NEW COURSE ALERT: Neuroscience Behind Cognition & Intelligence

– Hello, my name is Doctor Freddy Garcia. Today I’m joined by Doctor David Traster. And we’re gonna be doing a video case review. And this video case review is gonna have a specific topic, we’re gonna be talking about cognition and intelligence, and specifically, its clinical neuroscience because Doctor Traster has a new upcoming neurology primer, specifically on that topic, which we’re all very excited about. Doctor Traster, thank you for joining me today.

– Thank you, so excited to be here.

– Awesome. Hey, so let’s get into this case, people really enjoy when we do video case review ’cause it gives them some perspective into our faculty’s thinking process when working with these patients. So, can we get right into it?

– Let’s get right into it. So, we’re gonna talk a little about cognition and intelligence. And I think it’s important ’cause traditionally we speak a lot of the sensory motor system, but we know we can differentiate the impact of cognition and intelligence in everyday function. And when you look at just processing and how the brain processes any information, it’s very difficult to disassociate the impact of cognition and intelligence has on just our brains everyday function. And so when you look at the primer that we’re doing, here’s just a quick overview of what we’re gonna discuss in the actual course that’s gonna be all on demand at the Carrick Institute. We’re talking about the history of cognition, how we know, we know today, and kind of the last few thousand years people who thought they knew about cognition, who was correct, who was incorrect based on what we know today. We’ll talk about different areas of the cerebral cortex that relate to cognition and intelligence. We’ll talk about brain laterality, difference between one side of the brain and the other side of the brain. And then that leads us to functional specialization, how different areas of the brain do different jobs, but yet how they all talk and discuss and communicate in parallel processing a network. And then we’ll discuss we know sometimes we can do lesion studies, in this area, the brain is associated with this disorder. We’ll discuss about networks and what type of networks in the brain are associated with different disorders. And then we’ll dive really into brain hemisphericity, and brain hemicity. And we’ll talk how we went from hemispheric dominance, to hemispheric asymmetry to hemisphericity, to now a concept we call hemicity. And we’ll discuss the science in 2020 of the difference between the right side versus the left brain, left side of the brain, behavioral and cognitive preferences, and then different ways we can actually test that. ‘Cause classically, we talk about left brain and right brain. And I think there’s some confusion of how this all works and what we know about 2020. We’ll then discuss the role of the cerebellum, how the brain communicates in this idea of brain efficiency. And then obviously, we’ll talk about all different types of cognition, what is language? What are different types of memory, what is attention, and all different types of aspects of cognition, how to test it. And finally, we’ll talk about intelligence. And we’ll start looking at the research of IQ and intelligence, genes versus nature and environment. I’m looking at neuroimaging and trying to figure out where in the brain does intelligence live, and also look at intelligence as far as our patients, as far as society, and what does intelligence mean for our patient that’s sitting in front of us. And if they’re losing some of their critical thinking or some of their executive function, how does that actually relate to our patients, and then we’ll finally finish with a case review. And so speaking of a case review, what I wanted to do is discuss a case that came in a few weeks ago. And this woman came in, she drove in from another state, and her issue was cognitive. And so she came in with she’d complaints of fatigue, anxiety, brain fog and she would call decrease executive function and memory issues. So if it’s okay with you, I want to go through this case.

– Let’s do it.

– Cool, so, the first symptom she came in was a problem with fatigue. And you can see how bad was her fatigue. She said, seven out of 10 at an average, at worst, maybe 10 out of 10, and at best it would be four out of 10. And when you look at things that make it better, it’s really just resting. And then really everything she does, including working and stress makes it worse. We look at the history of things that could have caused this. There’s nothing that she could pinpoint. But we know she’s had a few close head injuries. When she was mountain biking, she’s about mid aged, about 40 year old female, 45 year old female. And so you’re looking at 10, 15 years ago, she could had some concussions, other symptoms brain fog, and again, how bad is the brain fog about seven out of 10, at worst 10 out of 10, at best five out of 10. She also has some anxiety we could see is not as bad as the other symptoms. The anxiety is more about two out of 10. You can see you can get up to eight out of 10 and finally have sensitivity to noise and difficulty remembering. And so we look at somebody that comes into our clinic and a lot of our clinics are a little more geared to sensory motor rehab. So, the question is your clinic and are you as a clinician capable to assess somebody that has more neurocognitive symptoms? And are you able to help these people or help this patient? And so by understanding a little bit about intelligence and IQ, you can start understanding which areas of the brain, which networks of the brain, and what aspects of neurology and brain function might be causing her symptoms.

– Hey, Doctor Traster, if I can make a comment. Even the chief complaint of fatigue I think is interesting, ’cause I’ve started differentiating between sure, they say they feel fatigue, but is it like their body isn’t doesn’t have to go or is their brain sluggish in the sense that they like, they’re like, I can’t get my brain to go at the rate that I used to or wanted it to go. Even the word fatigue is now different for me now that I look at it at patients.

– Absolutely. And something we’re gonna discuss in this course and in the future is this idea of brain efficiency. And this idea is when you’re better at something, or if you’re taking a, let’s say an IQ test, and you have a higher IQ. The higher you’re able to do an action, usually the more efficiently your brain can do it. And so when you look at the cerebral cortex, whether you’re learning how to shoot a foul shot, learning how to shoot a slap shot, learning how to play the piano, or if you’re baby, learning how to walk, or if you just got injured, and after an injury, relearning how to walk or moving after an injury, the more you’re learning, the more activity in your cerebral cortex. And usually, the more you can automate that activity, the more you can make it subcortical. And the more territory that frees up in the cerebral cortex. And so when you look at fatigue after injury, after infections, after certain disorders, just randomly, one thing we’d like to ask is how efficiently is the brain functioning and we start looking and examining by different compensations, different abnormal movement patterns, different exam findings of spreading, and then we start assessing different areas of the brain and seeing is this person moving and acting and thinking efficiently? Is there something we can do to make your brain more efficient? Is your brain acting flexible? If she’s stuck in a certain rigid state? Or is she over-flexible and she can’t be focused in. And so we look a lot about mental flexibility. And we look a lot of brain flexibility, but also brain efficiency. And we want the brain to be efficient, but being able to be flexible to handle different tasks. And so when we look at this type of patient, that’s what we’re starting to think about.

– I like the way you say that with mental flexibility, ’cause it kind of reminds me about one of the concepts, one of our other faculty members talks about that. I think you know more about Doctor Mike T. Nelson, he talks about metabolic flexibility and how important that is, and how we have to tailor our diets to that and so you’re now you’re kind of making me think you know what, same thing neurologically, we actually need that neurological or mental flexibility as well, ’cause being swayed to be either too rigid or too flexible can manifest as a disease as well, actually.

– Absolutely. And if you think about that last thousands of years, if you look at artists or educators or writers, they would draw pictures of guys are like, kings and royalty with very big foreheads. And if you look at how they would depict people, ordinary common men, they would have them small foreheads. So throughout time, we’ve had this idea that intelligence and cognition lives in the front part of our brain. But the fact is, it doesn’t, it lives all over. And it’s really about the whole brain, how it functions together. ‘Cause we know if you can have a frontal lobe injury, many times you don’t lower your IQ. And so we look at cognition, we look at intelligence, we’re gonna look more at how the brain works as a whole. And although the frontal lobe is extremely important with executive function, other aspects, it’s really the communication of the front of the brain to the back of the brain, the side of the brain, to the bottom of the brain, to the top of the brain. It’s how they all communicate together, and how your brain could use different pathways and parallel process information at the same time and come out with appropriate output. And so when we look at her the question is, is she perceiving her reality appropriately? Is she processing that information appropriately and efficiently? And what is the output? Is it appropriate, and we look at her history of what could have caused this. She knows again, she’s probably in the mid 40s. She knows in 1985, she’s always as a child that really never felt rested. So, we know kind of chronic history of maybe sleep issues or just fatigue. In 1990, she knows more mood swings, 2002, difficulty finding words. So, we know we want as a 20 year history of word finding. In 2003, began noticing symptoms of depression. And we know when you have some mood disorders, it makes things a lot more difficult, as far as recovering with almost anything. And then we know she was diagnosed with severe depression, and was also medication for a year but really didn’t really work. And so we really have almost a non specific cause of all these more general and specific neurocognitive symptoms. As we look at what we do, we’ll start right into our diagnostics. And then we’ll go into our exam and then kind of what we did a little bit and so we look at the case review, there is, this is significant for a few reasons. First thing is we can look at she came in June 1st, and she left June 5th, and I was with her three times a day for five days. So, I knew her case very well, just me and her, one on one. And so right away, you can look at the symptom score, and the higher the symptom score, the more symptoms. So you can see in five days, she went from a 65 to an eight. And so you really love the improvement of symptom score. When we look at the standard assessment of cognition, or concussion, we look at, we want this assessment to be at least 26 out of 50, higher the better. That’s your basic, where are you? What’s the date, numbers backwards, your short term working memory, names, repetition, 10 words and then delayed memory recall, these separate tasks, you can see she does very well. We look at trails A, this is connecting dots, one to two to three to four as fast as we can. We want her on 24 seconds. And what you’ll see is she did it in 25 seconds. And then at the end of the week when she’s better, she did it in 39 seconds. If you look at trails B when she came in, she was at 44 seconds and she was at 48 seconds. And when you look at her processing speed when she came in, she was 45. And when she left she was 36. So, point being is some things you see a lot better. All week she was doing better. But you see some test scores got worse. And then you see we repeated it because what I found is I asked her retired, why were some of these objective markers worse when you were feeling better? And it was because she was feeling so good. She was having a conversation with our therapists all the time. And so this is a good comment to say first, attention is important. And so when you look at these neurocognitive tests, you have to be aware and attentive of the test. And so for us when we came in, I thought maybe she was tired. Maybe she’s feeling better, but we made more compensations. And so though she’s feeling better, objectively, she got worse. So, we repeated the test one more time with that her conversating with our tech or the therapist, and you can see the trails A drops down at 27, which is back around normal. And you’d see the processing speed backs up to 54. And so point being is you can see she objectively improved, she’s subjectively improved. And it’s a good lesson to just make sure your staff is well trained, even if they are, they can get carried away or they can make mistakes. So, just to make sure you understand your data, to make sure if you’re really getting someone better and to be honest with yourself. And so we’re really happy with that. We look at the symptoms. This is just from Monday to Friday. You can see the big thing that can prove your sensitivity to noise. Still there a little bit, so we want that to improve. We love the fact that the brain fog went from a five to a zero. We love the fact that the fatigue went from a six to a zero. We love the fact that the emotionality, the irritability went down, and we like the fact that the sleeping soundly went down a little bit. And so in five days, we’re really happy. But we understand, we look at brain plasticity, it takes more than five days to create permanent changes. And so we’re very happy, we made some functional changes in five days. We’re very hopeful that if this carries on for the next few weeks, we could start creating some long term plasticity. And we’re very hopeful. And so far we’ve been very fortunate crossing our fingers, that by creating this short term change, we’ve been able to continue it long term and create long term symptomatic improvement, which we like. And then we look at neurocognitive score and this is the Cambridge Brain Sciences. We’ll discuss it a little bit. I have no disclosures. But this is something we use, this is the test we use. And so we’ll discuss a little bit some of the testing they use, why we enjoy it, why it’s beneficial for us. But also in the seminar, we’ll talk about how you can do without any technology and how you can do it for free. But it’s sometimes it’s nice, it looks professional and it saves you time. And so when you look at her cognitive tests, you can see overall she pretty much score to average down the line. But interestingly, she was below average on spatial planning tasks, and below average on mental rotation tasks. And so though cognition involves different areas of the whole brain, we understand that each network is involved with different functional tasks. And so, we discussed this in the seminar, each one of these tests is involved with different brain networks. And when you start looking at spatial orientation, you can even generalize it to be more one side of the brain versus the other. And in these networks from both sides, how they communicate, you can pinpoint these, the networks need to rehab. These are the networks that are healthy. And so we’d like using this as a quick scan. And then we look at our QEG. And if you can see the QEG, you can see overall is not too bad, but you could obviously see a difference in these beta waves. And you can see down here, this high beta 24, 28 hertz, you can see increased color which means increase activity versus five days later. And again, five days we were extremely happy, we see this much of change. And we’re not out of the woodwork yet. But we could see, we start looking at these brain activity. And this, these brainwaves that theoretically we’re doing, we’re on the right track, right? We’re slowing down this increase beta activity, and we’re on the right direction. Next slide. Balance, we all like to look at balance. And so if we just look at her basic balance, eyes open, eyes closed, flat surface, foam surface, so we’re gonna say how efficiently do we think she’s standing up against gravity? And how efficiently is she balanced? Or everything we’re saying is how efficiently is she doing this task, how accurately is she doing this task, ’cause maybe she’s accurate, but she’s taking too much energy to do it. Or maybe she’s doing it in appropriately and that’s why she’s fatigued. Maybe she has difficult multitasking, those are cognitive issues. And so we look at her balance, you can see all the reds. So right off the bat, she’s below average on all balanced tasks except for eyes open in a flat surface. And right, you can see five days later, you can see the increase. Still, I would like this to be a little better. But you can see now she’s moving more efficiently. She’s bouncing more efficiently. And so let’s go a little bit into the exam. And we’ll go through the exam very quickly. And we’ll discuss just some key findings, I put the whole exam on there, more or less so people could see what type of things we look at whether it’s normal or abnormal. And so I didn’t want to just cherry pick that abnormal findings. And so we started looking, we always start autonomics, especially you start looking for T cognitive issues, we wanna always look autonomics with our patients. And the things that stood out is when she was seated, her blood pressure was relatively symmetrical, but it was a little higher than I like, right. So, you started looking for her if these are starting to touch that 100 mark, and so is a little higher than I like, we lie her down and then it drops down to a more normal level. But you can see that left side is still higher by about 11 points. And so we still see that asymmetry now. And then we stand her up, you can see the heart rate is pretty good. You can see the oxygen stays good. You can see the blood pressure shoots up a bit, and you see the asymmetry stays. And so we started looking at that blood pressure as a marker, we’re gonna constantly monitor, and we’re gonna see if we can just improve her autonomic function that is gonna make her brain more efficient at her job, it’s gonna give her brain more fuel, it’s gonna help remove more waste at the most basic level. And so right away, we wanna look at autonomic function, and then her breathing and everything else was fine.

– I appreciate you saying that Doctor Traster, ’cause a lot of people go, all right, I’m gonna help my patient with this cognitive issue that they’re coming in with, the chief complaint. And then forget the basics such as autonomics, forgetting that if you don’t have good autonomic so you don’t have a good fuel delivery, which means this machine isn’t gonna work as well as you want it to anyways. So, I think it’s a great reminder of the fundamentals which are so important.

– Absolutely. And that people have high blood pressures, they automatically start putting themselves out of too high of a risk for some of our therapies right now, and so there’s certain therapies that we would like to use with people. But if their blood pressure’s a little high, then it forces us to do some other therapies first, where it forces us to maybe reduce the intensity of some of our therapies and really monitor the autonomics until we’re ready to start pushing them a little further. ‘Cause last thing we wanna do is over-activate her brain or overwhelm her or put her in some type of situation program that just overloads her with all the things that she’s having trouble with, and then just boosts up the blood pressure even more. And so this is really significant and we pick up the blood pressure right away. We look observation, everything looks fine, we start doing cranial nerve exam, cranial nerve one is fine, two is fine, we start looking at eye movement, ocular motor system, we can see a little bit of a less left esotropia which has a little trouble diverging during convergence. And we can see a little bit of a decrease of a left pursuit and a decrease of down pursuit. So, just having trouble falling a little bit of a target to the left and a target going downwards. We also see she’s a little short on her right words to cards, and she has a little bit of a decreased velocity on the right word to cards. And we do anti-psychiatry, psychometric and anti-psychiatry when her eyes move to the right. And so we start combining her autonomic findings, we start combining her ocular motor findings. When we look at our visual optokinetic, she had a decrease gain with a leftward optokinetic visual stimulation, and with a downward stimulation. And so like anyone that’s been trained through the Carrick Institute, going through the basic CNS program, going through the receptor base essentials, and they talked about being reset. And now we talk about the advanced programs, people should start already having an idea of different pathways and networks that might be involved with the sensory motor system. But the question becomes, can you take that sensory motor exam? And can you correlate that to her symptoms, ’cause she doesn’t have headaches, and she doesn’t have double vision? And so the question becomes, how do you correlate things you typically look at every day to somebody that has more cognitive type symptoms. We look at cranial nerve five, you can see a little difference in sensation in the trigeminal system. And we know we have a little bit of a TMJ issue. And then we go into cranial nerve eight, and she has a decreased gain and on our right head impulse test. And so again, we’re starting to look at some correlations, some ideas of why maybe things might have happened a long time ago, that could have led to some different changes essentially, and all the other cranial nerve exam was normal. We look at our sensory exam overall, her sensory motor exam, at least the sensory side of things are relatively normal. When you look at your MSRs, your DTR is relatively normal, and we don’t see any pathological reflexes. So, we’re really happy that the sensation looks relatively normal, basic reflexive pathways look normal, we don’t see any other motor signs or any problems with that descending motor system. And again, muscle strength is all normal. So, we’re happy about that. And we look at motor coordination, we start seeing a little bit of some differences. We look at finger tapping, she has a grade one on the right, but a grade three on the left. And so that’s throws us a little curveball based on what we saw. But patients are patients. So, we know that’s what’s going on. When we look at the dual tasking when she finger taps, she starts having right hesitations, right decrease amplitude, and she has more trouble on the right side and left side. And so although when you just do basic finger tapping, she’s better on the right than the left, the second you make her do A, C, E, G, every other letter, all of a sudden left side doesn’t change at all. But now the right side starts to break down. And so now you’re starting to look at maybe some compensations. And you start to ask yourself, how efficiently is your brain really working? How efficiently are the basic automated asks that you should be doing and do you find a difference, at least during finger tapping on one side versus the other? And so we did there, and then we start looking at automating movements so we see some dysdiadochokinesia more on the left, when we start getting more distally into the wrist and fingers, we start seeing more incognition on the right side, which again, is interesting looking at. Sometimes people could have developmental imbalances. And you might see if you take everybody in having to dysdiadochokinesia test, you’re gonna see a lot of people in the general population have no symptoms, have some discoordination on one side versus the other. And so a lot of our patients, the question is, what do you treat? If you find some dysdiadochokinesia on the left, but then all of a sudden you see some other functions that are dysdiadochokinetic on the right. Do you treat both sides, do you try to treat one, is one more important. And so based on this exam, and based on our discussion, you should have an idea of although we see a bilateral finding, what might you start with, what might be a little more significant related to her chief complaint, versus trying to treat something that might be irrelevant to getting her any better, because we’ve gotta remember all of our patients had a brain function before their disorder injury. They had a disorder or injury. And then they had a rehab or they had recovery after disorder injury. And our goal is to get him back to pre-injury or disorder levels. And some people had compensations or issues before that, but they were asymptomatic. And so we wanna do our best to understand what people were like before their injury or disorder, and have an idea of what things might we wanna improve, and what things are more weak, not related to their disorder. And finally, we have a little dysrhythmia bilaterally, in both the right side and the left side, and we look at brain efficiency, you start seeing bilateral dysrhythmia, bilateral discoordination. Again, you’re gonna ask yourself, how efficiently is your musculoskeletal system moving? And if that’s the case, can you make any theoretic translations into a cognitive system when you’re not looking at forward modeling, inverse modeling and how the brain comes up with cognition that have similarities and differences to movement. Finally, we looked at V and G or a VOG. And you can see when we have her vision included in darkness, she constantly has upward drifts with a little bit of convergence when you roll her head left. And so when we look at our VOG, we do our VOG a little different than other people do. We do some different details, we actually view this all in the gaze fixation class in the visual fixation class in the Carrick Institute. And so when you look at the way we do our VOG eyes open, vision included with vision, different head position, different eye position. We go through that on the last primary the individual fixation class, but the key thing is in darkness our eyes drift up. When you look at when she has her head turned right or left, she develops right beating nystagmus. And she has trouble holding her eyes 15 degrees to the right in darkness. And so we started looking at this abnormal ocular movement at rest. We started looking at an error when we turn the head neck and in the nystagmus miscervicogenic issue and we start looking at some neural integrator issues with the eyes to the right. And so we start getting some ideas. And this is just in darkness with vision occluded with eyes open. And then we open the eyes and we can start seeing some square jerks throughout the items. And so again, the visual fixation program, we spend a lot of time talking about square jerks, different areas of the brain that are associated with square jerks, different efficiency and energy efficiency and functional efficiency with increasing or decreasing square jerks. And so you can see it’s engaged holding, it’s in your pursuits, both horizontal and vertical. And then we also have the saccadic findings we talked about, and we have the visual optokinetic findings we talked about. So treatment. So overall, what we did, it’s not the treatment. And what we did that was important. It was the assessment, the understanding of what we had to do to make her brain more efficient, which was important. And so when we look at cognition, we can escape this idea of embodiment. And we can escape the idea that in order for us to react and coordinate ourselves in our environment, our brain and our body have evolved together. And the more accurate we know where our body is in space, it creates a certain level of frequency into our brain. And the more we’re understanding, Doctor Carrick has been talking about this for decades, correct. And so but the more we understand that, this body stimulation seems to create this under one hertz frequency oscillation in our brain, and we know this under one hertz frequency oscillation, we thought was his background noise. We now know there’s a low oscillation at rest is related to the default mode network. And we know this low oscillation at rest actually correlates to higher oscillations in the brain, which have more functional correlations. And so we’re starting to understand more about how appropriate sensory motor integration into the brain to allow your brain to know where your body is accurately translates into better cognition. And we also understand if you can’t move appropriately, chances are the same circuitry won’t be able to think appropriately. Or if you can’t move efficiently, you might not be able to use circuitry for cognition as efficiently. And so we start looking at what we started doing with this patient. We looked at different cervicogenic vertigo. So, we obviously did cervicogenic type rehab. We looked at certain upward drips and darkness, we looked at different imbalances, eyes open versus eyes closed, flat surface versus foam surface. So, we did a lot of distributor rehab type treatment. We did a lot of neurocognitive type treatment as far as cognitive tests or treatments associated to the test. And we did a lot of multitasking. So, we do a lot of multitasking treatment where she was doing cognitive therapies while balancing, while having different therapies done at once. And then we did things like interactive metronome. And different things with the timing, with efficiency. And so we really did is we created a sensory motor program that incorporated cognitive therapies that had a certain level of intensity that increased over time based on her improvements. And then what based on her outcome, we know we were successful in the five days, we then translate that to an at home program that involve balance, that involve eye and head movements, that involve cognitive exercises, that involve reaction time but also we work with her personal trainer and a nutritionist. And because she was already working with a personal trainer and nutritionist, and we talked to him about what she likes to do when he was working with her, is everything in a linear plane, everything on a machine. And so we discuss what we’re doing with her now is we’re moving to more free weights, we’re moving to more different angles. We’re changing up her routine every few weeks, and we’re adding more cognitive tasks. We’re also priming more for midline stability. So, we’re adding a lot more midline stability. And while we do midline stability therapies, we’re dual tasking. And so we’re creating more flexibility in her movement program. We’re creating more midline stability in her movement program. And we’re creating more dual tasking, forcing her to start thinking and using specific cognitive networks while she’s doing different movement patterns. And while she’s doing different midline stability exercises.

– Very cool. That, this is fantastic. I think this is the type of coursework where a lot of scholars approach things just like you said, that sensory motor rehab perspective, and they don’t start correlating some of these other complaints that their patients are coming up, coming in with and to be able to start correlating what you’re seeing on the exam, with those cognitive and intelligence findings, I think is gonna be a big help for the clinicians from the understanding standpoint, but also from the patients who are suffering from these disorders and what help and support and don’t really know where to go for some of that stuff. So this is gonna be a very helpful course for them.

– Absolutely, and I really enjoyed doing it because it really highlighted areas that maybe we don’t emphasize as much, or we didn’t as much. And it really highlights areas that we get a lot of symptoms, a lot of patients come in with these symptoms. And we have a lot of things we can do to help but do we correlate appropriately the symptoms they come in with, with the therapies we actually provide. And I’m really excited ’cause toward the end of the year, we’re doing more hands on courses, and we’re looking at the distributor applications program we’re doing an exam course. So, I’m really happy that those two courses are gonna be so hands on and practical. And so I was really excited to do one more, little more didactic at home on demand to really tie in intellectually, how we can help people with cognitive disorders, and what we can do to help these people that come in with more neurocognitive symptoms. Because soon toward the end of the year, we’re really gonna get more hands on and really discuss hands on what we do.

– Beautiful, this actually, this topic of cognition is something that the care consumer is gonna be moving into more assertively. We actually have more coursework on this exact topic planned for 2021, a larger program, but I think this is perfect sense to whet their appetite and expose them to what they don’t know yet. And I think you’re gonna give them some knowledge that will be app, give them some application. But if they do this appropriately, they actually should have more questions as well and say, hold on one second, now that I realize this, can I do this? Or can I do D, can I do C and serve my patients better? So, this is just the beginning of what we have planned for them. And you are obviously a big part of that ’cause you are an excellent teacher. And one of my, if I can give you this kudos, Doctor Traster, one of the things that I do admire about you is that you are an educator, but you’re also clinician educator, meaning you are really doing the things that you’re talking about, you don’t just speak from a podium. You are, this is a real patient. These are results that you’re really delivering. And I think that matters. And I think people respect you for that. And the fact you take your time and educate people I think is also very well appreciated.

– And I appreciate that, I know for this seminar like you were discussing, the key for me was a foundational approach to talk about the foundational concepts and the principles between the brain and cognition and the brain and intelligence. So like you said, because you have another course of the Carrick Institute coming out, that’s gonna be a lot more detailed, and it’s gonna be a much bigger course. So what we wanted to do to say, what can we do to help people start getting the foundation before they kind of hop in a longer course that’s gonna be more detailed, and help people start understanding why understanding neurocognition and mood disorders, cognitive disorders, memory disorders, why them as a chiropractor or physical therapist, personal trainer, acupuncturist, osteopath, psychiatrist, why they might want to be more of a manual therapy profession, really understand cognition, how they could help people at higher levels, than they may understand.

– That model is actually is a big shift for people because I think as clinicians at all those professions that you just talked about, we’re really good at the we call that receptor based model, that sensory motor type rehab. But there’s also an efference based model. And when I tell that, talk to people about this, at first they hear that they go hold on, what are you talking about, but to really understand the efference based model, you really need to understand cognition. And that prefrontal cortex and it’s so it’s the beginning of an exciting time. And of course, you’re contributing it to it as well. Doctor Traster, people wanna learn about your coursework, I’ll tell them this part. They can go to carrickinstitute.com, we’re releasing all those courses, but if they wanna learn more about you and your private practice, which is amazing, where can they learn about that?

– No problem, so we are The Neurologic Wellness Institute, and we have two offices in Illinois and downtown Chicago and Chicago suburbs. And they can find us at neurologicinstitute.com or neurologicwellnessinstitute.com.

– Perfect. All right, Doctor Traster, thank you very much, everybody for your time. Appreciate you tuning in. Doctor Traster, thank you for your time and sharing information. I think we have a couple more of these plans ’cause we have some more courses coming their way. So, we’ll keep connecting, okay.

– Perfect, thank you.

– Thank you, everybody.