Childhood Injury Prevention By Managed Care Organizations: Fill & Download for Free

When thinking about panic-inducing incurable diseases, the mind jumps to infectious diseases, which can cause pandemics that could wipe out a significant portion of the human population.Historically, epilepsy, the plague and AIDS have been such panic-inducing diseases, which changed whole societal conceptions, one might say. (Epilepsy is not infectious, of course, but in ancient times that was not known; assumptions about the origin of the disease ranged from a contagious agent to it being a sign of demonic possession or divine punishment.) Nowadays there are fortunately more or less effective treatments for all three of them. There are, however, other, still incurable diseases that continue to scare us because of the suffering they bring to the patient and their families. Here is a list with some of the most notorious incurable diseases grouped into categories. For most of the diseases I have reviewed and copied the symptoms and prognosis from the respective article on Wikipedia (copied portions marked in quotation marks, sentences rearranged where necessary). Each heading with the disease name provides a hyperlink to the respective article.Not advisable to read when in a bad mood, proceed on own accord:Infectious diseasesConsidering the case fatality rate and the fact that as of 2018 there is still no approved treatment, the “prize” would have to go to:Ebola virus disease“It is a viral hemorrhagic fever of humans and other primates. Signs and symptoms initially resemble those of a common cold. Vomiting, diarrhea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally. The disease has a high mortality, killing between 25% and 90% of those infected, with an average of about 50%. This is often due to low blood pressure from fluid loss, and typically follows six to sixteen days after symptoms appear. The highest risk of death was 90% in the 2002–2003 Republic of the Congo outbreak. The case fatality rate becomes considerably lower with adequate supportive care (e.g. fluid repletion). Several experimental treatments are being studied, but no specific treatment has been approved yet” as of December 2018.Marburg virus“It is a viral hemorrhagic fever and the clinical symptoms are indistinguishable from Ebola virus disease. Of the 252 people who contracted Marburg during the 2004–2005 outbreak of a particularly virulent serotype in Angola, 227 died, corresponding to a case fatality rate of 90%.” Antiviral medication may be of some help.RabiesI have included it mainly because of historical reasons. “It is a viral disease that causes inflammation of the brain in humans and other mammals and can be transmitted through bites by infected animals. Symptoms include violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion and ultimately loss of consciousness. It is preventable with vaccines and treatable with post-exposition prophylaxis but, once the symptoms manifest, the case fatality rate is near 100%.”CancerIt is one of the most feared group of diseases, because it affects so many people, treatment has a lot of physically and psychologically exhausting side-effects and stage IV cancer of the solid organs is mostly incurable. I cannot list all the types of cancer according to their fatality, but two of the most feared are:GlioblastomaThe most common malignant tumour of the brain and the one with the worst prognosis. “Usually, the length of survival following diagnosis is 12 to 15 months, with fewer than 3% to 5% of people surviving longer than five years. Without treatment, survival is typically 3 months.”Pancreatic cancerIt is only marginally less lethal than glioblastoma. “Overall five-year survival for pancreatic cancer in the US has improved from 2% in cases diagnosed in 1975–77, and 4% in 1987–89 diagnoses, to 6% in 2003–09. In the less than 20% of cases of pancreatic adenocarcinoma with a diagnosis of a localized and small cancerous growth (less than 2 cm in Stage T1), about 20% of Americans survive up to five years.”Connective tissue diseasesThe lethal forms are not so known to the general public because they are so rare, but they can be very painful and debilitating. A fellow Quoran named the following disease as the scariest one of all:Fibrodysplasia Ossificans ProgressivaThe disease is caused by a mutation of the body's repair mechanism, “which causes fibrous tissue (including muscle, tendon, and ligament) to be ossified spontaneously or when damaged. In many cases, injuries can cause joints to become permanently frozen in place. Surgical removal of the extra bone growths has been shown to cause the body to "repair" the affected area with even more bone. There is no cure. The median age of survival is 40 years with proper management. However, delayed diagnosis, trauma and infections can decrease life expectancy.”Premature aging (progeroid) syndromesProgeroid syndromes are a group of “rare genetic disorders which mimic physiological aging, making affected individuals appear to be older than they are.”ProgeriaIt is a specific form of a progeroid syndrome. Those born with progeria “typically live to their mid-teens to early twenties, few people exceed 13 years of age. At least 90% of patients die from complications of atherosclerosis, such as heart attack or stroke. Intelligence tends to be average to above average”, which adds to the psychological burden of the disease. No cure known.Neurodegenerative diseasesNeurodegenerative diseases affect the patients and their families on so many levels that they are understandably one of the worst incurable diseases to have. The burden of knowing that one is losing their memory and their sense of self is a very heavy one. Some neurodegenerative diseases (e.g. ALS) cause loss of motoric function without a relevant impact on cognitive function and memory.Alzheimer's disease“It is the cause of 60–70% of cases of dementia. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.”Amyotrophic Lateral Sclerosis (ALS)It causes the “death of neurons controlling voluntary muscles, which results in difficulty moving, speaking, swallowing, and eventually breathing. Most people with ALS die between two and four years after the diagnosis, with their breath stopping while they are sleeping. Guitarist Jason Becker has lived since 1989 with the disorder, while cosmologist Stephen Hawking lived for 55 more years following his diagnosis, but they are considered unusual cases.”Creutzfeldt–Jakob diseaseIt is a “fatal degenerative brain disorder, caused by misfolded proteins that can cause normally folded proteins to become misfolded as well. Most cases occur spontaneously, while about 7.5% of cases are inherited from a person's parents.” Exposure to brain or spinal tissue from an infected person (as in cornea or dural implants or in tribes practising cannibalism) can also cause the disease. “Early symptoms include memory problems, behavioral changes, poor coordination, and visual disturbances. Later on, dementia, involuntary movements, blindness, weakness and finally coma. About 90% of people die within a year of diagnosis.” Variant Creutzfeldt–Jakob disease is caused from eating beef infected by bovine spongiform encephalopathy (BSE = mad cow disease).Fatal Familial InsomniaIt is an “extremely rare sleep disorder that is typically inherited and results in death within a few months to a few years after onset. The main symptom is insomnia, but the disease can also cause a range of other symptoms, such as speech and physical coordination problems and dementia.”Frontotemporal DementiaIt is a “neurodegenerative disease, whose common signs and symptoms include significant changes in social and personal behavior, apathy, blunting of emotions, and deficits in both expressive and receptive language.” One’s “character” literally changes to the worse over the course of the disease. “The symptoms progress at a rapid, steady rate. Patients suffering from the disease can survive between 2 and 15 years.”Huntington's diseaseIt is an “inherited disorder that results in death of brain cells. As the disease advances, uncoordinated, jerky body movements become apparent. Physical abilities gradually worsen until coordinated movement becomes difficult and the person is unable to talk. Mental abilities generally decline into dementia. Life expectancy is generally around 20 years following the onset of visible symptoms. Symptoms usually begin between 30 and 50 years of age, but the disease may develop earlier in life in each successive generation, meaning that the children of affected parents can expect to develop the disease earlier than their parents.”Imagine living your life as a teenager and young adult in full mental capacity, knowing that you will most probably end in the same tragic way as your affected parent, knowing that your suffering will start sooner than theirs, but not knowing when. As a doctor, I am used to seeing disfigurements or bad-smelling ulcers which I know can never heal. But if I had to pick one disease which would frighten me the most, I think this would be it.PS:Let us all put our efforts together to find the best available care and, if possible, cure for these patients. Many of them can still enjoy aspects of life in the midst of so much suffering and there is much that they can teach us about life, in its good and not so good moments.Wishing everybody good health!Edit 16.12.18:The word disease covers pretty much every pathological condition which is not the result of traumatic injury. Some fellow Quorans pointed out that I only included terminal diseases and that I left out diseases which cannot be cured casually. It is a matter of debate if a disease is really incurable if its symptoms are amenable to therapy, but with a more liberal definition of incurable the list would have to be expanded as follows:NeurologicalAnoxic/ hypoxic injuryThe term cerebral hypoxia is used to refer to a reduced oxygen supply to the brain, anoxia means a (temporary) complete deprivation of oxygen, mostly due to disruption of the blood supply. Anoxic/hypoxic injury in the pre-, peri- or postnatal period “accounts for approximately 20% of cerebral palsy in children.” In adults it may be the result of stroke or cardiac arrest. The neurological damage can be subtle or totally debilitating.In newborns, hypothermia therapy (induced by cooling the baby to around 33 °C for three days under mechanical ventilation) effectively improves survival and neurological outcome if applied within 6 hours of the episode of cerebral hypoxia, because it reduces damage through oxygen radicals after reperfusion. In adults, the evidence is less supportive and the main goal is to prevent fever after cardiac arrest.Locked-in syndrome (“pseudocoma”)It is a condition in which a patient is quadriplegic (totally paralysed) and cannot move any voluntary muscles in the body except for the muscles in and around the eyes. Moreover, they cannot produce any vocal sounds due to lack of coordination between breathing and vocal cords. However, contrary to a vegetative state due to the afore-mentioned anoxic/ hypoxic injury, the neocortex of patients with locked-in syndrome is intact (the damage being in parts of the brainstem), so they remain conscious with sufficient cognitive function to the degree that they can communicate with vertical eye movements and blinking. There is no cure. Although electrical stimulation of muscle reflexes can help patients regain some rudimentary muscle activity, it is extremely rare for any significant motor function to return. torture.Locked-in syndrome is not lethal per se, but if incurable chronic conditions are to be included, this would be my worst nightmare. Watching the world go by without being able to communicate other than with your eyes must be pure torture.Neural tube defectsAnencephalyBaby Jaxon, Born With Anencephaly, Defies the Odds, Turns 1 Year Old“Children born with this disorder lack a telencephalon (the largest part of the brain consisting mainly of the cerebral hemispheres, including the neocortex, which is responsible for cognition). The remaining structure is usually covered only by a thin layer of membrane (skin, bone, meninges, etc. are usually all lacking). With very few exceptions, infants with this disorder do not survive longer than a few hours or possibly days after their birth from cardiorespiratory arrest. They are not aggressively resuscitated because there is no chance of the infants ever achieving a conscious existence. Instead, the usual clinical practice is to offer hydration, nutrition and comfort measures and to "let nature take its course".”The disorder occurs when the “rostral (head) end of the neural tube fails to close during embryonic development.” “The cause of anencephaly is disputed. Folic acid is known to be important in neural tube formation and the addition of folic acid to the diet of women of child-bearing age has significantly reduced, although not eliminated, the incidence of neural tube defects.”GeneticAneuploidy and other Chromosome abnormalitiesEverybody is familiar with Down syndrome (Trisomy 21), but there are many many more, which cannot be listed here. Having one or three instead of two chromosomes in every somatic cell is usually lethal before birth. In the rare case of a trisomy other than that of chromosome 21 where the fetus survives to birth (such as with Patau or Edwards syndrome), prognosis is very poor.Genetic metabolic disordersGenetic metabolic disorders are too many to be listed here. Perinatal screening can help identify the children with the predisposition for a wide range of metabolic disorders, so that the diet can be modified as needed. In some cases, the missing enzyme can be substituted. In other cases, drastic measures such as liver transplant or bone marrow transplant are needed. Some children develop severe disabilities despite optimal treatment from the onset, as is for example the case with Galactosemia. The following disorders could be considered more scary due to their dramatic manifestation or the lack of a causal therapy:Ataxia-telangiectasia“Many children are initially misdiagnosed as having cerebral palsy. The average life expectancy is approximately 25 years, but it continues to improve with advances in care. The two most common causes of death are chronic lung disease and cancer.”Lesch–Nyhan syndromeA fellow Quoran, who pointed out how dramatic the disease is in the comments section, prompted me to edit the answer so as to include such diseases. Lesch-Nyhan syndrome (LNS) is caused by mutations in the HPRT gene which lead to a build-up of uric acid. It is associated with severe gout and kidney problems, which can be prevented with allopurinol. “In the first year of life infants begin having poor muscle control and moderate mental retardation. In the second year of life, a particularly striking feature of LNS is self-mutilating behaviors, characterized by lip- and finger biting. Nearly all affected individuals need restraints to prevent self-injury and are restrained more than 75% of the time. This is often at their own request, because they feel more at ease that way, even when it involves restraints that would appear to be ineffective, as they do not physically prevent biting. Some even have their teeth extracted in order to avoid self-injury. Deep-brain stimulation has been proposed as a possible treatment. Neurological symptoms also include facial grimacing, involuntary writhing, and repetitive movements of the arms and legs similar to those seen in Huntington's disease, for which no effective medication exists. The prognosis for individuals with severe LNS is poor. Death is usually due to renal failure or complications from hypotonia, in the first or second decade of life.”Tay–Sachs diseaseIt is an autosomal recessive disease, more common in Ashkenazi Jews. The mutation results in the buildup of the molecule GM2 ganglioside within cells, causing the destruction of nerve cells in the brain and spinal cord. “The most common type, known as infantile Tay–Sachs disease, becomes apparent around three to six months of age with the baby losing the ability to turn over, sit, or crawl. This is then followed by seizures, hearing loss, and inability to move. Death usually occurs in early childhood.” No causal therapy is available.Zellweger syndrome“As a result of impaired peroxisome function, newborns have a profoundly low muscle tone, seizures, apnea and are unable to eat. Usually they do not survive beyond one year of age.”Other genetic disordersCystic fibrosisIt is an autosomal-recessive disorder, caused by mutations in both alleles of the CFTR-gene, which is “most common among people of Northern European ancestry (about one out of every 3,000 newborns is homozygous for the disease). It affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Patients have chronic difficulty breathing and coughing up mucus as a result of frequent lung infections. Lung infections are treated with antibiotics, but there is no adequate long-term cure other than transplant of both lungs, after which patients have a 5-year survival rate of 67%. Gene therapy has been explored as a potential cure, but results from clinical trials have shown limited success and using gene therapy as routine therapy is still not recommended” as of 2018.Epidermolysis bullosaIt is a group of genetic conditions that result in easy, painful “blistering of the skin and mucous membranes with minor trauma or friction. Its severity can range from mild to fatal. Those with mild cases may not develop symptoms until they start to crawl or walk. Complications may include esophageal narrowing, squamous cell skin cancer and the need for amputations. No causal therapy is known, although stem cell therapy has shown promising results.”PsychiatricParaphilic disorders“Paraphilia refers to the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors or individuals.” It can be debated what falls under the category of sexual diversity and what is pathological. In any case, it is considered a harmful disorder when it involves children or non-consenting persons in general. “The causes of paraphilias are unclear, although a growing body of research points to a possible prenatal neurodevelopmental correlation. Pedophilia in particular emerges before or during puberty and is stable over time. Most clinicians and researchers believe that paraphilic sexual interests cannot be altered. Instead, the goal of therapy is to reduce the person's discomfort with their paraphilia and limit any criminal behavior.” Both cognitive behavioral therapy and pharmacological methods (SSRIs and/ or anti-androgens) can be helpful in that regard. Only when a pedophile has fully mastered his/her urges, can their pedophilia be “de-classified” from an ongoing mental disorder to a (still unhealthy) sexual inclination.I can understand how some may be opposed to having pedophilia labelled as a disease, because that could imply a reduced responsibility on the part of the pedophilic child molester (all the while noting that not all child molesters are pedophiles and not all pedophiles molest children). Since child molesters are capable of distinguishing right from wrong when they commit their crimes, they bear full responsibility for them and deserve just punishment, irrespective of whether they have a primary sexual interest in children or not. Still, pedophilia is a mental disorder and, along with Antisocial personality disorder, one of the most difficult to treat. Given its heavy stigma, the reluctancy to seek treatment and the harm that it can cause, it is also one of the scariest mental disorders imaginable, probably both for the non-offending pedophile and for society.Second postscript:The list can never be all-inclusive, but I will be glad to read your thoughts in the comments section!

What are the consequences of removing each major brain area?“If the brain were so simple we could understand it, we would be so simple we couldn't.” ~ Lyall WatsonThe brain is incredibly resilient and adaptable. Phineas Gage was our first clue to that. In 1848 Gage had a 43-inch tamping iron blast through his head, entering his left cheek and exiting out of the top of his head. He lived to tell the tale, and worked as a stage coach driver. The area of the brain that got damaged in Gage’s case was the left frontal lobe. He did however have major personality changes. He was ill-tempered, proliferous in his use of profanity, no longer stuck with plans, and treated others poorly. Gage’s friends found him “no longer Gage”.Image:[1]Image: Images in clinical medicine. The tale of Phineas Gage, digitally remastered.[2]Removing parts of the brain does not result in the consequences we expect. The brain has an amazing ability to rewire itself to perform completely different tasks when necessary. Bradley Schlaggar, a pediatric neurologist, transplanted the visual cortex from an embryonic rat’s brain into the brain of a newborn rat, in the area of the somatosensory cortex (responsible for such bodily sensations as pressure and temperature). Once the rat was an adult, autopsy revealed that the transplanted visual cortex was operating as the somatosensory cortex.[3]Leah Krubitzer, a professor of psychology, performed a different experiment which demonstrated this amazing ability of the brain. She removed large pieces of brain in newborn marsupials. Autopsy of the marsupial adults revealed their brains had adjusted by creating the identical structures, in the same areas as a normal brain, but they were smaller so as to fit into the tinier space.[4]Left and Right Brain HemispheresSo let’s start with removing a hemisphere (half the brain). It is hard to believe that we can even live with half a brain. However Elena del Peral does and unless she told you she had half a brain you would not know. She is a friendly, bright, fit young woman who attends college and works at a childhood cancer foundation and is on the dean’s list.Image: Elena del Peral[5]In utero she suffered a left-sided congenital stroke. She was diagnosed because she began to suffer severe seizures due to the fact that the diseased tissue from her left hemisphere was sending electric storms across her corpus callosum (the part of the brain that allows for left and right hemisphere communication). The doctors decided to perform a hemisphectomy (removing half of her brain). The healthy part of the brain is bombarded by overly active impulses sent from the damaged side. This results in seizures, behavioural issues, social isolation, cognitive developmental impairment, and other issues. Once half of the brain is removed the healthy hemisphere can function normally, and plasticity can allow the person to start functioning relatively normally.So what does the research tell us about removing half a brain? Studies of intelligence and behaviour were made before, and after hemispherectomy for infantile hemiplegia. Results showed that patients made gains in intelligence after loss of half of the brain, however behavioural changes occurred and remained consistent over many years.Image source: www.cartoonaday.comRight Hemispheric Damage[6]Left homonymous hemianopsia (is a decreased vision or blindness in half the visual field, usually on one side of the vertical midline) or quadranopsia (incomplete hemianopsia related to the area of the lesion).Visual neglect/hemispatial inattention—a severe attention disorder to the left side.Impaired spatial orientation, body position and nonverbal communication.Partial paralysis of the left side of the body.Emotional and behavioral problems; confusion, lack of motivation, and uncooperativity or excessive dependence.Thinking skills may be negatively affected.Many people are unaware of the full extent of their impairment and even deny having a problem.May lose place in reading.Left Hemispheric Damage[7]Right homonymous hemianopsia or quadranopsia.Mood and behaviour impacted.Compulsive, disorganized and easily frustrated.Problems in memory, speech, writing, and cognitive processing.Problems on the right side of the body, including paralysis.Reading ability may be impaired at a cognitive level.The visual field loss on the right side may also be a cause of reading impairment.So let’s look at damage or removal at some of the major parts of the brain:Cerebral CortexThe cerebral cortex is the outer layer of tissue that covers the cerebrum (the part of the brain that includes the frontal, occipital, temporal and parietal lobes). It is composed of grey matter (mostly cell bodies), as opposed to the white matter below it (myelin sheaths of neuronal axons). It is highly folded, resulting in a much greater volume of the brain surface area in the confined volume of the skull. The corpus callosum (a thick band of nerves) connects the right and left cerebral cortex sides.Below are images of the lateral and medial areas of the cerebral cortex.Image: Lateral surface of the cerebral cortex[8]The cerebral cortex is responsible for most “higher order” or intellectual brain functions: thinking, reasoning, judging, planning, voluntary movement, and overall behavior.Injury to this area of the brain impairs judgment, dramatically changes personality, and results in problems with behavioural inhibition, focus and attention.Image: Medial surface of the cerebral cortex[9]The cortex has three distinct parts:Sensory areas: these are the parts of the cortex that receive sensory inputs from the thalamus are called primary sensory areas. The senses of vision, audition, and touch are managed by the primary visual cortex, primary auditory cortex and primary somatosensory cortex respectively.Motor areas: control of voluntary movements, especially fine motor movements performed by the hand. The right half of the motor area controls the left side of the body, and vice versa. Furthermore, the primary motor cortex executes voluntary movements, while the supplementary motor areas and premotor cortex select voluntary movements. In addition, the posterior parietal cortex guides voluntary movements in space, and the dorsolateral prefrontal cortex decides which voluntary movements to make according to higher-order instructions, rules, and self-generated thoughts.Association areas: produces meaningful perceptual experiences of the world, enables us to interact effectively, and supports abstract thinking and language.Thus damage or loss of this particular area of the brain results in specific losses associated with the area of the cortex described above.A cortical homunculus is a physical representation of the human body, located within the brain. A cortical homunculus is a neurological “map” of the anatomical divisions of the body. There are two types of cortical homunculi: sensory and motor.Source: London Natural History Museum: A sensory and motor homunculus, demonstrating how large the hands are compared to the arms and legs. The motor homunculus (left) shows what a human body would look like if each part were sized according to how much of the brain’s cortex is concerned with its movement. The sensory homunculus (right) is sized according to how much of the brain is concerned with each part’s sensory perception.Cerebral Cortex FunctionsThinking.Planning.Judgment.Voluntary movements.Speech and language.Reasoning.Cerebral Cortex Injury ProblemsParalysis.Visual, audition or touch sensory loss.Movement loss—voluntary, fine motor, or the ability to decide which movements should happen.Problems with sequencing.Lack of attention.Mood changes.Inability to use expressive language (Broca’s aphasia) or abstract language.Frontal lobe: The largest of the brain’s four main lobes. It is the emotional control center and controls the personality and executive decision making abilities. It is responsible for many different functions involving conscious thought, voluntary movement, and personality. The frontal lobe also facilitates word choice, organization, and behaviour. Frontal lobe damage can dramatically change personality and behaviour, and impair judgment, attention span and organization.Image courtesy: Martin SilvertantThe frontal lobe is responsible for helping us understand the thinking and experiences of others, and helping a person understand how to respond and behave appropriately in social situations. In autism and chronic post traumatic stress disorder the highway between the limbic system and the frontal lobe does not function properly. This results in a weak theory of mind for autistics, and an inability to process and let go of the trauma for people with PTSD.Image: James Fallon[10]The frontal lobe has been divided into “cool” cognitive aspects of executive functions, (dorsolateral prefrontal cortex), and the “hot” emotional/motivational aspects, (ventral and medial regions).Damage to the the dorsolateral prefrontal cortex results in disturbances in intellectual abilities (intelligence) such as problems in time-line sequencing of behaviour, problem solving challenges, problems in planning, and working memory defects (known as metacognitive executive dysfunction syndrome).Damage to the ventro-medial region results in impairment in being able to inhibit impulses— both emotions and behaviour.[11]Image:[12]Damage or removal of this area of the brain is known as Dysexecutive syndrome. This results in deficits in recognizing facial and vocal emotional expression (which supports the weak Theory of Mind in people with autism spectrum disorder).Furthermore, executive skills are reduced. For example, research has looked at set-shifting ability in neurosurgical patients with localized excisions of the frontal lobes. The patients had a deficit in the ability to shift their attention from something that had previously commanded their attention, or to move to something which had previously been irrelevant.[13] Another study found impairments in free recall in patients with frontal lobe lesions due to deficits in the ability to use organizational strategies.[14] Other deficits following frontal lobe damage or removal are loss of social awareness, emotional instability, irritability and impulsiveness.Frontal Lobe Functions[15]Motivation.Judgment.Behavioural choices.Planning.Personality.Organization.Attention.Expressive language and word choice.Frontal Lobe Injury ComplicationsPersonality change.Lack of attention.Loss of executive function (planning, organizing, and reasoning).Loss of judgment.Dramatic change in behaviour.Loss of motivation.Temporal Lobe: The temporal lobe is responsible for our visual and auditory memory, and it helps manage some speech (understanding language) and hearing capabilities. It is also responsible for sequencing, and organization.Image courtesy: Martin SilvertantA temporal lobe resection is a surgery performed on the brain to control seizures. The procedure involves removing brain tissue in the lobe to remove the seizure focus. Most often the anterior and mesial (deep middle) portions of the temporal lobe are involved.Kolb & Wishaw (1990) have identified eight principle symptoms of temporal lobe damage:[16]The temporal lobes are involved in primary organization of sensory input. Damage to these regions can cause disturbance of auditory sensation and perception; individuals with temporal lobes lesions have difficulty placing words or pictures into categories.Disturbance of selective attention of auditory and visual input. Left side lesions result in decreased recall of verbal and visual content, including speech perception. Right side lesions result in decreased recognition of tonal sequences, and many musical abilities. Right side lesions can also affect recognition of visual content (e.g. recall of faces).Disorders of visual perception.Impaired organization and categorization of verbal material.Disturbance of language can be affected by temporal lobe damage. Left temporal lesions disturb recognition of words. Right temporal damage can cause a loss of inhibition of talking.The temporal lobes are highly associated with memory skills. Left temporal lesions result in impaired memory for verbal material. Right side lesions result in recall of non-verbal material, such as music and drawings.Seizures of the temporal lobe can have dramatic effects on an individual’s personality; temporal lobe epilepsy can cause perseverative speech, paranoia and aggressive rages (Blumer and Benson, 1975).Severe damage to the temporal lobes can also alter sexual behaviour (e.g. increase in activity) (Blumer and Walker, 1975).Occipital Lobes[17]Image courtesy: Martin SilvertantLocated at the back of the brain—and thus are not particularly vulnerable to injury—the occipital lobes receive and process visual information. The occipital lobes also process colours and shapes. Whereas the right occipital lobe interprets images from the left visual space, the left occipital lobe interprets images from the right visual space. Damage to the occipital lobes can permanently damage visual perception.The Peristriate region of the occipital lobe is involved in visuospatial processing, discrimination of movement, and color discrimination.[18] Damage to one side of the occipital lobe causes homonomous loss of vision with exactly the same “field cut” in both eyes.Occipital Lobe FunctionsVision.Occipital Lobe Injury ComplicationsLoss of visual capability.Inability to identify colours.Visual Hallucinations.Visual illusions (distorted perceptions) can take the form of objects appearing larger or smaller than they actually are, objects lacking color or objects having abnormal coloring.Lesions in the parietal-temporal-occipital association area can cause word blindness with writing impairments (alexia and agraphia).[19]Parietal Lobes[20]Image courtesy: Martin SilvertantThe parietal lobes can be divided into two functional regions:[21]Sensation and perception — Integrates sensory information to form a single perception (cognition).Integration of sensory input — Primarily with the visual system to construct a spatial coordinate system to represent the world around us—giving objects meaning and environments depth.Individuals with damage to the parietal lobes often show striking deficits, such as abnormalities in body image and spatial relations. Parietal lobe damage disrupts shape, size and color identification, and distance perception.Left parietal lobe damage: results in Gerstmann’s Syndrome. It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).Right parietal lobe damage can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.Bi-lateral damage (large lesions to both sides) can cause Balint’s Syndrome, a visual attention and motor syndrome. It is characterized by the inability to voluntarily control the gaze (ocular apraxia), inability to integrate components of a visual scene (simultanagnosia), and the inability to accurately reach for an object with visual guidance (optic ataxia).Special deficits (primarily to memory and personality) can occur if there is damage to the area between the parietal and temporal lobes.Left parietal-temporal lesions can effect verbal memory and the ability to recall strings of digits.The right parietal-temporal lobe is concerned with non-verbal memory. Right parietal-temporal lesions can produce significant changes in personality.Parietal Lobe FunctionsTouch.Size, shape, color identification.Spatial perception.Visual perception.Parietal Lobe Injury ComplicationsInability to identify objects.Inability to associate words with meaning.Inability to distinguish left from right.Loss of spatial perception.CerebellumImage courtesy: Martin SilvertantKnown as the ‘little brain’, it manages movement (but does not initiate it), maintain posture and balance. It also controls fucntions like attention and language and the regulation of the fear and pleasure responses. It receives information from the sensory systems, spinal cord, and other parts of the brain, and uses it to coordinate movements. It allows a person to perform rapid and repetitive movements like running.You can live without a cerebellum. Some rare conditions exist called cerebellar hypoplasia and cerebellar agenesis.Cerebellar hypoplasia is an embryonic disorder that leads to a diminished or missing cerebellum that is due to genetics, or external influences (drugs, chemicals, infections, stroke).Cerebellar agenesis: the brain develops without a cerebellum. There are only ten known cases. The person is still able to move because movement is actually handled by the motor cortex, but lack the poise provided by the cerebellum. The condition is usually discovered post-mortem because the rest of the brain compensates to mask the lack of a cerebellum. The disadvantages include developmental delays, language deficits and neurological abnormalities; movements improve with age.Cerebellum Brain FunctionsMobility.Balance.Posture.Cerebellum Injury ProblemsInability to coordinate movement.Inability to walk.Dizziness.Tremors.Paralysis.Brainstem[22]Image courtesy: Martin SilvertantThe brainstem is connected to the spinal cord, and is responsible for controls unconscious functions (respiration, digestion, and pulse). Three structures comprise the brainstem: the midbrain, the pons, and the medulla oblongata. The midbrain controls eye movement and focus. The pons sends signals back and forth between the cerebrum and cerebellum. The medulla oblongata controls respiration, blood pressure, pulse rate, and digestion.The brainstem is responsible for vital survival functions,thus damage is often fatal. People who survive brainstem injury usually require assistance with simple physical functions like breathing and regulating pulse.Brainstem FunctionsRespiration.Pulse.Consciousness.Sleep / wake cycle.Concentration and attention.Brainstem Injury ProblemsProblems with breathing.Inability to swallow food and water (dysphagia).Dizziness and nausea.Insomnia.Sleep apnea.Irregular heartbeat (arrhythmia).Source: [23]The Limbic system is primarily responsible for our emotional life, and has a lot to do with the formation of memories.Limbic System[24]Damage to the Limbic system may cause:Changed, or inappropriate emotional responses.Change to drive and appetites such as not being able to control or monitor eating or drinking.Alteration and fluctuations in temperature control.Some memory functions are lost and difficulty learning can occur.Motivation may be impaired.Corpus CallosumThe Corpus Callosum is the area of the brain that connects the left and right hemispheres. It was well know due to Split Brain Syndrome, where it was cut to prevent severe epilepsy. Damage to the area interrupts the steady flow of information between the left and right hemispheres of the brain. When cut it prevent the left hand from knowing what the right hand is doing and visa versa.And just for fun, you can test your self. A worksheet and answer sheet is at the link below:http://www.changedlivesnewjourneys.com/wp-content/uploads/Worksheet-Outcomes-of-Damage-to-Brain-Structures.pdfA summaryImage:[25]The brain’s amazing potential for recoveryStrange but True: When Half a Brain Is Better than a Whole OneFootnotes[1] Phineas Gage: Neuroscience's Most Famous Patient[2] Images in clinical medicine. The tale of Phineas Gage, digitally remastered.[3] The Deepest Cut[4] The Deepest Cut[5] How Removing Half of Someone's Brain Can Improve Their Life[6] Right Vs. Left Brain - Hemianopsia.net Everything you need to know about Hemianopsia[7] Right Vs. Left Brain - Hemianopsia.net Everything you need to know about Hemianopsia[8] http://Patric Hagmann et.al. - Hagmann P, Cammoun L, Gigandet X, Meuli R, Honey CJ, et al. (2008) Mapping the Structural Core of Human Cerebral Cortex. PLoS Biol 6(7): e159. doi:10.1371/journal.pbio.0060159[9] http://Hagmann P, Cammoun L, Gigandet X, Meuli R, Honey CJ, et al. - File:Medial surface of cerebral cortex - gyri.png (https://commons.wikimedia.org/wiki/File:Medial_surface_of_cerebral_cortex_-_gyri.png)[10] Life as a Nonviolent Psychopath[11] Dysexecutive syndromes in neurologic disease.[12] Here’s What It’s Like To Live As A Nonviolent Psychopath[13] Contrasting mechanisms of impaired attentional set-shifting in patients with frontal lobe damage or Parkinson's disease[14] Impaired use of organizational strategies in free recall following frontal lobe damage[15] Parts of the Human Brain[16] Traumatic Brain Injury Resource Guide[17] Parts of the Human Brain[18] Traumatic Brain Injury Resource Guide - Occipital Lobes[19] Traumatic Brain Injury Resource Guide - Occipital Lobes[20] Parts of the Human Brain[21] Traumatic Brain Injury Resource Guide[22] Parts of the Human Brain[23] Limbic system[24] Back To Basics: Damage To Brain Structures - Changed Lives New Journeys[25] Mayfield Brain & Spine, Neurosurgeons, Neurosurgery, minimally invasive spine surgery, brain surgery, neurovascular surgery

NURSES MAKE NURSING DIAGNOSES. PHYSICIANS MAKE MEDICAL.Nurses who specialize in pediatrics devote their knowledge and skills to caring for children from infancy through the late teen years and their families. These specialized nurses usually complete advanced training in pediatrics and collaborate closely with physicians and other health care providers who share their dedication to children’s health.Like other nurses, pediatric nurses can perform physical examinations, measure vital statistics, take blood and urine samples and order diagnostic tests. Nurses with advanced training can interpret test results to form diagnoses and develop treatment plans.Parents often prefer to have their children treated by pediatric specialists, because children have special health care needs. Their bodies are growing and changing, and they often react differently to injury, illness and even common medications.In addition, children get scared and can’t always clearly communicate “what hurts.” Pediatric nurses know how to talk to children and how to dispel their fears. They also know how to ask children questions about their health, so they can gather complete and accurate information to aid in diagnosis and treatment.In addition to caring for patients with injuries and illnesses, pediatric nurses spend a significant amount of time educating parents and other caregivers about how to care for their children and protect children’s health. For families of children with chronic conditions, such as juvenile diabetes or paralysis, they design home care plans to help the families meet their child’s special needs.Prevention and health education is a big part of pediatric nursing. Pediatric nurses often staff community health fairs and visit schools to perform physical exams, immunize children and provide routine developmental health screenings.Pediatric nursing is a very special vocation, because it provides the opportunity to play a key role in a child’s life when that child needs you most.Working ConditionsPediatric nurses work in doctor’s offices, clinics, hospitals, surgical centers and other health care settings. Their skills bring a particular comfort to children being treated in acute care departments, such as the neonatal unit, pediatric critical care unit and pediatric oncology ward, and to their parents.Pediatric nurses also work in schools, in private practice and for community groups and other organizations that provide outpatient and preventive health care services for children, including children who have limited access to health care.In most cases, the pediatric nurse works closely with a physician who also specializes in pediatric or family medicine. Pediatric nursing duties are similar to nursing duties in other departments, although there is typically more interaction with the patient’s family.Working with children who are sick is emotionally draining so it’s important to take good care of yourself if you choose to work in this profession. Burnout is common among pediatric nurses.Salary Range and OutlookPediatric nurses earn $52,000 to $88,850 a year, although compensation depends on the level of education, experience, geographic location and the type of facility where they work. Experienced pediatric nurses can earn $100,000 a year or more.Academic RequirementsTo become a pediatric nurse, you must first achieve certification as a Registered Nurse (RN). To do that, the first step is to earn a Bachelor of Science in Nursing (BSN) degree. While you may also choose to earn a nursing diploma or associate degree, which takes three years, a BSN will make it easier for you to find a job. Currently, 55% of the nursing workforce holds a baccalaureate degree or higher. Recent research indicates that patients are safer and have better outcomes when they’re under the care of nurses with at least a baccalaureate-level education in nursing.While you’re in college, make sure to take classes in early childhood development. You can also try to find a job or volunteer at a pediatrician’s office, in a day care center or school or another job that involves caring for children.Once you graduate, you will have to take and pass the NCLEX-RN a national licensing exam, to practice as a registered nurse. Then you can find a job as an RN in the office of a pediatrician or family doctor or in the pediatric department of a hospital.Take advantage of in-service training and other opportunities to learn more about the unique health and developmental needs of children and adolescents. If you want to work with newborns (neonatal care), children who have cancer, children with emotional or developmental disabilities or children who are critically ill, you may need additional training in those nursing skills, as well.Once you have gained some experience, you can pursue specialized training toward a certificate in Pediatric Nursing. Or you may choose to earn a master’s degree in nursing to become a Pediatric Nurse Practitioner or a Clinical Nurse Specialist in pediatrics. Pediatric nurse practitioners are allowed to make diagnoses, prescribe medication and manage care. To become a pediatric nurse practitioner or clinical nurse specialist, you have to take an exam and meet state certification and continuing education requirements.In addition to nursing knowledge and practical skills, pediatric nurses must have the ability to form rapid connections with their juvenile patients. Children are often afraid to go to the doctor, so the pediatric nurse must be able to dispel that fear and quickly earn the child’s trust. These skills can be learned, but many pediatric nurses are people who are naturally good with kids.It also helps to be a quick thinker who can stay calm under pressure. Children know when an adult seems worried, so pediatric nurses must be able to smile through even the most distressing situations.