July 2002

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New NIST Procedure Seeks Improved Diagnosis Of Fragile X Syndrome National Institute Of Standards And Technology (NIST) (http://www.nist.gov/) Posted 5/14/2002 A robust protocol for measuring a specific class of genetic elements called "trinucleotide repeats" has been optimized at the National Institute of Standards and Technology (NIST) to help clinical laboratories accurately identify Fragile X syndrome, the most common cause of inherited mental retardation. The research is part of a NIST effort to develop standards for measuring the expansion of these trinucleotide repeats. The NIST protocol responds to the guidelines recently issued by the American College of Medical Genetics, which recognized that Fragile X is one of the most frequently ordered genetic tests and that there are many testing methods with different strengths and weaknesses. Fragile X syndrome results from the repetition of a particular sequence of three chemical units on the X chromosome. About 30 repeats is normal; higher numbers, especially in the range of 60 to 200, indicate an unstable "premutation" repeat length. As the number of repeats increases in successive generations, the production of a certain protein is shut off and symptoms of the disease appear or become more severe. Thus, accurate measurement of the size of the affected region of the chromosome is important as a diagnostic indicator of the disease and likelihood in future generations. Current methods become less reliable when the number of repeats exceeds 100. The NIST protocol establishes specific conditions for the creation of multiple copies of the genetic material and their analysis. NIST initially focused on repeat sizes of about 30 to 110; future work will assess methods for measuring larger repeat elements. Children With AD/HD Have Related Functional Disabilities Johns Hopkins Children's Center WASHINGTON, D.C. -- Pediatric researchers from the University at Buffalo and Children's Hospital of Buffalo have shown that children diagnosed withattention deficit/hyperactivity disorder (AD/HD) have as much functional disability as children with mild mental retardation and are not merely exhibiting "inconvenient" behavior. Results of the study were presented here last month at the annual meeting of the Society for Pediatric Research. Using a standard developed at UB for use by the developmental and rehabilitation medicine community to assess a patient's needs for rehabilitation services, the researchers determined that most of the 43 children in their preliminary study were significantly less able to care for themselves, recognize appropriate social behavior and communicate than children of similar age who were not diagnosed with the disorder. "When we applied this standard measure of disability to these children, we found that children who get referred for hyperactivity have high levels of documentable needs and require a lot more help than other children their age," said Thomas M. Lock, M.D., who presented the results. Lock is UB clinical assistant professor of pediatrics and associate medical director of the Robert Warner Rehabilitation Center at Children's Hospital of Buffalo. Lock said the results could have significant impact now because, as of this month, children diagnosed with attention deficit disorder who routinely have been receiving federal Supplementary Security Income funds must demonstrate they are truly disabled. Considerable controversy exists within the medical and education communities about whether AD/HD is a disability or a behavioral problem. Diagnosis of the disorder occurs most often in school-age children and usually is precipitated by disruptive classroom demeanor. Lock and colleagues felt that if functional deficits of children with AD/HD could be documented outside of school, the results would support the hypothesis that the disorder is, in fact, a disability. To accomplish this, they used an assessment tool called the Wee-FIM. The Functional Independence Measure, or FIM scale, was developed by the UB Department of Rehabilitation Medicine and has been adopted universally as a standard measure to characterize the level of adult disability and to direct treatment. The Wee-FIM has been standardized for children. It contains measures for self-care, bowel and bladder control, mobility, communication and social cognition. The 43 children assessed were found to have lower than normal Wee-FIM scores overall, and to show significant deficits in self-care, social cognition and communication. There also was a correlation between inattention symptoms reported by parents and the self-care and social cognition deficits characterized by the Wee-FIM. "These results confirm that young children with AD/HD have functional deficits in both self-care skills and social skills and that these deficits are related more closely to inattention than disruptive behaviors, age or IQ," Lock said. "The study should shed light on the public debate about whether these children are disabled or whether their families are playing the system for benefits." If these functional deficits can be confirmed in a broader study, they should be the focus of treatments in children with AD/HD, Lock stated. Fibromyalgia Pain Isn't All in Patients' Heads (Arthritis & Rheumatism, Jun-2002) Fibromyalgia pain isn't all in patients' heads, new brain study finds. fMRI scans give first objective measure of mysterious ailment, provide road map for future study ANN ARBOR, MI -- A new brain-scan study confirms scientifically what fibromyalgia patients have been telling a skeptical medical community for years: They're really in pain. In fact, the study finds, people with fibromyalgia say they feel severe pain, and have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease. The squeeze's force must be doubled to cause healthy people to feel the same level of pain -- and their pain signals show up in different brain areas. The results, published in the current issue of Arthritis & Rheumatism, the journal of the American College of Rheumatology, may offer the proof of fibromyalgia's physical roots that many doubtful physicians have sought. It may also open doors for further research on the still-unknown causes of the disease, which affects more than 2 percent of Americans, mainly women. Lead authors Richard Gracely, Ph.D., and Daniel Clauw, M.D., did the study at Georgetown University Medical Center and the National Institutes of Health, but are now continuing the work at the University of Michigan Health System. In an editorial in the same issue, Clauw and U-M rheumatologist Leslie Crofford, M.D., stress the importance of fibromyalgia research and care. To correlate subjective pain sensation with objective views of brain signals, the researchers used a super-fast form of MRI brain imaging, called functional MRI or fMRI, on 16 fibromyalgia patients and 16 people without the disease. As a result, they say, the study offers the first objective method for corroborating what fibromyalgia patients report they feel, and what's going on in their brains at the precise moment they feel it. And, it gives researchers a road map of the areas of the brain that are most -- and least -- active when patients feel pain. "The fMRI technology gave us a unique opportunity to look at the neurobiology underlying tenderness, which is a hallmark of fibromyalgia," says Clauw. "These results, combined with other work done by our group and others, have convinced us that some pathologic process is making these patients more sensitive. For some reason, still unknown, there's a neurobiological amplification of their pain signals." Further results from the study were presented last year at the ACR annual meeting. The project will continue later this year at UMHS, joining other fMRI fibromyalgia research now under way. For decades, patients and physicians have built a case that fibromyalgia is a specific, diagnosable chronic disease, characterized by tenderness and stiffness all over the body as well as fatigue, headaches, gastrointestinal problems and depression. Many patients with the disease find it interferes with their work, family and personal life. Statistics show that far more women than men are affected, and that it occurs mostly during the childbearing years. The ACR released classification criteria for fibromyalgia in 1990, to help doctors diagnose it and rule out other chronic pain conditions. Clauw and Crofford's editorial looks at the current state of research, and calls for rheumatologists to take the lead in fibromyalgia care and science. But many skeptics have debated the very existence of fibromyalgia as a clearly distinct disorder, saying it seemed to be rooted more in psychological and social factors than in physical, biological causes. Their argument has been bolstered by the failure of research to find a clear cause, an effective treatment, or a non-subjective way of assessing patients. While the debate has raged, neuroscientists have begun to use brain scan technology to identify the areas of the normal human brain that become most active during pain. A few studies have even assessed the blood flow in those areas in fibromyalgia patients during baseline brain scans. The new study is the first to use both high-speed scanning and a painful stimulus. In the study, fibromyalgia patients and healthy control subjects had their brains scanned for more than 10 minutes while a small, piston-controlled device applied precisely calibrated, rapidly pulsing pressure to the base of their left thumbnail. The pressures were varied over time, using painful and non-painful levels that had been set for each patient prior to the scan. The study's design gave two opportunities to compare patients and controls: the pressure levels at which the pain rating given by patients and control subjects was the same, and the rating that the two different types of participants gave when the same level of pressure was applied. The researchers found that it only took a mild pressure to produce self-reported feelings of pain in the fibromyalgia patients, while the control subjects tolerated the same pressure with little pain. "In the patients, that same mild pressure also produced measurable brain responses in areas that process the sensation of pain," says Clauw. "But the same kind of brain responses weren't seen in control subjects until the pressure on their thumb was more than doubled." Though brain activity increased in many of the same areas in both patients and control subjects, there were striking differences too. Patients feeling pain from mild pressure had increased activity in 12 areas of their brains, while the control subjects feeling the same pressure had activation in only two areas. When the pressure on the control subjects' thumbs was increased, so did their pain rating and the number of brain areas activated. But only eight of the areas were the same as those in patients' brains. In all, the fibromyalgia patients' brains had both some areas that were activated in them but not in controls, and some areas that stayed "quiet" in them but became active in the brains of controls feeling the same level of pain. This response suggests that patients have enhanced response to pain in some brain regions, and a diminished response in others, Clauw says. The study was supported in part by the National Fibromyalgia Research Association, the U.S. Army and the NIH. Brain-Imaging Cap Under Study For Space And Earth Use National Space Biomedical Research Institute HOUSTON (May 8, 2002) -- A lightweight, imaging cap being designed to assess brain function may go where no MRI has gone before. "On extended space missions, there will be a need to assess brain function as it relates to performance of high-level tasks and in the event of possible illness or injury," said Dr. Jeffrey Sutton, director of the National Space Biomedical Research Institute (NSBRI) and leader of its smart medical systems team. "This portable technology will be beneficial on Earth for assessing, diagnosing and monitoring treatment in brain disorders, such as strokes and seizures." The device utilizes diffuse optical tomography (DOT), a technique using near-infrared light and detectors to record brain activity. The light shines through the skull into the brain and records regional differences in blood flow and oxygen levels. These differences are then analyzed to reveal areas of brain activity. "Study participants at the Massachusetts General Hospital are being evaluated doing relatively simple tasks, such as hand movements, under normal and sleep-deprived conditions," said Sutton, an associate professor in the Harvard University - Massachusetts Institute of Technology Division of Health Sciences and Technology. "We'll also test it on patients experiencing changes in intracranial pressure, a condition which may be found in space." Sutton's lab, in collaboration with the MGH Photon Migration Lab, wants to see how well the imaging cap performs relative to functional magnetic resonance imaging (fMRI), the current standard for measuring brain activity non-invasively. The two techniques, fMRI and DOT, are compatible allowing both tests to be run on a participant simultaneously. "We will be able to overlay the images taken from both tests, compare the results and validate DOT's accuracy," Sutton said. "Although we know fMRI has better spatial resolution, the imaging cap is portable, lightweight, less confining and would allow astronauts or patients to move around during assessments." For its potential use in space, Sutton's group is focusing on the device's ability to detect brain function associated with performance of high-level tasks in real-life settings. Another feature is the system's potential for real-time evaluation of neurobehavioral problems, headaches, head trauma and changes in intracranial pressure. In addition to evaluating the imaging cap during simple motor tasks, a simulated space-docking task is being developed in collaboration with NASA flight surgeons. "It is simpler than an actual docking but will allow us to look at accuracy, reaction time, decision-making and overall performance under various conditions," Sutton said. "With the docking task and brain-imaging cap, we hope to develop an objective early-warning system that could avert a potential problem in space." The group is also developing the computer systems that would allow automated interpretation of data from the imaging cap. This function would be necessary in space to avoid lost time transmitting data to Earth for evaluation and also would be beneficial for Earth-based use in physician's clinics. "Just like automated interpretation of electrocardiograms, this in-office brain function assessment could enhance a physician's ability to diagnose a problem and take the appropriate action," he said. This device and others being developed by the NSBRI smart medicine team will improve delivery of medical care in space, however Sutton feels the first benefits will be realized on Earth in the assessment, treatment and monitoring of pediatric and adult patients. The NSBRI, funded by NASA, is a consortium of institutions. Members include Baylor College of Medicine, Brookhaven National Laboratory, Harvard, The Johns Hopkins University, MIT, Morehouse School of Medicine, Mount Sinai School of Medicine, Rice University, Texas A&M University, University of Arkansas for Medical Sciences, University of Pennsylvania Health System and University of Washington.

People With Autism And Asperger Syndrome Process Faces As Objects Yale University New Haven, Conn. -- Yale researchers have for the first time used functional MRI to study brain organization in persons with autism and Asperger Syndrome and found that they perceive faces as if they were objects. "This may be a result of a lifelong disinterest in people, and a failure to develop normal expertise for faces," said Robert Schultz, the study's principal investigator and director of the Neuroimaging Research Program in Autism at Yale. The three-year study resulted in the discovery of reduced activation in the fusiform gyrus - the classic face area of the cerebral cortex. Researchers also observed increased activation in an adjacent region of the brain that processes non-face objects. Autism and a closely related condition, Asperger Syndrome, are characterized by impairments in social functioning and interactions. Difficulty recognizing other people by their faces is also one of the characteristics of these disorders. "This finding is very compelling since it fits with our clinical experience of autism," Schultz said. "Persons with autism and Aspergers have very little interest in people, and our study shows that this disinterest is reflected in the manner in which the visual processing centers are organized in their brains. We cannot know at this point whether this difference in brain organization and function is at the heart of the cause of autism and related disorders or whether it is merely a reflection of what happens to the brain during early development when a person has autism or Asperger Syndrome." "Of the things that the developing child routinely encounters, the human face is probably the most frequent and important," said Schultz. "The ability to recognize and remember people by their face is critical for all types of interpersonal relationships. The face conveys many important types of information, including a person's age, sex and emotional state. Decoding this information is critical to successful functioning within a group. It is precisely these things that are so difficult for these patients." Unlike the typically developing child, the child with autism will have much less frequent exposure to people and social interactions, with much less actual processing time devoted to people and to the large range of emotions and social behaviors that humans typically exhibit. This atypical set of formative experiences occurs when the brain is still quite malleable. "Thus, it is possible that what we have observed with MRI in a predominantly young adult sample is the outcome of having autism or Asperger Syndrome, an outcome born from many years of abnormal experiences with the social world," Schultz said. "Our results have direct implications for early intervention with social training for persons with Asperger Syndrome, while the brain is still malleable, and capable of developing more normally," said Schultz. "Direct intervention for very young children with social disabilities could have a beneficial effect on the development and organization of their brains." Functional specificity in the right human auditory cortex for perceiving pitch direction Ingrid S. Johnsrude, Virginia B. Penhune and Robert J. Zatorre Wellcome Department of Cognitive Neurology, Institute of Neurology, London, UK, Neuropsychology/Cognitive Neuroscience Unit, Montreal Neurological Institute, McGill University, Montreal, Canada   Previous lesion and functional imaging studies in humans suggest a greater involvement of right rather than left auditory cortical areas in certain aspects of pitch processing. In the present study, adaptive psychophysical procedures were used to determine auditory perceptual thresholds in 14 neurologically normal subjects, and in 31 patients who had undergone surgical resection from either the right or left temporal lobe for the relief of intractable epilepsy. In a subset of the patients, the lesion encroached significantly upon the gyrus of Heschl or its underlying white matter as determined from MRI analysis. Subjects were asked to perform two different perceptual tasks on the same set of stimuli. In a pitch discrimination task, the subject had to decide whether two elements of a pure tone pair were the same or different. In a task requiring the judgement of direction of pitch change, subjects decided whether pitch rose or fell from the first tone to the second. Thresholds were determined by measuring the minimum pitch difference required for correct task performance. Mean thresholds in the pitch discrimination task did not differ between patient groups and control subjects. In contrast, patients with temporal lobe excisions that encroached upon the gyrus of Heschl in the right hemisphere (but not in the left) showed significantly elevated thresholds when judging the direction of pitch change. These findings support a specialization of function linked to right auditory cortical areas for the processing of pitch direction, and specifically suggest a dissociation between simple sensory discrimination and higher order perception.

Differences In Brain Function Found For Attention Deficit Disorder Stanford University Stanford neuroscientists have found a clear difference in brain functioning between boys who have attention deficit disorder [ADD] and those who do not, a step that could lead to better diagnosis of the most common developmental disorder of childhood. Follow-up studies will be required before the results of this study on a small number of boys can lead to brain-based methods of diagnosis, caution the lead researchers, Research Associate Chandan Vaidya and Associate Professor John Gabrieli of Stanford's Department of Psychology. Theirs is the first study, however, to show that Ritalin, the drug most commonly used to treat ADD, has different effects on the brains of people with and without ADD, and where those differences occur in the brain. The findings are reported in the Nov. 24 issue of the Proceedings of the National Academy of Sciences. The study is also the first to use functional magnetic resonance imaging [FMRI] in the study of ADD. This imaging method can show brain differences in individual people, instead of in averages of differences of two groups. This is critical for diagnosis, which has to be established on an individual basis. Unlike methods used in other studies of ADD, FMRI does not require injection or inhalation of radioactive substances. It relies instead on naturally occurring changes in brain function, which makes it appropriate for research and clinical purposes for children. Co-authors of the study are medical doctors Glenn Austin and Hugh Ridlehuber and school psychologist Gary Kirkorian of the Community/Academia Coalition in Los Altos, Calif. and Gary Glover and John Desmond of the Stanford Medical Center's Radiology Department. The findings have drawn considerable attention from neuroscientists because "ADD is so widespread, so controversial and confusing, and these are among the few clear findings in that field," said Gabrieli, who heads the brain imaging laboratory where the research was done. Attention deficit disorder, which often includes hyperactivity, is currently diagnosed on the basis of subjective observations of youngsters' behavior. If the new findings can be replicated, he said, it might be possible to make a biological diagnosis of the disorder by using FMRI. Since the common treatment for ADD is a prescription drug whose long-term effects on brain function are not known, parents and pediatricians most likely would welcome a more definitive way to diagnose the disorder. In the study, 16 boys between the ages of 8 and 13 were asked individually to play a mental game while lying in a magnetic resonance imaging device, which was set to image front portions of the brain, including the frontal-lobe cortex and the striatal structures below it. The boys, 10 of whom had been diagnosed with ADD and 6 of whom had not, were instructed to press a button when they saw any letter of the alphabet except the letter X on a display screen. Because most of the letters were not X, each child built up a predisposition to press the button and needed to control his impulse to press the button when he saw an X. The task was expected to be, and in fact proved to be, more difficult for the boys with ADD, because poor impulse control is one of the disorder's symptoms. Comparing the brain images later, researchers found a clear difference in the activation of neuronal tissue in two structures in the striatal region, which is known to be involved in motor control. The brain activation differences between the boys with ADD and those without were even more dramatic when the subjects were asked to perform the same task after taking the drug Ritalin. Ritalin is a stimulant medication used to temporarily relieve symptoms of ADD, such as inattention, impulsivity and hyperactivity. "Both the normal kids and the ADD kids got better in their impulse control when they had taken the drug," Vaidya said. "Ritalin improved everyone's performance, but how it actually did it differed in the brains." The boys with ADD showed more activity in the affected striatal structures (specifically known as the caudate and putamen) when taking the drug than when not. The healthy boys, in contrast, showed the reverse - less activity in those areas when taking the drug than when not. "From past work with adults and children, some of which required injecting radioactive material, a consensus developed that it is the frontal striatal circuitry of the brain that is what's not right with this disorder," Vaidya said. "That is why we imaged this part of the brain, and our study confirmed that these structures are, indeed, important for ADD." Ritalin primarily, but not exclusively, influences dopamine neurotransmission. The opposite effects of Ritalin on boys with ADD and boys without the disorder suggest that ADD involves atypical dopamine modulation in the striatum, she said. The researchers caution that the study was conducted with a small group and needs to be replicated with girls as well as with more boys before they can be certain they have found a universal neurobiological marker for the disorder. They also reported that they tried the experiment on three other boys who had not been diagnosed with ADD but who had siblings with the diagnosis. Two of the three siblings of ADD boys showed some Ritalin enhancement of the striatum, as did their affected brothers. "This would lend some support to the idea that ADD may involve atypical genetic influences on dopamine modulation," Vaidya said, but more studies would be necessary to establish a genetic influence. Because of the widespread interest in ADD, the researchers also were careful to point out other limitations of their study. A fraction of people diagnosed with ADD have not responded to Ritalin treatment, and this study did not include such children, they said. It also did not attempt to investigate possible changes in brain activation that might occur with the drug over time. The ADD boys did show a different brain activation level when not on the drug, but all of them had been taking Ritalin previously as part of their ongoing treatment. Despite these limitations, the study points to new directions for research into brain function that could improve individuals' performance. "This is one of the few studies to examine brain function in children, and to further our knowledge about normal and abnormal brain development," Gabrieli said. "It suggests that FMRI is a powerful tool to examine brain and behavior in the context of both normal and abnormal development." Currently, ADD impairs the function of an estimated 3 to 7 percent of youngsters in home and school, and the long-term consequences include lower educational and vocational accomplishments for them as adults as well as an increased risk for drug abuse and other risky behaviors. The study was funded by a grant from the El Camino Hospital District Board in Mountain View, Calif. Thyroid Hormone Disruption: Dioxins Linked To Attention Deficit, Learning Problems University Of Maryland, Baltimore Phone Research has shown that children exposed to common environmental toxins like dioxin and polychlorinated biphenyls (PCBs) prenatally and during infancy can suffer behavioral, learning and memory problems. A University of Maryland School of Medicine psychiatry professor now suggests that the underlying mechanism may be disruption of the normal action of thyroid hormone. In the January issue of the scientific journal Toxicology and Industrial Health, Dr. Peter Hauser and colleagues summarize recent studies that suggest links between perinatal exposure to dioxin-like substances and developmental abnomalities in learning and attention. They propose that the genetic condition known as resistance to thyroid hormone (RTH) may be a useful model for further study of the disruptive effects of dioxin and PCBs on brain development. Hauser is professor of psychiatry at the UM School of Medicine and chief of psychiatry at the Baltimore Veterans Affairs Medical Center. Co-authors are Drs. J. Michael McMillin and Vinod S. Bhatara of the University of South Dakota School of Medicine. Thyroid hormone plays an essential role in prenatal brain growth and development, as well as in normal behavioral and intellectual development. Even moderate impairment of thyroid hormone function has been associated with various problems in behavioral and intellectual development, and certain thyroid diseases such as RTH are associated with attention deficit hyperactivity disorder (ADD or ADHD) and language disorders. "Optimal amounts of thyroid hormone appear to be of vital importance for central nervous system development and maturation during a critical period which begins in utero and continues in humans for approximately the first two years after birth," Hauser said. During the first 12 weeks of pregnancy, thyroid hormone from the mother is transported through the placenta, where it affects fetal brainstem and brain-cell development. Through the remainder of pregnancy, both maternal and fetal thyroid hormone affect brain and central nervous system development. "Major neurodevelopmental events occurring in this period are exquisitely sensitive to thyroid hormones," Hauser said. Studies of adults exposed to dioxin and PCBs show no marked neurological effects. But numerous studies in humans and animals show that perinatal exposure frequently impairs brain and central nervous system development. Problems found include delayed speech and language development, slow development of reflexes and complex movements like walking, hyperactivity, and learning disabilities. "Human and animal studies have demonstrated that exposure to dioxin-like compounds can alter thyroid hormone function and produce neurobehavioral changes, but it remains to be definitively established that changes in thyroid function are responsible for the neurobehavioral effects," said Hauser. Since the neurological and behavioral abnormalities seen in humans who have been exposed in utero or infancy to dioxin-like chemicals are similar to those seen in people suffering from resistance to thyroid hormone (RTH), Hauser called for new studies that contrast RTH with perinatal exposure to dioxin and PCBs. "Such studies may provide new insights into the basic pathogenesis of developmental neurotoxicity following exposure to thyroid-disrupting synthetic compounds and may provide guidance for treatment and prevention," he said. Hauser and colleagues’ research was funded by the University of Maryland School of Medicine and the American Thyroid Association.

Crossroads Institute is please to announce its latest program addition: The Learning to Listen Program. Below is background and an overview of what we can offer those with Central Auditory Processing Deficit (CAPD). Learning to Listen Program (Auditory Processing) Hearing and Listening...What's the difference? Hearing is the ability of the ears to take in sound. The ear's mechanics or structure is capable of responding to sound. Listening is the result of our auditory processing or how our brain processes and interprets the sounds received from the ear. Listening Style is the learned behavior and how we prefer to listen. Auditory Processing is the ability to make sense of the sound that comes into the ear and to process or interpret what is heard. Difficulties with auditory processing does not mean the ear is not hearing, but rather difficulty with how this information is interpreted or processed by the brain. Auditory processing affects how we listen and therefore affects how we view the world. Auditory discrimination is the ability to recognize differences in phonemes (sounds). This includes the ability to identify words and sounds that are similar and those which are different. Auditory memory is the ability to store and recall information, which was given verbally. An individual with difficulties in this area may not be able to follow instructions given verbally or may have trouble recalling information from a story read aloud. Auditory sequencing is the ability to remember or reconstruct the order of items in a list or the order of sounds in a word or syllable. For instance, the word “task” may be heard as the word “tacks” because the order of the s and k were processed in reverse order, much like some children will visually see letters in reverse order, some children hear or process them in reverse order. Auditory blending is the process of putting together phonemes to form words. For example, the individual phonemes "c", "a", and "t" are blended to from the word, "cat". With some children they will process these sounds out of order and repeat the word as “tac”. Or they may omit the first sound or last sound and repeat the word as “at” or “ca”. An auditory processing deficit can interfere directly with speech and language and can affect all areas of learning, especially reading, comprehension and spelling. When instruction relies primarily on spoken language, the individual with an auditory processing deficit may have serious difficulty understanding the lesson or the directions. The Program We combine modern technology to assess and treat attentional issues, or verbal and reading comprehension or articulation and phonological deficits. Often children who come to our program with a label of ADD/ADHD are not...rather they have auditory processing issues such as discrimination or blending which interferes with the attentional processes. We often find children with reading comprehension issues have memory deficits. And most individuals who have articulation or phonological disorders also have receptive speech problems. This receptive problem often means that the individual cannot distinguish tokens of a target speech sound that are articulated correctly from those that contain errors. In other words, garbled in...garbled out... Crossroads Institute's Learning to Listen approach allows us to not only identify those with these problem but to treat them efficiently. Treatment with the Learning to Listen Program is commonly followed by rapid and substantial improvements in both receptive and productive speech, improved reading comprehension and improved attention, focus and concentration. With a thorough listening evaluation specific listening and processing problems can be pinpointed and identified and then specifically treated. Learning to Listen is one approach Crossroads Institute offers. After a comprehensive listening test that will evaluate air vs. bone conduction an 8 week listening program my be recommended to help re-wire the brain to learn how to process verbal information. This improved listening ability will improve tonal processing which in turn improves sequential auditory processing and language processing. In addition to the Learning to Listen Program, visualization programs may be recommended as well as neurotherapy to help balance brain wave activity that may be inhibiting processing. We also offer a full spectrum of neurodevelopmental home based exercises that can accelerate the progress your child makes. Functional Role of Auditory Cortex in Frequency Processing and Pitch Perception The Journal of Neurophysiology Vol. 87 No. 1 January 2002 Mark Jude Tramo,Gaurav D. Shah, and Louis D. Braida Department of Neurology, Harvard Medical School and Massachusetts General Hospital, Boston Research Laboratory of Electronics, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge Eaton-Peabody Laboratory of Auditory Physiology, Department of Otology and Laryngology, Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts Microelectrode studies in nonhuman primates and other mammals have demonstrated that many neurons in auditory cortex are excited by pure tone stimulation only when the tone's frequency lies within a narrow range of the audible spectrum. However, the effects of auditory cortex lesions in animals and humans have been interpreted as evidence against the notion that neuronal frequency selectivity is functionally relevant to frequency discrimination. Here we report psychophysical and anatomical evidence in favor of the hypothesis that fine-grained frequency resolution at the perceptual level relies on neuronal frequency selectivity in auditory cortex. An adaptive procedure was used to measure difference thresholds for pure tone frequency discrimination in five humans with focal brain lesions and eight normal controls. Only the patient with bilateral lesions of primary auditory cortex and surrounding areas showed markedly elevated frequency difference thresholds: Weber fractions for frequency direction discrimination ("higher""lower" pitch judgments) were about eightfold higher than Weber fractions measured in patients with unilateral lesions of auditory cortex, auditory midbrain, or dorsolateral frontal cortex; Weber fractions for frequency change discrimination ("same""different" pitch judgments) were about seven times higher. In contrast, pure-tone detection thresholds, difference thresholds for pure tone duration discrimination centered at 500 ms, difference thresholds for vibrotactile intensity discrimination, and judgments of visual line orientation were within normal limits or only mildly impaired following bilateral auditory cortex lesions. In light of current knowledge about the physiology and anatomy of primate auditory cortex and a review of previous lesion studies, we interpret the present results as evidence that fine-grained frequency processing at the perceptual level relies on the integrity of finely tuned neurons in auditory cortex. Human auditory-cortex mechanisms of preattentive sound discrimination. Kropotov JD, Alho K, Naatanen R, Ponomarev VA, Kropotova OV, Anichkov AD, Nechaev VB. Laboratory for Neurobiology of Action Programming, Institute of the Human Brain, Russian Academy of Sciences, St. Petersburg, Russia. Intracranial event-related potentials (ERPs) were recorded in neurological patients to infrequent higher-pitch 'deviant' tones and to frequent 'standard' tones when they occurred, in random order in a mixed sequence of standard and deviant tones and when they occurred in separate sequences, that is, infrequent tones alone with intervals similar to inter-deviant intervals of the mixed sequence and frequent tones alone with intervals similar to those between the standard tones of the mixed sequence. When the tones were ignored, ERPs showed three types of responses revealing three different processes involved in stimulus discrimination in the superior temporal cortex: (1) a pitch-dependent response in the primary auditory cortex; (2) an interstimulus-interval dependent response in the secondary auditory cortex; and (3) a change-detection ('mismatch') response in the auditory association cortex. When the tones were attended, ERPs to deviant and standard tones showed differences also in the basal ganglia-thalamic circuits and in the hippocampus, indicating their involvement in attentive processing of auditory stimulus changes. Auditory Cortical Responses to the Interactive Effects of Interaural Intensity Disparities and Frequency Julie R. Mendelson and Keith L. Grasse1 Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario Department of Psychology, Centre for Vision Research, Institute for Space & Terrestrial Science, York University, North York, Ontario Canada   Under natural conditions, stimuli reaching the two ears contain multiple acoustic components. Rarely does a stimulus containing only one component (e.g. pure tone burst) exist outside the realm of the laboratory. For example, in sound localization the simultaneous presence of multiple cues (spectral content, level, phase, etc.) serves to increase the number of available cues and provide the listener with more information, thereby helping to reduce errors in locating the sound source. The present study was designed to explore the relationship between two acoustic parameters: stimulus frequency and interaural intensity disparities (IIDs). By varying both stimulus frequency and IIDs for each cell, we hoped to gain insight into how multiple cues are processed. To this end, we examined the responses of neurons in cat primary auditory cortex (AI) to determine if their sensitivity to IIDs changed as a function of stimulus frequency. IIDs ranging from +30 to –30 dB were presented at different frequencies (frequency was always the same in the two ears). We found that approximately half of the units examined exhibited responses to IIDs that varied as a function of stimulus frequency (i.e. displayed some form of IID x Freq dependency). The remaining units displayed IID responses that were not clearly related to stimulus frequency. Studies have shown that cortical cells are sensitive to a variety of stimulus parameters such as interaural intensity, temporal and frequency when they are examined individually (Kitzes et al., 1980; Phillips and Irvine, 1981, 1983; Reale and Kettner, 1986; Mendelson, 1992). Under natural conditions, these cues rarely arise in isolation. In fact, in sound localization if only one of the available cues is present, spatial ambiguity often occurs, causing the organism to mislocalize. This ambiguity stems from the fact that sounds arising from different locations may produce identical values of a given cue. Thus, the presence of additional cues (spectral, temporal, level, etc.) helps to disambiguate the location of the sound source. The goal of the present study was to further our understanding of how the auditory cortex processes the interaction of multiple acoustic parameters. To date, relatively few studies have examined the interaction of two or more parameters (Kitzes et al., 1980; Takahashi et al., 1984; Semple and Kitzes, 1987; Wenstrup et al., 1988a,b; Fuzessery et al., 1990; Brainard et al., 1992; Irvine et al., 1996; Park et al., 1997). In general, these studies have shown that the response of some neurons to one parameter can be modulated by the simultaneous manipulation of a second parameter. For example, Irvine et al. (1995) studied the relationship between interaural intensity and temporal differences as would be predicted by the time–intensity trading phenomenon observed in psychophysical studies (Deatherage and Hirsh, 1959). They found that for the majority of units in the inferior colliculus, the response to interaural intensity disparities (IIDs) could not be predicted from the response to interaural temporal disparities (ITDs). The effect of sound pressure level (SPL) has also been shown to modulate the response of units in the inferior colliculus (Semple and Kitzes, 1987; Wenstrup et al., 1988a,b; Fuzessery et al., 1990) and auditory cortex (Irvine et al., 1996) to IIDs. Park et al., on the other hand, have shown that stimulus duration has no effect on the IID response of lateral superior olive (LSO) neurons (Park et al., 1997). Collectively, one point these studies clearly demonstrates is that the way in which neurons in the auditory system treat multiple parameters is by no means a simple matter. Two other parameters that warrant examination because of their intimate relationship are the intensity and spectral components of the signal. Recent studies have shown that IID-azimuth functions display different patterns of non-monotonicity/monotonicity at different frequencies (Irvine, 1987; Martin and Webster, 1989; Rice et al., 1992). However, the way in which the interaction of these parameters is encoded by the auditory cortex is not well understood. Thus, in the present study we investigated the relationship between IIDs and stimulus frequency in an attempt to explore how the response of a cortical unit to one parameter can be modified by the manipulation of a second parameter.

Child Masters Languages with Only Half a Brain By Hannah Cleaver BERLIN (Reuters Health) - A 7-year-old girl has astounded doctors by mastering two languages despite having had the dominant half of her brain removed--including the speech centre. "It was amazing. I had to tell my students to forget all the neuro-physiological theory they were learning," said Dr. Johannes Borgstein. The ear, nose and throat specialist at Rotterdam University Hospital in the Netherlands told Reuters Health that he had been treating the girl for tonsillitis. However, when he and his assistant Caroline Grootendorst checked her file they realised that she only had half a brain. "The operation was conducted 4 years ago when she was very young but you would not notice now," he said. "We didn't notice it. She was fairly well, and we had decided not to take out her tonsils but realised that she had this enormous case file. The young girl lives in Rotterdam and speaks fluent Dutch and Turkish--the former with her sister and doctors, the latter with her mother and other family members. When she was 3, the child developed Rasmussen syndrome, an infection that led to epilepsy, cramps and muscle ticks, while the left half of her brain slowly deteriorated. Surgeons decided the left half of her brain had to be removed and the operation was conducted at Utrecht University Hospital--the aim being to leave her with a better chance of a good quality of life with half a brain than if the syndrome was allowed to continue its course. "She was a happy 7 year old, with the most delightful of smiles, and a pair of thick little spectacles constantly sliding off the tip of her nose," Borgstein said. "Apart from a slightly awkward handshake the first impression was unremarkable, and she clambered onto the examination chair to have her ears checked. Fluently bilingual, she had been arguing with her little sister in perfectly-constructed Dutch, then turned to answer her mother in Turkish when it was time for the examination." He noted that her sight was impaired but that she could hear perfectly with both ears--the right side of the brain having compensated for the lack of the left side. "If this little girl could achieve so much with only half a brain, what could we not do with a complete one?" he asked. "The literature is sparse on the long-term follow-up of extensive cortical surgery, and we might expect her to reach a developmental peak far earlier than her normal siblings, though this is by no means confirmed," Borgstein said. "It remains a remarkable demonstration of the plasticity our brain is capable of, if we train it early enough," he added. Treatment Helps Dyslexics Significantly Improve Reading, Shows Brain Changes As Children Learn University Of Washington A novel treatment for dyslexia not only helps children to significantly improve their reading skills but also shows that the brain changes as dyslexics learn, according to a study by an interdisciplinary team of University of Washington scientists. The research, published in the current issue of the Journal of Neuroradiology, also provides new evidence that dyslexia is a treatable brain-based disorder, according to neurophysicist Todd Richards and neuropsychologist Virginia Berninger, who headed the UW research team. Dyslexia, which is a reading disorder and the most common learning disability, affects an estimated 5 percent to 15 percent of children. Contrary to popular myth, the hallmarks of the disorder are subtle deficits in oral language processing of the sounds of the language, not reversal of letters. "We want to make it very clear that we didn't cure dyslexia, but we think we effectively treated it," said Berninger. "Because of differences in their brains, the boys in our study will need additional educational treatment if they are to continue developing their reading skills. There are no quick fixes or magic bullets for curing dyslexia." Richards and Berninger said the new study is the first in a line of research that will explore the degree to which the brain affects ease of learning and, in turn, is affected by specific educational interventions. They expect this kind of research will build a foundation that educators can draw upon to improve the accountability of teaching practices. "Some children learn to read easier than others, and unless there is real brain damage, the brain will change as children learn," said Berninger. Dyslexia is not brain damage. There are just differences in the wiring of the brain for those parts that are involved in reading. There is no such thing as a perfect brain. Any brain probably has structural anomalies. With appropriate instruction, dyslexic brains may become more efficient at processing the sounds of language. Because they are more efficient they use less brain area and metabolic energy." Complete details about the intervention program -- a three-week reading and science workshop developed by Berninger -- will be published next fall in the journal Learning Disability Quarterly. The intervention draws on elements of existing treatments, putting them together in a novel way. In the workshop the boys were taught to analyze sound in spoken words, to attach sounds to letters automatically and to use different strategies for translating written words into spoken words. The treatment was novel because it took advantage of the boys' talent and interest in science and technology. It linked reading instruction with a hands-on science workshop that used materials from Seattle's Pacific Science Center. The workshop is only one of a number of dyslexic treatments being developed at the UW. The current study builds on previous UW research showing that there are chemical differences in brain function of dyslexic and non-dyslexic children during sound processing tasks. Fifteen boys -- eight dyslexics and seven non-dyslexics -- were involved in the new study. The boys ranged in age from 10 to 13 years and the dyslexic and control groups were matched for age, IQ and head size, but not in reading skills. The controls were above average readers for their age and learned to read very easily. The dyslexics had delayed reading skills and were reading well below average for their age group. They also had a family history of multi-generational dyslexia. Both groups underwent spectroscopic imaging at the beginning of the study. The dyslexic boys then entered the treatment program that was designed to improve their phonological abilities or skills in understanding and using the sounds of language. About a year after the first imaging session, the dyslexics' reading skills were tested and both groups were imaged again using the same tests to evaluate the long-term effect of the treatment. Following treatment the dyslexics expended 1.8 times the energy to do the same sound-processing task as the controls, compared to about 4 times the energy before treatment. According to Richards the dyslexics and controls were not statistically different after treatment. Over this same period the dyslexics also made large strides in their reading ability, especially in sounding out new words. "The relative gains they made compared to children of the same age were more than what would be expected for the time that passed between tests," added Berninger. They made significant gains in analyzing sounds needed to decode words and in sounding out unknown words. After the workshop all but one of the boys could read grade appropriate passages. "This research offers a message of hope. We can see improvement in children's reading levels with this intervention even if there are preexisting brain differences that make learning difficult. "Parents of the boys in the study told us that children who didn't read independently before are now picking up books on their own and reading them." The new results are part of a larger UW effort to understand the basis of dyslexia and develop treatments for the disorder. The National Institute of Child Health and Human Development funds the research and the UWi's multidisciplinary Learning Disabilities Center. The center does not offer a summer treatment program to the general public. Treatment studies are only open to children of families participating in the dyslexia family genetics and brain imaging project. Other members of the UW research team and co-authors of the study are David Corina, associate professor of psychology; Stephen Dager, professor of psychiatry and behavioral science; Robert Abbott, professor of educational psychology; Kenneth Maravilla, professor of radiology; and Ken Marro, a post-doctoral researcher in radiology. In addition, UW doctoral students Sandra Serafini and Keith Steury and radiology technician Denise Echelard, participated in the research. Study Ties Stuttering To Anatomical Differences In The Brain American Academy Of Neurology St. Paul, MN -- Stuttering has been long thought to be caused by emotional factors, but researchers who studied adults with persistent stuttering found that these individuals had anatomical irregularities in the areas of the brain that control language and speech. The study results, reported in Neurology, the scientific journal of the American Academy of Neurology, provide the first evidence that anatomic abnormalities within the areas of the brain that control speech and language puts an individual at risk for the development of stuttering. Using MRI scans to measure the brains of 16 persistent developmental stuttering (PDS) patients and 16 controls, the right and left temporal lobe were found to be significantly larger in the adults with PDS, according to neurologist and study author Anne Foundas, MD, at Tulane University in New Orleans, LA. In addition, irregularities in the shape of the brain were much more prevalent among the patients with PDS than among the control group that was studied. The study group included 12 right-handers (nine men and three women), and four left-handed men, which approximates the distribution of those reported in population studies of those who stutter. Besides attempting to determine a correlation between the shape and size of brain features and stuttering, the study sought to determine whether sex and writing hand preference influenced PDS. "Our data indicated that sex and writing hand seemed to be related to some anatomic features. For example, the Pars Triangularis was significantly larger in left than right-handers, and the Pars Triangularis and Pars Opercularis [adjacent portions of the frontal lobe] was larger in men than women," according to Foundas.

Brain's Visual Cortex Doesn't 'Tell' All It Knows MINNEAPOLIS / ST. PAUL--The print on a page may be too fine to read, but that doesn't mean your brain can't discern the pattern of lines. New research by scientists at the University of Minnesota and the University of California at San Diego (UCSD) has shown that neurons in the human visual cortex, a brain center that processes visual information, can respond to patterns of lines too fine for subjects to resolve. The work reveals that some types of visual information, while not consciously perceived, are still conveyed closer to the brain's center(s) of consciousness than was previously thought. The discovery contributes to the understanding of vision and has implications for the age-old question of consciousness. The work will be published in the May 24 issue of Nature. "This is probably the first demonstration that visual cortical neurons are capable of resolving fine lines past the limits previously thought to exist," said Sheng He, assistant professor of psychology at the University of Minnesota and first author of the Nature paper. His coauthor is Donald MacLeod of UCSD. Everyone with normal vision can perceive patterns of lines up to a certain point. But when the spacing of lines becomes too fine, the lines seem to disappear and only a uniform blur is seen. Previously, vision researchers thought this limitation was due to optical blurring in the eye--that is, a failure of the retina to resolve the lines. Now, at least some of the blurring has been shown to occur in the visual cortex, said He. The researchers studied the responses of two subjects to patterns of lines projected directly onto their retinas by lasers. The lines were either horizontal or vertical. It has been known for some time that certain neurons in the visual cortex respond preferentially to either vertical lines, horizontal lines or in-between orientations. With enough neurons responding to every conceivable orientation, humans can perceive lines that run in any direction. It has also been known that when human subjects are shown a pattern of vertical or horizontal lines for several seconds and then shown a second grid of lines, they are better able to perceive the orientation of the second grid if it is perpendicular to the original one. The reason is that the neurons responding to, say, a vertical grid become fatigued and have trouble perceiving a second vertical grid. But the neurons that respond to horizontal lines are fresh and respond strongly. He and MacLeod observed this phenomenon in their subjects. But when they projected lines so fine that they were slightly, but definitely, past the subjects' ability to resolve, the subjects exhibited the same difficulty perceiving a second grid of clearly visible lines with the same orientation. This, said He, is evidence that the cortical neurons geared to that orientation were perceiving the lines the first time, when the lines were invisible to the subjects. Therefore, the subjects' inability to see the too-fine lines must be due to a blurring that occurs after the visual cortex receives input. The visual cortex lies in the rear of the cerebrum. He said that researchers elsewhere have hypothesized that people cannot become aware of optical information unless it reaches the frontal area of the cortex. The work of He and MacLeod is consistent with this theory, He said. The blurring of lines appears to be due to processes inside the visual cortex that prevent some information from reaching other cortical areas and consciousness. "This suggests that not everything in the cortex can become conscious knowledge," said He. "Your visual cortex isn't telling you everything." The work was supported by the National Institutes of Health and the Alfred P. Sloan Foundation. Brain Processing of Visual Information MIT Research 1996 CAMBRIDGE, Mass.--Scientists at the Massachusetts Institute of Technology have discovered that an area of the brain previously thought to process only simple visual information also tackles complex images such as optical illusions. The research, conducted with animals, also provides evidence that both the simple and more complex areas of the brain involved in different aspects of vision work cooperatively, rather than in a rigid hierarchy, as scientists have believed to date. "Because half of the human brain is devoted directly or indirectly to vision, understanding the process of vision provides clues to understanding fundamental operations in the brain," said Professor Mriganka Sur of MIT's Department of Brain and Cognitive Sciences. The research, which will appear in the December 20 issue of the journal Science, was conducted by Professor Sur, graduate student Bhavin R. Sheth, and postdoctoral fellows Jitendra Sharma and S. Chenchal Rao, all of the same department. "We've found that even supposedly simple parts of the brain are doing complex, sophisticated processing of such things as visual illusions," said Mr. Sheth . "By knowing what various parts of the brain do, we can make predictions about how the brain will function if parts of it have to be removed or if there is some sort of trauma." Mr. Sheth compares vision to an orchestra, where clusters of cells in different parts of the brain cooperate to process different components of visual information such as vertical or horizontal orientation, color, size, shape, movement, and distinctions between overlapping objects. The MIT research focused on an area of the cerebral cortex--the outer layer of gray matter that envelops the entire brain--called the primary visual cortex, also known as V1 and Area 17 of the brain. In humans that area is about five centimeters in diameter--the size of four postage stamps--and a couple millimeters deep on both sides of the rear of the head, just below the crown. The V1 area is the first point of entry in the brain's cortex of visual information from the eye's retina. V1 has to date been thought to be involved only in processing very simple spatial orientations, such as whether an object is placed vertically or horizontally, but not whether that object is a pencil or a finger. Using optical imaging techniques to record visual responses in cats over the past two-and-one-half years, the researchers found that V1 can also process optical illusions and other complex images. The researchers said the same is likely to be true in the V1 area of the human brain. For example, if a person takes a sheet of notebook paper with horizontal lines and places an identical sheet as close as possible to the right of it and slightly lower, the lines on both pages won't connect in a continuous straight line. Yet the brain's visual processing system will try to fill the space between the two sets of real lines by creating an optical illusion known as a subjective contour. Subjective contours are higher-level visual functions that involve the brain's understanding the context and relationship of the images, not just the static placement of one set of lines next to another. Another example is a telephone: a handset may obscure part of the phone base under it, but the brain's visual processes will see both the handset and the entire phone base as two distinct objects that belong together. "We are just beginning to understand the brain mechanisms that underlie complex cognitive processes in vision," Professor Sur explained. "Our work is the first and most important step in showing that right in the earliest stages of the visual cortex, where visual input first enters the brain, there are groups of cells that break down these stimuli and respond to them. That leaves open the question of how higher-order visual cortex areas further process these kinds of stimuli." The discovery of complex subjective contour processing in the V1 area is bolstered by earlier work in Professor Sur's laboratory with Louis Toth, a former MIT graduate student (MIT PhD '95) now conducting brain research at Harvard Medical School. In a September 1996 paper in the Proceedings of the National Academy of Sciences, Professor Sur, Dr. Toth and colleagues reported that V1 could also be the site of "filling-in," another function traditionally thought to be high-level. "Filling-in" is when the brain compensates for a lack of information in one area of the visual field by making an educated guess from information elsewhere in the visual field. It explains why patients with small lesions don't see black spots, and why you are not aware of your "blind spot." The knowledge gained from both experiments can be applied to other brain areas and functions, Dr. Toth said. For example, Dr. V.S. Ramachandran from the University of California, San Diego, who has also studied "filling-in" phenomena in vision, is interested in how the similar wiring of the part of the brain that detects touch may explain why amputees perceive "phantom limbs." "The way the visual cortex is 'wired' is similar to the way the rest of the brain's cortex is 'wired,'" said Dr. Toth. Professor Sur said this is a very important concept in understanding the brain, because from merely an anatomical or structural study of the brain, different areas of the cortex look remarkably similar. What distinguishes the different areas of cortex is the inputs they get and how these inputs get processed and then farmed out to different areas. "So if one knows that an area of the brain with its connection and circuitry does a certain kind of thing, one immediately sees the possibility that all areas of the brain can do similar things to their respective inputs," Professor Sur said. "This is a very powerful idea." The work was supported by the National Institutes of Health.

Dr. Martha M. Grout is on staff with Crossroads Institute and brings with her a wealth of expertise in the field of Chinese Medicine and a background as a Board-certified Emergency Physician, practicing in the Emergency Department of John C. Lincoln Hospital, Deer Valley, in Phoenix, Arizona. She is a Fellow of the American College of Emergency Physicians, and a member of the American Holistic Medical Association. Dr. Grout is a Clinical Instructor for the UCLA Medical Acupuncture for Physicians Program. She uses acupuncture in her emergency medicine and private practices. We are pleased to bring you one of her published papers and articles.       Treatment Of Small Bowel Obstruction With Acupuncture Martha M. Grout, MD The journal of the American Academy of Medical Acupuncture               A Journal For Physicians By Physicians ABSTRACT     Obstruction is the most common surgical condition of the small bowel. Acupuncture may offer an effective, inexpensive, and more rapid treatment of this condition than standard medical therapy alone. Two patients were treated for small bowel obstruction with acupuncture in addition to standard therapy. Both recovered more rapidly than would be anticipated with allopathic treatment alone. INTRODUCTION     Obstruction is the most common surgical condition of the small bowel, often occurring as a consequence of scarring within the abdominal cavity, secondary to a prior surgical procedure. Standard treatment for patients includes placement of a nasogastric tube, use of intravenous fluid replacement, and early surgical exploration if the obstruction cannot be relieved expeditiously by medical means.1 Patients are frequently hospitalized for 5 or more days and require surgical intervention for definitive treatment. The overall mortality rate is between 20% and 70% for strangulating obstruction, and as low as 5%-8% for non-strangulating obstruction.2 One article suggests that non-operative therapy of up to 5 days' duration can be safely attempted for patients who present with postoperative small bowel obstruction, with 73% resolution of the obstruction and no significant increase in mortality. In that experience, the obstruction resolved within a mean of 22 hours and a maximum of 5 days.3 CASE REPORTS Case 1     A 27-year-old man presented to the emergency department of Phoenix (Arizona) Memorial Hospital with complaints of severe cramping abdominal pain, distension, nausea, and vomiting for 1 day. Five years previously, the patient had a ruptured appendix. Vital signs were within normal limits, as were complete blood cell count, electrolytes, amylase, prothrombin time, and partial thromboplastin time. Plain radiography of the abdomen showed marked small bowel obstruction with multiple air-fluid levels. The patient was treated with standard medical management, including intravenous fluids and nasogastric tube insertion.     In addition, after the standard medical management had been initiated, acupuncture treatment was performed using the points CV 12 Zhonguan and ST 36 Zusanli bilaterally.4 Hwato 25-mm needles were used for 20 minutes. The points were chosen to stimulate the correct functioning of the digestive system overall, using CV 12 Zhonguan, the functional Mu point for SP, and ST 36 Zusanli, recommended for treatment of counterflow Qi,5 which accurately describes small bowel obstruction. No further needles were used because the treating physician was concerned that stimulation of the small bowel directly, e.g., with CV 4, the Mu point of the small bowel, might lead to increased bowel motility against a closed obstruction with subsequent perforation.     The patient was admitted to the hospital and received no further acupuncture treatments. Within 6 hours, he began to pass flatus and his abdomen became much softer. The admitting surgeons expressed surprise that his system began to function so soon. The patient was discharged from the hospital after 3 days. Case 2     A 65-year-old woman presented to the emergency department of John C. Lincoln Hospital in Deer Valley (Phoenix, Arizona) with complaint of severe cramping abdominal pain and vomiting. Sixteen years previously, she had a colostomy placed due to carcinoma of the large bowel. She had experienced frequent bowel obstructions with surgical revision of the colostomy 4 times. The patient had symptoms of obstruction about every 6 weeks during the previous 4 years. Radiography never showed the typical air-fluid levels, probably because the patient always came to the hospital within a few hours of onset of her discomfort. She had symptoms suggestive of early small bowel obstruction, including cessation of functioning of her colostomy, severe cramping pain, and copious vomiting of feculent bile-stained liquid. The patient was always hospitalized, with nasogastric tube and intravenous fluids, for 2 or 3 days. She would return to work 3 or 4 days later.     On this occasion, the patient presented with typical symptoms of obstruction. She was treated with the standard nasogastric tube and intravenous therapy. In addition, after the medical management was initiated, she received acupuncture treatment using the points CV 12 Zhonguan, ST 25 Tianshu, CV 4 Guanyuan, ST 36 Zusanli, and PC 6 Neiguan. Hwato 25-mm needles were used and left in place for 20 minutes. The points were chosen to stimulate the correct functioning of the intestinal system. In this case, the treating physician was bolder in the choice of points since the patient had a history of multiple similar episodes, many of which had been treated without operative intervention. CV 12 Zhonguan and ST 36 Zusanli were chosen for the same rationale as in the first patient. In addition, CV 4 Guanyuan, the front Mu point of SI, was chosen to stimulate the small intestine, and ST 25 Tianshu, the front Mu point of LI, was chosen to stimulate functioning of the colostomy. PC 6 Neiguan was chosen to treat the patient's severe nausea and vomiting. The needles were manually tonified to achieve de Qi and then left in neutral position for 20 minutes. She received no further acupuncture treatments while in the hospital. Within 3 hours, the patient's colostomy began to function, she ingested oral fluids, and was released feeling well. She returned to work the next day, rather than 3-4 days later as had happened after previous episodes. Ten weeks after treatment, no further hospitalizations had occurred. Six weeks after her first acupuncture treatment, she had an 8-hour episode of abdominal pain; the patient was treated with an ear tack at the LI point with complete resolution of symptoms. DISCUSSION     A MEDLINE search revealed no literature on the treatment of small bowel obstruction using acupuncture as a modality of therapy. Both surgical and non-surgical interventions are advocated for treatment of this disease, depending on the clinical presentation and the cause of the obstruction.3,6,7 Patients with small bowel obstruction can have severe fluid and electrolyte imbalance, with potentially life-threatening dehydration. Edema of the bowel wall, strangulation, and perforation can occur if the condition is not relieved, progressing to peritonitis and sepsis. Many patients require surgical intervention, with lysis of adhesions, or even bowel resection if strangulation has occurred. Mean length of hospitalization in 1 study was 15.3 days.4 Mortality is reported to range from 5%-75% depending on the cause of the obstruction. Patients with intestinal adhesions have the lowest mortality, and those with neoplasm and/or advanced age, the highest.     Research of the available translated literature from China showed 1 article8 that addressed small bowel obstruction secondary to intestinal adhesions. Twenty-three cases were reported, all of which had at least 1 abdominal surgery. These cases were treated according to TCM principles of invigorating stagnant Blood (caused by the surgery), resolving Phlegm (accumulation of which resulted in intestinal adhesions), and regulating the flow of Qi (which, when rebellious, causes vomiting). This author used different points, depending on whether the pain was experienced in the epigastrium, the hypochondrium, or the lower abdomen. In addition to the points mentioned above, SP 10 Xuehai was used to remove accumulation of stagnant Blood, ST 40 Fonglong to resolve Phlegm, and ST 23 Taiyi to regulate the function of Qi (this point also transforms Phlegm and calms the spirit).4 For pain in the hypochondrium, LR 3 Xinjian, ST 28 Shuidao, and ST 29 Guilai were used to soothe the Liver, normalize the Gallbladder, and regulate the channels. For lower abdominal pain, CV 6 Qihai and CV 4 Guanyuan were used to warm the Middle Heater and regulate the flow of Qi.     The 2 patients described herein both had remarkably short courses of hospitalization: 3 days for the first, 4 hours for the second. Both patients had more rapid resolution of their symptoms than would have been expected from standard medical measures alone. Two successful treatments could easily be interpreted as coincidence or following the natural, though shortened, course of the disease. However, the results in these 2 cases are sufficiently striking as to suggest that acupuncture might play a role in the treatment of small bowel obstruction. It would be interesting to see results of acupuncture treatment of a larger series of patients, and perhaps eventually undertake a clinical trial, if results of acupuncture seem to be promising in the larger series of patients. It might also be possible to demonstrate clinical significance if there were several reports of patients similarly treated for small bowel obstruction with results similar to those herein described. CONCLUSION     These 2 case reports suggest an area for future study in the treatment of small bowel obstruction. Any treatment that could contribute to shorter hospitalization and less morbidity would be of value in the ongoing care of patients with this clinical condition. If acupuncture does prove effective in shortening the course of hospitalization and reducing morbidity due to small bowel obstruction, an additional modality of therapy can be added to the armamentarium of treatments for small bowel obstruction. In addition, cost savings may be significant. A new service Dr. Martha Grout now offers her clients is Auricular Therapy. This article originally appeared in Medical Acupuncture, the journal of the American Academy of Medical Acupuncture. Shen Men: A Critical Assessment through Advanced Auricular Therapy by Bryan L. Frank, MD and Nader Soliman, MD Abstract: Shen Men, or the Chinese "heavenly gate" point on the ear, is situated at the apex of the triangular fossa. It is one of the most recognized auricular points and is used in the treatment of most ailments. Shen Men is known to have a powerful influence in treating various conditions, including pain, sedation, addiction treatment, and inflammation. While Shen Men is universally recognized in the auricular acupuncture world, it is not associated with any specific organ, as the Chinese auricular points were derived from observation of functional effects, and not necessarily with respect to organs and anatomy. The Nogier French auricular system, however, was developed with anatomic and embryological consistency to localizations of the points or zones. Through understanding the anatomic and embryological characteristics of an auricular zone, the physician will more completely understand the patient's pathophysiology and generally experience more enduring clinical results in treatment of these auricular zones. Introduction: Auricular acupuncture was developed as a formal sotamotopic system through the discoveries of Dr. Paul Nogier, of France. With the initial recognition in 1951 that the "sciatic point" in fact correlated with the 4th lumbar vertebra rather than sciatica as an ailment, Dr. Nogier discovered the primary correspondence of the body on the auricle in an "inverted fetus" presentation. This observation led to the eventual identification of the body's anatomic or structural correspondence with zones in the auricle. The Chinese learned of Dr. Nogier's work through a German medical acupuncture article that arrived in China via Japan. The Chinese followed with thousands of clinical observations and developed auricular mappings which were similar to the early French system, though with some differences noted. This correspondence system was easy to teach "barefoot doctor" acupuncture technicians to readily assimilate into their paramedical practices. Developmental Perspectives: Dr. Nogier's original discovery led to the identification of the body mapping on the auricle which presented remarkable consistency with respect to anatomic and embryological considerations. Thus, the "inverted fetus" presents with the musculoskeletal (mesodermal) projections in the upper aspect of the ear including the antihelix, scaphoid fossa, and triangular fossa. Visceral (endodermal) organs present in the concha, and the head's (ectodermal) structures are located in the lobule in the earliest somatotopic mappings. Dr. Nogier eventually recognized that various organs' pain and dysfunction would present in different auricular zones, depending on the stage of the ailment. Phase 1 auricular zones correlate to normal physiology or acute pathology and is the presentation of the original "inverted fetus".(See figure 1) Phase 2 corresponds to degenerative conditions, and the "inverted fetus" is then transformed into an upright position. Phase 3 corresponds to subacute and chronic conditions, and the homunculus is in the transverse presentation with the head in the central auricle or concha. The location of a particular organ or anatomic structure's point will thus be identified in one or more locations depending on the stage of the disease process.3 The respective embryological tissues will shift in their auricular representation based on their Phase status. For example, the mesodermal structures occupy the upper ear in Phase 1, followed by the concha in Phase 2, then the lobule in Phase 3.(See figure 2) While it is now known that illness progresses form Phase 1 to Phase 3 then to Phase 2, Phase 2 was discovered second and therefore was labeled "2". Recovery progresses in a reverse fashion, from Phase 3 to Phase 2 to Phase 1.(See figure 3) Because of the focus on functional observations, several organs in the Chinese auricular system differ from the French system. Further, the Chinese identified various points which had functional or metaphorical names, rather than anatomic descriptions. One notable example of this disparity is the placement of the organ heart. Commonly placed between the lungs on the Chinese charts, this placement does not conform to anatomic and embryological considerations. The French charts will place the Phase 1 heart on the antihelix along the region which corresponds to the upper thoracic vertebrae.(See figure 4) This placement respects the nature of the heart as a mesodermal organ in its location for normal physiology or acute pathology. It is not surprising that the Chinese functional observations place the heart in the inferior concha, as that is the region for Phase 2 mesodermal structures. Patients with functional heart disease are likely to present with coronary arteriosclerosis, a degenerative condition of the coronary vessels, and thus in a Phase 2 state. Given that there may be clinical or sub-clinical manifestations as well, an active auricular point will likely be identified along the antihelix Phase 1 heart zone, as well. Phase 3 subacute or chronic heart conditions may be found in the lobule; any condition may present in one or more Phase locations. Another example of the disparity of French and Chinese points is that of degenerative arthritis of the knee. In Phase 1, the knee is represented in the middle of the triangular fossa. A Phase 2 degenerative knee is represented in the inferior concha, while that of the chronic Phase 3 knee is in the lobule. It is important, therefore, to understand that the zone near the Chinese heart point may in fact have no correlation to a heart ailment; rather it may represent a degenerative knee condition! Clearly the diagnostic and treatment implications are critical to correct understanding of these different presentations. It is this understanding of advanced auricular acupuncture which the Chinese system, developed through a functional correlation, has never integrated into their mappings on the ear. There is no consideration of the different phases based on stage of illness, nor is there strict conformity to point correlation based on anatomy and embryology. Often the physician's confusion regarding the presence of an active auricular point will become clear when the multi-phase anatomic evaluation is considered. Shen Men: The Chinese Shen Men point has been recognized for its application in many pain and dysfunctional conditions. With pain conditions, Shen Men is often considered to be a primary point for treatment. Neuropsychoemotionally, it is considered to alleviate apprehension, fear, anxiety, and to help regulate the sympathetic nervous system. Shen Men is regularly employed in addiction treatments.11 It is also recognized for its role in the treatment of inflammation. The presence of an electrically active or tender Shen Men is regarded by the Chinese auricular acupuncturist as an indication of neurasthenia or the presence of pain.12 As it became common for practitioners to look for Shen Men and to treat it for many conditions indiscriminately, it is important for us, as physicians, to know what the Shen Men point really represents. Shen Men is not a mystical, mysterious point as the impression on Chinese ear acupuncture charts give us. The Chinese acupuncturists have noticed the presence of a point here that is usually active in painful conditions, in many inflammatory conditions, and in cases of addiction. As a result, the name Shen Men was assigned for its functional qualities of electrical activity and clinical efficacy in numerous conditions. As Shen Men is a functional designation, the nature of the point and its representation of body organs and systems is not recognized. An anatomic and phase understanding will give us a clear understanding to the nature of Shen Men. In Phase 1, the Shen Men area corresponds to the Spleen zone. This mesodermal organ will functionally deal with inflammatory cellular elements and thus this zone is often seen in acute ailments. In Phase 2, the Shen Men zone corresponds to the representation of the ectodermal thalamus. As a significant central nervous system structure, it is not surprising that this zone would be seen in chronic degenerative and painful conditions and in patients suffering from chronic addictions. Finally, the Shen Men zone corresponds to the Phase 3 liver. Again, given the extensive interactions of hepatobiliary physiology, it is not surprising that subactue or chronic ailments would be identified in this zone. Conclusions: The significance of Shen Men may be more specifically recognized when the physician understands the anatomic and embryological implications, rather than simply the functional importance of this zone. Additionally, this advanced auricular acupuncture approach will lead to clearer diagnostic interpretation of a presenting illness as it is represented in one or more areas on the auricle. Ultimately, more enduring clinical effects may be realized with treatment of properly identified points. Proper identification and treatment of auricular points is encouraged for the physician to treat the patients' auricle in a true medical model rather than in a cursory technical approach.

Nonlinear dynamics of the EEG separated by independent component analysis after sound and light stimulation Seung-Hyun Jin, Jaeseung Jeong, Dong-Gyu Jeong , Dai-Jin Kim, Soo Yong Kim Department of Physics, Korea Advanced Institute of Science and Technology, The electroencephalogram (EEG) is a multiscaled signal consisting of several time-series components each with different dominant frequency ranges and different origins. Nonlinear measures of the EEG reflect the complexity of the overall EEG, but not of each component in it. The aim of this study is to examine effect of the sound and light (SL) stimulation on the complexity of each component of the EEG. We used independent component analysis to obtain independent components of the EEG. The first positive Lyapunov exponent (L1) was estimated as a nonlinear measure of complexity. Twelve subjects were administered photic and auditory stimuli with a frequency of 10 Hz, which corresponded to the alpha frequency of the EEG, by a sound and light entrainment device. We compared the L1 values of the EEGs and their independent components between baseline and after the SL stimulation. We detected that the L1 values of the EEG decreased after the SL stimulation in all channels except C3 and F4, indicating that the complexity of the EEG decreased. We showed that alpha components increased in proportion but decreased in complexity after the SL stimulation. The beta independent components were found to decrease in proportion and complexity. These results suggest that decreased complexity of the EEG after the SL stimulation may be principally caused by decreased complexity and increased proportion of the alpha independent components. We showed also that theta components increased in complexity after the SL stimulation. We propose that nonlinear dynamical analysis combined with independent component analysis may be helpful in understanding the temporal characteristics of the EEG, which cannot be detected by conventional linear or nonlinear methods. Electrical activity and development of neural circuits  Li I. Zhang & Mu-ming Poo   Keck Center of Integrative Neuroscience, University of California, San Francisco, California Department of Molecular and Cell Biology, University of California, Berkeley, California Correspondence should be addressed to M Poo A distinct feature of the nervous system is the intricate network of synaptic connections among neurons of diverse phenotypes. Although initial connections are formed largely through molecular mechanisms that depend on intrinsic developmental programs, spontaneous and experience-driven electrical activities in the developing brain exert critical epigenetic influence on synaptic maturation and refinement of neural circuits. Selective findings discussed here illustrate some of our current understanding of the effects of electrical activity on circuit development and highlight areas that await further study.   Since the pioneering work of Hubel and Wiesel on the effect of visual deprivation on the development of visual systems, it has become increasingly clear that electrical activity is essential for the development of neural circuits in many parts of the brain. Both spontaneous activity present early in the embryonic brain and experience-driven activity during the postnatal period are critical for circuit development. Here we begin with a discussion of various forms of electrical activity found in the developing brain and potential cellular actions of activity. This is followed by a summary of the effects of activity on the initial formation of synaptic contacts, the maturation of synapses and the structural refinement of connectivity. For activity-dependent synaptic modification, there is substantial evidence for an instructive role of electrical activity, with the instruction coded in the spatiotemporal pattern of activity. We thus review recent findings on the role of spike timing and the issue of input-specificity in the activity-induced synaptic modification, and discuss their implications for circuit development. Besides local synaptic effects, we also address more global effects of electrical activity on neurons, including changes in intrinsic excitability, gene expression and protein synthesis. Finally, we discuss the possibility that neurotrophins, a group of growth factors whose expression and secretion are regulated by activity, may serve as activity pattern-dependent morphogenic factors for shaping the developing connections. Selective coverage of this review reflects the authors' own research interests. More extensive discussion on electrical activity and circuit development may be found in several recent reviews. Spontaneous and experience-dependent activity Electrical activity in the nervous system occurs in two general forms: spontaneous activity independent of sensory inputs or motor outputs, and experience-driven or use-dependent activity. Both types of activity regulate the development of neural circuits. For example, before an animal has any visual experience, spontaneous activity is found in various parts of the embryonic retina and thalamus. These activities are thought to contribute to the refinement of neural circuits in the lateral geniculate nucleus (LGN) and primary visual cortex, resulting in orientation selectivity and ocular dominance in the newborn visual cortex. Activity associated with sensory experience during the postnatal critical period further refines and consolidates these circuits into mature forms. Spontaneous electrical activity has been examined in some detail, in the developing neocortex, thalamus, hippocampus, locus coeruleus, retina and spinal cord by direct recording of electrical activity or fluorescence imaging of Ca2+ transients. In general, this activity consists of bursts of action potentials that last for tens to hundreds of milliseconds, separated by intervals of a few minutes, and involves correlated firing of large populations of neurons. The activity may spread from one region to another in the form of propagating electrical waves, such as those observed in the developing retina, or it may remain localized to discrete domains, as in the neocortex and the spinal cord. Potential cellular actions of activity How do various forms of electrical activity described above exert their effects on developing circuits? Activity-induced Ca2+ elevation can be central in both pre- and postsynaptic neurons. Depolarization-induced Ca2+ elevation triggers presynaptic secretion of transmitters and proteins. Postsynaptic Ca2+ elevation resulting from transmitter receptor activation or depolarization may also induce secretion of retrograde and autocrine factors from the postsynaptic cell. Formation of synaptic contacts The formation of neural networks begins with growing axons finding their path, then recognizing their targets and finally establishing synaptic contacts. Evidence from neuromuscular synapse formation suggests that functional synaptic contacts can be established rapidly before the appearance of morphological specialization of synapses35. We can thus define `synapse formation' as the establishment of functional synaptic communication, separate from `synapse maturation,' which involves a much more protracted process of functional and morphological differentiation. We here consider the role of electrical activity in various phases of synapse development. Path finding of growing axons is generally thought to be independent of electrical activity and to require molecular guidance signals provided by the surrounding developing tissues. However, recent findings have shown that electrical activity may be required for growing thalamic axons to reach their appropriate cortical target area and for axons of cortical pyramidal neurons to form layer-specific intracortical connections. In these latter studies, it is difficult to determine with certainty whether the activity is involved in axon path finding per se or target selection of the axon after it has reached the target cell. Maturation of synaptic structures Electrical activity in growing axons can trigger secretion of neurotransmitters from growth cones, a process that allows immediate initiation of synaptic activity following contact between growth cones and target neurons possessing appropriate receptors on their surface. The role of neuronal or synaptic activity on the maturation of the synapse has been a controversial subject, as experimental findings have supported opposite conclusions. On the negative side, under conditions of chronic receptor blockade, one finds apparently normal development of some aspects of postsynaptic differentiation, such as clustering of muscle nicotinic receptors. On the positive side, there is clear evidence for the effects of synaptic activity on postsynaptic differentiation. Because the site of synapse formation on the dendrite is not predetermined, the first signal for synaptic localization presumably comes from axon–dendritic interactions, which must induce a relatively stable localized scaffold, for subsequent cascades of molecular localization in both the presynaptic nerve terminal and the postsynaptic cytoplasm. The identity of the `first signal' and the `earliest scaffold' remains elusive. Refinement of synaptic connectivity Following the initial formation of synaptic connections, many developing circuits undergo a period of refinement, through which some connections are eliminated while others are strengthened. This rewiring of connectivity depends on the pattern of electrical activity in the circuit and involves cooperative and competitive interactions between converging inputs on the postsynaptic cell. Importance of the temporal pattern of activity The pattern of electrical activity is instructive in the development of ocular dominance and orientation selectivity of the primary visual cortex. Findings indicate that information coded in the temporal patterns of activity is critical in shaping developing circuits. Although simple correlation-based Hebb's rule has been successful in modeling the rearrangements of developing circuits by activity, it is not clear how these events depend on the precise timing of the activity in the circuit. Inhibitory activity may also have an important regulatory role in the refinement of developing circuits. It would be of interest to determine how nascent inhibitory connections, while playing important regulatory roles in refining excitatory connections, can themselves be consolidated into the mature circuit. Global effects of electrical activity In addressing activity-induced synaptic changes, an outstanding issue is the synapse (input) specificity of synaptic modification—whether only the activated synapse is modified. There is increasing evidence that activity-induced LTP/LTD observed in many systems is not strictly input-specific, but may spread to adjacent synapses. Besides modifying synaptic connections, electrical activity also induces changes in the global properties of the neuron such as intrinsic excitability and patterns of gene expression and protein synthesis. Conclusion There is little doubt that electrical activity in the nervous system is important in the formation and refinement of developing neural circuits. However, with the exception of activity-induced LTP/LTD, our understanding of how electrical activity affects the structure and function of developing circuits is very limited.

Carbohydrates Improve Diet Quality American College of Nutrition (ACN) 4-Jun-02 Many fad diets are based on restricting carbohydrates while increasing protein and fat. A new survey from the USDA shows that diets high in carbohydrates are lower in calories and, generally, higher in nutrients. Also, adults eating high-carbohydrate diets are more likely to be in the normal weight range. About 55 percent of adults in the U.S. are either overweight or obese and this rate has increased greatly over the last 20 years. The U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals 1994-1996 collected diet data on 10,014 free-living adults across the country. The sample was divided into four levels of carbohydrate intake -- less than 30 percent, 30-45 percent, more than 45-55 percent, and more than 55 percent. Those eating the highest carbohydrate consumed up to 300 Calories less per day while eating the same amount of food. This was primarily due to increased dietary fiber and water content of the high-carbohydrate foods per 1,000 Calories of energy intake. Those choosing diets with the most carbohydrate had the lowest average body-mass index. They also consumed more essential nutrients such as vitamin A, carotene, vitamin C, folate, calcium, magnesium, and iron. Nutrients consumed in lower amounts by this group were fat, saturated fat, cholesterol, sodium, zinc, and vitamin B12. Dr. Shanthy Bowman, lead author of the study and a scientist with the USDA, said that "adults who obtained more than 55 percent of their energy from carbohydrate had an energy-restrictive, yet nutritious diet, no matter what their food selection strategies." Adults in the high-carbohydrate group did not avoid milk, meat, poultry, and fish products but chose low fat items from these food groups. This study also identified 10-14 percent of all calories coming from beverages, both alcoholic and nonalcoholic. "Reducing intake of non-nutritious beverages that are high in calories is another strategy identified by this study that could help people control weight gain without compromising the quality of the diet," according to Dr. Bowman. The findings appeared in the June, 2002 issue of the Journal of the American College of Nutrition. How to Eat Right When Eating Out University of Alabama at Birmingham 1-Jun-02 It's not too difficult to eat healthy meals when away from home if you take some simple steps, says Suzanne Henson, RD, MS, of UAB's EatRight Weight Management Program. "Look for restaurants that offer healthy meal selections and avoid the buffet, which tempts you to overeat. Order a la carte to gain control over portion sizes, or have an appetizer or a child's meal for your main course." Henson also recommends drinking plenty of water throughout your meal, which will make you feel more full. Starting off with a soup or salad will help, too. And take the leftovers home you'll save money and calories.

The Conscious Ear: My Life of Transformation Through Listening by Alfred A. Tomatis From Library Journal This autobiography by the French physician and ear specialist whose work has had a major impact on dyslexia and other learning disorders was originally published in French (1977). The Tomatis Method, which helps develop listening and communication skills, is used in 15 different countries. Tomatis addresses his experience with some of the most difficult therapeutic and educational problems (e.g., stuttering, autism, dyslexia, balance, motor control, and integration) and shows how they are affected and controlled by the ear. His account will be welcomed by speech therapists, performing artists, educators, and psychotherapists. Recommended. Samuel T. Huang, Northern Illinois Univ. Libs., DeKalb

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