Ethos Health Group

Why DTI Imaging Is Like The Day In 1967 That Sweden Changed Which Side Of The Road They Drove On

In September 1967 Sweden did the unthinkable and switched driving from the left side of the road to the right. Despite public outcry, the thinking was that it would make it easier for visitors from neighboring countries to avoid accidents, as they all drove on the right. Officials also believed that is would make the roads safer as Swedish cars' steering wheels were all on the right.

In true Scandinavian fashion, they called the initiative Dagen H or "Högertrafikomläggningen", (literally 'the right-hand traffic reorganization') and a huge PR push kicked off. The campaign included displaying the Dagen H logo on various commemorative items, including milk cartons and underwear. Swedish television held a contest for songs about the change, and the winning entry was "Håll dig till höger, Svensson" ('Keep to the right, Svensson') written by journalist Peter Himmelstrand and performed by The Telstars.

As you can see in the image above, the concerns voiced by the Swedish people were well founded as traffic jams piled up with confused drivers adjusting to the change.

These same "traffic jams" can be seen in the brain on a type of MRI called Diffusion Tensor Imaging, or DTI. DTI measures the movement of fluid throughout the brain, and since water is produced as a byproduct of normal neuronal metabolism we essentially see a "road map" of the brain.

The attached image shows the intricate pathways of the brain on a DTI study. The colors are populated by a computer program and represent the direction of fluid flow.

Diffusion tensor imaging does an excellent job of confirming the clinical diagnosis of TBI, and at Ethos it is often paired with susceptibility weighted imaging (SWI) and Neuroquant. It is important to remember that there is not any single test that stands alone to diagnosis TBI, but rather all the tests must be evaluated together. Diagnostics confirm the diagnosis already made by a clinician of brain injury, and help guide therapy and treatment for each patient.

This is why we caution both patients and attorneys to avoid placing too much weight in any single test result and whether it was positive or negative but rather to look at all the pieces of the puzzle together in totality.

If you or someone you know could benefit from our TBI testing, TBI rehab, or neurology evaluation, please reach out to Dr. Walker directly at 904-616-1284 or email [email protected].

Our goal at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.

Australian "Tree of Life" With An Uncanny Resemblance To An Often Injured Part Of The Human Brain

While humans are capable of creating amazing works of art, sometimes nature provides us with the most breathtaking designs of all! The image above is a drone photo from a lake in New South Wales, Australia that has been dubbed the "tree of life", and you can see from the image the moniker is accurate.

This unique appearance comes from tea tree oil leaching from trees along the riverbank into the drainage channels that have been carved into the lake over many years.

When I first saw this image I'm such a huge brain injury nerd that I immediately thought, "That doesn't look like a tree, it looks like a cross section of the cerebellum!" Take a look at the image attached and you can decide for yourself if I'm crazy or not about the resemblance.

The cerebellum is the "brain within the brain" that sits at the base of the skull and is responsible for many basic functions related to balance, motor coordination, and ambulation. This is highly relevant to motor vehicle collision occupant injuries as there tends to be a large amount of force with whiplash injuries transmitted at the craniocervical junction (the area where the brain and spine come together).

This area has traditionally been overlooked by many attorneys in TBI cases as they were focusing more on the types of symptoms that a neuropsychologist would evaluate like memory, executive function, mood, impulse control, etc. However, there are a lot of patients suffering with TBI whose primary area of injury is the cerebellum and their symptom pattern is very different and is not evaluated by neuropsych testing.

Injury to the cerebellum will typically manifest on tests like videonystagmography (VNG), oculomotor tracking, computerized balance testing, and other assessments targetting this region. The image attached is a normal vs. abnormal eye tracking study shows how dramatically eye movements can be impaired due to injury from this part of the brain.

Once we have identified the regions of the brain involved, a more specific and targeted treatment plan can be developed. For cerebellar injuries interventions like oculomotor rehab, balance therapy, and vestibular exercises are often employed to help achieve the best possible clinical results.

If you have a TBI client you feel would benefit from this testing, TBI rehab, or neurology eval, please reach out to Dr. Walker directly at 904-616-1284 or email [email protected].

Our goal at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.

Why Chef Julia Child Would Taste Soap When She Ate Cilantro And How This Can Help Identify Brain Injury

Fascinating fact: a surprising number of people, ranging from 4 to 14% of the population, experience an unpleasant taste in their mouth when they consume cilantro. Isn't it intriguing how our taste buds can differ so greatly?

Some describe it as the flavor of soap, or even worse, dead bugs! This is due to a variation these individuals (with Julia Child being perhaps the most famous one) have in their olfactory receptors that allows them to strongly perceive the soapy flavored aldehydes in cilantro leaves.

Believe it or not, olfactory function is an incredibly important parameter to consider in the evaluation of traumatic brain injury.
The most commonly injured cranial nerve following TBI is cranial nerve 1, the olfactory nerve, and this is effected in roughly 20% of brain injury patients.

Although we don't have a cilantro taste test as a part of our TBI evaluation options, we do utilize the University of Pennsylvania Smell Identification Test which is the current gold standard for point of care olfactory evaluation. This assessment uses "micro encapsulation technology", which essentially means it's the world's fanciest scratch and sniff test, to measure olfactory function using a wide variety of smells.

The test even has built in malingering detection as there are certain scents that will cause irritation to the nose that can be detected by the patient even if they have a complete loss of smell. Some of you likely experienced this if you temporarily lost your sense of smell with COVID. Even though you couldn't taste or smell much, certain incredibly strong odors like vinegar or ammonia could still be detected.

The reason for this is that the trigeminal nerve (cranial nerve 5) also assists in olfactory function, particularly with certain strong odors, so essentially there's a built in back up system. So while a TBI patient with injury to the olfactory nerve would have a substantially disrupted sense of smell, certain strong odors would still be identifiable.

Obviously having a decreased sense of smell doesn't diagnose a TBI in isolation, but this is true of all the TBI testing we utilize at Ethos. This is why we measure so many different parameters of brain function as this allows us to pinpoint with nearly complete certainty if the test results as a whole are indicative of brain injury. This knowledge is combined with our clinical examination of the patient, history, review of medical records and other factors to arrive at a confident differential diagnosis.

Although we, at Ethos, may not be able to change your disdain for cilantro, we are here to assist you with your TBI. If you or someone you're acquainted with could benefit from TBI diagnostics or therapy at any of our various locations throughout Florida, feel free to contact us via email at [email protected] or simply give us a call at 904-616-1284. We're always ready to lend a helping hand!

How The Giant Hand Of An NBA Superstar Is Important To Understanding TBI Diagnostics

We've all heard the saying that a picture is worth a thousand words....but I think a picture with comparison that provides context can be worth a million words! The image above is the hand of NBA superstar Giannis Antetokounmpo (my son's favorite player) compared to blogger Payal Doshi and as you can see the contrast is pretty startling!

Even for a professional basketball player Giannis has massive hands as they are nearly 10 inches long and 12 inches wide! It's no wonder his nickname is the Greek Freak as he has physical attributes far outside the norm.

We see a similar phenomenon in the images from diagnostic testing for the brain. When you see an image from a TBI test standing on it's own without any context it can be difficult to know what you're really seeing and if it's normal, slightly abnormal, or grossly abnormal. It's like in the image of Giannis Antetokounmpo's hands without the comparison those of an average person. Yes, they look big, but you don't really see how big they are in the absence of a normal sized hand to compare to.

Take for example, the image from a diagnostic test we utilize at Ethos on our TBI patients called oculomotor tracking. It shows what the eyes are following, and we know that after a brain injury these subtle eye movements are often dysfunctional.

So is the image discussed above normal or abnormal? It looks like quite a mess of jumbled lines, but we can't use that standard to decide. Take for example, the image below from a more common test called an electroencephalogram, or EEG. It also looks like a mess of random squiggling lines...

But it just so happens that the image of the EEG, is a completely normal EEG, so clearly there's a bit more to making abnormal test results obvious for an untrained eye (like a patient, attorney, or insurance adjuster) than just showing the image on it's own.

Let's use the Giannis hand comparison but apply it instead to TBI test results. Below in the images, is the same image of oculomotor tracking, but with the normal image included for comparison. As you can see, now it's obvious to anymore viewing these images just how grossly abnormal the top tracing is when compared to a normal study just below it.

Why is any of this relevant to TBI diagnostic testing? We have found that the most impactful way for these test results to be communicated effectively to patients, attorney, insurance companies, or anyone else who may be involved is to not just show the abnormal images, but to put them next to the normal ones.

For this reason we include as an appendix with all of our oculomotor testing and videonystagmography (VNG) tests normal images to make this comparison much easier and more impactful. If you aren't sure exactly what you're looking at on a set of TBI test results for your client or patient and would like to review them with me, please reach out via email at [email protected].

If you or someone you know would benefit from TBI diagnostics or therapy at any of our locations across Florida, please reach out via email at [email protected] or you can call directly at 904-616-1284.