All Posts tagged Neurophysiology

Concussion? We can help

Concussion? We can help

Some reflections on concussion from the author below. We can help if you do have concussion.

A Carolina Panthers player left the Super Bowl and was found to have a concussion.

By David L. Katz


Fortunately for me and the others gathered at the Katz home, we enjoyed a fabulous, meal for the Big Game. No surprise there; my wife is the culinary genius behind the site.

Thank goodness for the wonderful dinner, because the game itself was rather disappointing. There was, I trust my fellow spectators will agree, an unusual bumper crop of penalties, some egregiously bad calls by the referees, some truly strange mistakes by players and a disquieting bounty of poor sportsmanship into the bargain. Congratulations to the Broncos and Peyton just the same, but seriously, weird game.

Alas, it also featured an announcement all fans of the game should now know is a reason for a collective wince: concussion protocol. Corey Brown, of the Carolina Panthers, left the game after a head injury, underwent neurological evaluation and was found to have a concussion.

I trust everyone now knows the ominous implications of that kind of injury if repeated periodically over the course of a career. The media attention to Chronic Traumatic Encephalopathy, or CTE, is considerable and rising. The movie “Concussion,” starring Will Smith, raises the profile further. I highly recommend the movie if you haven’t seen it, by the way. It is very well done, and beautifully acted, and entertaining even as it educates.

I have no particular expertise in CTE beyond any doctor’s basic understanding of it, and others have said plenty already. If you are interested, as every football fan should be, and certainly as every parent of a child inclined to play football must be, the relevant information is readily available. I will take the opportunity to make a different point, about the cultural malleability of “normal,” and thus, “acceptable.”

While I have no claim to the football-fan hall of fame, I like the game as much as the next guy. I am wondering more and more, though, if my entertainment is worth the price the players are paying.

Football is part of our culture, and thus normal. We might thus think that if it has occasional consequences, those, too, are normal. That may make them seem acceptable. But that’s the real danger here: complacency. We can perhaps only see it looking across cultures, rather than from corner to corner within the box that is our own.

Consider, for instance, the Gladiatorial Games of Roman times. Those were, infamously, contests to the death, whether between people, or people and wild, half-starved animals. The only vague approximations of any such barbaric entertainment in the modern world are, so far as I know, bull fighting, and the generally illegal contests between fighting dogs or roosters. There is no longer any mainstream interest in watching bloody death for entertainment.

But that’s simply because sensibilities and culture have evolved. The Romans were people just like us. Their society, too, was made up of mothers and fathers, aunts and uncles. They, too, knew love and compassion. But they cheered while watching young men, literally, kill one another. In their culture, it was normal, and thus acceptable; but I trust we agree history has reached a different verdict.

I happen to be a fan of both the late Heath Ledger, and Paul Bettany, and was thus predisposed to love the movie “A Knight’s Tale.” I’m no movie critic – I can’t say whether or not it’s a great movie – I can only say I like it.

The movie is especially noteworthy for how it handles anachronism. More than once, it features period elements, like music, and then transitions them to the modern analog, such as a rousing rendition of “The Boys Are Back in Town” by Thin Lizzy. More memorable still is a scene at a dance. Heath Ledger’s character is dancing with his love interest in the stylized manner of medieval folk dance. The music then transitions to the late, great David Bowie – “Golden Years,” to be exact – and the dancing keeps pace, morphing into what one would expect, more or less, in any given club on any given Saturday.

The director, I think, was telling us something important: The old-fashioned music and dance of medieval times would not have felt old-fashioned then. It was, simply, the music and dance of its day. It was normal. Showing medieval folk dancing to a modern audience says: this was an old-fashioned party. The director substituted “current” music and dance to show us how it felt to the participants. It was current and normal then, and no matter how it feels to us now, that’s how it would have felt to them.

That’s relevant to football. We are not willing to entertain ourselves by watching young men bash one another’s heads in with maces, as the Romans did. But we do entertain ourselves as young men bash their helmeted heads into one another repeatedly over a span of years, with all-too-often calamitous consequences.

Our gridiron heroes are latter-day gladiators. And their house – the house of football – inspires almost religious devotion in our culture. But that may be only because it is part of our culture. Imagine if football did not yet exist, and we were thinking of introducing it, and knew about CTE from the start. Would we add such a game and such a liability to our cultural entertainments?

The one-time editor of the Journal of the American Medical Association, and later Medscape, Dr. George Lundberg, reflected along similar lines in the New York Times recently. He discusses cultural evolution over a much shorter period than the Middle Ages to now, noting a marked change in his personal – and our societal – enthusiasm for the brutalities of boxing. Both the sport and its following have changed dramatically in recent years, and he conjectures that football is in that same queue.

My principal mission here is to point out the inevitability of culturally induced blindness to the unacceptable elements of what is currently normal. We live in a time of epidemic obesity and its complications in our children, yet continue to market multicolored marshmallows to them as “part of a complete breakfast.” This is absurd, and history will judge us accordingly, but it’s normal now – and so we overlook the hypocrisy. Cultures around the world justify practices as heinous as female genital mutilation. What passes for “normal” is self-defining, and to some extent, self-perpetuating.

Until, that is, we evolve beyond it. Looking back, what was normal yesterday often proves repulsive and contemptible today.

We speak routinely about “thinking outside the box,” but when the box is culture, that is much easier said than done. Everything we know is inside the box, as are we. The contents of the box at any given time are normal.

History turns the years into a ladder. Out of the box we all climb, into a bigger box presumably, as we gain the perspective of altitude, and roll our eyes at the mess we’ve left behind.

I love watching football. The Romans presumably loved their gladiatorial games. Both are normal in context. That doesn’t guarantee that either is right.

For the sake of today’s players, and our sons inclined to take their places, I hope we reform the game of football sooner than later. It’s a great game, but not when paid for with brains scrambled, and lives cut short.

In general, we need to recognize how readily we follow the gospel of any given culture telling us what’s normal. We need to recognize that normal is simply what we do now, and that it isn’t necessarily right. Perhaps the true measure of cultural enlightenment is how ably we judge ourselves in real time as history is sure to do in the fullness of time.


Exercise and the Brain: A winning team

Exercise and the Brain: A winning team

“The best way to improve mental performance, is to improve physical performance” – Tim Ferriss¹

So, how does exercise improve learning and memory?Learning requires repeated connection and communication between neurons in a process known as long term potentiation¹.

“Long term potentiation: The strengthening of brain cells’ capacity to send signals across a synapse for the purpose of learning and memory.“ – John Ratey M.D., from ‘Spark’.²

The more repeated this firing across a synapse, the stronger the connection becomes.

“Neurons that fire together, wire together.” – Dr. Daniel Siegel.³

With the example of learning a new language, nerve cells that are recruited in learning a new word will fire a glutamate signal across the synapse.²Without practice, the original synaptic connection will diminish, and the signal will weaken.²The end result, is you’ll forget. On the other hand, regular practice and firing of this new neural connection will strengthen the synapse. The synapse will actually grow in size, and this will improve the ability of the synapse to fire in the future.² And guess what? You’ll remember!

What parts of the brain are involved in memory? One area of the brain that we often read about in terms of memory is the hippocampus.The process of learning, however, involves many more areas of the brain working together.² When the brain receives an incoming stimulus, there is an emotional intensity assigned to it (limbic region), and it is considered amongst past experiences, as well as the social and environmental context, before being formed as a new memory in the hippocampus.The pre-frontal cortex is the decision maker of the brain . It sequences this information, and is able to make a rational decision or judgement about any particular scenario before it settles as a formed memory in the hippocampus.

Coming back to the hippocampus, research has shown that it is particularly vulnerable to degenerative disease.⁴Studies have shown that the hippocampus can literally shrink in size, during the course of degeneration such as dementia.²

The positive, though, is that research has also shown that cardiovacular exercise, as well as routine cognitive challenges (e.g., problem solving, learning a new language) can increase the size of the hippocampus.²

This is another example of neuroplasticity.

Brain-derived neurotrophic factor (BDNF) is crucial for the health of our nervous systems, and it massively increases during cardiovascular exercise.²BDNF is thought to play a really important role in learning, and has been found in lab studies to be present in the hippocampus.²Researchers have found that if BDNF is added to neurons in a petri dish, the neurons sprouted new branches (dendrites), which could be thought of like fertiliser for long term potentiation (learning).²BDNF also helps with synaptic connections, binding to receptors at the synapse and strengthening the neural signal.²

So how much, and what kind of exercise is effective?Unfortunately it still isn’t exactly known what is an ideal type and duration of exercise for improved learning and memory.²

Going by the recommendations of the World Health Organisation⁵, these are guidelines for general health:

Children aged 5-17 years

1.At least 60 minutes of moderate to vigorous intensity physical activity each day.
2.Any extra exercise will provide additional benefits.
3.Should be mostly aerobic exercise. Vigorous-intensity activities should be included, for safe and appropriate muscle strengthening, at least 3 times per week.

Adults aged 18-64 years:

1.At least 150 minutes of moderate-intensity aerobic exercise activity, or at least 75 minutes of vigorous-intensity aerobic activity in one week. (Or a comination of moderate and vigorous intensity activity).
2.Aerobic activity should be at least 10 minutes in duration.
3.For additional health benefits, adults should aim for double the above mentioned recommendation (300 minutes moderate intensity, or 150 minutes of vigorous activity, or combination, per week).
4.Muscle strengthening involving major muscle groups on 2 or more days a week.

Adults aged 65 years and above:

1.At least 150 minutes of moderate-intensity aerobic physical activity, or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week (or equivalent combination).
2.Aerobic activity should be at least 10 minutes in duration.
3.For additional health benefits, adults should aim for double the above mentioned recommendation (300 minutes moderate intensity, or 150 minutes of vigorous activity, or combination, per week).
4.Balance and falls prevention for older adults with poor mobility, 3 or more days per week.
5.Muscle strengthening involving major muscle groups on 2 or more days a week.
6.When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

For anyone being treated for any medical condition, discuss these with your medical practitioner before starting a new exercise program.

For more detailed recommendations, please see the World Health Organisation’s website.

Dr Ratey suggests combining the benefits of cardiovascular exercise (e.g., 60-70% of maximum heart rate) with skill-based, non-aerobic exercise. This will depend on what each person enjoys, and will be able to be consistent with.²

Examples would be tennis, basketball, surfing, or any other activity that challenges both strength, balance, fine motor control, and cardiovascular endurance. This will help challenge and develop different areas of the brain, such as the cerebellum and basal ganglia.


•Exercise can play an important role in counteracting the neurotoxic effects of prolonged stress.

•Cardiovascular exercise encourages an increase in neurotransmitters, proteins, and hormones that help with neurogenesis and nervous system health.

•Cardiovascular exercise has been shown to considerably improve cognition and long term memory, by strengthening synaptic connections and encouraging neurogenesis (nerve cell growth).

•A combination of strengthening, fine motor skills, and cardiovascular activity seems to be a good way of challenging and developing different areas of the brain.


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