Ethos Health Group, Ocala, FL (2025)

08/08/2025

At Ethos Health Group, we supply normal images to compare with injured clients, as in the picture below. We have learned that this can greatly assist in painting the picture and helps explain our patients' injuries and symptoms.

09/20/2024

Today we raise awareness for National Concussion Day! Let's educate ourselves on the signs and symptoms of concussions and work towards promoting a safer environment for everyone and remember that help is available. A simple checklist of concussion related symptoms is available on our website.
ethosTBI.com

04/15/2024

Why A Rare Medical Condition Would've Caused David Bowie To Flunk TBI Testing

David Bowie was renowned for his other worldly artistry and creativity that was way ahead of his time. Part of his stage persona revolved not just around his vivid makeup and incredible gift for music, but also for his magnetic, almost eerie pair of eyes: one clear blue, the other a moody black.

What gave Bowie’s eyes their hypnotic dual colors, and why is this important for your clients with TBI?

Many people mistakenly assume it was caused by heterochromia, a condition in which a person has two different iris colors. It’s hereditary and usually harmless, and the condition is in fact much more common in dogs, cats, and horses.

But Bowie’s case was different. His eyes were the product not of genes but a teenage fistfight that resulted in anisocoria, a condition in which a person’s eyes have different-size pupils.

In the spring of 1962, Bowie got into a fight with his school pal — and, later, lifetime artistic partner — George Underwood. Both of the boys were fond for the same girl, and as the story goes, Underwood wasn’t exactly pleased. In a fit of passion reportedly punched Bowie in his left eye, and Underwood’s fingernail scratched the surface of Bowie’s eyeball, paralyzing the muscles that contract the iris.

When a person with typical, uninjured eyes stumbles into light their pupils contract and become smaller, showing more of their iris. In darkness, the pupils expand and do the opposite to allow as much light in as possible so you can get into bed without tripping over an errant object on the floor. In Bowie’s case, his left pupil remained permanently expanded, leading to his famous pair of blue and black eyes. And despite the fistfight, the boys’ relationship healed: The two became lifelong friends and artistic collaborators, so apparently they were able to move past their teenage scuffle.

The ability to monitor the constriction and dilation of the pupils has been utilized for years by medical professionals in the assessment of patients with brain injury. You've all seen a doctor shine a penlight into a patient's eye and watch to see if the pupil constricts in response to light and then dilates back to normal.

While this is a useful part of a neurologic examination it can be somewhat subjective and also doesn't detect much of the very subtle changes in pupil function that are too fast to be seen by the naked eye.

A technology first developed about 20 years ago called quantitative pupillometry uses high speed cameras to measure the speed at which the pupils constrict, any delay in response, how much they constrict, and how long it takes before the pupils dilate back to normal. As many of these functions take place in a matter of milliseconds this testing gives far more detailed and objective data than what could be seen on a neurologic examination by a doctor.

This is highly relevant to brain injury as we know that dysfunction in the autonomic, or unconscious portion of the nervous system is what can impact pupillary function. Normative data exists that we can compare our patients to, and this test not only helps us confirm the diagnosis of TBI but also can help guide and monitor progress of the treatment we are providing.

As you can see, David Bowie's eyes would have completely thrown this testing for a loop, but fortunately aniscoria is a fairly rare condition that is easily observed on an initial examination of the patient!

If you have a TBI client you feel would benefit from this testing, TBI rehab, or neurology eval, please reach out to Dr. Walker directly at 904-616-1284 or by email at drwalker@flspineandinjury.com.

Our goat at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.

04/10/2024

Why DTI Imaging Is Like The Day In 1967 That Sweden Changed Which Side Of The Road They Drove On

In September 1967 Sweden did the unthinkable and switched driving from the left side of the road to the right. Despite public outcry, the thinking was that it would make it easier for visitors from neighboring countries to avoid accidents, as they all drove on the right. Officials also believed that is would make the roads safer as Swedish cars' steering wheels were all on the right.

In true Scandinavian fashion, they called the initiative Dagen H or "Högertrafikomläggningen", (literally 'the right-hand traffic reorganization') and a huge PR push kicked off. The campaign included displaying the Dagen H logo on various commemorative items, including milk cartons and underwear. Swedish television held a contest for songs about the change, and the winning entry was "Håll dig till höger, Svensson" ('Keep to the right, Svensson') written by journalist Peter Himmelstrand and performed by The Telstars.

As you can see in the image above, the concerns voiced by the Swedish people were well founded as traffic jams piled up with confused drivers adjusting to the change.

These same "traffic jams" can be seen in the brain on a type of MRI called Diffusion Tensor Imaging, or DTI. DTI measures the movement of fluid throughout the brain, and since water is produced as a byproduct of normal neuronal metabolism we essentially see a "road map" of the brain.

The attached image shows the intricate pathways of the brain on a DTI study. The colors are populated by a computer program and represent the direction of fluid flow.

Diffusion tensor imaging does an excellent job of confirming the clinical diagnosis of TBI, and at Ethos it is often paired with susceptibility weighted imaging (SWI) and Neuroquant. It is important to remember that there is not any single test that stands alone to diagnosis TBI, but rather all the tests must be evaluated together. Diagnostics confirm the diagnosis already made by a clinician of brain injury, and help guide therapy and treatment for each patient.

This is why we caution both patients and attorneys to avoid placing too much weight in any single test result and whether it was positive or negative but rather to look at all the pieces of the puzzle together in totality.

If you or someone you know could benefit from our TBI testing, TBI rehab, or neurology evaluation, please reach out to Dr. Walker directly at 904-616-1284 or email drwalker@flspineandinjury.com.

Our goal at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.

04/01/2024

Australian "Tree of Life" With An Uncanny Resemblance To An Often Injured Part Of The Human Brain

While humans are capable of creating amazing works of art, sometimes nature provides us with the most breathtaking designs of all! The image above is a drone photo from a lake in New South Wales, Australia that has been dubbed the "tree of life", and you can see from the image the moniker is accurate.

This unique appearance comes from tea tree oil leaching from trees along the riverbank into the drainage channels that have been carved into the lake over many years.

When I first saw this image I'm such a huge brain injury nerd that I immediately thought, "That doesn't look like a tree, it looks like a cross section of the cerebellum!" Take a look at the image attached and you can decide for yourself if I'm crazy or not about the resemblance.

The cerebellum is the "brain within the brain" that sits at the base of the skull and is responsible for many basic functions related to balance, motor coordination, and ambulation. This is highly relevant to motor vehicle collision occupant injuries as there tends to be a large amount of force with whiplash injuries transmitted at the craniocervical junction (the area where the brain and spine come together).

This area has traditionally been overlooked by many attorneys in TBI cases as they were focusing more on the types of symptoms that a neuropsychologist would evaluate like memory, executive function, mood, impulse control, etc. However, there are a lot of patients suffering with TBI whose primary area of injury is the cerebellum and their symptom pattern is very different and is not evaluated by neuropsych testing.

Injury to the cerebellum will typically manifest on tests like videonystagmography (VNG), oculomotor tracking, computerized balance testing, and other assessments targetting this region. The image attached is a normal vs. abnormal eye tracking study shows how dramatically eye movements can be impaired due to injury from this part of the brain.

Once we have identified the regions of the brain involved, a more specific and targeted treatment plan can be developed. For cerebellar injuries interventions like oculomotor rehab, balance therapy, and vestibular exercises are often employed to help achieve the best possible clinical results.

If you have a TBI client you feel would benefit from this testing, TBI rehab, or neurology eval, please reach out to Dr. Walker directly at 904-616-1284 or email drwalker@flspineandinjury.com.

Our goal at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.

03/25/2024

Why Chef Julia Child Would Taste Soap When She Ate Cilantro And How This Can Help Identify Brain Injury

Fascinating fact: a surprising number of people, ranging from 4 to 14% of the population, experience an unpleasant taste in their mouth when they consume cilantro. Isn't it intriguing how our taste buds can differ so greatly?

Some describe it as the flavor of soap, or even worse, dead bugs! This is due to a variation these individuals (with Julia Child being perhaps the most famous one) have in their olfactory receptors that allows them to strongly perceive the soapy flavored aldehydes in cilantro leaves.

Believe it or not, olfactory function is an incredibly important parameter to consider in the evaluation of traumatic brain injury.
The most commonly injured cranial nerve following TBI is cranial nerve 1, the olfactory nerve, and this is effected in roughly 20% of brain injury patients.

Although we don't have a cilantro taste test as a part of our TBI evaluation options, we do utilize the University of Pennsylvania Smell Identification Test which is the current gold standard for point of care olfactory evaluation. This assessment uses "micro encapsulation technology", which essentially means it's the world's fanciest scratch and sniff test, to measure olfactory function using a wide variety of smells.

The test even has built in malingering detection as there are certain scents that will cause irritation to the nose that can be detected by the patient even if they have a complete loss of smell. Some of you likely experienced this if you temporarily lost your sense of smell with COVID. Even though you couldn't taste or smell much, certain incredibly strong odors like vinegar or ammonia could still be detected.

The reason for this is that the trigeminal nerve (cranial nerve 5) also assists in olfactory function, particularly with certain strong odors, so essentially there's a built in back up system. So while a TBI patient with injury to the olfactory nerve would have a substantially disrupted sense of smell, certain strong odors would still be identifiable.

Obviously having a decreased sense of smell doesn't diagnose a TBI in isolation, but this is true of all the TBI testing we utilize at Ethos. This is why we measure so many different parameters of brain function as this allows us to pinpoint with nearly complete certainty if the test results as a whole are indicative of brain injury. This knowledge is combined with our clinical examination of the patient, history, review of medical records and other factors to arrive at a confident differential diagnosis.

Although we, at Ethos, may not be able to change your disdain for cilantro, we are here to assist you with your TBI. If you or someone you're acquainted with could benefit from TBI diagnostics or therapy at any of our various locations throughout Florida, feel free to contact us via email at drwalker@flspineandinjury.com or simply give us a call at 904-616-1284. We're always ready to lend a helping hand!

03/18/2024

The Ancient Greek Astronomy Computer That Has Changed How TBI Is Diagnosed And Treated

In 1900, a deep sea diver named Elias Stadiatis emerged from the eastern Mediterranean sea visibly shaken and mumbling about a "heap of dead naked people". He was part of a sponge diving expedition, so it's understandable that what he saw threw him for a loop!

It turns out that his crew had uncovered an ancient shipwreck, and the "dead naked people" were marble statues that had been strewn across the sea floor. This discovery prompted what would become the first major underwater archaeological dig in history that would yield artifacts far more interesting than just ancient sculptures.

One object recovered from the site was roughly the size of a dictionary and was thought at first to be a mass of coins that had fused together. However, months later at the National Archaeological Museum in Athens the lump began to fall apart revealing precision bronze gearwheels that were not thought to have existed for many centuries after the date of the wreck.

It turns out that the sponge divers had accidentally uncovered what became known as the Antikythera mechanism, essentially the earliest analog computer known to man. It contains over 80 individual moving parts intricately engineered together to help track the movements of the planets and stars.

Scientists remain to this day baffled that a device of such high complexity was created in the ancient world, but this amazing technology remains utterly primitive when compared to even the simplest computer we use on a daily basis today.

This same acceleration of technology has changed the way TBI is confirmed and treated. While the initial diagnosis of mTBI (aka concussion) is still made clinically, technology like video nystagmography (VNG), oculomotor tracking, QEEG with event related potentials, quantitative pupillometry, and many other devices serve two purposes:

To confirm the established diagnosis of TBI

To guide and inform treatment for the patient

This is a very important distinction, particularly as it relates to Daubert challenges, in that TBI is not diagnosed off of any single test in isolation, but rather it's a clinical diagnosis made by a healthcare provider that technology allows for much more objective confirmation and fine tuned guidance of treatment.

If you or someone you know would benefit from TBI diagnostics or therapy at any of our locations across Florida, please reach out via email at drwalker@flspineandinjury.com or you can call directly at 904-616-1284.

03/11/2024

How The Giant Hand Of An NBA Superstar Is Important To Understanding TBI Diagnostics

We've all heard the saying that a picture is worth a thousand words....but I think a picture with comparison that provides context can be worth a million words! The image above is the hand of NBA superstar Giannis Antetokounmpo (my son's favorite player) compared to blogger Payal Doshi and as you can see the contrast is pretty startling!

Even for a professional basketball player Giannis has massive hands as they are nearly 10 inches long and 12 inches wide! It's no wonder his nickname is the Greek Freak as he has physical attributes far outside the norm.

We see a similar phenomenon in the images from diagnostic testing for the brain. When you see an image from a TBI test standing on it's own without any context it can be difficult to know what you're really seeing and if it's normal, slightly abnormal, or grossly abnormal. It's like in the image of Giannis Antetokounmpo's hands without the comparison those of an average person. Yes, they look big, but you don't really see how big they are in the absence of a normal sized hand to compare to.

Take for example, the image from a diagnostic test we utilize at Ethos on our TBI patients called oculomotor tracking. It shows what the eyes are following, and we know that after a brain injury these subtle eye movements are often dysfunctional.

So is the image discussed above normal or abnormal? It looks like quite a mess of jumbled lines, but we can't use that standard to decide. Take for example, the image below from a more common test called an electroencephalogram, or EEG. It also looks like a mess of random squiggling lines...

But it just so happens that the image of the EEG, is a completely normal EEG, so clearly there's a bit more to making abnormal test results obvious for an untrained eye (like a patient, attorney, or insurance adjuster) than just showing the image on it's own.

Let's use the Giannis hand comparison but apply it instead to TBI test results. Below in the images, is the same image of oculomotor tracking, but with the normal image included for comparison. As you can see, now it's obvious to anymore viewing these images just how grossly abnormal the top tracing is when compared to a normal study just below it.

Why is any of this relevant to TBI diagnostic testing? We have found that the most impactful way for these test results to be communicated effectively to patients, attorney, insurance companies, or anyone else who may be involved is to not just show the abnormal images, but to put them next to the normal ones.

For this reason we include as an appendix with all of our oculomotor testing and videonystagmography (VNG) tests normal images to make this comparison much easier and more impactful. If you aren't sure exactly what you're looking at on a set of TBI test results for your client or patient and would like to review them with me, please reach out via email at drwalker@flspineandinjury.com.

If you or someone you know would benefit from TBI diagnostics or therapy at any of our locations across Florida, please reach out via email at drwalker@flspineandinjury.com or you can call directly at 904-616-1284.

02/09/2024

Discoveries Unveiled: Loss of Smell Post Traumatic Brain Injury Can Severely Impact Quality of Life.

Close your eyes and picture what Thanksgiving dinner cooking smells like in your home. Or think of what it was like to smell the head of your newborn child as you hold them close. Have you ever been walking by a store and all of a sudden had memories flood back because they were selling the same perfume your grandmother wore?

Or even worse, have you ever been dumb enough to indulge one of your children saying, "Hey Dad, smell my finger?" I'm proud to say I've only fallen for this ruse once (my youngest son caught me off guard when he was 5, and let's just say his finger did not smell like Thanksgiving dinner or Grandma's perfume), and it's seared in my brain never to repeat the mistake!

Smells provide some of the most powerful stimulation to the brain, and has a profound impact on our memory and how we perceive the world. If you'd like a great overview of the phenomenon, I highly suggest this recent article from the Harvard Gazette titled "The Nose Knows".

Read it here:
https://news.harvard.edu/gazette/story/2020/02/how-scent-emotion-and-memory-are-intertwined-and-exploited/

It is well established that traumatic brain injury can lead to decrease or loss of smell. Studies have shown roughly 20% of TBI patients suffer with temporary or permanent olfactory dysfunction. This can be measured using standardized testing like the University of Pennsylvania Smell Identification Test (UPSIT) which we routinely utilize with our TBI patients.

A recent study helped to quantify an often overlooked element related to loss of smell: decreased quality of life.

Published in the January 2020 issue of the European Archives of Oto-Rhino-Laryngology, the study compared qualify of life in TBI patients with and without olfactory dysfunction. Previous studies had evaluated the impact of olfactory dysfunction on quality of life in areas like food enjoyment, hazard avoidance, personal hygiene, and social isolation; but very few had ever looked at this in the context of post TBI olfactory problems.

The study found that when TBI patients with olfactory issues were compared with TBI patients whose smell/taste was unaffected, those in the former group were 5 times as likely to feel more anxious, 3.4 times more likely to have weight problems, 5.5 times more likely to avoid groups of people, and 6 times as likely to feel isolated.

Remember, this isn't even comparing them to the general public, but to patients who have TBI but have their olfactory function intact.

This is why a detailed assessment of numerous aspects of brain function is critical. Too often cognitive performance and perhaps an MRI are the only tests that are performed, and it's no wonder that patients and their attorneys alike are often left with more questions than answers when it comes to objective evidence of TBI.

At Ethos, we understand that preventing olfactory issues may not be possible, but we have an extensive range of testing options available. Our cutting-edge technologies, such as VNG, EEG with ERP, oculomotor tracking, and balance testing, provide us with a wealth of valuable data for review.

Rest assured, we have a plethora of therapies that greatly improve the quality of life for our patients. Whether you or someone you know requires TBI diagnostics, TBI rehab or therapy, or a neurology evaluation, our Florida locations are here to help. Feel free to contact us via email at drwalker@flspineandinjury.com or give us a call directly at 904-616-1284. We look forward to assisting you!

02/01/2024

How Target Predicted A Teen Girl Was Pregnant....Will Your iPhone Do The Same For TBI?

The amount of data that is being collected on a given day in our lives is quite frankly staggering. Retailers have perfected the science of data mining to predict purchasing patterns, trends, and apparently even pregnancy.

Target is one of the most sophisticated retailers when it comes to the analysis of consumer shopping habits, largely because of the reams of data generated by it's app many shoppers use. One of the predictions Target data scientists learned to make was pregnancy, as this is a very lucrative stage of life for retailers given that there are loads of purchases that are now a necessity, and price sensitivity is typically lower than normal.

For example, lots of people buy lotion, but Target noticed that women on the baby registry were buying larger quantities of unscented lotion around the beginning of their second trimester. They also noted that sometime in the first 20 weeks, pregnant women loaded up on supplements like calcium, magnesium and zinc. Many shoppers purchase soap and cotton balls, but when someone suddenly starts buying lots of scent-free soap and extra-big bags of cotton balls, in addition to hand sanitizers and washcloths, it signals they could be getting close to their delivery date.

All of came to a head a few years ago for Target when a store manager in Minneapolis was confronted by an angry father.

“My daughter got this in the mail!” he said. “She’s still in high school, and you’re sending her coupons for baby clothes and cribs? Are you trying to encourage her to get pregnant?”

The manager didn’t have any idea what the man was talking about. He looked at the mailer. Sure enough, it was addressed to the man’s daughter and contained advertisements for maternity clothing, nursery furniture and pictures of smiling infants. The manager apologized and then called a few days later to apologize again.

On the phone, though, the father was somewhat abashed. “I had a talk with my daughter,” he said. “It turns out there’s been some activities in my house I haven’t been completely aware of. She’s due in August. I owe you an apology.”

This brings me to a study I read that was recently published in the journal, Nature. The study discovered that the results of neuropsychological testing could be predicted by analyzing 7 days of smartphone usage (you can check out the study by clicking the link below). The authors claim that, "preliminary results suggest that passive measures from smartphone use could be a continuous ecological surrogate for laboratory-based neuropsychological assessment."

While I don't think this will replace neuropsych testing anytime soon, it is fascinating to see that how a smart phone is used gives equivalent data to measuring executive function, dexterity, trail making, and cognitive function with sophisticated testing. There are also software programs in the works that can assess cognitive function via analyzing typing and speech patterns, so this is just the tip of the iceberg for the biomarkers we'll soon be able to assess.

With the array of testing available at Ethos we can't predict pregnancy, but we do have a robust amount of data that can be reviewed with VNG, EEG with ERP, oculomotor tracking, balance testing, and much more. If you or someone you know would benefit from TBI diagnostics, TBI rehab or therapy, or neurology evaluation at any of our locations across Florida, please reach out via email at drwalker@flspineandinjury.com or you can call directly at 904-616-1284.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550173/

01/26/2024

A Weird Recipe for Squishy Brains by A Leading Neurologist

If you're like most people you've never had the opportunity (if you want to look at it this way) to touch a human brain. You probably envision it as having a firm, rubbery type of texture, but in reality, the brain has a much softer texture that feels more like tofu or butter. When you add to that the numerous sharp edges and protuberances inside the skull, it's easy to see how the brain can be injured in events that might not seem particularly violent, like a low speed car crash.

If you're ever wanted to feel the consistency of the brain first hand, but are a bit squeamish about how this could be achieved then world-renowned neurologist Daniel Amen has a solution for you.

Watch the video below to see how you can recreate the squish feel of the human brain:

https://www.youtube.com/watch?v=eA9kJGqHX4A

I haven't cooked this up in my kitchen yet, so drop me a line if you actually recreate Dr. Amen's brain recipe and tell me what you think.

If you'd like to see a more realistic video showing the soft, pliable nature of brain tissue, this if from the University of Utah's Neurosurgery Department (warning, don't watch if you are disturbed by blood as this is a much more clinical video than the first one).

https://www.youtube.com/watch?v=jHxyP-nUhUY

If you or someone you know would benefit from TBI diagnostics or therapy at any of our locations across Florida, please reach out via email at drwalker@flspineandinjury.com or you can call directly at 904-616-1284.

01/18/2024

Unbelievable Resilience: How a Headless Chicken Defied the Odds and Survived the Most Severe TBI for 18 Months.

In September 1945, farmer Lloyd Olsen tried to kill a chicken named Mike to eat for dinner. His ax missed the chicken's jugular vein and most of its brain stem, so Mike remained alive. For 18 months the farmer fed it a mixture of milk and water using an eyedropper and toured with the chicken across the United States.

Beyond a sideshow oddity, Mike the chicken illustrates an important concept of the neuroarchitecture of the brain known as neural circuit function redundancy. This refers to the fact that vastly different synaptic connections can enable the same neurologic function. It's a design mechanism to ensure that if damage is sustained in a specific area of the brain there are other regions that can still pick up the slack.

Given that none of you will likely find a niche representing wrongfully beheaded chickens, why is this of relevance to your practice?

I have found that many attorneys want to grab onto imaging findings like white matter lesions in a particular part of the brain on MRI and make the easy link of "There's a lesion on this part of the brain, and the patient reports symptoms associated with injury to that part of the brain, so this is a slam dunk."

The challenge with this way of thinking lies in the redundancy concept I mentioned earlier. There are virtually no bodily functions that are exclusively controlled by just a single area of the brain. So rather than pin your case on one particular diagnostic study or one specific brain region it may be more prudent to evaluate as many domains of brain function as possible with as many tools available.

For example, damage to the cerebellum could be assessed by performing oculomotor tracking (such as the images attached to this post), videonystagmography (VNG), and computerized balance testing.

Other tests can then be layered on top of these to assess other regions of the brain like EEG with ERPs, quantitative pupillometry, autonomic testing, neurocognitive testing, olfactory testing, and more. While I don't know that any of these tests would have been needed to diagnose the source of Mike the headless chicken's problems they can be quite impactful for your injured clients.

If you or someone you know would benefit from TBI diagnostics or therapy at any of our locations across Florida, please reach out via email at drwalker@flspineandinjury.com or you can call directly at 904-616-1284.

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