments to be passively stretched, whether me as the therapist stretches you the patient or whether you stretch yourself using your own body, using stretch straps, things like that. The ability to passively stretch muscle tissue at a specific joint. Now mobility is different. Mobility is the ability of a joint to actively move through a range of motion. And of course, we're always chasing a full range of motion. So the ability, for example, of the need to advance across the toes in active closed chain dorsiflexion, the ability of the hip to externally rotate or flex sitting down into a squat, that would be an assessment of mobility, actively moving the joint through the range of motion. And you, the patient or athlete moving yourself through the range of motion, aka how much motion can you actually access? Because we see some folks have a big difference between their flexibility and their mobility. We may be able to passively move their ankle, passively move their leg into a normal or above average range of motion. But when that person stands up, they re-encounter gravity and they try to actively move that joint. We can sometimes see a big difference between mobility and flexibility. And that brings us to a really important point that a lot of what we see in marketing, in programs, in our own home programs for athletes and patients is that we say we're prescribing mobility. But really, what we are giving for the most part is flexibility, that a lot of passive stretching is what is given out, which can improve flexibility. Yes, but may not always result in any sort of functional change in mobility. We see a ton of programs all over social media, especially in the fitness athlete space, that are marketed at improving mobility. But when we actually look at the content of those programs, things like ROMWOD, things like GOWOD, things like whatever WOD, that we actually see a lot of passive stretching, a lot of flexibility. And so it's no wonder that folks come in and have been doing one of these programs for weeks, months, years, and have not seen any sort of beneficial improvements. In their mobility, their ability to actively move joints through a range of motion, because they have not been doing any sort of mobility work, they have been doing a lot of flexibility work. And we know those two things don't always translate. We don't always see a bunch of flexibility work translate into any sort of improvements in actual meaningful functional mobility. 7:32 THE RESEARCH ON STRETCHING So what does the research say? There's a bunch of research on passive stretching. There's a bunch of research on the benefits specifically of eccentric loading to improve range of motion, to improve active mobility. And we've always kind of wondered the question of what is the dose response relationship with flexibility training, with stretching? We have a great paper that came out last month in the Journal of Strength and Conditioning Research by Wernicke and colleagues. I'll post the link on Instagram and in the show notes on the podcast that sought to answer that question. So this was a study that sought to look at the effects on maximal voluntary muscular contraction, flexibility and muscle thickness of the ankle plantar flexors. Now, the experimental group had a lot of stretching prescribed. Specifically, they stretched six times a day for 10 minutes each session for six weeks. So about 42 total hours of stretching through the calf complex, an hour per day for 42 days. They perform the stretching with a night splint type orthotic of a boot that prepositions the foot into ankle dorsiflexion with the addition of a strap assist to pull their ankle into additional dorsiflexion if able. So essentially stretching the gastric complex 10 minutes, six times a day for six weeks. Now, what did the results show? The results did show an improvement in range of motion of when they remeasured ankle dorsiflexion. There were improvements that reached statistical significance. But really, when we look at the results, when we look at the actual data itself and not the summary of data in the discussion, we look at the raw data. What do we think about the results? We think that the functional improvement here is probably questionable. Then we actually look at the ranges of motion increases experienced by these subjects that most folks experience the change of about 0.25 to 0.5 centimeters or about one tenth to two tenths of an inch of an improvement in ankle dorsiflexion. Now, when we measure functional ankle dorsiflexion in the clinic, we use the closed chain half kneeling knee to wall task to measure the ability of the knee to advance over the toes with a planted heel. We show this assessment in our online essential foundations course, and we show this in our live seminar as well. And what we'd like to see there is that an athlete with the heel flat can advance their knee over their toes about four inches. That ideally they would contact the wall. We know if they can contact the wall, they have about four inches of motion there or possibly more. But that is enough motion, for example, to be able to advance the knees over the toes and sit down into a nice full depth squat. And so when we look at changes of 0.1 inches in a test where we're looking to see four full inches of range of motion, we realize that's not really that much of a functional improvement of yes, the results did reach statistical significance. But the practical application here is very, very, very minimal of that person. If we improve their ankle dorsiflexion and it was, for example, zero inches, somebody like me, somebody with a very stiff ankle, particularly my right ankle that has about zero inches of closed chain dorsiflexion. What good really is 0.1 to 0.2 inches of closed chain dorsiflexion improvement? The answer is not. It's not right. It's not a functional improvement. It's not a meaningful improvement. Yes, it was a statistically significant improvement, but in real life, it would not help that person move any better. It would not improve that person's mobility, even though their flexibility, yes, has technically changed. So we need to be mindful of how to actually interpret results of studies like this. We also need to now talk about what is the practical application of a study like this to practice, because this study came out and a lot of social media posts were made, a lot of podcasts were made that said, look, you're just not stretching enough. If you stretch an hour a day for six weeks, you can see an improvement in joint range of motion. And yes, again, while true, not functional. 10:14 APPLYING RESEARCH TO PRACTICE We also have to step back and really analyze the methodology of this paper and also analyze things like the inclusion and exclusion criteria of this paper. We're probably unlikely to find an actual real person, a patient or athlete who's going to do six hours a week, an hour per day, seven days a week for many, many weeks of flexibility training, essentially, right? We hear time is the biggest barrier to exercise. We hear time is the biggest barrier to home exercise program compliance. So it doesn't really make sense that if we can't get somebody to perform a 12 minute remom for the home exercise program, what's the likelihood that they're going to do an hour a day of home exercise program on top of maybe also trying to exercise an hour or more per day? The answer is unlikely. Right. We know that if we if we dose that out to somebody, there are very few patients who are going to come back and say, yep, I did. I did six sessions a day, 10 minutes per session, and I did it every day, seven days a week, just like you prescribed, doctor. That's a very unlikely result. So we need to be mindful of that when we're talking about applying this to real actual people. We also really need to dig into the inclusion criteria and look at the baseline assessments in a study like this, because this study would portray that some of these folks were stiff and saw improvements. Some of these folks had OK mobility and saw improvements. But really, when we look at the baseline assessments, the quote unquote stiffest person in the study still had three point four inches of closed chain dorsal flexion, right? More than enough ankle mobility to be able to squat to depth, assuming nothing was wrong mobility wise in that person's hip or knee. That person would have all the dorsal flexion needed to be able to, for example, functionally squat to depth. So we have to ask ourselves, is this actually representative of the populations that we treat? Is it representative of somebody who might come to us and say they need help with their mobility? What's the likelihood that they're actually going to do an hour a day of this type of training? And also, this is not the person that's going to present in our clinic, right? Of the person who can close chain dorsal flex at least three point four inches. You're not even going to consider that their ankle is stiff and maybe even prescribe some mobility stuff for their ankle to them, because they already possess all the range of motion needed to squat. On the high end in these subjects, they were beyond three point four inches, right? There were people with four, five, six, some folks close to seven inches of closed chain dorsal flexion. Way above average mobility. And so we need to recognize and ask the question of why are we studying the effects of flexibility and mobility on people who already have adequate, above average, perfect or excellent mobility, right? We see this a lot in medical research of we study the effects of, for example, resistance training on bone loading in older adults, and we exclude people with osteoporosis and osteopenia and folks who have any sort of issue that might throw an extra variable into the study. And what we find ourselves is studying interventions on people who don't need the intervention, right? And this study is exactly that case of we are studying the effects of flexibility training on the mobility of people who don't need any help with their flexibility or mobility. So again, can we generalize studies like this to the general population? Probably not. And for a lot of reasons, the ones we've already discussed here. And what we need to realize when we look at this data and look at a big picture is when we look at the results of studies like this, when we look at all the data aggregated, yes, but also unaggregated on those data tables, what are we looking at? That we tend to find that folks fall into buckets, that we can classify them. We know that, for example, with low back pain, we can find people who are flexion intolerant, extension intolerant, shear intolerant. We know they may or may not respond to directional preference type exercises, but people tend to fall in classification buckets based on what's going on. And we need to recognize that mobility is no different. Even looking at this study, looking at the baseline measurements of folks, we have folks who appear to have great mobility, who improved with intervention. We have folks who have great mobility, who did not improve with interventions. We had folks with poor mobility, who improved with intervention. And then we had the most unfortunate group of all, folks with poor mobility, who did not seem to improve with intervention. So we need to recognize that the person we're working with in the clinic, in the gym, probably fits into one of those buckets. If they are somebody who is interested in working on the mobility, even if we may not need it, right? We have that person who can hinge all the way to the floor with a perfectly flat back and locked out knees and touch their palms to the floor. A very bendy, flexible individual who is asking you for help on their mobility, right? That person does not need mobility help. They do not need flexibility help. But yet they are maybe seeking some extra mobility programming. We have folks with poor mobility, who need mobility training, who we know will not work on it anyways, especially an hour a day. So we see that our patients and athletes fall into these buckets, and we need to recognize which bucket they may fall into. We may not know early on how they're going to respond to interventions, especially if they haven't tried anything previously, but we'll know very quickly across the plan of care of their physical therapy if they're going to be somebody who responds to interventions like these. So what do we actually do with that person in front of us? Well, I think what we don't do enough is ask people a few simple questions of I see that you have some mobility things you could work on. How much time do you actually have for this? I don't think we ask that question enough. I think we give people what we want to see them do, what we hope they will do, and then we're often disappointed when they don't do it because we haven't asked first of all how much time they're willing to dedicate to it. I appreciate over the years how I've started to ask this question, and people have been very honest of I'm never going to do this at home. I'm only going to do this when I come here to physical therapy. Well, I appreciate that honesty, right? Because I'm not going to waste my time writing out a really detailed program that you're not going to do. So I think starting with that, excuse me, that question is very, very important. And then also recognizing and being really, really thorough and methodical in your reassessments along the way so you know if this person appears to be somebody who's going to respond to mobility type interventions. This study in particular has a lot of issues with the methodology, only including people who already possess a lot of nice functional mobility. It did a lot of long-term passive stretching, and we also need to recognize that primarily due to the way the intervention was done in this study, they primarily stretched the gastroc but assessed mobility and range of motion by the closed chain dorsiflexion test, which really looks at soleus muscle flexibility more so than gastroc. So we're stretching the gastroc, but assessing the ability of the knee to advance over the toes in a kneeling position, which is really looking at the soleus muscle complex. So we need to recognize the limitations of this study, and in our own practice of actually making sure we're giving the right mobility to the right person based on the deficits that we're finding in their assessment. We hear often, what are some great shoulder stretches? Well, it depends on what is limiting your shoulder mobility. If I give you a bunch of lat stretches and you seem to be really limited in external rotation because of maybe something going on in your subscap or your internal rotators not related to your lat, if you pass all of the screens we see for the lat, then giving you a bunch of lat stretching, a bunch of shoulder stretching, it's really not going to benefit and improve the mobility we need to work on. So we need to be sure we're working in the right area and addressing the right area with our exercises as well. So mobility, how much can we move the needle? Well, it really depends. It seems to be maybe a genetic component. It seems to be a combination of how well people respond to this type of training, and we also need to recognize that it appears to take a lot of time, possibly more time than the patient or athlete in front of us actually has. So understand the difference between flexibility and mobility. Flexibility, the ability for us to stretch muscles passively or a patient or athlete to stretch themselves passively versus mobility, the ability of the person to actively move their joints through a range of motion under gravity, functional movements, things like a squat, a lot of close chain type movements. We have research that looks at long-term stretching, but we know the quality of the research is not that great and the practical application of the research itself is not that great. Yes, we can reference the study and say if you're willing to stretch six hours a week, you might see changes in your ankle mobility, but again, we don't know that for sure. In practice, we know that our athletes and patients tend to fall in buckets. We need to be able to recognize those folks where they lie in our assessment. And again, always ask the question of how much do you really want to work on this? How much time do you really have to work on this? Somebody who says I have an extra hour a day before bed at night. Okay, that's a person who maybe could try out an hour of flexibility training before bed. Whether you give them a program, whether they sign up for something like ROM WOD, GO WOD, Mobility WOD, whatever WOD, Stretch WOD, the millions of programs out there. Or somebody who goes I'm not going to do this at all. I know myself, I'm not going to do this at night before bed. I'm not going to do it in the morning. I'm not going to do it before I work out and I'm not going to do it after I work out. Okay, that is a person that we probably should not spend our time on trying to give a bunch of mobility homework already knowing that they're pretty intentional and honest that they're not going to do it. So mobility, can we move the needle? Maybe. Jury's still out. We still need to see more research, of course, more impactful research, more functional research, and more practical research. Research that actually looks at what sort of changes can we expect to make in maybe 12 to 15 minutes a day? The range of time that we're probably prescribing to most of our patients and athletes. So I hope this was helpful. I hope you have a fantastic Friday. Hope you have a great weekend. If you're going to be at a live course, enjoy yourself. Enjoy the CrossFit Games. Watch Kelly Benfee and Ruth Huron. Have a great Friday. Have a great weekend. Bye everybody. 20:32 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CU's from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up. You
Real Life Pharmacology - Pharmacology Education for Health Care Professionals
In this podcast episode, I discuss thiamine pharmacology and its important role in energy production. In patients with alcohol use disorder, thiamine deficiency can be somewhat common. Wernicke's encephalopathy can result from thiamine deficiency in patients with alcohol use disorder. Common symptoms from Wernicke's encephalopathy can include confusion, lethargy, and other central nervous system issues. Thiamine replacement can help treat this issue.
My guest is Eddie Chang, MD, a neurosurgeon and professor of neurological surgery at the University of California, San Francisco (UCSF) and the co-director of the Center for Neural Engineering & Prostheses. We discuss the brain mechanisms underlying speech, language learning and comprehension, communicating human emotion with words and hand gestures, bilingualism and language disorders, such as stuttering. Dr. Chang also explains his work developing and applying state-of-the-art technology to decode speech and using that information and artificial intelligence (AI) to successfully restore communication to patients who have suffered paralyzing injuries or “locked in syndrome.” We also discuss his work treating patients with epilepsy. Finally, we consider the future: how modern neuroscience is overturning textbook medical books, the impact of digital technology such as smartphones on language and the future of natural and computer-assisted human communication. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman Levels: https://www.levelshealth.com/huberman Eight Sleep: https://www.eightsleep.com/huberman InsideTracker: https://insidetracker.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Huberman Lab Premium https://hubermanlab.com/premium For the full show notes, visit hubermanlab.com Timestamps (00:00:00) Dr. Eddie Chang, Speech & Language (00:03:00) Levels, Eight Sleep, InsideTracker, Momentous Supplements (00:07:19) Neuroplasticity, Learning of Speech & Environmental Sounds (00:13:10) White Noise Machines, Infant Sleep & Sensitization (00:17:26) Mapping Speech & Language in the Brain (00:24:26) Emotion; Anxiety & Epilepsy (00:30:19) Epilepsy, Medications & Neurosurgery (00:33:01) Ketogenic Diet & Epilepsy (00:34:56) AG1 (Athletic Greens) (00:36:10) Absence Seizures, Nocturnal Seizures & Other Seizure Types (00:41:08) Brain Areas for Speech & Language, Broca's & Wernicke's Areas, New Findings (00:53:23) Lateralization of Speech/Language & Handedness, Strokes (00:59:05) Bilingualism, Shared Language Circuits (01:01:18) Speech vs. Language, Signal Transduction from Ear to Brain (01:12:38) Shaping Breath: Larynx, Vocal Folds & Pharynx; Vocalizations (01:17:37) Mapping Language in the Brain (01:20:26) Plosives & Consonant Clusters; Learning Multiple Languages (01:25:07) Motor Patterns of Speech & Language (01:28:33) Reading & Writing; Dyslexia & Treatments (01:34:47) Evolution of Language (01:37:54) Stroke & Foreign Accent Syndrome (01:40:31) Auditory Memory, Long-Term Motor Memory (01:45:26) Paralysis, ALS, “Locked-In Syndrome” & Brain Computer Interface (BCI) (02:02:14) Neuralink, BCI, Superhuman Skills & Augmentation (02:10:21) Non-Verbal Communication, Facial Expressions, BCI & Avatars (02:17:35) Stutter, Anxiety & Treatment (02:22:55) Tools: Practices for Maintaining Calm Under Extreme Demands (02:31:10) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous Supplements, Huberman Lab Premium, Neural Network Newsletter, Social Media Title Card Photo Credit: Mike Blabac Disclaimer
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