Functional Neurology – Exercise definitions

So what are some of the terms that you can come across at a Functional Neurology appointment? Here’s a list… and the definitions. Presented in no particular order!

Saccade – Eye movements in a non-smooth manner. Usually used to describe following a series of dots on a page, where your eye jumps from one dot to the next.

Pursuit- The opposite of Saccade. The eye movement happens in one continuous movement. Usually following a line.

Complicated background – A background that has lines or stripes of some kind that can create an illusion of movement when your eye follows it.

Optopkinetic stimulus – A type of complicated background. Often run on an electronic device where the bars or stripes can be different colors and widths and the stimulus can run at different speeds.

Directional targeting- similar to optokinetic stimulus but instead of bars, the screen is replaced by objects in a row moving in the same direction.

Halmagyi – a quick movement of the head in one direction with a slow return to the original position. Named after Gabor Halmagyi who created the exercise.

Complicated pattern, or figure eights – The movement of your hand, foot or both in a figure eight pattern. When using both the hand and foot, variations can include circles going in opposite direction, or figure eights in opposite direction. Advanced patients may be asked to spell out words in cursive.

Rotational movement-  Spinning on a chair. Often done in conjunction with optopkinetic stimulus and/or directional targeting.

I’m sure there’s more to add to this list. But that will have to wait for another post!

Brain on Fire: My Month of Madness

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In Brain on Fire: My Month of Madness, the author writes about her experience with a rare autoimmune condition in which her body begins attacking her brain, leaving her helpless. It is a story about Susannah’s family coming together to fight for her survival and the doctors who tried everything to bring her back to normalcy.

The doctors don’t actually know how it began for me. What’s clear is that if that man had sneezed on you, you’d most likely just get a cold. For me, it flipped my universe upside down and very nearly sent me to an asylum for life. (p. 9)

What I enjoyed most about this book was the rare, inside peek into brain disorders. Speaking as one who has experienced a lot, yet has survived and come out the other side, Susannah offers an objective view of some of the strange symptoms she experienced as she succumbed to her body’s attack. Her re-entry back into the real world and wondering who she is now is a struggle I could relate to.

Who would I recommend this book to? Anyone! It’s a light, fascinating read that is hard to put down.

Friday Links & Updates

Links:

This week:

  • Overdid it on Saturday because I felt so great, so I’ve had some MdDS issues all week, which slowed me down. But I did start doing the MdDS exercises on my own at home in very short bursts! I haven’t told Dr Z yet (shh!) because I only got my nerve up to try it today, but I think it’s all good. I have done it at home before, but it’s never been as effective, so I gave up. But now, I think my brain might be healed enough that it will be effective and helpful.
  • Over the past couple of weeks I’ve noticed increased pressure in my right occipital lobe region. When I did SOT, the doctor relieved that pressure but it started coming back again. I was debating about how soon to go back and see her when earlier this week I accidentally gave myself a “soft punch” to the jawbone. I was folding down a bench seat and as it sprung forward I realized my head was in the way and managed to turn it right as the seat came down. It did knock me, but not as badly as if I hadn’t moved my head. I basically gave myself a giant halmagyi. As a result, my neck felt off all day yesterday so I went in to see the SOT doctor and it felt so wonderful. I came home and took an hour and  half long nap, so I think some healing is happening.
  • After completing my initial round with SOT last month, my cerebellar dominance had switched from the left to the right. After giving myself the “soft punch” I had a consistent desire to do complicated movement with my  right hand thus implying to me that it switched back to the right. Now that I did today’s SOT, that urge is gone, so I’m going back to my left hand and foot.

Current Exercises:

  • Complicated pattern with my left hand and foot (3x/day)
  • Following my thumb from center to down left with a complicated background moving at a faster pace.
  • Short bursts of optokinetics going up and to the left.

Functional Neurology: My first appointment

When I began going to Functional Neurology, I had spent a year recovering from my first concussion, and was still limited in my daily life.

Even after 3 months of vision therapy, my eyes still couldn’t track properly. I could barely read. I had short term memory issues. If I wanted to remember anything, I had to write it down. Right away. Otherwise it was gone. I also got overwhelmed easily. Because my eyes had to work overtime, I was easily overstimulated by sight and sound.

Enter Functional Neurology and Dr Z.

In January of 2012 I had my first appointment. During that time, he mostly took in my patient history and then performed simple neurological tests to see how my balance, cognitive abilities, memory, nose, eyes, and vestibular system were working.

With balance, he used a special scale with a foam pad on top. Inside the scale were sensors that could track my center of balance. My balance was tested with my head in different positions such as straight forward, facing up, down and to the sides both with and without the foam pad. With the foam pad, this allowed us to see how my brain performed with more input from my feet. All of this data fed into a computer program that traced my movement on to a screen and created a map of my movements.

Concerning memory issues, I was able to describe the memory problems that I had, then Dr Z had me remember different combinations of objects and number to see if I could repeat them back.

For cognitive issues, I remember being asked to skip count, name as many objects as I could starting with the same letter, and spell EARTH backwards.

He also had me close my eyes and smell different scents to see if I could recognize them.

Dr Z did several exercises for my eyes. He used a simple red and white striped strip of fabric and moved it slowly in front of my face to see how my eyes tracked when perceiving movement. He also had me focus on his thumbs at different locations, and watched as my eyes moved between them.

And then came the big, bad goggles! These special goggles, called video-electronystagmography goggles have special cameras that tracked my eye movements. The ones I used were fairly basic, providing a direct feed to a laptop screen, while I moved my eyes as directed.

The last test that I remember doing involved wearing the goggles while sitting cross-legged on a revolving chair and being spun in alternate directions. This tested the responsiveness of my vestibulo-ocular reflex.

While some of these tests have been replaced by more advanced technologies, the principles remain the same: test neurological functions, create baselines, and then develop exercises to improve those functions by taking advantage of nerve plasticity!

Bugs, Bowels and Behavior: The Groundbreaking Story of The Gut-Brain Connection

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Bugs, Bowels, and Behavior: The Groundbreaking Story of the Gut-Brain Connection is a fascinating look at the correlation between the gut issues and autism. It contains 15 papers that explore how the gut and it’s bacterial residents can affect the brain and cause autism. Each paper seems to fall into one of three categories:

  1. A broad overview of the intestinal system
  2. A detailed analysis of an element in the intestinal system
  3. A personal account about how to apply this knowledge in real life

However, odd as it may seem to some readers, the microbial world of the gastrointestinal tract has been increasingly recognized as a potential source of neuropsychiatric symptoms. While it is somewhat easy to understand how brain inflammation could lead to autistic features, it is more challenging to comprehend the role of the gut ecosystem (microbiome) in both creating and maintaining an ongoing central nervous system (CNS) inflammatory response.

After reading this book, I felt that I had a much better handle on the science behind intestinal permeability and how it can affect our brain. The science was usually presented in a way that was easy for a non-science minded person to grasp. The material does build with more complex reports near the end, however there are simpler, more personal reports sprinkled refreshingly throughout. It was nice to have the freedom to skip a report if it got too bogged down in scientific jargon that I didn’t understand.

Who I would recommend this book too? Any involved adult working with a child that has development issues, whether autism, ADD, Asperger’s, dyselxia, etc.

Friday Links & Updates

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Links:

This week:

  • At my appointment with Dr Z this week, I met a colleague of his that has a clinic in the same town my grandmother grew up in. Small world.
  • Also, at my appointment, I went over a list of items that I haven’t noticed improvement since starting my MdDS exercises. I’ve noticed tremendous improvement related to my MdDS, but there’s some other areas that are lagging behind that it doesn’t seem to be making a difference with, such as looking up easily. I currently feel like I’m going to fall over every time. So he gave me a new exercise and as a result, I spent about an hour gardening today. Between today, and an earlier stint this week, I’ve spent more time gardening this week then I did all last year. (Thus the picture of the flowers.)
  • Current exercises:
    • Complicated pattern with my left hand and foot (3x/day)
    • Following my thumb from center to down left with a complicated background moving at a faster pace.
    • Short bursts of optokinetics going up and to the left.

Functional Neurology: A brief summary introduction

When I was first introduced to functional neurology, it was overwhelming. My guess is that it would be overwhelming to someone who was not experiencing brain issues and to enter into it with having mental dysfunction just makes it worse. The terminology was different, the tools and techniques were different, and the way they thought about my injury was, different.

One of the first things that struck me during my first functional neurology appointment was the barrage of new terms the doctor uses in giving a neurological exam. During my first exam, I met with Dr Z and he did some simple neurological tests to see if I was a possible candidate for functional neurology and when words like saccade, cortex, and nystagmus all come pouring out and I was left scratching my head trying to make sense of it all.

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A patient modeling video-electronystagmography goggles

 

Another factor was the tools and techniques used to evaluate my condition. While the technology has changed and gotten more sophisticated and detailed since I started doing functional neurology, the things they are measuring for remain similar. One of the most important things that they look at are eye movements and for that, I wore special goggles with built in cameras that are attached to a computer program the recorded my movements. Using the goggles made me feel like a deep sea diver. They also tested my balance using a sophisticated scale like device that when I stood on it, tracked my center of gravity.

Functional neurology also introduced me to the idea of neuroplasticity. For years, it was thought that the brain was stagnate and could not change. We now know that the brain is capable of significant changes in re-wiring and healing itself. This is at the core of functional neurology and what it has to offer. Dr Z explained how nerves can create new connections to replace lost ones and that it is possible to regain significant amounts of function, which I can now attest to!

Functional neurology, is really, a whole new world that is opening up to people who have suffered brain damage or who have neurological impairments. While it was overwhelming at first for me, I have grown to love it and to see the hope and restoration it offers!

Mal de Debarquement Syndrome and roadtrips

One of the most unique symptoms of Mal de Debarquement Syndrome is the relief of symptoms from driving. I often feel my best when driving and I never realized it was connected to my MdDS until I was actually diagnosed and realized that was a common affect.

This week, I took a quick road trip to Seattle (from Portland) with my parents and a brother (he had an appointment with a specialist at the Children’s hospital there). I get very nervous going on road trips, as ever since my second concussion I’ve gotten very motion sick sitting in the back seat, a little motion sick sitting in the passenger seat, and zero motion sickness if I’m driving. The only way I’ve found I can sit in the back seat without symptoms is to be so exhausted I conk out.

My mom, for health reasons has to sit in the passenger seat, which means that 99% of the time I’m driving. Thankfully, this normally isn’t an issue, as I like to drive.

However, with my recent head re-bonking, I knew I wasn’t going to be up to driving the 3 hour drive to Seattle (and back). On our way up, I avoided taking a nap all day so that my brain would be exhausted enough that I would hopefully be able to sack out in the back seat while my dad drove, and indeed, the plan worked. I slept the first hour, and then drove the last two. However, on the way back down, I couldn’t sleep, and ended up closing my eyes for an hour and listening to the story while my dad drove, and amazingly it worked! I was able to last over an hour this way. I also at times, would stare out the left window (I was sitting on the left side) and I felt like that was slightly therapeutic as it imitated my MdDS exercises at the functional neurology.

This was incredibly encouraging progress that makes me hope eventually I’ll be able to ride in the back seat for hours at a time without keeping my eyes closed. Oh the things we take for granted!