Assistant Professor of Clinical Neurology at Indiana University and IU Health Physicians
Answered a year ago
As a Clinical Neurophysiologist, I frequently use my knowledge of neurophysiologic data to aid in clinical biomedical decision making for my patients both in the operating room and in the outpatient setting. I accomplish this through the use of Electroencephalograms (EEGs) and Intraoperative Neuromonitoring (IONM) modalities. EEGs provide a measure of cortical electricity through the use of scalp electrodes to estimate the risk of recurrence of epileptic seizures, to assess a patient's epilepsy syndrome for choosing appropriate antiepileptic medications, and to suggest effective epilepsy surgeries for patients with medically intractable epilepsy who are monitored continuously in the epilepsy monitoring unit. Clinical Neurophysiologists use EEGs by identifying interictal epileptiform discharges as well as by lateralizing and localizing seizures to aid in the clinical decision making for diagnosis and medical and surgical management of epilepsy. IONM with evoked potentials and cortical and subcortical mapping identifies eloquent cerebral cortices and the tracts they serve in the white matter which must not be damaged during an open resection to help neurosurgeons achieve the best surgical outcomes and minimize operative complications. Surface EEG called electrocorticography also is used during intracranial surgery to detect and treat intraoperative seizures which may occur as a result of IONM from the electrical currents delivered for cortical and subcortical mapping. Knowledge of neurophysiology allows the Clinical Neurophysiologist to assess patients for medical and surgical management of their epilepsy and assist neurosurgeons in providing effective and safe execution of intracranial surgery.
Sure! I've taught physiology and have an upcoming textbook on it, and also run as a volunteer EMT. My first few lectures in my class are on the 5 basic principles of physiology. #1 is Ohms law. simplified, flow = driving force/resistance. Applies to everything. One night, I was putting in an IV. Perfect. Open IV bag, nothing is moving. My brain kicked in to "F=D/R". Looked closely. Hey, moron, you forgot to take the tourniquet off! I immediately defaulted my chapter one of my text and fixed it. A background in physiology has been a huge help in my off the job service
One particularly memorable experience that underscored the importance of a deep understanding of physiology involved working with an elite judo athlete who faced chronic shoulder instability after a series of recurring injuries. As part of the Australian Judo team's support crew, I was responsible for not only treating injuries but also enabling athletes to compete at their best. This athlete's case was complex; the usual rehabilitation protocols had been ineffective, and surgery was on the table as a last resort. Drawing on my training and over 30 years of experience, I carefully assessed the muscular and neuromuscular patterns in his shoulder girdle, realizing that the traditional approach was not addressing underlying imbalances contributing to his instability. By tailoring a targeted rehabilitation plan focused on muscle activation patterns unique to the demands of judo, we managed to stabilize his shoulder enough to avoid surgery, allowing him to continue competing. This experience highlighted the value of a comprehensive approach where understanding the intricate biomechanics of the sport and the physiological demands on specific muscles made all the difference. It is one thing to know anatomy on a theoretical level, but being able to apply it practically, especially under pressure in a high-stakes environment, requires extensive hands-on experience. Years of treating athletes across various sports had trained me to detect these subtleties, and it underscored why ongoing professional development is so critical in physiotherapy. Moments like these reinforce my commitment to tailored treatment strategies that go beyond the basics, making a tangible difference in the lives and careers of the athletes I work with.
One memorable instance where understanding physiology was crucial occurred when treating a patient with a complex dental issue tied to a heart condition. This patient needed a dental extraction, but their underlying cardiovascular issues posed a heightened risk. With my knowledge of how oral and systemic health interact, I coordinated closely with their cardiologist, ensuring that we optimized the patient's condition before any procedure. This deeper understanding of physiology allowed me to mitigate risks and provide the safest care possible. In this situation, knowing how the cardiovascular system could respond to surgical stress made a critical difference. By making accommodations like selecting specific anesthetic protocols and adjusting the timing of the procedure, we avoided potential complications. This experience reinforced the value of understanding the body as a whole. Dental professionals who grasp these physiological connections can provide well-rounded care, especially for patients with multifaceted health challenges.