Addressing The Poke-Phenomenon (Pokemon GO) - Just being in a beautiful place is not enough: You have to pay attention to it!

Important note for all parents with children who have been swept up by the poke-phenomenon - a step..hopefully... in the right direction? Share the fun with your kids. -JR

Pokémon Go could improve brain health, but you’re too distracted to let it...
"just being in a beautiful place is not enough: You have to pay attention to it"

Colin Ellard

Instead of passively sitting in front of a screen, Pokémon Go has inspired us to beat the streets, log miles through the urban terrain, set records with our Fitbits, and generally applaud ourselves for the massive collective outburst of healthy activity. But are we really getting the full mental benefits of a leisurely stroll?

Walking, regardless of if it’s on a treadmill or a trail in the woods, is good for us. Sitting is the new smoking, so in this sense, there’s no question that playing Pokémon Go is healthier than being slumped in front of an Xbox playing a console game (provided you avoid walking into traffic or being lured by criminals).

The harder question to answer is whether the kind of walking we do while collecting creatures is psychologically healthy. In spite of some of the glowing accounts of the app’s ability to encourage “exploration,” we are not likely garnering the same emotional and physiological benefits as we would on a technology-less walk. Beyond the positive effects of exercise, there are many other benefits we gain from strolling through the streets—but we often can’t access them when we’re avidly chasing virtual creatures through a 3-by-6 inch screen.

In the Urban Realities Laboratory at the University of Waterloo in Canada, my team and I study the relationship between the design of city streets and the healthy operation of the human mind. In many of our experiments, we connect participants to a suite of sensors that measure their arousal levels, brain state, eye movements, and heart rate, and then we take them for walks through the streets of a city. In experiments conducted in many major cities, including New York, Berlin, Mumbai, and Toronto, certain truths have emerged:

FULL ARTICLE HERE:

Which Children Are Particularly AT-Risk For Sleep Apnea? Its not just tonsils and obesity...

Online mode from wiki on sleep apnea in infants children  - not a patient

I would add the following:

• Epilepsy
• Brain Injury
• Hypermobility Syndromes
• Asthma
• Polycystic Ovarian Syndrome
• Failure to Thrive

Otherwise Healthy Kids

RISK FACTORS — Adenotonsillar hypertrophy and obesity are the major risk factors for obstructive sleep apnea (OSA) in otherwise healthy children. 

• Adenotonsillar hypertrophy — Adenotonsillar hypertrophy is a widely recognized risk factor for OSA in children. The size and location of the tonsils and adenoids are influenced by genetic factors, infection, and inflammation. Although tonsils that appear large on anterior oral exam may contribute to a reduction in the airway size, there is not a clear linear correlation of increased size of tonsils and adenoids with greater severity of OSA; thus, even tonsils within the tonsillar pillars (graded as a 1+) may be clinically significant and cause obstruction in the airway during sleep. 
• Obesity — Obesity is an important risk factor for OSA at all ages but is particularly prominent among adolescents. In a prospective study, OSA was diagnosed in 4 percent of adolescents (16 to 19 years of age), and most of these had not had OSA or habitual snoring during mid-childhood [11]. The strongest risk factors for OSA during adolescence were obesity, male sex, and a history of adenotonsillectomy. The importance of obesity as a predictor of OSA during adolescence is underscored by a separate study of 37 adolescents with moderate to severe obesity (BMI >97th percentile), among whom 45 percent had OSA on polysomnogram (defined as apnea-hypopnea index [AHI] >1.5)

Medically Complex Kids - Above Risk Factors PLUS (There are MANY MANY kids in this category) 

.... Medical, neurological, or dental conditions that reduce upper airway size, affect the neural control of the upper airway, or impact the collapsibility of the upper airway are also risk factors. Individuals presenting with OSA during infancy are particularly likely to have an underlying anatomic or genetic anomaly:

●Cerebral palsy

●Down syndrome / Trisomy 21

●Craniofacial anomalies (eg, retrognathia, micrognathia, midface hypoplasia)

●History of low birth weight / preemies 

●Muscular dystrophy or other neuromuscular disorders

●Myelomeningocele

●Achondroplasia

●Mucopolysaccharidoses (eg, Hunter syndrome and Hurler syndrome)

●Prader-Willi syndrome

●Orthodontic problems (e.g, high narrow hard palate, overlapping incisors, cross bite)

●
Family history of OSA / sleep apnea

Children with any of these conditions should be followed closely for signs and symptoms of OSA. Objective assessment with polysomnogram is recommended in children with complex medical conditions who present with signs and symptoms of obstructive sleep apnea.

Dr R Additions

• Epilepsy
• Brain Injury
• Hypermobility Syndromes
• Asthma
• Polycystic Ovarian Syndrome
• ...

Updating the Map: How the Brain will be Organized in the 21st Century

Human brain mapped in unprecedented detail

Nearly 100 previously unidentified brain areas revealed by examination of the cerebral cortex 

Researchers at the Washington University School of Medicine have compiled a massive study detailing an updated map of the human brain. The implications--both scientific and clinical--have great potential for accelerating our understanding of our "control center". -JR

• By Linda Geddes, Nature magazine on July 20, 2016

Think of a spinning globe and the patchwork of countries it depicts: such maps help us to understand where we are, and that nations differ from one another. Now, neuroscientists have charted an equivalent map of the brain’s outermost layer—the cerebral cortex—subdividing each hemisphere's mountain- and valley-like folds into 180 separate parcels.

Ninety-seven of these areas have never previously been described, despite showing clear differences in structure, function and connectivity from their neighbors. The new brain map is published today in Nature.

Each discrete area on the map contains cells with similar structure, function and connectivity. But these areas differ from each other, just as different countries have well-defined borders and unique cultures, says David Van Essen, a neuroscientist at Washington University Medical School in St Louis, Missouri, who supervised the study.

FULL ARTICLE HERE:

Neuroscientists have long sought to divide the brain into smaller pieces to better appreciate how it works as a whole. One of the best-known brain maps chops the cerebral cortex into 52 areas based on the arrangement of cells in the tissue. More recently, maps have been constructed using magnetic resonance imaging (MRI) techniques—such as functional MRI, which measures the flow of blood in response to different mental tasks.

Yet until now, most such maps have been based on a single type of measurement. That can provide an incomplete or even misleading view of the brain's inner workings, says Thomas Yeo, a computational neuroscientist at the National University of Singapore. The new map is based on multiple MRI measurements, which Yeo says “greatly increases confidence that they are producing the best in vivo estimates of cortical areas”.

How is POTS Diagnosed?

Detailed questioning of the patient is the key to accurate diagnosis.  Physical examination and appropriate investigations are also important. Other causes of symptoms need to be considered and identified.

Patients are usually diagnosed by a cardiologist, neurologist or medicine for the elderly consultant.

To be given a diagnosis of POTS, a person needs to have:

• A sustained increase in heart rate of greater than 30 beats per minute within 10 minutes of standing
• Those aged 12-19 years require an increase of at least 40 beats per minute
• These criteria may not apply to those with a low heart rate when resting
• There is usually no drop in blood pressure on standing

Investigations

It may be necessary for patients to have some or all of the tests below.

Electrocardiography (ECG)

An ECG is performed to rule out any heart problems that may cause symptoms similar to those found in POTS.

The Active Stand Test

The active stand test can be used to diagnose PoTS. Under careful supervision, heart rate and blood pressure are measured after resting lying down, then immediately upon standing and after 2, 5 and 10 minutes. This test may bring on symptoms of PoTS and some people may faint.

Tilt Test

What are the symptoms of POTS?

Symptoms can be debilitating, ranging from mild to severe and varying from day to day.

POTS symptoms

• Dizziness or pre-syncope (almost fainting).
• Syncope (fainting).
• Palpitation (awareness of heartbeat).
• Headaches - orthostatic headaches (due to upright posture)/migraine.
• Brain fog (difficulty in thinking).
• Tiredness.
• Sense of anxiety.
• Shakiness.
• Visual problems (greying, tunnel or glare).
• Gut problems (nausea, diarrhoea, pain).
• Sweating.
• Chest pain.
• Poor sleep.
• Purplish discolouration of skin due to blood pooling in hands and feet.
• Bladder problems.

Triggers that can worsen POTS

• Excess heat.
• After eating - especially refined carbohydrate: sugar, white flour etc.
• Standing up quickly.
• Dehydration.
• Time of day (especially rising after wakening).
• Menstrual period.
• Deconditioning or prolonged bed rest.
• Alcohol (as it dilates blood vessels).
• Inappropriately excessive exercise.
• Temporarily during illness such as viral infections or after operations.*

Can Anti-Inflammatory Therapies be Effective in Treatment of Epilepsy

Epilepsy, Seizures, and Inflammation: Role of 

the C-C Motif Ligand 2 Chemokine

Here is the abstract from a study published in DNA and Cell Biology. 

The whole study examining the impact of treating inflammation-induced seizures is available for free download until August 06, 2016 at the link below. -JR

ABSTRACT:

Epilepsy is a chronic disorder characterized by spontaneous recurrent seizures. Several lines of evidence demonstrate that inflammatory processes within the brain parenchyma contribute to recurrence and precipitation of seizures. In both epileptic patients and animal models, seizures upregulate inflammatory mediators, which in turn may enhance brain excitability. We recently showed that the C-C motif ligand 2 (CCL2) chemokine (also known as monocyte chemoattractant protein-1 [MCP-1]) mediates the seizure-promoting effects of inflammation. Systemic inflammatory challenge in chronically epileptic mice markedly enhanced seizure frequency and upregulated CCL2 expression in the brain. Selective pharmacological blockade of CCL2 synthesis or C-C chemokine receptor type 2 (CCR2) significantly suppressed inflammation-induced seizures. These results have important implications for the development of novel anticonvulsant therapies: drugs interfering with CCL2 signaling are used clinically for several human disorders and might be redirected for use in pharmacoresistant epilepsy. Here we review the role of CCL2/CCR2 signaling in linking systemic inflammation with seizure susceptibility and discuss some open questions that arise from our recent studies.

Link to Article Here

How to Get Your Brain--and Body--Out of Bed Every Morning

11 Tips That Will Help You Wake Up Every Morning

Effective tips to crank yourself up in the morning from pre-bed routines to morning of practices- JR.

By: Toria Sheffield via Bustle Lifestyle

1. Don't Hit Snooze. 2. Try a Burst of Cold Water. 3. Don't Drink Coffee Right Away. 4. Keep Your Alarm on The Other Side of The Room. 5. Invest in An Alarm Lamp. 6. Get an Alarm App. 7. Set Your Intentions. 8. Try Melatonin. 9. Train Yourself Gradually. 10. Move. 11. Limit Screen Time Before Bed.

Link to Full Article Here:

Optimal infant sleep habits may help prevent childhood obesity

"When parents keep babies up longer, they just sleep less". 

"the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one"- JR

Healthy infant sleep habits may help prevent childhood obesity

Perfect Baby (free image labeled for reuse. Not a patient)

-Review of research published in JAMA Pediatrics discussing the importance of regulating an infant's sleep schedule. -JR

US research out this week suggests that teaching parents techniques to help encourage healthy sleep habits in their children could help to prevent obesity. The new study, conducted by Penn State College of Medicine researchers, could lead to a new intervention technique to help tackle the growing levels of obesity worldwide.

The team studied the use of the intervention using data from the INSIGHT study (Intervention Nurses Start Infants Growing on Healthy Trajectories), a longitudinal trial study which looks at how responsive parenting intervention can prevent obesity.

A total of 291 mother and baby pairs were recruited, with the mothers randomly assigned to one of two groups.

One group was given obesity prevention education that covered sleep-related behaviours, bedtime routines, improving sleep duration and avoiding feeding and rocking to sleep. The other group, a control, were given safety education about preventing sudden infant death syndrome.

The study showed that the infants of parents who had learned the bedtime techniques went to bed earlier, had a more consistent bedtime routine, and slept for longer than the infants whose parents had been given safety education.

The infants were also more likely to self-soothe to sleep without being fed, and were less likely to be fed back to sleep when they awoke during the night.

And at nine months, infants who both self-soothed and went to bed by 8 p.m. slept for on average 80 minutes longer or more than those whose bedtimes were after 8 p.m. and did not self-soothe.

In addition, the team saw that the intervention also had a positive effect on obesity as well as sleep, with the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one.

Misconceptions about infant sleep

Commenting on the findings lead author Ian M. Paul had this advice for parents, “A lot of parents try to keep their babies up longer, thinking that then they’ll sleep longer at night and they won’t wake up. We found that’s not true. When parents keep babies up longer, they just sleep less.”

“If you want your baby to sleep longer and better, put them to sleep earlier. Regardless of what time you put babies to sleep, they wake overnight. If we don’t set the expectation that they’re going to be picked up and fed, they learn to soothe themselves back to sleep.”

In addition to helping prevent obesity, better sleep habits also have added health benefits for both parents and children, with lack of sleep previously shown to have a negative effect on a child’s development and parents’ psychological well-being.

Link to article here:

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Could a baby have a seizure? Review the signs and what you can do...

Signs of Seizures in Babies

Is your baby having a seizure? Find out the signs of seizures in babies and what to do if your child has one.

By Jeannette Moninger

Good review of the signs of seizures in babies and what you can do if you think your child may be having them. -JR

About 5 percent of Americans will experience a seizure at some point in their lives, with newborns and very young children at highest risk. Seizures happen when cells in the brain have abnormal electrical activity, temporarily disrupting the brain's normal electrical signals. "It's like a short circuit in the brain," says Adam Hartman, M.D., assistant professor of Neurology and Pediatrics at the Johns Hopkins Children's Center in Baltimore. Epilepsy is the most common cause of seizures, but many things, including birth trauma, brain disorders, and chemical imbalances, can trigger them. Often, doctors can't determine the reason for a seizure.

When you picture someone having a seizure, you probably envision a jerking, shaking body and a temporary loss of consciousness. But signs of seizures often are subtler in babies, Dr. Hartman notes. "At first, you might not notice that anything is wrong." Because the types of seizures that affect infants are different than those affecting adults, it is important to know these signs.

Signs of Seizures in Babies

• Febrile seizures. Your baby may roll her eyes, and her limbs may either stiffen or twitch and jerk. Up to 4 out of every 100 children age 6 months to 5 years have one of these seizures, which are triggered by high fevers, usually above 102°.
• Infantile spasms. This rare type of seizure occurs during an infant's first year (typically between 4 and 8 months). Your baby may bend forward or arch her back as her arms and legs stiffen. These spasms tend to occur when a child is waking up or going to sleep, or after a feeding. Infants can have hundreds of these seizures a day.
• Focal seizures. Your baby may sweat, vomit, become pale, and experience spasms or rigidity in one muscle group, such as fingers, arms, or legs. You may also observe gagging, lip smacking, screaming, crying, and loss of consciousness.
• Absence (petit mal) seizures. Your baby appears to be staring into space or daydreaming. She may blink rapidly or appear to be chewing. These episodes typically last less than 30 seconds and may occur several times a day.
• Atonic (drop attack) seizures. Your baby experiences a sudden loss of muscle tone that makes her go limp and unresponsive. Her head may drop suddenly, or if she is crawling or walking she might fall to the floor.
• Tonic seizures. Parts of your baby's body (arms, legs) or her entire body suddenly stiffen.
• Myoclonic seizures. A group of muscles, usually in the baby's neck, shoulders, or upper arms, starts to jerk. These seizures usually occur in clusters, several times a day and several days in a row.

What to do if Your Baby Has a Seizure

See your pediatrician if you think your baby is having seizures. "If possible, take a video of the episode on your smartphone to show to your doctor," suggests Dr. Hartman, who is also a member of the American Academy of Pediatrics' (AAP) Section on Neurology. It's important to pay attention to these things:

• How long the seizure lasts
• Where the seizure started (arms, legs, eyes) and whether it spread to other body parts
• What the movement looked like (staring, jerking, stiffening)
• What your baby was doing right before the episode (waking up, eating)

FULL ARTICLE HERE:

Welcome Kara Schmidt PA, Registered Dietician - Focusing on Neurology Development and Nutrition

Dear Friends, Colleagues,

Please Welcome Kara Schmidt, Physician Assistant, Registered Dietitian, and overall thoughtful person.

Kara Schmidt is a certified Physician Assistant and Registered Dietitian  joining us to focus on Pediatric Neurology & Developmental Disorders.  She will assist with: 

• Extension of Physician Services
  • Routine  follow-up.
  • Expedited evaluations (Post-Hospital/ER brain injury/concussion, epilepsy, sleep disorders)
  • Developmental testing (infant developmental delay, autism/ADOS testing, ADD/ADHD)

• Neurologic & Sleep Related Nutrition Concerns - Besides assisting Dr. Rotenberg in patient management she will offer our patients a  resource for neurologically relevant diet management such as ketogenic/Atkins diet, high salt diet (autonomic disorders), mitochondrial diet, Obesity, low weight, other vitamin sensitive disorders (B6 responsive seizures). 

 About Kara - (She Walks the Walk)

Kara completed her Bachelor of Science degree at Michigan State University in Dietetics before completing a dietetic internship at Methodist Hospital of Indianapolis to become a Registered Dietitian. Kara was awarded Michigan Recognized Young Dietitian of the Year in 2000 while working at the University of Michigan Health System. Inspired by working as a member of a multi-disciplinary team at the University of Michigan Health System, Kara decided to return to school to become a Physician Assistant.

Kara graduated from the University of Toledo with a Master of Science in Biomedical Science in 2010 to become a Physician Assistant. Since then, she has enjoyed working with children in general pediatrics. 

Both her personal as well as her professional experience makes her an amazing addition to our team.   Kara is married and has two sons 15 and 12 years old. Her older son has autism and  attends the Monarch school. 

You can watch a talk that she gave about her parenting experiences  here. 

Read more about her experiences HERE:

Please call /email with questions.

Josh Rotenberg MD

http://www.monarchschool.org/miracle-makers-morning-2013-part4

Miracle Makers Morning 2013 Part 4 Kara ... - Monarch School www.monarchschool.org Come visit us to see our students and faculty in action. Every Tuesday starting June 14, 2016. 9:00am - 10:30am. All Tours begin in The Monarch Center.