By George!

Meet George, his once dicky aorta, and his veering problem.

My brother in law George, youthful at 67, has a problem with walking. After about 10 steps he consistently veers to the right and to keep walking he corrects himself by limping on his left leg. This is not a pretty look and such veering can be embarrassing in the supermarket. But George is lucky to be with us. About a year ago he had an aortic valve replacement, a reasonably standard operation these days, but unfortunately the aorta split two hours later and he began to bleed out. Simply the heart had no blood to pump. The chest was quickly pulled open in intensive care and they managed to stabilise him, before another 12 hours of surgery. He lived to tell the tale (very few do) and remarkably, has no cognitive changes. His story even made the local paper.

Treating the rellies
I have never liked treating the rellies (see noinotes). But a year after his aortic event, George mentioned his veering and his limping. I happened to have my computer with me and on impulse, I checked his laterality.

Testing laterality means measuring the ability of a person to identify whether a body image is left or right. Both accuracy and speed can be measured. We are aware that this sense of laterality can be disturbed in some ongoing pain states such as CRPS1 and phantom limb pain and that restoration of laterality is a part of the effective graded motor imagery (Moseley 2006). George had no pain but I still tested him using Recognise Online.

A missing squirt of blood?
His results from hands, neck and shoulder laterality tests were all good- meaning he was getting left/right accuracies of over 80% and speeds per image of under 2 seconds without any left/right bias. The back was the same, but the feet laterality scores really surprised me. The time taken to make a decision on whether he was looking at a left or right foot was nearly 4 seconds for the left and 2.5 for the right. He was accurate in only about 60% of the left feet (i.e. not much more than chance) and about 75% for the right.

So I thought “oh dear, maybe that last squirt of blood destined for the foot laterality appreciation network in the brain didn’t quite make it and ended up on the floor of the intensive care ward.”

A GMI workout
George started on a laterality workout using the Recognise Online programme. He does at least an hour a day and although he found it exhausting initially, it is now getting easier and easier. He focuses on the feet but also includes some back and hand training. Within a week his average time to identify left and right feet dropped down to under 1.5 seconds and his left/right accuracy became equal and above 80%, although every now and then there were a few lapses with the left. He has been on the programme now for over six weeks.

Functional outcomes of the laterality exercises
There have been benefits (maybe treating rellies isn’t so hard after all!). George is not limping anywhere near as much and he is also walking more upright. He no longer has to look at his feet while he walks and he feels far more confident in moving around. George also commented that his “brain was clearer”. Last week he made the comment that he is “now remembering a few things that he didn’t know he knew – things about the hospital stay.” He was unconscious for over a week. I guess the exercises may have awoken a few memory networks?

The joys of anecdote
This is an anecdote of course. Anecdotes are particularly useful when novel therapies such as the graded motor imagery develop. Anecdotes are perhaps not as useful when the evidence about a therapy is well established (e.g. miracle cures after lumbar traction). But at the moment we welcome anecdotes at NOI – they can guide research and create healthy discussion. In George’s case it creates an awareness that GMI may have a place in perturbed motor states.

Can you help?
We are doing a project on laterality and low back pain with the University of South Australia. We are seeking back laterality responses in a group who are asymptomatic and a group who are suffering back pain. It takes less than 15 minutes to do. Here is the link.

You may have contributed to the Sarah Wallwork neck laterality study last year. We managed to get 1500 subjects and the results have been submitted for publication. We hope to get 1500 subjects again, so if you can do it, and get people with back problems to do it, it will really help. Here is the link again.

References
Moseley, G. L. (2006). “Graded motor imagery for pathologic pain.” Neurology 67: 1-6.

Last month’s notes on “Tattoos losing the ashes for Australia”
Last month’s notes on “tattoos losing the ashes for Australia” certainly stirred the pot.

Here are some of the responses. There were a few we had to exclude (!) especially from the English fraternity who were most disparaging of Australia’s sporting abilities (how short memories can be!).

There were lots of delicious thoughts – For example, many discussed the meaning of the tattoo, we were reminded that people with alopecia sometimes get tattooed eyebrows with a resultant increase in well being and thus the meaning and the location of the tattoo could be important. Others queried the influence of ink in the system. Many picked holes in the hypothesis citing world class cricketers and basketballers with tattoos and my n=2 sample. But others reminded us of sportstars whose performance dwindled with the advent of ink, but suggested that maybe the tattoo was about looking more of a bad boy, thus the athlete may have had low self esteem, which could affect performance.

We were also reminded that in the Australian Football League, Collingwood is well known as the most tattooed team, yet they won the grand final in 2010.

And the challenge to the hypothesis can be on pure science grounds. It was argued that a tattoo may well augment the embodiment of the limb – a facilitation of the motor response via visualisation.

Hard to pick a winner as always. For the best support of the hypothesis the prize goes to Cameron. For rejection, Edel.

NOI 2012
The NOI Neurodynamics and the Neuromatrix Conference is coming to Adeliade! Registrations are opening in April. There will be 200 early bird tickets available until July 31 2011. Don’t be a late old chook! Keep www.noi2012.com bookmarked for all scientific updates, workshop outlines, art and abstract submissions, sponsorship opportunities, information about Adelaide and other great 2012 opportunities and events.

Plasticity Mirror neurones Pain and stress literacy Neuroscience-backed psychology Neuroimmunology Neurodynamics and movement Brain sciences Intellectual nourishment Education as antigen Movement as antigen Spirituality and pain Information download Art Meditation Neuroscience updates Dance Social media applications for health care and research Hands on workshops Nerdy passions…

Links
NOI 2012
WHAT IS AFL?
NOI RESEARCH
RECOGNISE ONLINE
NOI NEURODYNAMICS
OTHER COOL NOI VIDEOS
SCRUBS VIDEO: 44 SECS
UPCOMING CONFERENCES
INTERNATIONAL PILLOW FIGHT
SARAH WALLWORK NECK LATERALITY STUDY: PRESENTATION

WWW.NOIGROUP.COM/COURSES
1 – 3rd Apr Mobilisation des Nervensystems, Kassel, DE
2 -3 Apr Mobilisation of the Nervous System, London, UK *FULL*
2 -3 Apr Mobilisation of the Nervous System, Liberty MO, US
8 – 10th Apr Mobilisation des Nervensystems, Fellbach, DE
9 – 10th Apr Neurodynamics and the Neuromatrix, Chicago IL, US
9 – 10th Apr Mobilisation of the Nervous System, Red Deer, Alberta, Canada *FULL*
9 – 10th Mobilisation of the Nervous System, Las Vegas NV, US
9 – 10th Apr Mobilisation of the Nervous System, Hillsboro OR, US
15 – 16th Apr Neurodynamics y la Neuromatrix, Valencia, ES
15 – 17th Apr Mobilisation des Nervensystems, Saarbrucken, DE
29th Apr – 1st May Applicazione Clinica: Arto Superiore, Milano, IT
29th Apr – 1st May Movilización del Sistema Nervioso, Pontevedra, ES
30th Apr Graded Motor Imagery, Chicago IL, US (FIRST EVER IN THE US!)
6 – 7th May Explain Pain, Adelaide, AU
8 – 10th May Mobilisation des Nervensystems, Wien, AT
14 – 15th Mobilisation of the Nervous System, Toronto, CA
14 – 15th Mobilisation of the Nervous System, Minneapolis MN, US
14 – 15th May Explain Pain, Fairbanks, Alaska AK, US
17th May Explain Pain (1 day course), Bristol, UK
20 – 22nd May Klinische Anwendungen: Obere Extremität, Thorax und HWS, Saarbrucken, DE
21 – 22nd May Neurodynamics and the Neuromatrix, London, UK
21 – 22nd May Explain Pain, Lake Tahoe CA, US
25 – 27th May Mobilizacao do Sistema Nervoso, Florianopolis, BR
25 – 26th Mobilisation of the Nervous System, Ottawa ON, CA
27 – 29th May Mobilisation des Nervensystems, Munchen, DE
28 – 29th May Explicando a Dor, Florianopolis, BR
1 – 3rd Jun Mobilizacao do Sistema Nervoso, Brasilia, BR

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