DOCSLIB.ORG

Upper Limb Movement After Hemispherectomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Limb Movement After Hemispherectomy Upper Limb Movement After Hemispherectomy David Robert Henry Nobbs UCL Thesis submitted for the degree of DOCTOR OF PHILOSOPHY 1 I, David Robert Henry Nobbs, confirm the work presented in this thesis is my own. Where information has been derived from other sources, I confirm this has been indicated in the thesis. 1st March 2018 Signed: ................................. Date: ........................................ 2 Abstract Hemispherectomy is a surgical procedure for treating intractable epilepsy, involving the removal or disconnection of a cerebral hemisphere. Prior to surgery, patients have weakness along one side of their body and disruptions to their motor control. These impairments can be further exacerbated by the operation. This thesis provides an investigation into upper limb movement after surgery in terms of gross motor control and ipsilateral descending motor pathways for distal function. A neurophysiological assessment was used to identify the pathway driving the distal muscles of the paretic upper limbs. The results support the findings of previous studies that suggest superior function is likely to be dependent on a common, branching corticospinal pathway to the left and right sides. In addition, one patient without evidence of a common pathway had some use of the paretic wrist suggesting the presence of a distinct ipsilesional – possibly corticoreticulospinal – pathway. Upper limb kinematics during functional unimanual and bimanual reaching was also assessed. Unimanual deficits were identified and abnormalities in inter-limb coordination were found. These include a tendency to perform bimanual reaches as sequential unimanual reaches and reduced spatial interference in the trajectories of the two limbs. Whilst there were significant differences between the comparison and patient groups for these measures, there was also significant variance between the patients, underlining the heterogeneity of this cohort. 3 Impact statement The results of the studies in this thesis are expected to impact academic research into ipsilateral motor control after hemispherectomy. Firstly, neurophysiological studies can be pursued to further understand the two potential patterns of motor reorganisation that may underlie distal upper limb function. Secondly, neuroimaging studies can be pursued to understand the neural structures and connectivity involved in bimanual coordination with a single hemisphere. The results of this thesis have already been communicated to academic audiences through poster presentations at academic conferences. The results are planned to be disseminated further through the submission of manuscripts to academic journals. Furthermore, the methods used in this thesis can impact the clinical motor assessment of patients who undergo hemispherectomy. The positive findings of the neurophysiological assessment can impact the pre-operative assessment of hemispherectomised patients. The results of the kinematic assessment demonstrate its feasibility as a performance outcome measure of functional reaching in hemispherectomised patients that can be used in clinical practice. The results have already been communicated beyond academia through talks at epilepsy workshops involving clinicians from many different areas. In the future the validity and reliability of the methodologies can be established through collaborations with healthcare professionals working in the pre- and post- operative assessment of hemispherectomy candidates. 4 Acknowledgments I would like to thank my supervisors, Professor Faraneh Vargha-Khadem, Dr Luc Berthouze and Professor Helen Cross for sharing their knowledge, giving me their time and guiding me throughout this project. I also greatly appreciate the assistance of all those on the Epilepsy Surgery Programme at Great Ormond Street Hospital. They not only provide an excellent clinical service, but are also passionate about research. I am grateful to those colleagues that assisted in data collection and provided feedback on the results, including Linda Hammett, Simon Farmer, Margaret Mayston, Alki Liasis, Sian Handley, Tina Banks, Jessica Cooper and Sebastian Guderian. I have received help and advice from many in the Cognitive Neuroscience and Neuropsychiatry Department at the Institute of Child Health, UCL. In particular, I would like to thank Torsten Baldeweg, Frederique Liegeois, Serife Dervish, Ania Dzieciol, Joe Bathelt, Sharon Geva, Georgia Pitts and Zita Patai. I would like to thank my family for their patience and encouragement. Finally, I wish to express my gratitude to all those who took part in this study, especially the patient participants. It was a great pleasure to meet them. By giving their time to research, they make possible the advances that are made in the field. This thesis was funded by a Child Health Research Appeal Trust studentship. 5 Table of Contents Abstract ..................................................................................................................... 3 Impact statement ...................................................................................................... 4 Acknowledgments .................................................................................................... 5 1. General introduction ...................................................................................... 12 1.1 Hemispherectomy as treatment for intractable epilepsy ........................... 12 1.2 Existing measures of upper limb function ................................................. 16 1.3 Optical motion capture .............................................................................. 18 1.4 Ipsilateral motor control ............................................................................ 21 1.4.1 Corticospinal projections ................................................................... 21 1.4.2 Pathways from the brainstem ........................................................... 24 1.4.3 Brainstem projections and hand function .......................................... 26 1.4.4 Pre-surgical assessment ................................................................... 28 1.5 Remainder of the thesis ............................................................................ 29 2. Clinical assessments ..................................................................................... 33 2.1 Introduction ............................................................................................... 34 2.2 Participants ............................................................................................... 35 2.3 Methodology ............................................................................................. 36 2.3.1 Clinical histories ................................................................................ 36 2.3.2 Motor tests ........................................................................................ 36 2.3.3 Visual tests ........................................................................................ 37 2.4 Results ...................................................................................................... 40 2.4.1 Clinical history: C.B. .......................................................................... 40 2.4.2 Clinical history: D.N. .......................................................................... 42 2.4.3 Clinical history: E.B. .......................................................................... 44 2.4.4 Clinical history: H.W. ......................................................................... 47 2.4.5 Clinical history: J.S. ........................................................................... 49 2.4.6 Clinical history: P.O. .......................................................................... 51 2.4.7 Motor tests ........................................................................................ 54 2.4.8 Visual tests ........................................................................................ 55 2.5 Discussion ................................................................................................ 61 2.5.1 Clinical histories ................................................................................ 61 2.5.2 MRI scans ......................................................................................... 61 2.5.3 Motor performance ............................................................................ 62 6 2.5.4 Visual performance ........................................................................... 63 2.5.5 Conclusions ...................................................................................... 64 3. Neurophysiological assessment of motor pathways .................................. 65 3.1 Introduction ............................................................................................... 66 3.1.1 Motor pathways after early brain damage ......................................... 67 3.1.2 Branching pathways .......................................................................... 68 3.1.3 Neurophysiological evidence for branching pathways ...................... 69 3.1.4 Correlations in the frequency domain ............................................... 73 3.1.5 Mirror movements and hemispherectomy ......................................... 74 3.2 Methodology ............................................................................................. 76 3.2.1 Participants ....................................................................................... 76 3.2.2
Load more

Recommended publications
  • Late Complications of Hemispherectomy: Report of a Case Relieved by Surgery
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.33.3.372 on 1 June 1970. Downloaded from J. Neurol. Neurosurg. Psychiat., 1970, 33, 372-375 Late complications of hemispherectomy: report of a case relieved by surgery NINAN T. MATHEW, JACOB ABRAHAM, AND JACOB CHANDY From the Department of Neurological Sciences, Christian Medical College Hospital, Vellore, S. India SUM M A RY A case of Sturge-Weber disease treated with left hemispherectomy presented, 11 years later, with complications related to delayed intracranial haemorrhage. A loculation syndrome of the right lateral ventricle was detected and it was corrected by a ventriculoatrial shunt operation. The side of the hemispherectomy was evacuated of all the chronic products of haemorrhage, including the subdural membrane. The patient was relieved of her symptoms. It is considered that compli- cations related to delayed haemorrhage after hemispherectomy are remediable. Immediate and delayed complications occur after 10 July 1969, with persistent headache, vomiting, and hemispherectomy. Early complications include ob- increasing drowsiness of three weeks' duration. She was structive hydrocephalus and herniations of the born with a Sturge-Weber syndrome and had had a leftProtected by copyright. remaining hemisphere (Cabieses, Jeri, and Landa, hemispherectomy performed in another country 11 years before. She was free from seizures and major behavioural 1957; Laine, Pruvot, and Osson, 1964). A syndrome problems and was attending a school for backward of delayed intracranial haemorrhage was reported by children till November 1968, when she developed severe Oppenheimer and Griffith (1966). The essential constant headache, vomiting, and drowsiness. She was features of the syndrome are (I) an infantile hemi- admitted elsewhere in early December 1968, where plegia treated by hemispherectomy; (2) a trouble- browniish yellow fluid with a protein content of 1,150 mg/ free period lasting for some years; (3) a period of 100 nil.
    [Show full text]
  • This Article Appeared in a Journal Published by Elsevier. the Attached
    This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy Neuropsychologia 48 (2010) 1683–1688 Contents lists available at ScienceDirect Neuropsychologia journal homepage: www.elsevier.com/locate/neuropsychologia Cerebral lateralization of vigilance: A function of task difficulty a, b b c William S. Helton ∗, Joel S. Warm , Lloyd D. Tripp , Gerald Matthews , Raja Parasuraman e, Peter A. Hancock d a Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand b Air Force Research Laboratory, Wright Patterson Air Force Base, Dayton, OH, USA c Department of Psychology, University of Cincinnati, OH, USA d Department of Psychology, University of Central Florida, Orlando, FL, USA e Department of Psychology, George Mason University, VA, USA article info a b s t r a c t Article history: Functional near infrared spectroscopy (fNIRS) measures of cerebral oxygenation levels were collected Received 6 July 2009 from participants performing difficult and easy versions of a 12 min vigilance task and for controls who Received in revised form 10 February 2010 merely watched the displays without a work imperative.
    [Show full text]
  • A Novel Diagnostic Tool for Concussion
    Neurosurg Focus 33 (6):E9, 2012 Magnetoencephalographic virtual recording: a novel diagnostic tool for concussion MATTHEW TORMENTI, M.D.,1 DONALD KRIEGER, PH.D.,1 AVA M. PUCCIO, R.N., PH.D.,1 MALCOLM R. MCNEIL, PH.D.,2 WALTER SCHNEIDER, PH.D.,3 AND DAVID O. OKONKWO, M.D., PH.D.1 Departments of 1Neurological Surgery, 2Communication Science and Disorders, and 3Psychology, University of Pittsburgh, Pennsylvania Object. Heightened recognition of the prevalence and significance of head injury in sports and in combat veter- ans has brought increased attention to the physiological and behavioral consequences of concussion. Current clinical practice is in part dependent on patient self-report as the basis for medical decisions and treatment. Magnetoen- cephalography (MEG) shows promise in the assessment of the pathophysiological derangements in concussion. The authors have developed a novel MEG-based neuroimaging strategy to provide objective, noninvasive, diagnostic information in neurological disorders. In the current study the authors demonstrate a novel task protocol and then assess MEG virtual recordings obtained during task performance as a diagnostic tool for concussion. Methods. Ten individuals (5 control volunteers and 5 patients with a history of concussion) were enrolled in this pilot study. All participants underwent an MEG evaluation during performance of a language/spatial task. Each individual produced 960 responses to 320 sentence stimuli; 0.3 sec of MEG data from each word presentation and each response were analyzed: the data from each participant were classified using a rule constructed from the data obtained from the other 9 participants. Results. Analysis of response times showed significant differences (p < 10-4) between concussed and normal groups, demonstrating the sensitivity of the task.
    [Show full text]
  • Epilepsy the Term Epilepsy Describes Brain Disorders That Involve Repeated Seizures
    Epilepsy The term epilepsy describes brain disorders that involve repeated seizures. Seizures are sudden, uncontrollable waves of electrical activity in the brain that cause involuntary movement, a change in attention, or loss of consciousness. They may involve the entire brain or take place in one part of the brain. Your doctor may use a physical exam, electroencephalogram (EEG), head CT, head MRI or lumbar puncture to diagnose you. Treatment depends on what is causing your seizures. What is epilepsy? The term epilepsy describes brain disorders that involve repeated seizures also called convulsions. A seizure is a sudden, uncontrollable wave of electrical activity in the brain that can affect a person's behavior for a short period of time. For example, there can be involuntary movement, a change in attention, or loss of consciousness. The word epilepsy or seizure does not imply that there is a cause for it. Doctors perform many tests to find the cause for your seizures (such as brain injury, brain bleed, tumor among a few). However, in many cases, the cause of epilepsy cannot be found. A seizure may happen just once, a few or many times over a long period. Symptoms may vary between patients and depend on the type of seizure. They often relate to the normal function of the affected part of the brain. Epilepsy is not contagious. There are two major types of seizures: generalized, in which the entire brain is involved, and focal, in which abnormal activity occurs in one part of the brain. Generalized: seizures involve the entire brain Focal: abnormal activity takes place in just one part of the brain.
    [Show full text]
  • Non-Invasive Functional-Brain-Imaging with a Novel Magnetoencephalography System
    Non-Invasive Functional-Brain-Imaging with a Novel Magnetoencephalography System Amir Borna, Member, IEEE, Tony R. Carter, Anthony P. Colombo, Yuan-Yu Jau, Jim McKay, Michael Weisend, Samu Taulu, Julia M. Stephen, and Peter D. D. Schwindt systems benefit from mature technology and analysis methods, Abstract—A non-invasive functional-brain-imaging system they face two limiting factors: 1) fixed sensor positions, and 2) based on optically-pumped-magnetometers (OPM) is presented. high maintenance cost. SQUID sensors operate at ~ 4 K and The OPM-based magnetoencephalography (MEG) system liquid helium is used to achieve cryogenic temperature. Regular features 20 OPM channels conforming to the subject’s scalp. Due to proximity (12 mm) of the OPM channels to the brain, it is costly maintenance is required to fill the helium reservoir and anticipated that this MEG system offers an enhanced spatial calibrate the SQUID-based MEG system, although recent resolution as it can capture finer spatial features compared to advancements in helium recycling [18] is reducing maintenance traditional MEG systems employing superconducting quantum costs. The main limitation of SQUID-based MEG system, interference device (SQUID). We have conducted two MEG which also stems from the use of cryogens, is fixed sensor experiments on three subjects: somatosensory evoked magnetic position. Due to use of liquid helium a thick Dewar is required field (SEF) and auditory evoked magnetic field (AEF) using our OPM-based MEG system and a commercial SQUID-based MEG to isolate the sensors from the room temperature, hence the system. We have cross validated the robustness of our system by fixed position of sensors inside the rigid helmet.
    [Show full text]
  • Reorganization of the Social Brain in Individuals with Only One Intact Cerebral Hemisphere
    brain sciences Article Reorganization of the Social Brain in Individuals with Only One Intact Cerebral Hemisphere Dorit Kliemann 1,2,3,*, Ralph Adolphs 4,5, Lynn K. Paul 4, J. Michael Tyszka 4 and Daniel Tranel 1,3,6 1 Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA; [email protected] 2 Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA 3 Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, USA 4 Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA; [email protected] (R.A.); [email protected] (L.K.P.); [email protected] (J.M.T.) 5 Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA 91125, USA 6 Department of Neurology, University of Iowa, Iowa City, IA 52242, USA * Correspondence: [email protected] Abstract: Social cognition and emotion are ubiquitous human processes that recruit a reliable set of brain networks in healthy individuals. These brain networks typically comprise midline (e.g., medial prefrontal cortex) as well as lateral regions of the brain including homotopic regions in both hemispheres (e.g., left and right temporo-parietal junction). Yet the necessary roles of these networks, and the broader roles of the left and right cerebral hemispheres in socioemotional functioning, remains debated. Here, we investigated these questions in four rare adults whose right (three cases) or left (one case) cerebral hemisphere had been surgically removed (to a large extent) to treat epilepsy. We studied four closely matched healthy comparison participants, and also compared the patient findings to data from a previously published larger healthy comparison sample (n = 33).
    [Show full text]
  • The First-Night Effect Suppresses the Strength of Slow-Wave
    Vision Research 99 (2014) 154–161 Contents lists available at ScienceDirect Vision Research journal homepage: www.elsevier.com/locate/visres The first-night effect suppresses the strength of slow-wave activity originating in the visual areas during sleep ⇑ Masako Tamaki, Ji Won Bang, Takeo Watanabe, Yuka Sasaki Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Box 1821, 190 Thayer Street, Providence, RI 02912, USA article info abstract Article history: Our visual system is plastic and adaptive in response to the stimuli and environments we experience. Received 2 June 2013 Although visual adaptation and plasticity have been extensively studied while participants are awake, lit- Received in revised form 29 October 2013 tle is known about what happens while they are asleep. It has been documented that sleep structure as Available online 7 November 2013 measured by sleep stages using polysomnography is altered specifically in the first sleep session due to exposure to a new sleep environment, known as the first-night effect (FNE). However, the impact of the Keywords: FNE on spontaneous oscillations in the visual system is poorly understood. How does the FNE affect the Sleep visual system during sleep? To address this question, the present study examined whether the FNE mod- First-night effect ifies the strength of slow-wave activity (SWA, 1–4 Hz)—the dominant spontaneous brain oscillation in Slow-wave activity Adaptation slow-wave sleep—in the visual areas. We measured the strength of SWA originating in the visual areas Plasticity during the first and the second sleep sessions. Magnetoencephalography, polysomnography, and mag- netic resonance imaging were used to localize the source of SWA to the visual areas.
    [Show full text]
  • Anesthesia for Anatomical Hemispherectomy, 217 Antiepileptic
    Index Note: Page numbers followed by f and t indicate fi gures and tables, respectively. A Anesthesia Academic skills assessment, in neuropsychological assess- for anatomical hemispherectomy, 217 ment, 105 antiepileptic drugs and, 114 Acid-base status, perioperative management of, 114 for awake craniotomy, 116 Adaptive function assessment, in neuropsychological for corpus callosotomy, 116 assessment, 106 for hemispherectomy, 116–117, 217 After-discharges, 31 induction of, 114 Age of patient maintenance of, 115 and adaptive plasticity, 15–16 for posterior quadrantic surgery, 197–198 and cerebral blood fl ow, 113 Sturge-Weber syndrome and, 113 at lesion occurrence, and EEG fi ndings, 16 in surgery for subhemispheric epilepsy, 197–198 and pediatric epilepsy surgery, 3 tuberous sclerosis and, 113 and physiological diff erences, 113 for vagus nerve stimulation, 116 and seizure semiology, 41 Angioma(s) at surgery, and outcomes, 19 cutaneous, in Sturge-Weber syndrome, 206 Airway facial, 206 intraoperative management of, 114–115 Angular gyrus, electrical stimulation of, 48 preoperative evaluation, 113 Anterior lobe lobectomy (ATL) Alien limb phenomenon, stimulation-induced, 49 left (L-ATL), and language function, 76 [11C]Alphamethyl-L-tryptophan (AMT), as PET radiotracer, and memory function, 77–78 83–84, 86 Anteromesial temporal lobectomy (AMTL), 136–146 in extratemporal lobe epilepsy, 86–87, 175 complications of, 144–145 in postsurgical evaluation, 90 craniotomy in, 138, 139f in temporal lobe epilepsy, 86 historical perspective on, 136–137 in tuberous
    [Show full text]
  • Magnetoencephalography: Clinical and Research Practices
    brain sciences Review Magnetoencephalography: Clinical and Research Practices Jennifer R. Stapleton-Kotloski 1,2,*, Robert J. Kotloski 3,4 ID , Gautam Popli 1 and Dwayne W. Godwin 1,5 1 Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; [email protected] (G.P.); [email protected] (D.W.G.) 2 Research and Education, W. G. “Bill” Hefner Salisbury VAMC, Salisbury, NC 28144, USA 3 Department of Neurology, William S Middleton Veterans Memorial Hospital, Madison, WI 53705, USA; [email protected] 4 Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA 5 Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA * Correspondence: [email protected]; Tel.: +1-336-716-5243 Received: 28 June 2018; Accepted: 11 August 2018; Published: 17 August 2018 Abstract: Magnetoencephalography (MEG) is a neurophysiological technique that detects the magnetic fields associated with brain activity. Synthetic aperture magnetometry (SAM), a MEG magnetic source imaging technique, can be used to construct both detailed maps of global brain activity as well as virtual electrode signals, which provide information that is similar to invasive electrode recordings. This innovative approach has demonstrated utility in both clinical and research settings. For individuals with epilepsy, MEG provides valuable, nonredundant information. MEG accurately localizes the irritative zone associated with interictal spikes, often detecting epileptiform activity other methods cannot, and may give localizing information when other methods fail. These capabilities potentially greatly increase the population eligible for epilepsy surgery and improve planning for those undergoing surgery. MEG methods can be readily adapted to research settings, allowing noninvasive assessment of whole brain neurophysiological activity, with a theoretical spatial range down to submillimeter voxels, and in both humans and nonhuman primates.
    [Show full text]
  • View Full Page
    13894 • The Journal of Neuroscience, August 21, 2013 • 33(34):13894–13902 Behavioral/Cognitive Enhanced Spontaneous Oscillations in the Supplementary Motor Area Are Associated with Sleep-Dependent Offline Learning of Finger-Tapping Motor-Sequence Task Masako Tamaki,1 Tsung-Ren Huang,2 Yuko Yotsumoto,2 Matti Ha¨ma¨la¨inen,3 Fa-Hsuan Lin,4 Jose´E.Na´n˜ez Sr,5 Takeo Watanabe,1 and Yuka Sasaki1 1Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island 02912, 2Department of Psychology, Boston University, Boston, Massachusetts 02215, 3Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts 02129, 4Institute of Biomedical Engineering, National Taiwan University, Taipei, 100 Taiwan, and 5School of Social and Behavioral Sciences, Arizona State University, Phoenix, Arizona 85004 Sleep is beneficial for various types of learning and memory, including a finger-tapping motor-sequence task. However, methodological issues hinder clarification of the crucial cortical regions for sleep-dependent consolidation in motor-sequence learning. Here, to inves- tigate the core cortical region for sleep-dependent consolidation of finger-tapping motor-sequence learning, while human subjects were asleep, we measured spontaneous cortical oscillations by magnetoencephalography together with polysomnography, and source- localized the origins of oscillations using individual anatomical brain information from MRI. First, we confirmed that performance of the task at a retest session after sleep significantly increased compared with performance at the training session before sleep. Second, spontaneous ␦ and fast-␴ oscillations significantly increased in the supplementary motor area (SMA) during post-training compared with pretraining sleep, showing significant and high correlation with the performance increase. Third, the increased spontaneous oscillations in the SMA correlated with performance improvement were specific to slow-wave sleep.
    [Show full text]
  • ASET Position Statement Utilization of Professional Credentials
    ASET Position Statement Utilization of Professional Credentials It is universally acceptable to utilize professional credentials after an individual’s name. Professional credentials for Neurodiagnostic Technologists are awarded for successful completion of national board examinations. If the examination process has more than one written exam, both exams must be completed before the credentials may be used. The authorized* professional credentials for Neurodiagnostic Technologists include: ® o CAP for certification for autonomic professionals ® o CLTM for certification in long term monitoring ® o CMEG for a certificate for magnetoencephalography ® o CNIM for certification in neurophysiologic intraoperative monitoring ® o R. EEG T. for registry in electroencephalography o R. EEG/EP T. to indicate credentials in both EEG and evoked potentials ® o R. EP T. for registry in evoked potentials o R.NCS.T. for registry in nerve conduction studies . CNCT for certification as a nerve conduction technologist ™ o RPSGT for registry in polysomnography . CPSGT for certification as a polysomnographic technician ™ o CCSH for certification in clinical sleep health o RST for registry for sleep technology *Authorized refers to 1) the correct letters and punctuation for the credentials, and 2) the holder of the credential can be verified by the credentialing or examination body/organization. It is not acceptable to use initials or an abbreviation after an individual’s name to designate a job title or function, such as EEGT for an EEG tech, EPT for an evoked potential tech, ORT for neurophysiologic intraoperative monitoring, and so forth. These abbreviations are confusing, improper, and may be interpreted as a deliberate attempt to imply that the technologist has professional credentials.
    [Show full text]
  • Full Article
    Article Considerationsfor Successfully Litigating a Traumatic Brain Injury Case by Michael W Young As a complex lattice of neurons, glial cells, and synapses, the basic understanding of what a TBI is and how it can affect an human brain is where ideas are formed, emotions are felt, and individual remains limited. stimulation initiated. One's ability to communicate, remember, and understand is directly dependent on a well-functioning In the most basic sense, a TBI is an injury to the brain due to brain. Indeed, every breath one takes is done at the direction of external trauma to the head. The injury itself may be focol, his or her brain. And while we have learned much about the diffuse, or both. See generally, Hubbard,J & Hodge, S., brain and its function, we remain incredibly ignorant of much Traumatic Brain Injury, in HEAD TRAUMA AND BRAIN INJURY FOR of the brain's ability. Accordingly, while cases involving a brain LAWYERS, 127-153(2016). A TBI is traditionally classified as injury intuitively seem straightforward, they are often quite either mild, moderate, or severe depending on a number of difficult and complicated. Even the most careful practitioner can factors. Often the Glasgow Coma Scale is used to measure the fail to fully understand and effectively prosecute his or her severity of a TBI by looking at a number of neurological client's case. Failing to completely understand the nature of a parameters such as eye movement, motor response, and verbal client's injury can be catastrophic. However, among the difficult interaction. The more severe the TBI, the lower the individual terrain, advantage awaits.
    [Show full text]