Saturday, December 12, 2009

Apollo Chorus of Chicago: Messiah

I just got back from the Apollo Chorus of Chicago singing the George Frideric Handel's Messiah with Stephen Alltop directing and Maire O'Brien, soprano, Lauren McNeese, mezzo-soprano, Mark Van Arsdale, tenor and James Maddelena, baritone at Chicago's Symphony Center. It was awe inspiring. If you've never heard the Messiah live you must...and yes, all were standing when the Hallelujah Chorus was sung. They received a long standing ovation at the conclusion of the program.

I've been lucky enough to sing under the direction of Mr. Alltop and to sing on the same stage as Ms. Maire O'Brien. I've also sung with other members of the Apollo Chorus as well in my church choir.

The Apollo Chorus is the oldest volunteer choir in the USA and gave their first performance of the Messiah in 1879. A most amazing group! DM

Penlight Red/Green (PLRG) Procedure For Screening of Convergence Insufficiency

Get instructions and the CITT Symptom Survey by clicking on title. DM

Office-Based Optometric Therapy for Convergence Insufficiency

The 2008 CITT study published in the Archives of Ophthalmology clearly supports the superiority of office-based vision therapy to home-based vision therapy alone for convergence insufficiency. As noted in the AOA’s Clinical Practice Guideline (CPG) on Care of the Patient with Accommodative and Vergence Dysfunction home-based vision therapy may be less effective than in-office therapy because no therapist is available to correct inappropriate procedures or to motivate the patient. The preferred clinical management therefore consists of in-office vision therapy supplemented with home therapy.

Another Reason Not to Kiss a Frog

...Yet another aquarium pet has been tied to a Salmonella outbreak, the CDC says.

Water frogs -- particularly African Dwarf Frogs -- may be responsible for infecting 48 patients in 25 states with Salmonella typhimurium, according to government researchers....

Comments: Click on title for more information. DM

Visual Outcome in 879 Children Treated for Strabismus: Insufficient Accommodation and Vision Deprivation, Deficient Emmetropisation and Anisometropia

..On the basis of these findings, severe residual amblyopia in children remaining after treatment could be explained by additional vision deprivation. It can be reduced by starting spectacle correction of hypermetropia before the age of 18 months. Anisometropia seemed the result of deficient emmetropisation. ...

Comments: So programs like the American Optometric Association's InfantSee program, where we see children from 6-12 months at no cost to the parents, have value! Why doesn't our ophthalmology colleagues recognize this? DM

PTSD and Kids

...Post-traumatic stress disorder leaves permanent mental scars on those who go through emotional trauma, and new research shows the damage can be just as extensive in children....Experiencing extreme stress like abuse and violence can cause children to isolate themselves from others, feel disconnected from reality and struggle in school, but new research may help kids with post-traumatic stress disorder (PTSD) find better help....

Thursday, December 10, 2009

The Wounded Warrior and Optometry

I had an opportunity to participate in the Department of Veteran Affairs Veteran's Health Administration-Department of Defense Conference on Sensory Impairment Issues in Traumatic Brain Injury in Chicago from December 8th-10th, 2009 at the Sheraton Chicago Hotel and Towers. I am not involved in the VA, nor-DoD, but was kindly welcomed to the conference because of my interest in traumatic brain injury.

Between 6-700 doctors, researchers, therapists, administrators, and Wounded Warriors participated. The meetings started at 8Am and went all day until after 5PM with working lunches given out on 2 of the days...The VA and DoD did it right...and the people of the United States got their monies' worth out of all who participated.

Participants came from all over the United States.

This was one of those rare meetings where the docs, researchers, & therapist were sitting right next to the men and women we were all concerned about...the wounded warrior...most programs started with one of these incredible individuals telling their story of how they acquired their own special brand of TBI.

We were constantly reminded why we do what we do. We can do no less. We should do a great deal more.

I've been given many certificates for completing various educational programs...this one I will treasure for some time to come....DM

Binocular function in school children with reading difficulties

Introduction Prior findings suggest that poor readers tend to have poor binocular vision skills, but data on the binocular abilities of children with poor reading skills are lacking. Our aim was to characterize distance and near horizontal heterophoria, distance and near horizontal fusional vergence ranges, accommodative convergence/ accommodation (AC/A) ratio, near point of convergence, and stereopsis in poor-reading school-age children without dyslexia selected from a non-clinical population.
Methods We conducted a cross-sectional study on 87 poor readers and 32 control children (all 8-13 years of age) in grades three to six recruited from eleven elementary schools in Madrid, Spain. With best spectacle correction in each
subject, distance and near horizontal heterophoria measurements were obtained using the von Graefe technique, distance and near horizontal fusional vergence ranges were
obtained using Risley rotary prisms, the AC/A ratio was measured using the gradient method, near point of convergence (NPC) was evaluated by the standard pushup
technique using a transilluminator, and stereoacuity was tested with the Randot stereotest.
Results Mean distance base-in break and base-in recovery values were nearly 2 Δ lower (p<0.01) in the poor readers than those recorded in the control group. However, mean distance base-out vergences (blur, break and recovery),mean distance and near horizontal heterophoria, mean near horizontal fusional vergence ranges, mean AC/A ratio, mean near point of convergence (NPC), and mean stereoacuity did not differ significantly between the poor readers and controls.
Conclusions This study provides information on the binocular ability of children with poor reading skills but without dyslexia. Our findings suggest reduced distance base-in break and base-in recovery, such that distance fusional vergence ranges should always be assessed in children who complain of reading difficulties.

Comments: Click on title for PDF of article. DM

People affected by autism believe increase is 'real,' not diagnostic

..Expert consensus is that the rapid increase is a result of changes in diagnostic practice, but many lay people directly or indirectly affected by the disorder believe that the number of cases have increased in absolute terms. Many also believe that increasing incidence is the result of exposure to new environmental hazards and other effects of modern lifestyles....

Comments: Unfortunately, too many people know science well enough to use it to make reasonable conclusions for the data. They just listen to the news, radio, internet and their's sad. DM

Wednesday, December 9, 2009

Enthusiasm: My Favorite Quote

Enthusiasm is one of the most powerful engines of success. When you do a thing, do it with all your might. Put your whole soul into it. Stamp it with your personality, Be active, be energetic, be enthusiastic and faithful and you will accomplish your objective. Nothing great was ever achieved without enthusiasm.

Ralph Waldo Emerson

Introduction to Traumatic Brain Injury

...This module provides an overview of the nature of traumatic brain injury (TBI) and the impact it can have on a person’s life as well as on the lives of their family. This includes looking at their whole situation, including their community and available services. By exploring this information, the module assists workers to enable individuals with a TBI to achieve and maintain their maximum potential within their family and community. ...

Comments: What a great introduction to TBI....and it's free! DM

Home-Based Early Intervention Benefits Autism Outcomes

...Early intervention with autistic toddlers as young as 18 months resulted in improvements in cognition and adaptive behavior, a small but rigorous randomized trial found....

Evidence Based Medicine

An excellent discussion of evidence based medicine....a must read for all docs! DM

Episodic vision screenings seen as no substitute for continuous care.

From AOA First Look:

Episodic vision screenings seen as no substitute for continuous care.

In the "Scrubbing In" column in the Philadelphia Inquirer (12/7), Rachel K. Sobel, a second-year resident at the Wills Eye Institute at Thomas Jefferson University, recounted her experiences at "Give Kids Sight Day, a free screening event for kids 18 and younger" recently held at the Wills Eye Institute. Sobel observed, "It doesn't take magic to make most children see. What most kids need is an old invention: glasses. So, it's a stone-cold shame, in our modern world with technological wonders, that a child cannot obtain simple spectacles." Calling the situation an "indictment of our system," Sobel asserted that "episodic screenings are no substitute for continuous care." She also explored how poor Medicaid reimbursement and lack of parental responsibility make "free screenings...a fact of life."

Comments: Finally, a second year medical resident "gets it!". Please tell the rest of your profession to join optometry to have every state mandate comprehensive eye examinations for all our children. Good job Rachel! DM

Is ethnicity a risk factor for severe retinopathy of prematurity?

...Ethnicity is a risk factor for severe ROP. Asian and black infants have a higher risk of developing threshold ROP compared to white infants....

Down Syndrome Prevalence In The United States

...Down syndrome is a chromosomal disorder that affects an estimated 1 in 800 births or 5,400 infants in the United States each year. The chance of surviving beyond the first year of life has improved in the past few years, with 90 percent of children with Down syndrome now living past 5 years of age....

Constraint-Induced Movement Therapy May Improve Arm Use In Children With Hemiplegic Cerebral Palsy

...Constraint-induced movement therapy (CIMT) is a potentially effective form of intervention for children with hemiplegic cerebral palsy,...

How Mental Imagery Training Aids Perceptual Learning

...Practice makes perfect. But imaginary practice? ... show that perceptual learning - learning by repeated exposure to a stimulus - can occur by mental imagery as much as by the real thing. The results, published in Current Biology, suggest that thinking about something over and over again could actually be as good as doing it. ...

Brain Waves Can 'Write' On A Computer In Early Tests

...Neuroscientists ... have demonstrated how brain waves can be used to type alphanumerical characters on a computer screen. By merely focusing on the "q" in a matrix of letters, for example, that "q" appears on the monitor. ..

PTSD and Kids

...Post-traumatic stress disorder leaves permanent mental scars on those who go through emotional trauma, and new research shows the damage can be just as extensive in children.....Experiencing extreme stress like abuse and violence can cause children to isolate themselves from others, feel disconnected from reality and struggle in school, but new research may help kids with post-traumatic stress disorder (PTSD) find better help....

Smaller Brain Linked to Soldiers' PTSD Risk

...Post-traumatic stress disorder (PTSD) after fighting in a war zone was strongly linked to smaller cortical volumes in four areas of the brain involved in identifying objects and words and putting them in context, according to a study led by Steven H. Woodward, PhD, of the National Center for PTSD at the VA Palo Alto Health Care System in Ca...

Monday, December 7, 2009

A Wise Quote

Science, my lad, is made up of mistakes, but they are mistakes which it is useful to make, because they lead little by little to the truth.

Jules Verne (1828-1905)

Pharmacological management of neurobehavioral disorders following traumatic brain injury—A state-of-the-art review

Abstract—Pharmacological management of neurobehavioral disorders following traumatic brain injury (TBI) is common
practice. However, the evidence available to guide this practice remains sparse. This review summarizes, in brief, the state of knowledge, organized via a time continuum from injury as well as by symptom complex. The areas of neuroprotection,
hypoarousal, attention and memory deficits, aggression, agitation, depression, and mania are reviewed. The literature wassearched with PubMed on the terms “traumatic brain injury” or “brain injury” with “pharmacology” (and the symptoms according
to which this review is arranged). Additional searches were conducted with the specific symptoms as search terms, crossed with the therapeutic agents or drug classes discussed. Where a paucity of prospective data exists, case reports and retrospective studies are included. Studies to date have yielded minimal positive
evidence for enhancing function, memory, and behavior after TBI. No single agent likely will become sentinel in the recovery process, and combination therapy in the acute and postacute settings are required. A need exists to further define the
role of psychopharmacology in postacute TBI medicine and the specific characteristics of subpopulations who might benefit.

Comments: Click on title for PDF. DM

Auditory and visual impairments in patients with blast-related traumatic brain injury: Effect of dual sensory impairment on Functional Independence Me

Abstract—The frequencies of hearing impairment (HI), vision impairment (VI), or dual (hearing and vision) sensory impairment
(DSI) in patients with blast-related traumatic brain injury (TBI) and their effects on functional recovery are not well documented. In this preliminary study of 175 patients admitted to a Polytrauma Rehabilitation Center, we completed hearing
and vision examinations and obtained Functional Independence Measure (FIM) scores at admission and discharge for 62 patients with blast-related TBI. We diagnosed HI only, VI only, and DSI in 19%, 34%, and 32% of patients, respectively. Only 15% of the patients had no sensory impairment in either auditory or visual modality. An analysis of variance showed a group difference for the total and motor FIM scores at discharge (p < 0.04). Regression model analyses demonstrated that DSI significantly contributed to reduced gain in total (t =-2.25) and motor (t = -2.50) FIM scores (p < 0.05). Understanding the long-term consequences of sensory impairments in the functional recovery of patients with blast-related TBI requires further research.

Comments: Get PDF by clicking on title. DM

Advances in neuroimaging of traumatic brain injury and posttraumatic stress disorder

Abstract—Improved diagnosis and treatment of traumatic
brain injury (TBI) and posttraumatic stress disorder (PTSD) are needed for our military and veterans, their families, and society at large. Advances in brain imaging offer important biomarkers of structural, functional, and metabolic information concerning the brain. This article reviews the application of various imaging
techniques to the clinical problems of TBI and PTSD. For TBI, we focus on findings and advances in neuroimaging that hold promise for better detection, characterization, and monitoring of objective brain changes in symptomatic patients with combat-related, closed-head brain injuries not readily apparent by standard computed tomography or conventional magnetic resonance imaging techniques.

Comments: Click on title for PDF of article. DM

Eye and visual function in traumatic brain injury

Abstract—Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma
population, whereas common causes of TBI in the civilian sector
include motor vehicle accidents and falls. Known visual consequences
of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and
managed early in the rehabilitation journey. The incidence, locations,
and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal
visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations,
and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected servicemembers; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.

Comments: For PDF of article click on title. DM

Charles Bonnet syndrome

A friend and colleague (Samantha Slotnick, O.D., F.A.A.O., F.C.O.V.D.)of mine sent this email:

...A non-VT OD friend of mine cued me into this wonderful video. Oliver Sacks discusses , as an experience of non-psychotic hallucinations in the visually impaired. Conjecture is that the lack of cortical stimulation in those with acquired visual loss results in hypersensitivity in the visual cortex, particularly over certain regions, observable with fMRI. The result is visual experience in the absence of visual stimulus. Parallel occurrences with auditory hallucinations in the hearing impaired....

Comments: It is interesting because this shows visual hallucinations who are blind. DM

Sunday, December 6, 2009

Chocolate Is Associated with Lower Mortality Following First MI

Just in time for the holidays!!!

Amount of chocolate consumption was related inversely to cardiac-related mortality during an 8-year follow-up

Several studies have suggested that chocolate, perhaps in a process mediated by its antioxidant content, protects the heart (JW Gen Med Jul 10 2007 and JW Gen Med Sep 23 2003). A Swedish team identified 1169 nondiabetic patients who were hospitalized with initial nonfatal myocardial infarctions. Detailed food histories for the preceding 12 months were completed by 86% of patients; participants were followed for an additional 8 years.

Compared with patients who never ate chocolate, those who ate chocolate less than once monthly suffered 27% less cardiac-related mortality (after multivariate adjustments); risk was 44% lower for weekly chocolate eaters and 66% lower for those who ate chocolate two or more times weekly. Nonfatal adverse cardiac events, strokes, and total mortality, however, were not related clearly to chocolate consumption. Consuming other sweets (e.g., cookies, cakes, ice cream) had no relation to cardiac mortality.

Comment: The strengths of this study are its size and long-term follow-up. The main weakness is that chocolate consumption was assessed only once, during hospitalization for initial MIs, and not during follow-up. To me, the most interesting result of the study is that chocolate strongly protected against cardiac mortality but not against adverse cardiac events. The same finding has been reported for ω-3 fatty acid supplements, which suggests that the primary beneficial effect of both chocolate and ω-3 fatty acid supplements is in suppressing arrhythmias.

My Comments: Now I can honestly tell my wife that my chocolate addiction will allow me to avoid cardiac problems later on in life!! Yummy! (BTW this goes for red wine too!!) DM