Podcasts about Wernicke

  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

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,

En el episodio de hoy, os hablo de un libro muy interesante publicado este 2024 titulado “Dime qué sientes. Diario de un neurocirujano. Pacientes despiertos, las 5 dimensiones del cerebro y un cambio de paradigma”. Su autor es el Dr. Jesús Martín-Fernández, un neurocirujano español especializado en cirugía despierta y formado con Hughes Duffau en Montpelier (Francia). Este libro divulgativo y con tintes autobiográficos defiende la tesis de que tenemos que comprender el cerebro en forma de red, o red de redes, que tienen nodos o puntos clave y que hay ciertas zonas clásicamente sagradas en neurociencia, como el área de Broca, que no existen como tal y que lo importante sobre todo a la hora de la neurocirugía, es respetar los tractos profundos y largos que llevan las grandes funciones cognitivas y motoras. A través de los casos que expone Jesús en el libro, se puede ver cómo van monitorizando al paciente despierto para preservar las funciones cognitivas con diferentes test y con ayuda de inteligencia artificial, todo mientras están quitando un tumor, que en muchas ocasiones, había sido catalogado como ‘inoperable'. Referencias del episodio: 1. Martín-Fernández, J., Moritz-Gasser, S., Herbet, G., & Duffau, H. (2024). Is intraoperative mapping of music performance mandatory to preserve skills in professional musicians? Awake surgery for lower-grade glioma conducted from a meta-networking perspective. Neurosurgical focus, 56(2), E9. https://doi.org/10.3171/2023.11.FOCUS23702 (https://pubmed.ncbi.nlm.nih.gov/38301246/). 2. Tremblay, P., & Dick, A. S. (2016). Broca and Wernicke are dead, or moving past the classic model of language neurobiology. Brain and language, 162, 60–71. https://doi.org/10.1016/j.bandl.2016.08.004 (https://pubmed.ncbi.nlm.nih.gov/27584714/). 3. Duffau H. (2021). The death of localizationism: The concepts of functional connectome and neuroplasticity deciphered by awake mapping, and their implications for best care of brain-damaged patients. Revue neurologique, 177(9), 1093–1103. https://doi.org/10.1016/j.neurol.2021.07.016 (https://pubmed.ncbi.nlm.nih.gov/34563375/). 4. Duffau H. (2018). The error of Broca: From the traditional localizationist concept to a connectomal anatomy of human brain. Journal of chemical neuroanatomy, 89, 73–81. https://doi.org/10.1016/j.jchemneu.2017.04.003 (https://pubmed.ncbi.nlm.nih.gov/28416459/). 5. Herbet, G., & Duffau, H. (2020). Revisiting the Functional Anatomy of the Human Brain: Toward a Meta-Networking Theory of Cerebral Functions. Physiological reviews, 100(3), 1181–1228. https://doi.org/10.1152/physrev.00033.2019 (https://pubmed.ncbi.nlm.nih.gov/32078778/). 6. Martín-Fernández, J. (2024). Dime qué sientes. Diario de un neurocirujano. Pacientes despiertos, las 5 dimensiones del cerebro y un cambio de paradigma. Ed. Paidós. 1ªed (https://www.amazon.es/Dime-qu%C3%A9-sientes-neurocirujano-dimensiones-ebook/dp/B0CVN4HVCV).

Na coluna desta semana de Literatura, Luanna Bernardes fala sobre as referências literárias usadas nas Olímpiadas de Paris. Algumas delas foram "O Fantasma da Ópera", do escritor Gaston Leroux, "O Pequeno Príncipe", do Antoine de Saint-Exupéry e "Vinte Mil Léguas Submarinas", do Júlio Wernicke.

Luciano Wernicke – Periodista @otraagenda1220 26-7-2024

A recent article in the journal Organization Science argues that“Although prior research attributes news media coverage of firms to the alignment of firm behavior with societal expectations of appropriateness, the appropriateness of firm behavior is judged through an ideological lens. Therefore, the influence of a firm's behavior on its news media coverage is likely to be contingent on news organizations' ideology.” The veracity of this statement has seemingly never been more true than in recent years when the news media has become increasingly polarised along ideological grounds and there would at times appear to be a news outlet to support any view, however mainstream or obscure.To explore this further I am delighted be joined by one of the co-authors of the paper, Professor Georg Wernicke of HEC Paris.About our guest…Georg Wernicke is an Associate Professor of Strategy and Business Policy at HEC Paris. Georg's research is on topics in, and at the intersection of, corporate governance and corporate social responsibility (CSR), broadly defined. More specifically, he is interested in the drivers of public disapproval of firms' practices, for example the compensation firms pay to their CEOs, how firms' prosocial activities affect disapproval, and, in turn, which subset of firms and CEOs reacts to being targeted. Georg also analyzes how the characteristics and values of CEOs affect firm level outcomes such as corporate misconduct or the adoption of prosocial practices, as well as how demographic minority status affects labor-market outcomes for directors after occurrences of financial fraud. Furthermore, Georg engages in projects that explore the antecedents of superior firm performance on CSR.The article referenced in the discussion is available here: https://pubsonline.informs.org/doi/abs/10.1287/orsc.2022.17237You can find out more about Georg and his work at his personal page: https://www.georg-wernicke.com/Or on his faculty page at HEC Paris: https://www.hec.edu/en/faculty-research/faculty-directory/faculty-member/WERNICKE-Georg Hosted on Acast. See acast.com/privacy for more information.

In this episode, Dr Ferghal Armstrong and Dr Richard Bradlow unpack the complex relationship between alcohol, thiamine deficiency, and the severe neurological condition Wernicke's encephalopathy. Ferghal opens by questioning long-held beliefs about alcohol's direct effects on thiamine absorption, while Richard provides a contextual understanding of the symptomatic manifestations. The discussion touches on the practicalities of diagnosing and treating thiamine deficiency, focusing particularly on clinical scenarios where immediate action can prevent irreversible damage.**Learning Outcomes**1. **Understanding Thiamine Deficiency and Alcohol Use**- Thiamine deficiency is commonly seen in individuals with alcohol use disorders due to poor diet, liver damage, and compromised gut integrity. Ferghal emphasises that alcohol does not directly reduce thiamine but affects its absorption and storage indirectly.- Recognise the critical symptoms of thiamine deficiency: Ataxia, ophthalmoplegia, and confusion. Richard shares that only 10% of individuals present with the classic triad, stressing the need for a low threshold in administering thiamine.- Ferghal reveals that thiamine is stored in the liver, with approximately 20-30 milligrams available. Without replenishment, these levels deplete quickly, making regular intake essential.2. **Diagnosis and Management**- Learn to assess risk factors beyond alcohol consumption. Richard suggests evaluating diet, liver health, and any conditions that hamper gut absorption.- Understand the importance of high-dose, parenteral thiamine administration in suspected cases of Wernicke's encephalopathy. This prevents irreversible neuronal damage, particularly in the cerebellum and midbrain.- Find out why rapid thiamine delivery is critical. Ferghal explains that alcohol withdrawal demands a higher energy output, which depletes thiamine stores faster, precipitating encephalopathy.3. **Preventative Measures and Harm Reduction**- Recognise the importance of thiamine supplements for those engaging in hazardous drinking, even if not experiencing withdrawal. Richard advocates for over-the-counter vitamin B1 tablets, taken multiple times daily for optimal absorption.- Explore how diet can play a crucial role in preventing thiamine deficiency. Liver, cereals, and fortified foods are excellent sources of thiamine, as Ferghal points out.- Koraskoff's syndrome is an irreversible consequence of untreated thiamine deficiency. It leads to significant memory deficits and an ataxic gait, which underscores the need for timely intervention.**Actionable Takeaways**1. **Routine Screening for Thiamine Deficiency**- Incorporate routine screening for thiamine deficiency in patients with alcohol use disorder. Ferghal and Richard highlight this as a vital practice to prevent conditions like Wernicke's encephalopathy and Korsakoff syndrome.- Develop a checklist for evaluating risk factors, including dietary patterns, liver function, and gut health issues.- Push for early intervention even with subclinical symptoms. Ferghal stresses the colossal benefits of early detection and treatment.2. **Educate on Thiamine Supplementation**- Ensure patients receive clear instructions on thiamine supplementation. Richard recommends oral vitamin B1, taken in divided doses throughout the day.- Cultural and dietary recommendations should include foods rich in thiamine, like liver and fortified cereals.- Advocate for harm reduction strategies that include vitamin supplements. Ferghal points out this can significantly reduce the risk of severe neurological...

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

Organisationen sind oft kundengetrieben oder vertriebsgetrieben, d.h. Organisationen richten sich dabei auf den Kunden aus. Als Ergänzung dazu gibt es die datengetriebene Organisation. Da es viele Informationsflüsse gibt, ist es wichtig, die Daten zu analysieren. Dies hilft einem ebenfalls, den Vertrieb kundengetrieben und effektivitätsgetrieben aufzustellen! Gast der heutigen Folge ist Dr. Sebastian Wernicke, der ein ganzes Buch zu dem Thema "data inspired" geschrieben hat. Die Fragen, die wir gemeinsam behandeln: Wo kommen die Trends der datengetriebenen Organisationen her? Wie kann man diese Trends für sich umsetzen?  

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.

Sebastian war schon vor über drei Jahren Gast hier im Podcast in Episode #44. Damals haben wir uns vor allem über seine Tätigkeit als Chief Data Scientist bei ONE LOGIC (heute ONE DATA) unterhalten. Vor kurzem hat Sebastian ein Buch veröffentlicht mit dem Titel "Data Inspired: Erfolgskonzepte für die datengetriebene Organisation". Genau darüber wollen wir uns heute unterhalten. ----------------------------------- (00:00:00) Start (00:03:37) Vorstellung „Data Inspired“ (00:04:49) Inspiration für das Buch (00:06:27) Fragmente.txt (00:07:35) ChatGPT als Buchautor? (00:09:19) Ein Buch schreiben ist viel Arbeit (00:13:19) Wie kam es zum Namen des Buches (00:16:19) Worum geht es in „Data Inspired“ (00:21:22) Der große Druck auf Unternehmen (00:23:29) Erfahrung ist im Umgang mit Daten wichtig (00:26:20) Winner takes all (00:28:39) GenAI als Beispiel für fehlende Business Cases (00:31:29) Fords Chatbot, welcher ein Auto für 1€ verkauft (00:36:22) Zu viel Forschung und Spielerei ist ein häufiger Vorwurf (00:38:19) Gibt es wirklich low-hanging fruits? (00:41:49) Das Management richtig einstellen (00:46:29) Einstiegspunkte in das Thema (00:51:22) Ausblick für die Zukunft ----------------------------------- Weiterführende Informationen: ► Buch Data Inspired auf Amazon, https://www.amazon.de/Data-inspired-Erfolgskonzepte-datengetriebene-Organisation/dp/3800671298 bzw. im Buchhandel, https://www.lesezeichen.biz/shop/article/49982658/sebastian_wernicke_data_inspired.html ► LinkedIn Sebastian: https://www.linkedin.com/in/wernicke/ ► LinkedIn Bernard: https://www.linkedin.com/in/bernardsonnenschein/ ► Nutze jetzt den Code "Friends20" auf https://www.eventbrite.de/e/dataunplugged-tickets-686542897287, um einen Rabatt von 20% auf das Ticket zu erhalten. ► Wir danken außerdem unserem Partner, der Public Cloud Group (PCG): https://hubs.li/Q02cH6qN0

#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

Bringing a much needed calming zen influence to the Vayse Institute of Over Thinking and Catastrophic Worry, Hine and Buckley welcome therapist and former Tibetan Buddhist monk, Roger Jayamanne to the podcast. Roger leads Hine and Buckley through a quest which is thousands of years and many life cycles old as they discuss his life within the tradition of Tibetan Buddhism and what it actually teaches: was the Buddha a real person? Is life just sorrow and suffering? What is the Tao?... and he divulges some of the weirder, reality-defying experiences he has had on his travels including mind reading, a monk's arm stretching to six feet long and a lama summoning a parliament of owls as a spiritual escort to Edinburgh Airport... (recorded 13 November 2023) Thanks to Roger for putting up with our frenzied anxiety and thanks as always to Keith for the show notes. Roger Jayamanne Online Jaya counselling website (https://jayacounselling.co.uk/) The Wellbeing Evolution YouTube channel (https://www.youtube.com/@thewellbeingevolution5113/videos) The Wellbeing Evolution on Instagram (https://www.instagram.com/the_wellbeing_evolution/) Roger's Counselling Directory profile (https://www.counselling-directory.org.uk/counsellors/roger-jayamanne) Practical Techniques for Self-Discovery & Embracing Awareness with Roger Jayamanne, Therapy Talks podcast (https://podcasts.apple.com/us/podcast/practical-techniques-for-self-discovery-embracing-awareness/id1607765524?i=1000633375551) Introduction Dharma - Wikipedia (https://en.wikipedia.org/wiki/Dharma) Reincarnation - Wikipedia (https://en.wikipedia.org/wiki/Reincarnation) Nirvana (concept) - Wikipedia (https://en.wikipedia.org/wiki/Nirvana) [Nirvana (band) - Wikipedia](https://en.wikipedia.org/wiki/Nirvana_(band) Green Day - Wikipedia (https://en.wikipedia.org/wiki/Green_Day) Tibetan Buddhism - Wikipedia (https://en.wikipedia.org/wiki/Tibetan_Buddhism) Roger's early exposure to Buddhism History of Buddhism in the UK - Wikipedia (https://en.wikipedia.org/wiki/Buddhism_in_the_United_Kingdom#History_of_Buddhism_in_the_UK) The Buddha - Wikipedia (https://en.wikipedia.org/wiki/The_Buddha) Buddhist meditation - Wikipedia (https://en.wikipedia.org/wiki/Buddhist_meditation) Sri Lanka - Wikipedia (https://en.wikipedia.org/wiki/Sri_Lanka) Batik - Wikipedia (https://en.wikipedia.org/wiki/Batik) Sri Lanka's Batik Industry - SriLankaBusiness.com (https://www.srilankabusiness.com/blog/sri_lankas_batik_industry.html) Carl Jung - Wikipedia (https://en.wikipedia.org/wiki/Carl_Jung) Dream - Wikipedia (https://en.wikipedia.org/wiki/Dream) Collective unconscious - Wikipedia (https://en.wikipedia.org/wiki/Collective_unconscious) Jungian archetypes - Wikipedia (https://en.wikipedia.org/wiki/Jungian_archetypes) Neurology - Wikipedia (https://en.wikipedia.org/wiki/Neurology) Bardo - Wikipedia (https://en.wikipedia.org/wiki/Bardo) Karma in Buddhism - Wikipedia (https://en.wikipedia.org/wiki/Karma_in_Buddhism) Karma in Tibetan Buddhism - Wikipedia (https://en.wikipedia.org/wiki/Karma_in_Tibetan_Buddhism) Deja vu - Wikipedia (https://en.wikipedia.org/wiki/D%C3%A9j%C3%A0_vu) Haven't We Met Before? 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Wikipedia (https://en.wikipedia.org/wiki/Minecraft) Śūnyatā (emptiness) - Wikipedia (https://en.wikipedia.org/wiki/%C5%9A%C5%ABnyat%C4%81) Mahayana - Wikipedia (https://en.wikipedia.org/wiki/Mahayana) The Ten Levels of the Bodhisattva - BuddhaJourney.net (https://buddhajourney.net/the-ten-levels-of-the-bodhisattva/) The Matrix - Wikipedia (https://en.wikipedia.org/wiki/The_Matrix) The Matrix: Neo sees the code (https://www.youtube.com/watch?v=0pYyzolIN3I) Siddhi - Wikipedia (https://en.wikipedia.org/wiki/Siddhi) Kirtan (musically recited story in Indian traditions) - Wikipedia (https://en.wikipedia.org/wiki/Kirtan) Khenpo - Wikipedia (https://en.wikipedia.org/wiki/Khenpo) Maras - tibetanbuddhistencyclopedia.com (http://tibetanbuddhistencyclopedia.com/en/index.php?title=Four_maras) Barn Owl - Wikipedia (https://en.wikipedia.org/wiki/Barn_owl) Himalayas - Wikipedia (https://en.wikipedia.org/wiki/Himalayas) How to start with Buddhism and meditation How to practice Buddhism - OneMindDharma.com (https://oneminddharma.com/how-to-practice-buddhism/) Letting Go: Understanding Attachment from a Buddhist Perspective - Zen-Buddhism.net (https://www.zen-buddhism.net/letting-go-understanding-attachment-in-buddhism/) Learning formless meditation - InstrinsicSelf.us (https://intrinsicself.us/learning-formless-meditation/) Peter Hine and Stephen Buckley, Dreams, Nightmares and Pan - Spirit Box podcast S2 #18 (https://podcasts.apple.com/gb/podcast/s2-18-peter-hine-and-stephen-buckley-dreams/id1504757824?i=1000622843537) Follow the breath - TheGregariousHermit.com (https://thegregarioushermit.com/meditation/meditation-boot-camp/11-follow-the-breath) How to Perform Body Scan Meditation - PositivePsychology.com (https://positivepsychology.com/body-scan-meditation/) Mindfulness - Wikipedia (https://en.wikipedia.org/wiki/Mindfulness) Mindfulness and Being Present in the Moment - PsychologyToday.com (https://www.psychologytoday.com/us/blog/trauma-and-hope/201801/mindfulness-and-being-present-in-the-moment) Zazen - Wikipedia (https://en.wikipedia.org/wiki/Zazen) Roger's (and Hine's) recommendations Zen Mind, Beginner's Mind - Wikipedia (https://en.wikipedia.org/wiki/Zen_Mind%2C_Beginner's_Mind) Not Always So: Practising the True Spirit of Zen by Shunryu Suzuki, Goodreads (https://www.goodreads.com/book/show/238843.Not_Always_So) Shunryū Suzuki, Wikipedia (https://en.wikipedia.org/wiki/Shunry%C5%AB_Suzuki) The Master and His Emissary - Wikipedia (https://en.wikipedia.org/wiki/The_Master_and_His_Emissary) Siddhartha (novel) - Wikipedia (https://en.wikipedia.org/wiki/Siddhartha_(novel)) Siddhartha by Hermann Hesse - Goodreads (https://www.goodreads.com/book/show/52036.Siddhartha) The Sun of Wisdom: Teachings on the Noble Nagarjuna's Fundamental Wisdom of the Middle Way by Khenpo Tsultrim Gyamtso, Goodreads (https://www.goodreads.com/book/show/1362979.The_Sun_of_Wisdom) Buckley's closing question Dalai Lama - Wikipedia (https://en.wikipedia.org/wiki/Dalai_Lama) Bartleby (1970 film) - Wikipedia (https://en.wikipedia.org/wiki/Bartleby_(1970_film)) Bartleby (1970) (https://www.youtube.com/watch?v=lrREmd4ds_w) My Dinner with Andre (1981 film) - Wikipedia (https://en.wikipedia.org/wiki/My_Dinner_with_Andre) My Dinner with Andre (1981) (https://www.youtube.com/watch?v=O4lvOjiHFw0) Ghostbusters (1984 film) - Wikipedia (https://en.wikipedia.org/wiki/Ghostbusters) Ghostbusters (1984) | Official Trailer (https://www.youtube.com/watch?v=wQAljlSmjC8) Vayse Online Vayse website (https://www.vayse.co.uk/) Vayse on Twitter (https://twitter.com/vayseesyav) Vayse on Instagram (https://www.instagram.com/vayseesyav/) Music From Vayse - Volume 1 by Polypores (https://vayse.bandcamp.com/album/music-from-vayse-volume-1) Vayse on Ko-Fi (https://ko-fi.com/vayse) Vayse email: vayseinfo@gmail.com Special Guest: Roger Jayamanne.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: July 18, 2017From the "Gilded Age" to the "germ theory", Dr. Joshua VanDerWerf (physician, historian, humanitarian), illustrates the birth of American neurology. You may recognize the names Chiari, Wernicke, and Broca, but what about William Alexander Hammond or Silas Weir Mitchell? These figures, among others, and their contributions to neurology are the subject of this week's BrainWaves episode. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice.REFERENCESGoetz CG, Chmura TA, Lanska D. Part 1: the history of 19th century neurology and the American Neurological Association. Ann Neurol 2003;53 Suppl 4:S2-26. PMID 12722087Koehler PJ, Lanska DJ. Mitchell's influence on European studies of peripheral nerve injuries during World War I. J Hist Neurosci 2004;13(4):326-35. PMID 15545104Lanska DJ. Characteristics and lasting contributions of 19th-century American neurologists. J Hist Neurosci 2001;10(2):202-16. PMID 11512433We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

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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

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Episode 143: Pulmonary Cocci BasicsDr. Lovedip Kooner explains the history, diagnosis, and treatment of pulmonary coccidioidomycosis (cocci for short.) Disseminated cocci infection was also discussed. Dr. Arreaza added some anecdotes of patients seen with this infection.  Written by Lovedip Kooner, MD. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition:Coccidioidomycosis, also known as Valley Fever, is an infection caused by the fungi Coccidioides immitis and Coccidioides posadasii. Coccidioides is also referred to as cocci. Generally speaking, C. immitis is found in California and C. posadasii is found in Arizona, and Central and South America. More recently Cocci has also been found as far north as Washington and British Columbia. History:The fungal infection was first reported by Wernicke and Posadas in Argentina in 1892 where they described a case where a man had cutaneous cocci of the head, arm, and trunk. To this day, the head is preserved in Argentina. 4 For many years, only disseminated cases were recognized and described as “coccidioidal granulomas.” The work of Dixon and Gifford in 1935 elucidated that a pneumonic disease of unknown cause termed “San Joaquin Valley Fever” was, in fact, the primary coccidioidal infection and the port of entry of almost all coccidioidal disease. Initial infection occurs predominantly by inhalation of aerosolized arthroconidia and rarely by direct cutaneous inoculation.1,2Coccidioides spp. survive best in areas with low rainfall (12–50 cm per year), limited winter freezes, and alkaline soils. With climate change models, predicting the geographical range expansion.These dimorphic fungi exist in a mycelial form in the soil. Coccidioides species have been found in animal burrows near the Kern River and in Armadillo burrows in South American countries like Brazil. The mycelia produce arthroconidia (spores) that are ultimately airborne and inhaled.The inoculum required for infection is low and in animal models as few as a single arthroconidium may cause infection.3 Infection:Once arthroconidia are inhaled into the lung, there is typically a 1-3-week incubation period. The arthroconidia undergo morphologic changes into spherules, which are large structures that contain endospores.4 As spherules mature, they rupture and release endospores. Endospores can be spread hematogenous or through lymphatics to essentially any organ, leading to the development of new spherules and potentially disseminated disease.5 Not everyone who inhales the arthroconidia gets the infection. Clinical Manifestations.About 60% of patients who inhale arthroconidia are asymptomatic. 30% have a mild respiratory illness, like the flu. 10% have a more serious disease course and are diagnosed. Other symptoms may include fever, drenching night sweats, and weight loss. Extreme fatigue that limits baseline activity may also raise concerns. Symptom onset up to 2 months after endemic exposure should lead to coccidioidomycosis on the differential. Coccidioidomycosis cases have been documented in Michigan, Europe, and China. These cases were of people who traveled to endemic areas for as little as a few days and then were later diagnosed. 1-3% of all coccidioidomycosis cases are disseminated, severe, or chronic pulmonary infections. If undiagnosed, coccidioidomycosis may lead to significant morbidity and mortality. Dissemination sites include the skin, lymph nodes, bones, and Central Nervous System (CNS) which is the most severe. Any organ can be infected, including documented cases of the prostate and adrenal gland. Arreaza: Recap: 60% are subclinical, 30% are mild, 10% serious, 1-3% are disseminated. What are some risk factors for severe infection? Should I stop biking?Risk factors for severe infection:Severe pulmonary infections can happen in anyone but occur more commonly in diabetics, tobacco users, and people older than 65 years of age.Oceanic or Filipino ethnicity and black or African American have a higher rate of dissemination. Immunosuppression, including HIV, transplant patients, and immunosuppressive medications like corticosteroids or TNF-alpha inhibitors have been shown to be risk factors for dissemination. Pregnant patients, particularly in the third trimester have higher rates of severe infection as well.Arreaza: How do we diagnose the disease?Diagnosis:Diagnosis is commonly made serologically. EIA (enzyme immunoassay) is used more often. There are more false positives than false negatives and varies by manufacturer. Kern County Health Department uses Immunodiffusion IgG and IgM and Complement Fixation are used. Immunodiffusion IgG and IgM are scaled by non-reactive, weakly reactive, reactive and strongly reactive. Compliment fixations are scaled by a ratio/dilution. Serum Compliment fixations

Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a faculty member at Central Michigan University where I lead the Strong Story Lab. 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 Mary Ann Eller. We'll be talking about incorporating the Life Participation Approach to Aphasia (better known as LPAA) in Acute Care Settings. Let me first tell you a bit about our guest.   Mary Ann Eller, MA, CCC-SLP is the Assistant Manager for Rehab Services in the Speech and Language Pathology Department at Duke Regional Hospital in Durham, NC. She has worked in the Duke University Health Care System since 1989. She specializes in evaluating and treating adults with neurogenic and swallowing disorders in acute care and inpatient acute rehab. Her current professional passions are finding functional, practical, and patient-center approaches to the care of people with aphasia, dementia and all cognitive/communication problems.   In this episode you will: Receive a permission slip to do secret therapy. Hear about how the Life Participation Approach to Aphasia Core Values can be implemented into acute care. Understand how implementing the Life Participation Approach to Aphasia supports the Joint Commission standards on health literacy. Be empowered to welcome interruptions and struggles and embrace the messiness and the creativity and the joy of using LPAA in acute care.   Katie Strong: Welcome Mary Ann! I'm just so excited to have this conversation with you today! And we were just in Durham, at the Aphasia Access Leadership Summit, where you showcased your beautiful city. Thanks for hosting us.   Mary Ann Eller: I'm really excited to be here and very honored that you asked me to do this podcast.   Katie Strong: Well, I'm excited for people to hear about your thoughts. And as we get started, I wondered if you could share a bit about your own speech language pathology journey, and about the hospital setting you work in.   Mary Ann Eller: I grew up in Pittsburgh. I went to the University of Pittsburgh for my undergraduate and graduate degree and then I went to the Shock Trauma Center in Baltimore for my CFY. And that's where I fell in love with acute care, you can't get more acute than that. Then I moved to Durham, North Carolina and I have worked at Duke since 1989, which is 34 years if you're counting. And I started when I was five! It's been a great experience. I've worked mostly in acute care and acute inpatient rehab. When I was new in my career, I loved the excitement of acute care. And I think as I grew older, I fell in love with rehab because I have more personal experiences with being in the hospital and with myself and with my parents. I just saw how important effective communication was at that time in people's lives. And that's what I really want to talk about today.   Katie Strong: Yeah, I'm excited for this conversation. And as we dig in a little deeper, tell me how you became interested in applying the Life Participation Approach to Aphasia (LPAA) to acute care settings.   Mary Ann Eller: Yeah, this is an interesting story to me. At the University of Pittsburgh, Audrey Holland was there at the time. As people who know her and her work, she is known for being extremely functional. So, I sort of grew up professionally knowing that being functional was the way to go. That was in the late 80s, so the LPAA had not been developed yet, which was around the year 2000, I believe when the impairment-based focus of therapy was recognized as not meeting the mark. It wasn't really helping people where they were at. And so, this LPAA not being a therapy approach, but more of an idea. LPAA is a philosophy of treatment, not a specific treatment approach. So, we could still use the treatment approaches that we knew and were evidence-based, but the philosophy of what we are using them for became more widely known in 2000. So, I didn't know about LPAA until about five years ago, even though I was familiar with being functional. So, in my little isolated world, I wasn't doing CEUs on aphasia because I needed to be a generalist. I had, by that time become a manager in the department and needed to stay up to date on swallowing and dysarthria and cognition. So, I wasn't really in the world of aphasia. So, I continued to do impairment-based therapy for a long time.   But I did secret therapy, which I knew is what Audrey would want me to do. And it was, I would do the things that I knew the patient and the family needed me to do but I'd feel a little bit guilty doing it because I knew it wasn't “evidence- based.” And I wasn't doing the, you know, Response Elaboration Training, or whatever it was that I had learned, but I would meet their needs. So when, about five years ago, I went to an Aphasia Access Conference and Audrey was there, and I got to see her again. And she remembered me, which was really an honor. I was validated that the things that I had been doing in just my nature were correct. They were the best thing for the patient. That was really validating. I was always, and I'm saying this for any clinician who's out there listening, to not be afraid. I was afraid that I was doing it wrong. And I had been doing it for many years, had lots of experience, but I didn't want to get around other professionals that were more recognized in the field, because what if I was doing it wrong? Or what if there was a new approach that I didn't know about? And when I got there, it really wasn't that atmosphere at all at Aphasia Access. It was very welcoming, and it was very validating. And I realized that a lot of my instincts were right.   Katie Strong: I love it. So, it's almost like the LPAA shone a light on that secret therapy, and really validated you.   Mary Ann Eller: It sounds so funny that “secret therapy” but it's really what it felt like. So, I got to bring it out into the open and it was a secret no more.   Katie Strong: Yeah, I love it. Well, I mean, obviously, then you feel like LPAA has value. Do you think LPAA has a role in acute care? And how do the Life Participation Approach Core Values apply to this setting?   Mary Ann Eller: That was a great thing that I had to work out in my brain. Absolutely, it has a role in acute care. What I was learning about LPAA, when I first started learning, was a lot of information for when the clients were further along down the line. So, they were in the community, and they were participating in their goal setting, and they were deciding, “hey, I want to go back to work.” And that's what the speech pathologist was working on. And those things were wonderful, but that's not the setting I was in. So, I started to think about how these Core Values can apply to acute care. The Core Values, I'll read some of them right here, there's five of them. The first Core Value of LPAA is that “the goal is an enhancement of life participation.” So, when you're waking up with a stroke, and aphasia, the life you have to participate in is in a hospital bed. So yes, that applies. Number two, “all those affected by aphasia are entitled to service.” You are entitled to service if you have aphasia, in addition to swallowing and dysphagia services. That's important too, but you are entitled to service if you have aphasia, you don't skip it in acute care. Number three, “both personal and environmental factors are targets of assessment and intervention.” That is a lot of what I do in acute care with LPAA, I am looking into the environment, which includes the nurses and the nursing assistants, and the family, and the call bell, and the bathroom and all of those things that are in the environment. And that is what I am targeting and that's LPAA. Number four, “success is measured by documented life enhancement changes.” It is an enhancement of a person's life, like if they can use a call bell and get to the bathroom. If you've ever been in that situation, that is the most important life-enhancing really, lately. And then number five, “emphasis is placed on availability of services as needed at all stages of life with aphasia.” That includes the beginning, so yes, it absolutely has a place in acute care.   Katie Strong: I love this. I feel like it's preach, you're preaching it girl. You know, it's just, I mean, I think for many, many years, we've thought about, “oh LPAA is just something that you do after you try everything else.” I love hearing you talking about bringing it into acute care just right from the beginning, it's so important.   Mary Ann Eller: If I could say one more thing, I think the weight of responsibility for setting goals is one of the things that's talked about in LPAA. You want to be partners with the person who has aphasia in goal setting. And of course, you want whatever it is that they want to work on to be the center. However, when you wake up with aphasia and you have no experience with it whatsoever, you can't expect someone with aphasia to be able to set their goals of communication at that moment. So, I think that that's the biggest difference with the approach and thinking of LPAA. In acute care, the responsibility is more so on the clinician and the family to get to know the person and what's important to him and set the goals at that stage. Slowly educating and then giving the responsibility over to them as soon as possible to set the goals.   Katie Strong: Beautiful, beautiful. We talked about it earlier, the importance of being able to communicate effectively in your health care setting. And one consideration for LPAA is that JCAHO, or the Joint Commission has placed a real high value on environments that support patients and having conversations about their health care to understand their health status and engage in their own health care decisions. Could you talk about how LPAA supports the Joint Commission standards on health literacy?   Mary Ann Eller: Yes. And let me just say, for people who aren't familiar with hospitals, the Joint Commission is the regulatory board that comes in once every two or three years, and they tell you whether your hospital can continue to operate or not. So, the standards are very, very important. And I'm going to read you one of the standards that they have, and I think every speech pathologist is probably going to be, as they hear the standard, is going to be like “Well, wait, that's not really happening with my people with aphasia”. And I think that's where a real opportunity lies for us. You, I think, are attaching the standards?   Katie Strong: Yes, I'm going to. I'll put them in the show notes so listeners can check them out and we'll have a link to the standards there.   Mary Ann Eller: Okay, so one of the standards says that patients are expected to receive information about their care so they can make an educated decision, be listened to by their providers, and the hospital is required to identify patient communication needs and provide services to meet them. And so, you think about maybe someone who speaks another language, or maybe someone who is deaf, or someone who is illiterate. And those are all most of the things I think that people think about when they read that standard. But this also includes people with dementia, and people with aphasia, because you have that diagnosis, doesn't mean that you're unable to communicate. It means that you need special supports to be able to communicate and a lot of healthcare providers are not aware that speech pathologists can offer that support. And so, I think that's where a lot of our work lies.   There's a quote that I like to use in my talks, it's by George Bernard Shaw, it says, “the single biggest problem in communication is the illusion that it has taken place.” And think that there are so many boxes that are checked in acute care, like “the nurse provided education on stroke, and how to prevent further strokes.” And they check the box, and they do a great job, I'm not getting down in that. But if you have aphasia, you did not receive that communication, she communicated it to you. I communicated something to you but that doesn't mean that you received it. And people when they have a stroke, or a brain tumor, whatever it has that produced aphasia, you and their families are in a state of shock, so you're not able to absorb the information. So, I think that that is one thing we need to really be cognizant of when we are trying to change the culture of a hospital.   Katie Strong: Absolutely. And I was thinking of some of the materials you sent me to take a look at in preparation for our conversation today like that Joint Commission talking about communication requiring that two-way process of expressive and receptive or receiving and understanding, you know. That information is really important, very important.   Mary Ann Eller: Yeah, yeah, absolutely.   Katie Strong: And I think sometimes too, we know that our clients or our patients that we are working with take more time to be able to understand what's going on with them and their health care.   Mary Ann Eller: Yeah, and a lot of times what we use to make that happen isn't really that complicated. It often involves slowing down, turning off the TV, sitting down at eye level, and stopping periodically to say, “did you get that?” and “repeat that back to me.” And that's for everybody, not just people with aphasia. It seems like it should be common sense, but it's really not. People in hospitals, especially in the last three years, have been under a lot of pressure and have to do a lot of things. And so, communication can often get lost.   Katie Strong: Absolutely. All this sounds great Mary Ann, but what do you think might prevent some SLPs from embracing LPAA framework in acute care settings?   Mary Ann Eller: That's such a good question because I went through that for 20-30 years, I guess. I didn't embrace it because I didn't know about it. I think that one of the biggest things is being at the Aphasia Access Conferences. I loved it and I loved having the honor of presenting last time we had it, but I just thought, “gosh, I want this to get to people who don't know about it.” Because there are tons of clinicians who maybe hear about it in grad school and perhaps, they go out to their placements and the supervisors maybe don't know about it. And so, they don't put it into practice, or they don't know exactly how to integrate it into practice. I think that number one, that's the biggest thing that's going to prevent clinicians from using it is because they don't know about it.   I think the other thing is that the “secret therapy” that I talked about is realizing, and if nobody's given you this permission slip, I am giving it to every clinician out there. Here is your verbal permission slip, please treat the communication elephant in the room. Whatever it is with somebody in acute care. If they are struggling to order a meal, if they are struggling to call the nurse, if they're struggling with telling you something or talking to the person beside the bed, that's what you work on. Work on what is right in front of you. You don't have to complete an entire Western Aphasia Battery. You don't have to make sure that you have them name 10 things. Those things all have a place, and I think we can fit evaluation and treatment in, but please deal with the person who's right in front of you, not the agenda that you brought into the room. So, there's your permission slip. I think people don't know how to document it and that's okay. I have a couple suggestions a little bit later when I talk about that. I think they feel it takes too much time and it really doesn't, I think you can do these things instead of the big agenda that you brought into the room. I think these people are going to be dealing with aphasia for a long time. And so, they will get to a speech pathologist who will do the more standard evidence-based treatments when they're appropriate. I'm not saying they're never appropriate, sometimes they are. But in my experience of 34 years, a person in acute care with aphasia needs a ton of education, a ton of successes, and just a lot of validation that here's your recovery process, here's what's going to happen. They are in shock, and they don't know how to deal with things, and I think we are the ones who are speaking to that. Everybody else has their silo that they're speaking about with their blood pressure and their arm and their leg and all of these things. But communication is the soul of a person and I think reassuring those sorts of things and giving them successes at that stage is really vital. So yes, that's your permission slip.   Katie Strong: Yeah, yeah, received. And we're going to make lots of copies of that permission slip and mail them out to everybody. So, you touched on this a little bit, but we'd love to hear some ideas that you have about how to incorporate LPAA principles into acute care.   Mary Ann Eller: Here are some practical things. Honeycomb Speech Therapy is a great service that sent out or made available some free checklists for different settings. I downloaded one of those and so that's a good place to start. So, there's, I'm looking at it now, the Functional Needs Checklists by Setting and looking through using call light, using the menu, asking medical questions, and following safety precautions. I think as a clinician, starting to think through your aphasic patients in acute care by communication need versus impairment.   The other thing I'll say that's a really good way to incorporate this is whatever templates you're using in your electronic medical record. The way that we have done ours in the past has been by impairment because that's how we're trained. “How can you talk?” “How can you comprehend?” “How can you read?” “How can you write?” And in our brains we're pulling it together and we're knowing how this might affect their ability to use the call bell. But I think using a table or a checklist that automatically makes you have to pull it together and give a set of supports that will enable the person to do that or not, depending on how severe they are, is one way to make sure that that you incorporate LPAA.   Katie Strong: I love that. And I love the shout out to Honeycomb and Sarah Baar. We actually had her on the podcast. It's been a couple of years, but I think it's Episode 57 if listeners want to check out a little bit more of hearing her thoughts. But I agree, helping yourself be a little more strategic about how you're going to address all of these areas. Because, as you said earlier time is I mean, time is essential everywhere but in acute care, it's really the big commodity.   Mary Ann Eller: Yup. Another thing is to welcome interruptions because when you're in acute care you will be interrupted. And the nurse will come in to give meds and I think to go into a patient's room open for whatever happens. So that when the nurse comes in and gives meds, you are demonstrating some supported communication techniques. So maybe you always have a pad of paper and a pen or a whiteboard. And so, you write down the medicine, and then you ask the nurse, “what's the medicine for?” and they say, “blood pressure,” and then you write down blood pressure, you show it to the patient, and they nod. And then they have experienced what JCAHO was asking us to do, which is communicating what's happening to them. And not only has that happened, but you also are educating the nurse to see how successful that communication is when you write down a word, for example. Welcome the interruptions to show communication.   I've had doctors come in and explain what's going to happen next for their discharge and I write that down or slow it down or whatever the support needed is. Same with social work. There are so many opportunities to use functional communication and LPAA in acute care. As I was thinking through this question, one of the most effective ways that I remember using it in my recent past is with a patient that had Wernicke's aphasia. And it was at the height of COVID, so everybody had masks on, including her. And she was very, very fluent, and she could not understand spoken language, I mean, lots of it. She could walk, you know, and that made all the more frustrating for her, they'd say, “you can't walk by yourself, you need to sit down.” Well, she didn't understand what they were saying. So, she might say in return, “fine, how are you?” And so, people thought that she was crazy. She was not crazy, she had Wernicke's aphasia. She did not understand spoken language. And so, when we finally got the consult after the woman was put in a Posey Bed, I was able to tease that out. I was able to educate the staff on “hey, if you do X, Y, and Z,” which included writing down what you're saying, a key word, then she can look at it, she can look at the context, and she can follow your directions. And it was the biggest difference. I mean, speech pathologists really do a great service for people with aphasia in acute care. So, those are just a couple of things that I thought of.   Katie Strong: I love it. I love it. Well, you alluded to it earlier, but I'm going to invite it back into the room now. That is the elephant in the room, hello dysphagia. How does an acute care SLP balance the needs of the patient with dysphagia and also support communication issues as well?   Mary Ann Eller: That is a good question, and I don't find it difficult at all to do that. And the reason I don't find it difficult is because I've embraced some messiness in my evaluations.   Katie Strong: Tell me more!   Mary Ann Eller: And sometimes that's hard to do, especially early in your career. Or if you are a very focused kind of Type A organized person, which a lot of speech pathologists are and that's why we're so good at our jobs. But it is a little bit messy. And what I mean by that is, you can easily do both at the same time. You can evaluate dysphagia and you can evaluate their language. You can have them following commands with your clinical swallow even though you're not saying hold up two fingers and point to the window or whatever you were taught. You can say, “hey, would you pick up that glass of water?” without pointing to it and see if they do it. You can ask them open-ended questions and closed-ended questions to see what kind of language they have. While you are writing your recommendations on the whiteboard, you can have them read it back and assess their reading in that way. There's lots of things that you can do to assess both at the same time. So, it really doesn't take that much more time, it just takes a difference in how you think about it.   Katie Strong: Powerful stuff. Yeah. I love that it's not, doesn't have to be mutually exclusive, and couldn't and shouldn't be. I'm sure our listeners would be interested in exploring some of the resources that influenced your thinking about this topic of LPAA. Would you be willing to share a few?   Mary Ann Eller: So, one that I read 8 or 10 years ago was by Lyn Turkstra. And I talked with her about this at a conference once and it was really interesting. It's on Inpatient Cognitive Rehab, Time for a Change. I can't remember the year that she published it.   Katie Strong: I think I've got it here, it's 2013. And listeners we'll have all these resources in the show notes for you, too. But yeah, it's a 2013 publication.   Mary Ann Eller: I talked with her about it at a conference once and she said that she really kind of had a hard time getting it published because it was so against the grain at the time. And basically, what it was is inpatient rehab, for those of you who don't know, is after acute care oftentimes. So, it may be within a week of having a stroke and maybe you stay for two weeks at this point. So, within the first month of having a stroke and having aphasia. So, Lyn Turkstra's thinking was, we're programmed and taught to do things in a world of rehab that used to be months long and now it's only a couple of weeks and now earlier than it used to be. So hey, why don't we focus on some other things like education and laying the foundation and making sure that there's a therapeutic alliance with speech therapy so that the person knows, you know, down the line, this is the person you're going to go to and have a good experience with that. That was the first paper that got me thinking.   And then after I started going to the Aphasia Access a few years ago, I looked up an old paper of Audrey Holland's that was Early Aphasia Management and Acute Care. And that was in 2001 that she wrote that. That talks about a lot of the same things, is that we don't have to do an entire Western Aphasia Battery, but let's take care of their actual needs in acute care.   I loved Roberta Elman's CAPE checklist and I felt kind of dumb when I went to Aphasia Access and I started asking people, “hey, I'm in acute care, and I'm thinking about XYZ.” And they said, “oh, well, that's what CAPE does.” And I was like, “what's CAPE?” I just didn't know. And CAPE stands for, it's a checklist of four interventions, C is connect with the person with aphasia, A is augmentative communication, P is partner training, and E is education and resources. Basically, it's if you do these four things in the very early stages, then you've got your bases covered. And it's like, Oh, that's awesome. I wish I would have thought of that. I'm just glad she did.   Katie Strong: Before you move forward, I just want to say thank you for being so open about feeling uncomfortable that you didn't know things. And I guess from my aspect, I think it's also for maybe listeners who are not practitioners but are researchers putting frameworks out there. We really need to be better at getting our work out to the people who can implement it, you know? So, I mean, I think it takes both sides of things to really get it. You can have beautiful, evidence-based work but if it doesn't get into the hands of the practitioners who are using it, it just doesn't matter. So, thank you for being so open about that and I hope that, I'm thinking that it probably resonates with a lot of the listeners here too. That you know, we don't always know what we don't know.   Mary Ann Eller: Yeah, yeah. Thank you for that. You know, it's funny, because even yesterday, I have a lady who has been in the rehab unit for a really long time, for a variety of reasons. But she has pretty severe aphasia, and I was looking over these notes for this conversation today and I realized as I went through the CAPE that I didn't provide her with any educational resources. It's like, wait a minute, I didn't do this. And it's just, you get caught up in the day-to-day things, even if you're invited to do a podcast about it. And sometimes it's just one of those things. Nobody's perfect. But I think if we can have some standards in front of us and go back to them, that we're going to do a great job, that the frameworks are out there. And I guess the other paper I wanted to mention was also by Roberta Elman it's, “Are we missing the forest for the trees?” and I love that.   Katie Strong: It's a great title.   Mary Ann Eller: Yeah. It was like, okay, we're doing all this stuff for aphasia but the person can't communicate when they get home. And I really, really liked that stark reality and I looked back on a lot of my patients, and I'm like, “ wow, I did a great job while they were in rehab.” But I wonder how they're doing at home because I didn't really work with her husband that much. And that is a failure on my part. And, you know, we do better the next time. But those are the things that really influenced how I thought about this.   Katie Strong: Fantastic. Well, we'll make sure to have links to all of those articles and resources in the show notes. Mary Ann, you've been thinking about applying LPAA in your acute care work for a while now. Do you have any ideas that you could share with us that you have in the works in your own practice?   Mary Ann Eller: Yeah, I have a couple. Well, one of the things that I did and it's a very specific intervention, is I developed a Picture Menu because I was doing a lot of work with dementia care and nutrition because of an initiative in our hospital with geriatric care. And dementia is a place where nutrition is often overlooked because they're usually in acute care because maybe they fell or lots of reasons. And the tray ends up getting put in front of them but because of their dementia, they don't eat it and then they start getting sicker and sicker. So, because of that, I realized, even if they could eat, they might not want the tuna fish sandwich that's in front of them, because that's the standard tray that you get if you don't order your meals. And they don't order their meals because they can't communicate. You know, it's not just dementia, it's people with aphasia. And our menus were extremely word based. They were great but they had a lot of words to them. And if you can't read it for a variety of reasons, maybe you're blind, maybe you speak a different language, maybe you're illiterate, all different reasons. Then the person comes up to your bed and takes a really great bedside order like a waitress on an iPad, but again, all words. I teamed up with some people at my hospital and we went down to the kitchen, and we took pictures of all the items on the menu, and we put it on a big giant, laminated menu that we bring to the bedside and have them point to it. So yeah, and I've trained the patient menu techs, the people who actually take the orders, to use it. So, it's a work in progress because it's an extra step but yeah, it's really useful for the people that can use it. So, that's one thing.   The other thing is the idea that I had, and it is not flushed out at all. I'm just gonna like put it out there and if somebody wants to steal it and do it before I do, feel free. But in my hospital, which is Duke Regional Hospital, it's part of the Duke System, but it's a smaller community hospital made up of about 380 beds. A couple of brilliant speech pathologists teamed up, and developed a trach team. And the trach team consisted of a pulmonologist and a respiratory therapist and a PT and an OT and the main players that revolve around trachs. And through a lot of hard work, they were able to do some culture change and practice change and get these patients with trachs taken care of through weekly rounding and all sorts of focus changes. And I thought, why can't we do that for people with aphasia? Or communication, just have a communication team? And I don't know what it's going to look like yet but why can't we get the players? I mean, maybe it's just the speech pathologist. But identify in my hospital through speech pathology consults, okay, here are the most vulnerable people to not get their needs met in acute care because they have global aphasia or severe dementia and they're on our caseload. Let's put them on a special list and let's give them special attention in some way and have a communication team. And as you round on these patients, you let the rest of the hospital see you doing this. You let them see how to intervene with these people. And it catches on so that they then learn these techniques, whatever they may be. We act as advocates for these people that are particularly vulnerable. Again, I don't know how it's going to work yet, but that's an idea.   Katie Strong: Yeah, I love it. And I would love to hear how it unfolds, so.   Mary Ann Eller: Me too.   Katie Strong: Yeah. Okay. I'd like to take it a little bit further because you're the manager of a department, right? So, talk about maybe a few tips in transitioning to an LPAA focus with a staff that isn't particularly familiar with that philosophy.   Mary Ann Eller: That is a really great question, and there's not one answer. And I'd love to bring in your friend, Natalie Douglas, in implementation science to speak on this. I'll tell you what I did and then I'll tell you what a bigger department might do. I have myself and five full-time speech pathologists, We all have varying levels of familiarity with LPAA and we all have been practicing in some form or fashion. So, I did an anonymous survey, and I asked some questions like, “how comfortable are you seeing people with aphasia?”, “have you ever heard of LPAA?”, “how comfortable are you using supported communication techniques?” And I did it anonymously because everybody is not going to want anybody else to know that they're not comfortable with it. So, even if there's just one person on my team who doesn't know LPAA or who isn't comfortable, I don't know who it is, I have an idea, maybe. But I'm going to put it in front of everybody and say, “hey, there's one person on our team who's not comfortable, let's focus on this.” And so that's what I did. My team is fantastic and they are very open.   And so that's what we did. We had some focus teaching on it we watched some of the Aphasia Access videos on supported communication and LPAA. And then we changed our templates to include some tables that I talked about before that have the checklists on them. I think though, and I had a conversation last night with Kim Irby who is the interim chief over at ‘Big' Duke who has like, I don't know, 40 or 50, speech pathologists. And I asked her, I said, “what have you used with bigger departments?” And she had a really good point, she's like, “you know, education alone is not enough, it's not going to produce a behavior change. People are going to think their behavior is changing and they're going to think, through doing LPAA, and they might be. But really, you have to have people be able to be in the moment with a coach and do it together.” That can be tricky. I mean, you've got people with varying levels of comfort, varying egos, varying all sorts of things. And so, she and I thought, you know, I think probably the most practical way would be to educate and then pair people up together as peers and see a person with aphasia. Try things together then come back and let's all talk about it. It's not, “hey, I'm going to go with you as your boss and make sure you're doing this right.” That would be like totally not cool. So, I don't know, again, I want Natalie to tell me how to implement this.   Katie Strong: We all want Natalie to tell us what to do, for sure. But I love this idea of learning together, right? That you're not imposing “this is what you have to do.” But really, you know, because I do think that the LPAA approach takes your own style...Each person delivers it in a different way, right? And it's different with each patient that you're with because it's personalized.   Mary Ann Eller: Absolutely. And you can't teach that. It's not an agenda, it's an attitude and an openness, armed with the goals that you have, and armed with the core values of LPAA.   Katie Strong: Yeah, I do really love and thinking back to the Turkstra article you were talking about and just that importance of therapeutic alliance with our discipline, right? So that then later on, they think about speech pathology as a positive resource to help. Beautiful. Okay, Mary Ann, as we wrap up, do you have any final thoughts you'd like to share with our listeners?   Mary Ann Eller: I want them to remember the permission slip I gave them. I didn't give it to them, Audrey Holland gave it to them in 1989. Okay. And we're carrying it forward and there is a permission slip to work on the communication elephant in the room. Whatever it is, that is your goal. I think, I guess in my mind, early aphasia intervention should be guided by the person with aphasia's need in the moment first, then the bigger picture. I go in with a really, really loose agenda and I'm open to anything. I welcome interruptions and struggles and I think that that is the messiness and the creativity and the joy of using LPAA in acute care.   I've been a patient in the bed for health reasons and I've sat next to my parents in the bed. I think that once you do that you realize how not only practical but necessary it is that we change our focus on communication at this stage of recovery. Because you don't care what the doctor knows, you care that the doctor cares and can explain it to you in a way that you can make your decisions. And that's the power we have. We've all had health care workers and seen them who have been outstanding and who have been terrible. I think we obviously want to be outstanding. And it doesn't take a lot to be outstanding when you know what your job is, which is to help the person with aphasia to communicate and to be understood in whatever supported techniques that we have and that is our job. And I think that is an amazing privilege. Really, I look at it as a privilege. We are inserting ourselves into a person's worst day and we are the person that walks in there and has the power to help them do two of the most important things, eat and communicate.   Katie Strong: I agree.   Mary Ann Eller: So, I think that those are pretty powerful and I think that it's a real privilege to be able to do that.   Katie Strong: Thank you, thank you. I feel like you've just given us some gold that we need to really admire and take out and show off. Right? That we need to let all of it shine and really take these important pieces about changing our practice in acute care. And really helping people be able to understand and have conversations about their health care so they can participate in really important conversations that impact their life.   Mary Ann Eller: I hope so, I hope so. And I'm not a researcher, I have not done papers and you know, all of those kinds of things. And I used to feel a little bit intimidated by that. It's like, well, do I really have anything to say? And I realized as time goes on, it's like, yes, absolutely. And I want to really reach out to the clinicians that are listening to this. Please use your voice. Please reach out for partners. If you hear somebody at a conference or you reach out to me if you want to, if you're listening to this. Just grow your knowledge and grow your ability to this great job that we have.   Katie Strong: Thanks for a real, practical and inspirational conversation.   Mary Ann Eller: Well, thank you for letting me have it.   Katie Strong: Thanks, Mary Ann.   On behalf of Aphasia Access, we thank you for listening to this episode of Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to check out our growing library of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Guest Contact Information   Email Mary Ann at mary.eller@duke.edu   Resources   Aphasia Access LPAA Training Videos (LPAA 101, LPAA, Core Value, Communication Access- Fundamental Techniques) https://www.aphasiaaccess.org/videos/ Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000). Life Participation Approach to Aphasia: A statement of values for the future. ASHA Leader, 5(3). https://leader.pubs.asha.org/doi/10.1044/leader.FTR.05032000.4 Elman, R. J. (2014). Aphasia intervention: Are we missing the forest through the trees? 44th Clinical Aphasiology Conference, St. Simons Island, GA. http://aphasiology.pitt.edu/2529/ Elman, R. J. (2020). C.A.P.E.: A checklist of four essential and evidence-based categories for aphasia intervention. Chapter 2. In A. L. Holland & R. J. Elman (Eds.) Neurogenic communication disorders and the Life Participation Approach: The social imperative in supporting individuals and families (pp. 21-52) Plural Publishing. Holland, A. & Fridriksson, J. (2001). Aphasia management during the early phases of recovery following stroke. American Journal of Speech-Language Pathology, 10(1), 19-28.https://doi.org/10.1044/1058-0360(2001/004) The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. Turkstra, J. S. (2013). Inpatient cognitive rehabilitation: Is it time for a change? Journal of Head Trauma Rehabilitation, 28(4), 332-336. https://doi.org/10.1097/htr.0b013e31828b4f3f     If you liked this episode – more listening… Additional Aphasia Access Conversations Podcast episodes relating to the topic of acute care and applying LPAA to different settings.   Episode #57 Patient-Centered Home Programs Across the Continuum of Care for Individuals with Aphasia: A Conversation with Sarah Baar.   Episode#99 Communication Partner Training for Health Care Professionals with Dr. Jytte Isaksen   Episode #38 Broadening the Role of the SLP in Acute Care Assessment: A Conversation with Robyn O'Halloran   Acknowledgements – A special thank you to Amanda Zalucki from the Strong Story Lab at Central Michigan University for their assistance in the transcription of this episode.

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/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Today I talked to Marian O'Shea Wernicke about her new novel Out of Ireland (She Writes Press, 2023). Most people have heard of the Irish famine in 1848 and of the resistance movement against British sovereignty that consumed much of the nineteenth and twentieth centuries. In this fictional attempt to understand her great-grandmother's life, Marian O'Shea Wernicke examines the years between the famine and the Easter Rebellion of 1916. In the process, she creates a compelling tale of a young Irish girl, Mary Eileen O'Donovan, whose impoverished family forces her to marry a neighboring farmer in his forties when Eileen, as she's known, has barely passed her sixteenth birthday. The match improves her family's material situation, but it is not what Eileen wants from life. A bookish girl, she has ambitions of studying to become a teacher, but pressure from her family puts paid to those plans. She grudgingly agrees to wed John Sullivan and does her best to make him a good wife. When she becomes pregnant, the couple's newborn son unites them for a while, but John's morose nature and frequent drunkenness make him a difficult man to love, especially for an idealistic girl. When the crops fail and Eileen's younger brother falls foul of the Fenians, she and John decide their only choice is to emigrate. But leaving Ireland turns out to carry a high price as well …  Marian O'Shea Wernicke, a former professor of English, is the author of A 20th-Century Man, a memoir of her father; the anthology Confessions: Fact or Fiction? (with Herta Feely); and Toward That Which Is Beautiful. Out of Ireland is her second novel. C. P. Lesley is the author of two historical fiction series set during the childhood of Ivan the Terrible and three other novels. Her latest book, Song of the Storyteller, appeared in January 2023. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Today I talked to Marian O'Shea Wernicke about her new novel Out of Ireland (She Writes Press, 2023). Most people have heard of the Irish famine in 1848 and of the resistance movement against British sovereignty that consumed much of the nineteenth and twentieth centuries. In this fictional attempt to understand her great-grandmother's life, Marian O'Shea Wernicke examines the years between the famine and the Easter Rebellion of 1916. In the process, she creates a compelling tale of a young Irish girl, Mary Eileen O'Donovan, whose impoverished family forces her to marry a neighboring farmer in his forties when Eileen, as she's known, has barely passed her sixteenth birthday. The match improves her family's material situation, but it is not what Eileen wants from life. A bookish girl, she has ambitions of studying to become a teacher, but pressure from her family puts paid to those plans. She grudgingly agrees to wed John Sullivan and does her best to make him a good wife. When she becomes pregnant, the couple's newborn son unites them for a while, but John's morose nature and frequent drunkenness make him a difficult man to love, especially for an idealistic girl. When the crops fail and Eileen's younger brother falls foul of the Fenians, she and John decide their only choice is to emigrate. But leaving Ireland turns out to carry a high price as well …  Marian O'Shea Wernicke, a former professor of English, is the author of A 20th-Century Man, a memoir of her father; the anthology Confessions: Fact or Fiction? (with Herta Feely); and Toward That Which Is Beautiful. Out of Ireland is her second novel. C. P. Lesley is the author of two historical fiction series set during the childhood of Ivan the Terrible and three other novels. Her latest book, Song of the Storyteller, appeared in January 2023. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/literature

Join Bree and Mary for a discussion of a Midsummer Night's Dream -- a "starter play" for many a young actor, and a blissful escape. 

THIS SHOW WAS RECORDED IN FRONT OF A LIVE AUDIENCE From ancient places with stories and secrets to people and characters with stories and secrets of their own, join these fascinating authors and learn about their unique tales and lives just as you fall in love with your next great read. Find out more about these authors at: ∙ Amy Bernstein: https://amywrites.live/ ∙ Julia Brewer Daily: https://www.juliadaily.com/ ∙ Linda Moore: https://lindamooreauthor.com/ ∙ Marian O'Shea Wernicke: https://www.marianosheawernicke.com/ LAUNCH PAD combines the best of book celebration and solid marketing strengths. Each on-air episode is hosted by Grace Sammon and celebrates book releases and the authors that create them. Each episode engages guests and listeners in the book launch journey from concept to publication. Applying her years of experience as an educator, entrepreneur, author, and storyteller herself, Grace brings to readers, reviewers, book club members, and more an intimate look at some of today's newest releases. Visit Grace at her website www.gracesammon.net. Contact Grace about being a guest on the show, email her at grace@gracesammon.net Follow Grace: On Facebook https://www.facebook.com/GraceSammonWrites/ On Instagram https://www.instagram.com/GraceSammonWrites/ On Twitter https://www.twitter.com/GSammonWrites On LinkedIn: https://www.linkedin.com/in/grace-sammon-84389153/ Visit author marketing coach, Mary Helen Sheriff at her website www.maryhelensheriff.com/marketing for more about information about how she can help you navigate this marketing of your book. Be sure to sign up for her marketing newsletter while you are there. Follow Mary On Facebook @maryhelensheriff On Instagram @maryhelensheriff On LinkedIn https://www.linkedin.com/in/maryhelensheriff/ On Book Bub @maryhelensheriff #launchpad #bookish #bookishroadtrip #roadtrip #bookmarketing #Storytellers # Storytelling #AuhtorInterview #LetsTalkBooks #LeaveYourMark #AuthorLife #StorytellerLife #ArtofStory #AuthorTalkNetwork #AuthorTalkNetwork #awardwinningfiction #womensfiction #memoir #historical fiction #WFW #womensfictionwritersassociation #nationalwomensbookassociation #awardwinningfiction #novelist #historicalfiction #bookdebut #debutnovel #booklaunch #launchpad #bookish #bookishroadtrip #roadtrip #bookmarketing #Storytellers # Storytelling #AuhtorInterview #LetsTalkBooks #LeaveYourMark #AuthorLife #StorytellerLife #ArtofStory #AuthorTalkNetwork #AuthorTalkNetwork #awardwinningfiction #womensfiction #memoir #historical fiction #WFW #womensfictionwritersassociation #nationalwomensbookassociation #awardwinningfiction #novelist #historicalfiction #bookdebut #debutnovel #booklaunch #memoir #immigration #archeology #texas #Ireland #ranch #arthistory LAUNCH PAD is a copyrighted work © of Grace Sammon and Authors on The Air Global Radio Network.

Mike Pieri interviews Luciano Wernicke as they discuss his book Inside Diego: How the best footballer in the world became the greatest of all time - an intimate portrait of football legend Maradona from the person in football who knew him best, his personal trainer. Fernando Signorini spent more than a decade at the superstar's side, witnessing many highs and lows and this interview discusses much of what the book contains. A pleasure to speak to Luciano all the way from Buenos Aires.

Discovered in 1874 by Carl Wernicke, a German neurologist, Wernicke's area is one of the two main areas in the Cerebral Cortex that is responsible for speech. As many people are left-hemisphere dominant, Wernicke's Area is often found on the left side, but in those that are right-hemisphere dominant, the Wernicke's Area may be found on the right side of the brain. In this fast-facts episode, Edward reviews the Wernicke's Area's form and function, as well as the key features that make us who we are.To create this episode, I used information provided by Javed, et al., 2021 in StatPearls, through NCBI Bookshelf, which can be found here: https://www.ncbi.nlm.nih.gov/books/NBK533001/No statement, phrase, or episode of this series—or any episode in this podcast—are intended to treat, diagnose, cure, prevent, or otherwise change your mind or body in any form or manner. This podcast—and this series especially—is meant purely for education purposes for the common person. Please do not rely on any of the information I share in this podcast in any way for your medical or psychological treatment. If you feel that you may have a condition mentioned or not mentioned in this podcast, do not come to me. Instead, immediately go to a trusted psychiatrist, psychologist, therapist, counselor, or other reliable source of information and help for further guidance. Never disregard professional, psychological, or medical advice—nor delay in the seeking of this advice—because of something that you have heard or read from this podcast, this podcast's episode descriptions, this podcast's promotional materials, or any other information explicitly or implicitly generated from this podcast.-----If you love this podcast, show your support by rating, subscribing, and downloading!  The best way to support me is by sharing this podcast with others—the more people can learn, the better we can understand the crazy world we live in :DI realize that this episode is coming back after a very long hiatus--I have had a few issues with my podcast server, but the rest of the episodes of this season will be published in the next few days :) Sorry for the delays and thank you for your patience!

French physician and anatomist, Pierre Paul Broca, discovered what's now known as the Broca's Area in 1861 after looking for similarities between two patients who were speech-impaired. Typically on the same side as the Wernicke's Area (typically left, but sometimes right), the Broca's Area serves in language production, comprehension, and integration. In this fast-facts episode, Edward reviews the Broca's Area's form and function, as well as the key features that make us who we are.To create this episode, I used information provided by Stinnett, Reddy, and Zabel, 2021 in StatPearls, through NCBI Bookshelf, which can be found here: https://www.ncbi.nlm.nih.gov/books/NBK526096/No statement, phrase, or episode of this series—or any episode in this podcast—are intended to treat, diagnose, cure, prevent, or otherwise change your mind or body in any form or manner. This podcast—and this series especially—is meant purely for education purposes for the common person. Please do not rely on any of the information I share in this podcast in any way for your medical or psychological treatment. If you feel that you may have a condition mentioned or not mentioned in this podcast, do not come to me. Instead, immediately go to a trusted psychiatrist, psychologist, therapist, counselor, or other reliable source of information and help for further guidance. Never disregard professional, psychological, or medical advice—nor delay in the seeking of this advice—because of something that you have heard or read from this podcast, this podcast's episode descriptions, this podcast's promotional materials, or any other information explicitly or implicitly generated from this podcast.-----If you love this podcast, show your support by rating, subscribing, and downloading!  The best way to support me is by sharing this podcast with others—the more people can learn, the better we can understand the crazy world we live in :DI realize that this episode is coming back after a very long hiatus--I have had a few issues with my podcast server, but the rest of the episodes of this season will be published in the next few days :) Sorry for the delays and thank you for your patience!

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.

Show notes at pharmacyjoe.com/episode783. In this episode, I’ll discuss why the administration of glucose without thiamine might precipitate or worsen Wernicke’s encephalopathy. The post 783: Why Might the Administration of Glucose Without Thiamine Precipitate or Worsen Wernicke’s Encephalopathy? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode783. In this episode, I’ll discuss why the administration of glucose without thiamine might precipitate or worsen Wernicke’s encephalopathy. The post 783: Why Might the Administration of Glucose Without Thiamine Precipitate or Worsen Wernicke’s Encephalopathy? appeared first on Pharmacy Joe.

This week we welcome special guest Grant Wernicke Jr. to the podcast! Grant is a firefighter/EMT and was the first-ever winner of the Discipline Equals Freedom Reset, hosted by Jocko Fuel and Echelon Front. Listen in as we talk about his experience in the modern-day fire service and how he went from reading Extreme Ownership on his honeymoon to meeting Jocko Willink, touring the Jocko Podcast studio, and more. Click HERE to keep up with Grant on Instagram. Host: Cale Matthews Audio Engineer: Art Pipok Visit us at solid7podcast.com to rate the show, buy us a Jocko Go, see upcoming events, follow us on social media, support worthy causes, and become a Patreon supporter. © Copyright 2023 Solid Seven Podcast. All Rights Reserved.

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/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Show notes at pharmacyjoe.com/episode782. In this episode, I will discuss how I would treat Wernicke's Encephalopathy if I were completely out of IV thiamine. The post 782: Wernicke's Encephalopathy Treatment During an IV Thiamine Shortage appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode782. In this episode, I will discuss how I would treat Wernicke s Encephalopathy if I were completely out of IV thiamine. The post 782: Wernicke s Encephalopathy Treatment During an IV Thiamine Shortage appeared first on Pharmacy Joe.

#neurofeedbackpodcast #eeg #brain Jay Gunkelman is the man who has read well over 500,000 Brain Scans and he discusses on the NeuroNoodle Neurofeedback and Neuropsychology Podcast Brain Anatomy and Function that start with the letter F Jay Gunkelman and Pete Jansons also discuss the most watched videos of 2022 Other Topics include: falx cerebri, function, perfusion, Brain Perfusion, Ian Cook, Frontal Cortex, gyrus, sulcus, Einstein's Brain, Left Hemisphere, right hemisphere, SMR, Motor Strip, Cingulate, Flexibility, OCD, Obsessive Compulsive disorder, Temporal Lobe Split, Cochlea, B.A.R.E Testing, Pianist the keyboard is the motor strip, Wernicke's Area, Word Salad, Bruce Willis, Homunculus, Motor Homunculus, Abdominal Epilepsy, Insula, Frontal Eye Fields, High Speed Fiber Tracks, Versículo Most Watched Episodes 2022: "The Little Known Reason Why Michael Jordan Sticks out His Tongue?" https://youtu.be/qGo0rSPNfjQ "What happened to Bob Saget?" https://youtube.com/shorts/4I4H-E5VE0M "Chronic Fatigue Syndrome - What is it?" https://youtu.be/a0klWnoIUyQ "How Light Can Improve Mental Health: Photobiomodulation with Dr. Lew Lim Founder Vielight" https://youtu.be/0gYz7HQyx-8 "Does it Matter Where You Place the EEG Electrodes?" https://youtu.be/nN2HusIlnPg "The Jay Gunkelman Story Part 1" https://youtu.be/inKwhggsLsY "Electroencephalogram Certification Types" https://youtu.be/zuGGzftNBMc "Neuroinflammation, tACS, tDCS and SMR" https://youtu.be/h1zryEossTM "Ruth Lanius Interview: PTSD, Emotions, and More with Sebern Fisher and Jay Gunkelman" https://youtu.be/sANme28BCZE "QEEG vs SPECT Scan? Snippet from NeuroNoodle Neurofeedback Podcast" https://youtu.be/HWJ-4raVDz0 --- Send in a voice message: https://anchor.fm/neuronoodle/message Support this podcast: https://anchor.fm/neuronoodle/support

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