Identifying the Most Common Neurodegenerative Diseases. Transcript Module Three Day 2 Review. Presentation by Drs. Datis Kharrazian and Brandon Brock

Transcription

1 Identifying the Most Common Neurodegenerative Diseases and Clinical Applications (MODULE THREE) Transcript Module Three Day 2 Review Presentation by Drs. Datis Kharrazian and Brandon Brock So, you know, as we go into the review for this weekend, here s a couple of things I just want you to understand. With functional neurology, once you go through exam, and you ve kind of figured out where things could be, where things are involved with, there s a lot of creativity that takes place then. I think most of us finish our exam and workups, and then go, Huh. What are we going to do? And there s this level of not knowing what we re going to do. And that s okay. And then you have some creativity, and you try some things, and you see if the exam findings change. So you just have to be comfortable with the fact that when you finish your exam, and you identify the area, then it s okay to be very creative and try different things, and see what makes the exam findings change. Okay? Now, the better you are at knowing what parts of the brain are involved, and how to activate those areas, the sooner and faster and more effectively you ll get to rehab exercise that can make a difference. Okay? Now, there s times when you can t find anything that makes a difference. Right? Yeah a lot. There s time that our model does not work. There s times where we just I can t find anything to change the exam findings. So whether it s ataxia, or tremor, or something, and it s the worst feeling in the world, because you can t activate it. Now a lot of times, when that happens, we just stop and go, Hey, let s try to handle this from a metabolic, nutritional, inflammatory component first, and then come back and see if the exam findings change. So that s one part of it. But you know, you do what you can. So I think for a lot of people, when they first learn functional neurology, they see a case and they go, Oh my God, I would have never figured out how to do that. Well, you could have done it a different way, and it probably would have worked too, as long as you see some findings change. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 1

2 So, when people first start to learn functional neurology, the biggest confusion and difficulty they have is, they don t know where to start. Because, I don t know where to start. Well, we re trying to build you up with the forms that we give you. So, once again, if you can remember your flow charts that we went through with the cases, those two charts, the one for repetitive testing and the one with the clinical workup, how we go through it, how we ve gone through it, and then if you can know your brain region localization form, start using that, and then go through each of these sheets, then you have a good place to start and master those skills. We have we sit back and we think, How do we build people up to understand the big picture piece by piece? Okay? So next time, we have some great tools, great forms, great paperwork, and then build it up, so now that you have this understanding of general functions of brain, how do we really get you guys to now understand the vestibular system in detail? And then after that, how do we understand central cerebellar in detail? Right? So right now, each time we ll have some tools and different things for you to use, and that s like the stuff you just need to know and memorize, right? And then you can go back and look at your diagrams and flow charts and all those things, and they can help you. So, if you look at the things that we really try to teach in this neurodegenerative model, Saturday was mostly focused on clinical assessment, and then today we really focused on clinical applications, and there s key things that you want to learn from each one of these. So for the first one, identifying early neurodegeneration, I would say, make sure you guys know Parkinsonisms, make sure you guys know your dementias, and make sure you guys know your cerebellar findings. So with Parkinsonisms, what are their early signs? Masked face, gut motility issues, stiffness, rigidity. All the things in your brain region localization form related to indirect pathways. Those are involved. With dementias, you can use your brain region localization form. All the things with memory, recall, medial temporal lobe, cerebellar diseases, you can look at your brain region localization form for those types of symptoms, right? And look at your exam findings that are associated with it. So you should be able to pick up those things really, really well. And then went into differential diagnosis, so anything to add to that? Yeah, just to remember this: That you know, you have your Lewy bodies, you have your taus, you have your other types of pathologies. But it s like this: Is it Parkinson s? Is it Parkinson s with cognition? Is it Parkinson s with dysautonomia? That means, is it just Parkinson s disease? Is it supranuclear palsy? Is it Lewy body dementia? Or is it multiple system atrophy? And then you look at it, and you re like, Hey, is it all cognitive stuff first? Is it frontal temporal dementia? Is it Alzheimer s? Or is it corticobasal degeneration? Here s what you need to spend time on between now and the next class: Can you literally walk through those and instantly know what they are, and know how to do this: a timeline? When did this start, and what was the first thing? And where are they at now, and what do they look like? Because at some point, if you boil it all down, they re all in a bed, degenerated, and can t move. In a lot of instances. Or they just get up and wander around. So you don t know anything, because the communication is used, because of gate issues, and because of complete lack of cognition. And so, finding a relative or a family member that can take MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 2

3 you through it, if you decide to treat somebody at that level which, I ve got to tell you, is difficult. I mean, those medications are really used for people that are at stages that are not going to respond to what we do. I think if you look at s charts, each of those breakdowns, they re really great. So just, in his presentation at the very end But the key things, the cognitive decline first, or the motor systems decline first, right? So the order of how they decline helps you differentiate some of these diseases, right? So look at your initial symptoms, and then that helps you break down the diff-dis to some of these patterns. Then we went into, from the identifying early neurodegeneration and diff-di, into the cellular mechanisms. And for the most part it s really simple. Proteins misfold, they aggregate, and then your body has to break them down. And there s certain things that we can do from a nutritional perspective. We can use flavonoids. From the lifestyle-diet perspective we can use fasting. We can try to manipulate those things to some degree. And then we went from the cellular right into the nutritional principles, and then we talked about a single-nutrient model, where we have one, like, a whole list of nutrients that are neuroprotective, whether it s things like fish oils, or flavonoids, or methylation support, right? Those are all things that have or mitochondrial support things that can have some protection, but it doesn t really initialize mechanisms. So then we talked about systems biology approach. From a systems biology approach we talked about the brain-gut, gut-brain axis, blood sugar issues, brain to blood sugar stability, blood sugar stability to brain, the vicious cycles between the two. We talked about circulation and oxygenation, blood flow, and how to identify those patterns, and try to unwind someone. We expect, as someone as individuals neurodegenerate, there really is a It s not really a neurodegenerative disorder. None of these things are. They re all neuroendocrine-immune metabolic disorders. So there s a neuroendocrine metabolic immunological web, and you have to untangle it the best you can with working with the patient s motivation, finances, skill, degree of degeneration, family support, and all those variables that get in the way. Have a or in the way, or are supportive of what you need to do. That s a tough situation. Like, what are the things that get in the way of your treatment? And it s a lot of times it s a spouse that just or kids, or living conditions. It s not always easy. That might be more difficult than treating the actual condition itself. To be honest with you, I never get to go through all of the things I want to do. I ll see a patient, I ll see the whole web, I ll smile and go, I get it, I got the pieces, I know what I need to do. I never get to go through all of it. One of two reasons: One, they well, first of all, they may not get better. But if they do get better, and things are positive, they re getting better. There s a point where they go, I feel great. Thank you. Bye. There s a level of where they re at, where they re happy with it, but it s not the level I could see them going, and then they re gone. So, I mean, but that s but you have to have this ability to keep It s like a chess game. How many moves can you go? How many things can you play ahead of time to make the difference MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 3

4 for them, right? So, the better you are at understanding how these things connect, the deeper you can go, and also the more efficient you can be to take your treatment choices, okay? So that s another key skill, that is picking your treatment choices. Don t be It s really inefficient, I should say. It s really inefficient to say, just to think of one model. That you just do heavy metal chelation, or you just do methyl checking for SNPs and methylation support, or you just do B12 shots. I mean or just do IV glutathione. That s just so limited. You want to go through the whole spectrum of everything from a molecular model to a mitochondrial model, to a brain model, to neuroplasticity model, to a long-term potentiation model, to, you know, all these different factors and then try to put it together. It gets really, really fun. Like, it really is fun. The better you get at it, it s just so fun. You know, I don t practice every day, because I m still in school, I m doing research. But the days I do practice are the days I wake up laughing and smiling and can t wait to go in the office, because it s fun, you know? And, you know, so I think, you know, I think everyone has the same type of passion for it. Anything to add with rehabilitation? No, with rehabilitation, it s just this: Use your creativity. The people who don t use their creativity, and they just try to stay in one single exercise, are the ones that typically don t do well. Use your creativity, start putting things together, make a multimodal, see how far you can go, see what the fatigability is, and then push them every day. Give them things they can do, and then push them further. And eventually you will find a plateau, and that s pretty much where you re at. So, remember this: Even if you give somebody really sick this much of their function back, they re this much happier. And if you do that, that might be more that You heard the video testimony. We ve been to see several doctors, and it was a long ride home. Anything related to pharmacology? [9.50] Pharmacology is you know, look. I can t tell you how important it is that you realize that most of your patients in this category, that we re talking about, with neurodegenerative illness, they re going to be degenerated, and they re going to be on drugs, and it s probably going to be more than one, because their blood pressure s probably going to be unstable, so they re going to be on a blood pressure drug. She could have easily been on five or six different drugs, but she wasn t. On that, you ve got to learn to walk your way around it. You ve got to learn to understand why in the world they re on it. Has it been helping them? Sometimes, do they need to be on it? Sometimes do they need to be on another one? But for the most part, these neurodegenerative drugs are these drugs for neurodegenerative problems. It s just really nice to know the pharmacokinetics of it, and be able to say, Yeah, I know how that works. And if it works, I know what it means. And if it doesn t work, I know what it means. So that helps me be a better functional provider. That s it. And when you learn that, you will become I promise you, beyond a shadow of a doubt superior to what you are right now. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 4

5 And the only thing I would say with pharmacological interventions is, there is a point, I can tell you, I think it s too far gone. I see a patient on way too many drugs, I really just don t I don t accept them as patients. I go, You have a model you re in that is not the model we use, and there s too much to untangle here. The model we have, the model I practice in, cannot help with what you ve got going on right now. So, you have to also know your limitations. I mean, each individual has to have theirs, and obviously the best scenario is you find them early, before they get medicated for all these things. But also, I know that if someone has complex medication issues, I d refer them to someone like, or other people that I trust, because again, as a practitioner, you know what you re good at, what you re not good at. Some people are better at different things than you are. And then you go back and forth, and you have relationships. I know when I screen a new patient in my office, I screen patients that I think I can help. And I think I know what I can do for them, and I don t take the ones I know I m going to fail with before I even start. Man, you ve got a If you have a patient that has dementia, and they re already belligerent, and they re on an antipsychotic Don t do it, man. I m just telling you right now. You d better be very clear what the agenda is. We discussed right up front that we were going to talk about the ethics and the boundaries of patients that should be treated in this model. And there s patients that just don t belong in it. And if they do, maybe it s like this: You know, they want me to help their whatever, but it s not the totality of treatment trying to get them back to the golden days. And I think that s so important to talk about, because there s a lot of people that claim to be able to just really honestly treat and fix things they can t do. And there s no miracles, that we re talking about. I mean, there are probably miracles, but I don t think we want to base ourselves on a miracle model. I don t know. Am I right about that? I mean, I just You know, the word miracle is the worst thing you could say. I mean, you get a good patient outcome. It s just that simple. You get a good patient outcome, or you don t. Okay? Don t play God-like. Just help your patient or don t. That s the simple thing. If you can t help them, you can t help them. You know? Let s move on. Clinical nutrition principles for neurodegeneration. So we have some isolated slides we thought were important just to review. So remember that there s isolated nutrient approach, systems biology approach. They re both different, they both have a place, they both have an application. I think the systems biology approach is much more effective. We talked about these different types of support products. These can definitely be used preventatively too. If you want to make your brain as efficient as possible using things like fatty acids and taking anti-inflammatory sources, and methyl donors, that can only be helpful. Because remember, your career is totally dependent upon the health of your brain. If your brain degenerates, your career is over. It s that simple. And you know, for a long time I used to travel and teach seminars almost every weekend. I did that for, I don t know, over a decade. And I would go into different cities, and as I d go into different cities, I d have different friends, and I could just see them degenerate. Because you see someone every twice a year, you see how they progress, and you see their speech change, you see their facial paresis change, you see their movements change, you see their cognition change. And you re going, Wow. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 5

6 And their hair falls out And you can almost always see their practice go down as their brain became unhealthy. Right? So the healthier your brain is, the more efficient you can be in practice. So you can, you know, think of these things preventatively for yourself as something that s useful. The systems biology approach is really critical. I mean, just this weekend, talking to people. There s people in here that know they re anemic. They still haven t done anything for it. There s people in here that they know they have serious dysglycemia, hypoglycemia issues, and it s impacting their brain, you know? These things just apply to all of us too, not just our patients. So, you know, we should also remember to do what we can to keep our brains healthy. Now, this was an important diagram that I went into, because we know that when you look at people that have neuro patients that have neurodegenerative diseases, that they can have a neurodegenerative model. So if you guys remember, we talked about, when people have neurodegeneration, they have to use collateral neurons to do basic functions, so they burn up more glucose. So lots of times, when you have patients, when they have an area of the brain that s neurodegenerated, and you try to activate it and utilize it through their daily tasks, that can quickly utilize and burn up their sugar, their glucose, or the increased demands of the brain, and they have the tendency to have low blood sugar and their blood sugar levels drop, right? We talked about the medial temporal lobe and the hippocampus controlling cortisol rhythms, and how the cerebellum could fire to sympathetic centers. So these are all factors that have a big impact on this relationship. Anything? Yeah. This slide right here is really about as good as it gets when it comes to Hey, why in the world does this person have bad blood sugar? I mean, sometimes people will get hypoglycemic just because their brain is just losing it. I, for one, this is one of those slides that I ve printed off and kind of laminated and keep it around. There s You know, if you look through your notes, there s going to be about ten to twelve pages where you re going to be like, I want this page separated out, with me in every room, so that I can reflect on it while I m learning. And this is a really good slide to be able to look at. And I just want to say this last thing. If you have one of these underlying metabolic issues, the end result is this: Your brain is bad. It s not the fact that you re going to you may lose a toe, or go blind, or whatever the case may be with uncontrolled diabetes. But you ve got to remember this: Your brain s going down. That s why we re here. Please don t let your brain go down. I d much rather lose a toe, or have one break off. That s a different story. Or to pull someone else s toe off. Yeah. Yeah. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 6

7 Alright. So this is another diagram that we talked about, and this is related to just circulation and blood flow mechanisms. I think most people take blood pressure and just ignore it. I think most people see cold hands and cold feet and then ignore it. I think most people have patients that have some blood sugar issues, and then ignore it. But these are, like, the most fundamental things that a brain needs to have efficiency. So if you have a neurodegenerative disease, or if you have someone that needs brain rehabilitation, you can t overlook these. Okay? What you ll find is, patient after patient after patient after patient that s gone to multiple practitioners, they come in and you re going, Why didn t just Why didn t they start with the basics? Why didn t they just Why did they jump into all these different exotic treatments and all these different things and not just focus on the fundamentals? Right? Fundamentals is where all the major things usually happen. So, you know, we talked about just touching their extremities, checking their capillary refill times, feeling for temperature differences between their distal and proximal tissue, looking if their blood pressure is hypotensive or hypertensive, making sure they re not anemic. Those are fundamental steps that, honestly, every patient should go through, and especially those where you re concerned about their brain health to any degree. Anything? No, that s great. Okay. And then the other thing that we talked about is this whole brain-gut axis disorder, and we know that it goes both ways. And we said, we know we talked about as the brain loses integrity and its function, you get less activity of the autonomic centers, including the vagus areas. As you reduce muscle contraction activity, you lose gut motility. As people lose gut motility, they get fermentation and dysbiosis, and those types of patterns. As they lose their bowel control, bacteria from the lower intestine goes into the small intestine, they can have SIBO pattern, they lose their ability to contract the gall bladder, which leads to formation of gallstones, because they get biliary stasis, they lose the ability to produce digestive enzymes, they can t digest their foods, they become they have malabsorption syndromes, they get intestinal permeability. As you look at your neurodegenerative patients, like Alzheimer s dementia patients, many of them have significant malabsorption syndromes. The patient I showed you today, she had malabsorption syndromes. She had early Parkinsonisms, she had gut motility, she had an infection in her gut. She s not having ideal integrative function neurologically to her gut, and she has an inflammatory cascade in her gut, and those things combined cause her to have the malabsorption syndrome to the point where she s underweight and losing weight and muscle mass, and all those things. You can expect to see a lot of that in your neurodegenerative patient population. Okay? And also, you know, these pathways from the gut then have this inflammatory consequence in the brain. The research right now with Parkinson s is really going into: It starts in the gut and goes up the vagus to the brain. It s really fascinating, and paper after paper s now showing those types of patterns in those trends, so we re realizing how important this whole axis is, and that these protein aggregates actually move up all the way into areas of the brain, and then they spread throughout the brain. Very, very, very interesting stuff. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 7

8 Yeah, that s radical. That s a whole different way of thinking, but, I mean, we have people that have been doing vagal stimulation as the biggest thing. You d think things change, man. I don t know what to tell you. So [20.08] Then those, you know We think of vagal stimulation as something cool, but it s always been done in yoga, and Indian rehabilitation therapies, where they would do things like gargling and chanting and all those things to keep their health and their energy intact, have vitality and healthy digestion. All that stuff came way before functional neurology model, you know. And it s effective. Okay. The other thing we talked about is kind of this whole vicious cycle that s taking place. Somebody said, Hey, the other day, when you were looking at chronic patient Let me put it this way. If someone has chronic disease, it doesn t matter what they start with. Let s say they start with IBS. What do you think is going to happen to their brain? It s going to be inflamed and go through accelerated neurodegeneration. Alright? IBS. Irritable brain syndrome. We could have had a seminar called Functional Gastrointestinal Seminars. Or we could have had another one called Functional Blood Sugar Seminars. It wouldn t matter. We would end up all in the same place, because at the end of the day, it s just really a web. It s not really, you know, we re not,,, We re kind of focusing on the brain just because it s the seminar. We should just call it Functional Everything Seminar at the End of the Brain. At the end of Really, at the end of the day when you look at it, I think we ve come up with about a hundred and fifty loops of pathology. They all loop around. I mean, it s amazing if you don t break those loops, they just keep going. That s not to say that we re trying to complicate it, but you also have to have reality of what s happening with physiology, and then pick out what you think is most appropriate. The more diverse you are, the more efficient you become when it comes to patient management. Okay? And then, this is just all different sections in your brain region localization form. So you remember, these are on your form. They match exactly with the compilation charts we have. Then what we re going to do is, we re going to take compilation charts, put the vasculature on it next time, so now you guys know all the blood vessels, so if someone has a stroke, or someone has an occlusion in one area, or have blood vessel MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 8

9 disease, how it relates to areas of the brain and their symptoms. And then we re going to make a compilation chart for the brainstem, so then you guys know the brainstem. And then next time we re putting together a vestibular localization form. We ve got a vestibular localization form made, but we re going to It s really good. It s cool. So you can diff-di all the different vestibular areas and all the regions, and you will definitely own vestibular mechanisms and rehab and functions after that. And as these things start adding up, they really start to really give you a strong foundation, but you ve got to sit down and memorize them. Some things you just have to memorize. Okay? And then we went into some of the pharmacology here. Yeah, I mean, the pharmacology is the pharmacology. I mean, I like what Stahl really has gone through, because the guy s pretty open minded, and he talks about nutrition, and he talks about medications and stuff like that, and then I added some stuff into it about just some of the common medications. But realistically, there s a time and a place for all of these. I mean, beta blockers, they might be necessary with severe hypertension or sympathetic overload. The SSRIs, if somebody s belligerent. SNRIs if they need brain stimulation but they can t handle a dopamine driver. If somebody is now having seizures because they have neurological disorders, then they may need a seizure medication. I mean, you can look at these and be able to say, Hey look, you re taking this. This is the medication that you ve got. What does it mean to you as Again, I hate and I ve been very redundant, but what does it mean to you for the physiological provider? Okay? The other ones are just charts Let me This one here, do you want these? Let me try to do that. Let s just review some concepts. Okay. So here s what I want to ask you guys. Do you have any degree of neurodegeneration? MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 9

10 Oh. How many of you have thought about that this weekend? Like, Oh crap, I m not doing so good! Okay. Have any of you filled out the brain region localization form yourself? Honestly. Honestly. Okay. So fill it out. Fill it out, and then as you Some of the things you can check yourself, like if you have cerebellar stuff, you can check yourself for balance and finger to nose, and those other things. Or have your partner or friend check you out. But you want to then kind of look at your own efficiency. Now, I can tell you, for me, I have a ritual on days I see patients. My ritual is, I go in the office an hour early, and the very first patient is myself. Okay? It s And I actually He stimulates himself. I stimulate myself. So I have It takes an hour. I have a ritual supplements I take, I have things I do. I definitely If I m going to go see patients that day, I have ritual things that I take. I definitely need to get blood flow and circulation up. So I go and do my little high-intensity routine before I go into the office. I take my supplements, my brain s working, blood flow s there, circulation s there. A few tests that I do based on what my areas of imbalances and degeneration already are. I try to activate those areas until my exam findings get normal. When I m done with that, I m ready to look at my patient charts. So to me, I have a practice where I have patients fly in from all over, and I only have sometimes one day with them to figure out what s going on, and I cannot be off. It can t be the day things didn t work out, okay? I also have to get plenty of sleep. Sleep is critical for brain function. So I don t like to really go out and do things the day before patients. I take that day very, very, very seriously for myself, okay? And then I want to go in there and do the best job, and then I want to write my report, and I want to be really proud of the workup I did, and I want to, you know, and then put things together, and then make a change. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 10

11 So I think, if you guys can embrace the fact that maybe you should fill out your own brain region localization forms, try to make your brain as efficient as possible yourself, it only makes you more efficient. Makes you be able to do more things. Makes you be able to last longer throughout the day before you crash and get tired, right? So take a minute and then kind of see what s going on. Ask yourself this question: How s your frontal cortex, how s your focus, attention, and concentration? If that s off, you want to do things to improve your frontal cortex integrity. How would you have cerebellar symptoms? How s your balance? Maybe you need to do balance exercises. Maybe you want to do core stability exercises. Maybe if you re working out, you do exercises that are challenging your balance more. Right? Maybe you have some early Parkinson s symptoms. Maybe Parkinson s disease is in your family. Maybe you want to do burst activity. Maybe you really want to look at neuroprotective things, right? So those become really efficient ways to just improve your skills, you know? Practitioners, you know, spend all this time and energy and money learning to increase their knowledge, but they don t do enough to preserve their brain. So you want to kind of look at preserving your brain, making it as efficient as possible; at the same time, you know, learning as many things as you can. But the fact that you re learning is also protective for your brain, which is great. Yeah. And I ve got a ritual too, for usually after I get done teaching. Because if not, I get what s called a teaching hangover, and I just I m walking around like So I know there s things I have to do for my brain so that it can recover. Mainly for me, it s recovery. And now that I m getting, you know I m not as young as I was, I do some stuff for enhancement, for function. Oh, enhancement. Yeah, enhancement. You stimulate yourself, and I have enhancement. So listen: It s one of those things where I just I know that I want to be more creative, and I want to have enough, you know, mental function and focus, so I do a few things. And we ve all got our little rituals. So Okay. Anyways. So here s the thing: If you guys are onsite, definitely come to the workshops. Yeah. Because these workshops, we re finding, is they re absolutely critical. Now, if you can t come into workshops, like you re students, you re streaming in clubs, then put together workshops. If you re streaming with friends, get together and do some hands-on workshops before or after. Just do whatever you can. MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 11

12 Now, we re going to start making videos where we are going to go We re making a whole set of videos related to things you can do at home, things you can do with patients related to the physical examination, to really build up skills. But that hands-on approach to it is really, really critical, okay? So if you re coming, if you haven t come, I can tell you that the skill level of people that came to that first workshop dramatically improved, as you went gait after gait after gait, you can see people on the breaks, and they re catching all the different things that they found. And once they built that level of skill, that s with them for the rest of their career. And the next time they build another little skill, another little skill, another little skill. I mean, it was so impressive to see how quickly people were getting things. Well, it surprised us too, the level of pathology we saw. I mean, most of the time, you know, everybody s pretty cool here, you know, they re all normal. People were getting up there and, like, Hey, have you had a head injury? And it s like, Yeah. I mean, and that s normal. I mean, a lot of people have been through a lot of trauma, so I would say this: You know, a lot of people are like, Why don t you stream the Friday night hands-on thing? Well, because it s hands-on. That s the whole point. The whole point is for you to be there and to do it. I mean, not to watch it. If that s the case, it s just watching another video, right? Or watching another activity. We want you to be there, see it, do it, have somebody look at you, go through it, and have some repetition. And not only that, you know, we don t just video every single thing that we do. I mean, it s not like somebody s walking around with a camera constantly, going, Hey man, what s up? But we will have some workshops if you re streaming, and examination findings, actually next time as we get into vestibular. So if you guys are streaming, it s I would say this. The next hands-on workshop might be the most important one we do. And it s That s not for any other purpose other than to say it s all the Epley, all the Hall-Pike, all the maneuvers that will actually challenge the peripheral system are going to be done in that workshop, and I will tell you right now, that stuff you will not learn watching a video. Okay? So it s important to be there. [recording ends abruptly] [30.19] FunctionalNeurologySeminars.com Courses.FunctionalNeurologySeminars.com MODULE 3 TRANSCRIPT: DAY 2 REVIEW 2016 FUNCTIONAL NEUROLOGY SEMINARS LP Page 12