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Jun 27, 2015


 — Months later, the father mustered the strength to sort through what was left in his dead son’s bedroom. A Little League photo collage. Mardi Gras beads from that soccer tournament in New Orleans. And a typewritten personal essay tucked into a yellow folder, with a single word pencarved into its plastic cover: “Concussions.” His son Curtis had written the paper for a college composition class in 2009, five years before his death. In it, Curtis recalled having been knocked unconscious three times in 14 years while playing soccer, twice after leaping to head the ball, only to — “WHAM” — collide with another player. The continuing side effects, he wrote, included “horrendous migraine headaches.” “If I feel this way now,” he wondered, “what will it be like when I’m older?” He was 19. Reading those words, his father, Bill Baushke, felt the floor drop beneath him. This meant that Curtis knew. He knew well before most of us that repeated concussions could also lead soccer players — and not just those who box or play football — down the dark spiral of cognitive damage and decline. Well before the death in 2012 of the semiprofessional soccer player Patrick Grange, 29, who was posthumously found to have chronic traumatic encephalopathy, the degenerative brain disease linked to concussions. Before the 2014 death of Hilderaldo Bellini, 83, the retired Brazilian soccer star, also found to have C.T.E. Before the specter of C.T.E. began to loom over every contact sport. Curtis Baushke, racked by migraines and struggling with focus, was still focused enough to know. “Allowing kids to play too soon after a concussion could be very dangerous,” he wrote. “We need to find out the actual damage concussions cause people.” When Curtis was not quite 5, a neighborhood boy bragged that his father was signing him up for soccer. Curtis then wanted to play soccer, too, but his parents were football and baseball people. “You go ahead and play soccer,” Bill Baushke recalled saying. “But next year you’re going to play baseball.” Although Curtis excelled at both games, he eventually chose to concentrate on soccer, partly because he had been hit by pitches several times, once to the head. “He wanted to play a safe sport like soccer,” his father said. With Curtis’s older brother, Ryan, playing as well, the Baushkes became a soccer family, their free time revolving around practices and games, field conditions and out­of­town tournaments. Life was lived on the mosquito­rich lawns down by the Cumberland River, under the lights at the sprawling Heritage Park and in the stands at the athletic field behind Clarksville High School. Curtis played as a freshman on the varsity team, as well as for a premier club that served as a feeder system to colleges. “You’d start him maybe on defense,” Dave Donahue, one of his high school coaches, said. “But if you needed some punch, you’d put him in midfield, and then if you were a goal behind, you’d put him up front.” “He was full speed, and just a terrific athlete,” said Donahue, who coached hundreds of players in his 26 years at Clarksville High. “He stands out, even to this day.” Bill Baushke, 57, recalled how gifted his son had been at winning balls in the air with headers, at setting up teammates with pinpoint­perfect passes, at sending corner kicks curving toward the goal. But he also remembered the many times when Curtis “had his bell rung, sat out a couple of plays, and was told to go back in” — as well as that upsetting day when a disturbed classmate hit him in the head with a bowling ball, knocking him out. Curtis began exhibiting behavior now recognized as suggestive of postconcussive trauma. Dramatic mood swings. Depression. Headaches so debilitating he would need to lie down in a dark room. After high school, Curtis took a few classes at Hopkinsville Community College, where he wrote his personal essay about concussions. He moved to Chattanooga, Tenn., to live with his brother and took more college courses in hopes of becoming a sportswriter. But Curtis, who was also found to have bipolar disorder, continued to struggle. He lost his job writing a blog about college draft picks. He injured himself while competing in a new passion — disc golf — and became addicted to prescription medicine. He moved back to the family house in the country, with that large front lawn where he and his buddies used to kick around a soccer ball. He stole, and used drugs, and lied. Maybe not liedÍž maybe he forgot. “He wouldn’t remember doing things,” his father said. “He would sit there and deny it, but in his mind, he was telling the truth.” Because of those severe migraines, his parents took him to a series of specialists, to no avail. They even had his brain scanned for tumors. Nothing. But it had to be something, Curtis insisted. He began to maintain that he had C.T.E. “He would delve into it headfirst, researching it on the computer,” his brother, Ryan, said. “Trying to find out what was going on.” Looking back, the Baushkes might have dismissed his belief as a convenient self­diagnosis by Internet. All they knew was that their sweet younger boy — who loved his grandmother, loved practical jokes, loved duck hunting — was failing to find his footing. More than once he made arrangements to move out, only to pull back at the last moment. “I just don’t think that he felt he could do it,” his mother, Patti Baushke, 55, said as she sat before family photographs splayed across the dining room table. A year ago last week, Bill and Curtis Baushke made plans to watch the United States play Germany in the World Cup. The elder Baushke left his job in Nashville early, only to come upon his son snoring loudly on his bed. He went to his own bedroom, changed his clothes and turned on the television in the living room, where wooden duck decoys adorned the shelves. The game began, and the father called for his son. Called again, then went to rouse him. But Curtis had stopped breathing, and neither his father nor emergency medical technicians could revive him. Accidental overdose of prescription drugs. His parents did what they knew Curtis would have wanted. A few months later, the Baushkes participated in a conference call with researchers who had examined Curtis’s brain at Boston University’s CTE Center, which works with the Sports Legacy Institute, a nonprofit organization dedicated to brain trauma research and prevention. Their determination: Curtis had Stage 2 C.T.E., meaning there was clear evidence of deterioration in the brain — surprising, given his young age. “I cried and cried,” his mother recalled. “He was so right. Curtis wasn’t just making it up and talking crazy. He thought he had it, and he did.” With that, the silence of unspoken what­ifs filled a house in the country, where the photographs on the dining room table depicted a gifted and airborne young athlete, meeting yet another soccer ball head­on. A version of this article appears in print on June 22, 2015, on page D1 of the New York edition with the headline: Playing a Safer Sport, and Paying the Price. © 2015 The New York Times Company

Aug 16, 2012

Before being diagnosed with bipolar disorder, Linea was a bright student-athlete, ready to pursue a music career. So the diagnosis surprised her mother, Cinda. She's a professor and program director of the special education graduate center at Seattle University, and taught classes on emotional and behavioral  disorders and mental illness.

Cinda thought that her daughter's ups and downs were normal for a sensitive teen. But when Linea entered college, her mood swings became harder to ignore – and she says they eventually led her to seriously consider suicide.

Read the full article on

 

Aug 14, 2012

Also called: Inborn genetic brain disorders

A genetic disorder is a disease caused  by a different form of a gene, called a variation, or a change in a gene, called a mutation. Genetic brain disorders specifically affect the development and function of the brain.

Some genetic brain disorders are due to random gene mutations or mutations caused by environmental  exposure, such as cigarette smoke. Other disorders are inherited, which means that a mutated gene or group of genes is passed down through a family. Still other disorders are due to a combination of genetic changes and other outside factors.  Some examples of genetic brain disorders include leukodystrophies, phenylketonuria, Tay-Sachs disease, and Wilson disease.

Many people with genetic brain disorders fail to produce enough of certain proteins that influence brain development and function. These brain disorders can cause serious problems that affect the nervous system. Some are life-threatening.

 

Apr 1, 2012

 The Multi Modal Treatment Study of Children With ADHD, also called the MTA study, in results published in the Journal of the American Academy of Child and Adolescent Psychiatry  indicates that children who respond to stimulants such as Ritalin did better in the first year than children who were not taking medication or receiving other treatments.  However, but the end of 14 months most of the children were not taking the medication and in multi year follow ups of those children who were taking the medication they were performing no better than peers who were not taking the medication on measures of academic performance or social interaction.  They were attending better but not necessarily learning better.  Stimlulant drugs were compared to behavioral treatments.  Neurofeedback was not included in the study as a choice for these children.

This suggests that medication for ADHD long term is not any more effective than behavioral strategies.  There are indications however than children at three years somewhat shorter and 6lbs lighter than their peers who did not take the medication.  

There are studies such as ones by Rossiter and Lavaque and more recently by Monastra that indicate that Neurofeedback is equally as effective as Ritalin or stimulants or more so and that Neurofeedback also impacts academic performance.  Tansey has published a study in the Journal of Australian Psychology indicating an increase in IQ  of 7-15 points with Neurofeedback.  That result has been seen by other researchers as well, such as Joel Lubar.  Follow up studies by Lubar, Monastra and others have shown that Neurofeedback patients maintained their gains.  Lubar did the longest follow up of 16 years.  In Monastra's study the control group had to return to medication to function in school and the treatment group of Neurofeedback stayed off their medication and improved their academic performance.  

What should a parent do?  

If medication helps and you need something immediate and the medical risks are acceptable, there is nothing wrong with this as a short term solution.  It is not a life long solution however and its effects will not last.  That is what the evidence seems to indicate.  Neurofeedback on the other hand when properly conducted does last.  If the brain is injured or sustains an illness that may effect the neurofeedback results.  Children, adults and adolescents can be trained while they are medicated; however your physician should work with the neurofeedback therapist to reduce the medication as the treatment becomes more effective.  It is likley that the brain will need less medication or possibly none at all. 

Best Wishes,

Dr. Gluck

See RITALIN GONE WRONG which appeared in the Sunday New York Times Review in articles section or read it HERE

Feb 21, 2012

Controlling Parents More Likely to Have Delinquent Children

ScienceDaily (Feb. 10, 2012) — Authoritarian parents whose child-rearing style can be summed up as "it's my way or the highway" are more likely to raise disrespectful, delinquent children who do not see them as legitimate authority figures than authoritative parents who listen to their children and gain their respect and  trust, according to new research from the University of New Hampshire.


"When children consider their parents to be legitimate authority figures, they trust the parent and feel they have an obligation to do what their parents tell them to do. This is an important attribute for  any authority figure to possess, as the parent does not have to rely on a system of rewards and punishments to control behavior, and the child is more likely to follow the rules when the parent is not physically present," said Rick Trinkner, a doctoral candidate at UNH and the lead researcher.

This is the first study to look at whether parenting styles influence adolescents' beliefs about the legitimacy of parent authority and if those perceptions affect delinquent behavior. The results are presented in the February issue of the Journal of Adolescence in the article "Don't trust anyone over 30: Parental legitimacy as a mediator between parenting style and changes in delinquent behavior over time."

The research was conducted by UNH researchers Trinkner; Ellen Cohn, professor of psychology; Cesar Rebellon, associate professor of sociology; and Karen Van Gundy, associate professor of sociology.

The researchers relied on data from the New Hampshire Youth Study, an ongoing, longitudinal survey of middle school and high school students examining the psychological, sociological, developmental, and legal factors that influence adolescent delinquency. Analyses reported are based on data collected over an 18-month period beginning in the fall of 2007.

"While it is generally agreed that authoritative parenting is more effective than authoritarian and permissive styles, little is known about why some parenting styles are more efficient than others. Our results showed that parental legitimacy was an important mechanism by which parenting styles affected adolescent behavior," Trinkner said.

The researchers evaluated three parenting styles: authoritative, authoritarian, and permissive.

Authoritative parents are both demanding and controlling, but they are also warm and receptive to their children's needs. They are receptive to bidirectional communication in that they explain to their children why they have established rules and also listen to their children's opinions about those rules. Children of authoritative parents tend to be self-reliant, self-controlled, and content.

On the other hand, authoritarian parents are demanding and highly controlling, but detached and unreceptive to their children's needs. These parents support unilateral communication where they establish rules without explanation and expect them to be obeyed without complaint or question. Authoritarian parenting produces children who are discontent, withdrawn, and distrustful.

Finally, in contrast to authoritarian parenting, permissive parents are nondemanding and noncontrolling. They tend to be warm and receptive to their children's needs, but place few boundaries on their children. If they do establish rules, they rarely enforce them to any great extent. These parents tend to produce children who are the least self-reliant, explorative, and self-controlled out of all the parenting styles.

"The style that parents used to rear their children had a direct influence on whether those children perceived their parents as legitimate authority figures. Adolescents who perceived parents as legitimate were then less likely to engage in delinquent behavior. Thus, authoritative parenting may be more effective than the other styles because this style makes adolescents more willing to accept their parents' attempts to socialize them and subsequently follow their rules," Trinkner said.

"Conversely, authoritarian parents have the opposite effect in that they actually reduce the likelihood of their children perceiving their authority as legitimate. Adolescents from authoritarian parents are more likely to resist their parents' attempts at socialization," he said.

While the children of permissive parents were less likely to respect their parents as authority figures, the researchers found they were no more or no less likely to engage in delinquent behavior.

According to the researchers, the results show that fostering and creating parental legitimacy is one technique for parents to exert control over their children. Additionally, parents are more likely to be viewed as legitimate authorities if they utilize authoritative parenting practices rather than authoritarian or permissive practices, which tend to undermine parental authority.

"Our data offer further evidence that authoritative parenting is an effective way for parents to successfully socialize their children and that its influence works largely through its effect on youth perceptions of parental legitimacy," Trinkner said.

Dec 1, 2011

Physicians have documented changes in blood flow in high school atheletes' brains as  a result of a concussion.  Symptoms lasted longer than ex[ected and the absence of structural injury does not necessarily mean an absence of injury to the b

1 comments
Feb 20, 2011

There is an awakening occurring, finally, about the connection between football and brain injury.  Of course, it is not only football.  Basketball, soccer, diving also have their risks of brain injury.  However, football, today,  seems to be to our culture what baseball was when I was growing up.  It is a great attractor of children, adolescents, and adults.  It is filled with pageantry, pride, personal effort, and respect for great achievement and drive under pressure and against difficult odds.  It is also, of course, a huge business, providing large profits for owners and great wealth for some professional players. 

Life is about risk, for sure, but as parents, and doctors, it is also about weighing risks versus benefits.  Selfless acts of bravery and self sacrifice for the preservation of human life or principles like justice and protection of the weak aside, it behooves us to always weigh the benefits of an act against its risk, and against alternative activities that might yield similar results with lower risk. 

Maybe self sacrifice was part of what Mr. Duerson had in mind when he killed himself this past week and requested that his brain be donated to Boston University for the study of Chronic Traumatic Encephalopathy, the current name for chronic post concussion syndrome.  One would hope.  More likely, his suicide is the result of incredible and intolerable pain and hopelessness of ever being able to get any relief.  It is indeed a permanent solution to a temporary state.  Suicidal feelings or intentions are a medical emergency and that person should seek care immediately or be brought for help by those around him or her.  That being said, perhaps Mr. Duerson thought he could be of more help dead than alive.  I doubt it.  He participated in helping other players with CTE, but no one knows, for sure, what was in his mind or heart.  You might want to read about it in the New York Times Sports Section:

http://www.nytimes.com/2011/02/20/sports/football/20duerson.html?_r=1&ref=sports#

I didn't know Mr. Duerson, or even much about his career until now.  Yet, I regret his passing and just as much the personal pain he went through that brought him to this place.  My condolences go to those who suffer this as a personal loss. 

One thing for sure is that brain injury IS TREATABLE.  If you have ever played football or have a child who has, he or she may have suffered a mild brain injury.  Certainly a concussion is evidence of injury and repeated concussions even more so.  It would be wise to see a neurologist and get a very thorough exam.  The neurologist should have experience in diagnosing and treating mild traumatic brain injury.  Too often the symptoms are minimized or missed.  The most sensitive tests for mild TBI are Quantitative EEG, SPECT scans and neuropsychological testing. 

Do yourself, your spouse, and your child a favor, sustain life, and get checked.

 

All the Best,

Dr. Gluck

Jul 14, 2010

I have had a cough for a while and been feeling low in energy, so I went to see my doctor.  He looked at my throat, listened to my chest and said, "Just to be on the safe side, lets get an X-Ray".  Off I walked to the X-Ray room where I encountered a nice medical assistant who was wearing sunglasses because she just had her eyes dilated in an eye exam.  I found out I could have the x-ray because my insurance company will pay the doctor for the test; otherwise I would have to go to the hospital for the x-ray. 

I got to thinking how complicated our healthcare system had become.  One thing I like about my doctor is that most things can get done right there in the office.  That is the way it was when I was a kid.  I mean, you didn't go to the hospital unless you were really really sick.  Now we often have to go to a hospital or a "lab" even to get blood drawn. 

X-ray done and normal.  A nice medical assistant took my blood sample.

As I waited in the room I began to reflect on just how it is I chose my doctor. Indeed how do we choose our doctors and therapists.  What do we look for?

In my initial meetings with him I remember he told me he read both the traditional and the so called alternative medicine literature.  That appealed to me. Don't throw out the old, but stay updated with the new and modify what you have learned based on the new science and new methods.  He takes his time making a diagnosis and does not jump to conclusions, but when he says something and I question him about it he knows the literature.  So we communicate well and he is competent.  One thing I know, he does not believe in quick fixes but rather sound clinical practice:  one step at a time.  Not that he can't make quick decisions. He can because among other things he is Board Certified in Critical Care Medicine.  (You know, the doctors who take care of really sick people in the ICU.)

When I left I thought about EEG Biofeedback or Neurofeedback and how people choose a therapist.

Before you read any further the bottom line is that you need to trust and be comfortable with whomever you are working with.  It is important to tell the therapist about what is going on in your life, what changes and what does not change and your triumphs and your difficulties.  All of that information can influence where and how s/he trains.

Before this massive explosion in neuroscience research we listened to our patients' complaints and based on what we knew about anatomy and physiology of the brain we chose our sites and our frequencies to train.  The best researched clinical areas were attention deficits, brain injury and seizures,  Now we have Board certification and a supervision system.  I remember having to beg to be supervised nearly 20 years ago when I started because no one got supervised.  We just practiced.  That did not seem right to me.  So I had a very good supervisor, a psychologist and expert in EEGs from the Menninger Hospital.

It seemed pretty simple. If people got better then you did more of that and if they didn't you stopped and tried something new.

People used to get better from all sorts of folk remedies, but that did not make them safe or effective. Of course we still use folk remedies and herbs today, because some of them are safe and effective.  However, most people were happy when scientists were able to take X-Rays, do blood tests, CT Scans and MRIs because it made healthcare for many more effective.  While they can be over used or misused no one in their right mind would advocate getting rid of them. 

Well there are people out there still flying by the seat of their pants and testing treatment protocols in EEG Biofeedback and saying, well this made so many people with your symptoms better so we will do the same with you.  Sometimes that works.  Sometimes it doesn't.  We have new technology. 

We have our own version of the MRI or CT Scan and blood tests.  Its called a Quantitative Electroencephalogram (QEEG).  Why?  Because we treat the brain.  It is a voluntary retraining of the brain and it simply makes sense to test the thing you are treating to find out as much about it as you can before you treat.  That is the same reason psychologists do testing and schools do educational evaluations.  And they all used standardized statistical analysis, science, to measure what is going on with the patient or the student.  Just like a QEEG.

But despite thousands of articles having been published using QEEG some clinicians still resist its use. 

So when you choose a biofeedback therapist for your brain, make sure s/he knows the old and uses the new. 

Tradition is to be honored and cherished.  Progress is to be respected and used.  What we do should be based on research and not trial and error. 

Warm Regards,

Jerry Gluck

 

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