Is studying Neurosciences as easy as driving a car?

Warm wishes to all my dear teachers, colleagues and students who motivated me to an attempt to write this small piece of article for them.

-          Love, AS

One of the most interesting subjects that we as physiotherapists interact with is neurosciences. It is an extremely interesting subject wherein there are multiple challenges and equally interesting results seen. But somehow, many times the young budding Physios are scared or sceptical about this subject and majority have an aversion or a poor understanding for it.

I remember my own experiences as a young undergraduate student who was totally scared and aversive towards neurology as a clinical subject. But interaction with 5 Neuro stalwarts changed my perspectives towards neurology and made me realize that studying neurosciences is as easy as driving a 2 wheeler or a car.

My elder brother always used to tell me as a young lad learning to drive a 2 wheeler that the 1^st thing you have to know when you drive any vehicle is to know where the brakes are. Once you start, you won’t have the time to search for it later. So what happens if there is a problem with the brake of our vehicle? Obliviously it won’t stop and go out of control. So do we see such a thing in our body in any diseased condition? Do we see something like this when the patients cannot control their movements and tend to go out of control? This is what happens when we have a lesion in the cerebellum. Thus the cerebellum is the brake of the human body. Involvement of this system causes our break failure and we tend to see overshooting, inappropriate stepping, in coordination in walking and other activities. This is what we classically describe as ataxias.

But by itself the brakes cannot control the vehicle if we do not control the steering wheel or the handle. Thus it becomes very important to steer a vehicle properly in order to prevent accidents and reach our destination. This steering function is by our basal ganglia. Just like steering control loss would make the vehicle go out of control, similarly involvement of the basal ganglia can make us go out of control. Such is seen in conditions like hemiballismus where loss of steering control is seen.

So who drives us then? When we start a car, the engine starts but the vehicle cannot move. The engine is our wakefulness which is controlled by the Reticular system. If the reticular system is impaired, we won’t get ‘started’. Thus the driving force for us is in this system. But is the reticular system capable of driving us by itself? Even if the engine has started, it will just continue to be in idling unless we accelerate the vehicle. The accelerator is very important tool in this. So what happens when we keep the engine in idling without accelerating? It’s simple, we just won’t move anywhere. This function of generating stimulus for movement and accelerating our body is by the motor cortex of the cerebral system. The cortex ensures that we are accelerated adequately to move in an appropriate manner. So what happens if our accelerator gets damaged? We will have problems generating that amount of tone in order to move ahead. This is classically seen in injuries of the motor cortex like stroke patients. Their engines are at an idling situation but are unable to accelerate to move their body in a required manner and thus they generate spasticity.

Also, this engine, in order to move the vehicles, has to move the axle or the chain/ belt of the vehicle in a proper gear. What can happen if this axle or belt breaks? Results will be the same. The engine will keep on idling but will not be able to move the car. Thus axle or belt is the spinal cord. When it is injured, the brain generates an idling tone but the limbs cannot move as there is no transmission by the engine to the tyres. This is what can be seen in paraplegia or quadriplegia.

So then what happens to the car when the engine starts, we don’t put vehicle in gear but just accelerate? The car would not move. Instead, it would just create a lot of RPMs and start vigorously vibrating. The more we accelerate the more sound it would produce and create a static rigidity. This is classically what would happen when there is lesion of the extra pyramidal system. The body’s engine starts increasing a lot of tone, but the person cannot move anywhere. Thus the extra pyramidal system (Substantia Nigra) is the gear of the human body. We always have to drive our car in the proper gear or it can damage the engine due to excess RPMs. Even the extra pyramidal system puts our body in proper gears in order to drive ourselves in proper systems. So what if my gears don’t work properly? I would produce excess tone but not able to move properly. Just try driving your car in 1^st gear at speed of 40 or 50 and you will experience a festinating gait. (I didn’t advice to experiment such driving with the brakes cut). Thus an extra pyramidal system problem gives us excess tone but no movement. Incase we move, it will be like speeding in the 1^st gear. This is what we see in Parkinson’s patients, lot of resting movement but no motions as against Cerebellar Ataxias where there is no movement till vehicle moves, but once it does, there are movement tremors.

So if we look at things simply, the upper motor neuron, cerebellar system and extra pyramidal systems are much easy to understand. So what about the lower motor neuron system? Well, the vehicles have lots of wiring and cable systems. These connects the battery (heart) to the lights (visual), horn (auditory), brake cables (nerves), and the AutoCop security system (skin). Lesions in any of these cables will eventually cause inability to generate stimulus to that part and thus produce weakness. There may be a short circuit in the wires where the wire covering may be removed (neuropraxia) to the point where the entire wire is broken (neurotemesis) and thus cause problem in handling the car.

Well, there’s still a lot to go on. Recent technology allows us a lot of luxury while driving. We now have the GPS system which allows us to detect directions to reach our destination and identifies driving challenges. This is the role of the frontal cortex which helps in planning and mapping of tasks and systems and identifies objects. Also the high class vehicles have a climate (cruise) control system in order to automatically detect and maintain the temperature and internal atmosphere of the car. This is what the Hypothalamus does for us.

In spite of all the systems working ok, there would still be a problem if there is dust in the carburettor or the air filter. Also when the vehicle will run, the engine will get heated and the vehicle will start experiencing jerks. Such is the dyspnoea seen in disorders of the respiratory system. Also what can all these do when the chassis of the car breaks!!! Thus is the importance of the musculoskeletal system. But heyyy!!!, weren’t we just discussing neurosciences????

So easy or difficult is up to you all to decide. All I can say is thanks to my stalwarts of neurosciences and to many others who have been doing their best to generate interest in neurosciences amongst many young Physios for years apart. So who says studying neurology is really difficult. You always learn it when you just drive your car……

Apurv Shimpi

A SALUTE TO THE BRAVE 2 WHEELER RIDERS OF PUNE

Often when I drive my car on the busy streets of Pune, I happen to give lots of gaalis to the cycle & two wheeler riders (mann me ha…, as do all the car & bus drivers). The two wheeler riders show the bestest example of the most undisciplined traffic followers in the entire world. From lane cutting, to criss crossing, to breaking the signals (which is our birthright in Pune), they do everything. And especially in the rainy season, they particularly happen to drive right in front of you at the slowest pace.

And then I took up to driving my two wheeler for this season as well (petrol costs & everyday car……, phew). I seriously think driving a two wheeler is a huge task in Pune. I remember P.L. Deshpandes Mumbaikar, Punekar ka Nagpurkar where he says driving a two wheeler in Pune is equivalent to driving a national movement, most difficult task… And as a Physio I started perceiving the problems that 2 wheeler riders encounter in Pune.

Well, we all know Pune has the highest number of two wheelers in India (Or Asia or the World I think). Most of us city riders have the scooter types. I know we can’t insult the two wheelers by calling them scooters, but guys, they are what they are. Most of these auto-gears two wheelers are the most prominent sources of back & neck problems in this city. (I’m happy for this yaar. Gives me my patients, right!!!)

The small bases of the wheels are poor shock absorbers. As against the bikes, who have large wheel diameters & thus provide better shock absorption. Whenever we are sitting on any engine, there are two problems worth understanding. One is the sitting position itself. Sitting increases the pressures within our vertebral discs to a large extent. Our back is a rigid pillar consisting of components giving us mechanical & structural stability. We have natural bends (curves) in our spine which help in giving us an upright posture. But more so, these curves work as our natural shock absorbers helping us distribute the loads on our body. This function is largely done by our vertebral discs which are the best force distributors ever occurring naturally. But they require support & reinforcement by our core muscles as well. The discs encounter minimal force in a lying down position, more force in standing, still more in sitting & a lot more force while sitting with back unsupported. This is exactly what happens when we are sitting on a two wheeler because no two wheelers have a seat with back support.

The second problem is the vibrations of the engine. 4 stroke engines have fewer vibrations than 2 stroke engines. But engine vibrations are directly related to the cc’s of the engine. More cc displacement means more engine power & also more engine vibrations. These vibrations on the unsupported back by themselves are good enough to give us back problems. And to add to the misery are the obstacles on the roads. These can be our beloved potholes, speed breakers or even the so called crossings for senior citizens. And jerk to the back means an increase & rise in the disc pressures almost 60 to 70 times of their normal capability. This is true for the back as well as the neck. Also the posture we drive is very bad. Instead of a proper upright position, we prefer to bend forwards while riding. (Style hai bhai…) This puts high amounts of forces on the spine. I’m very sure more than 90% of the two wheeler riders in Pune suffer from back pain, neck pain & neck spasms.

The other frequently encountered “adventures” of two wheelers are triple seat riding. Most of the two wheelers have a suspension system adequate for one or maximum two riders. A few two wheelers these days have good telescopic suspensions as well, but only for the front wheels. So the poor pillion riders is most of the times compromised. Triple seat riding puts excessive loads on the shock absorption system which has never been designed to handle extreme loads. This misfires badly on our spine & makes us vulnerable to back injuries. The other adventures include driving on the wrong side of the road & breaking signals. This “risks” are the commonest causes of accidents & injuries but are highly neglected in our scenario.

To add to this, we all take it as a personal insult to wear helmets as well. I really don’t know why we feel insulted or inferior or below our dignity to follow any of the traffic rules & laws. Helmets are amongst the best protectors against head injuries. (But we all already know this). The only exception can be people suffering from neck pain & discomfort as this may aggravate their problems. But apart from this, its helmet or hell met…..

Also is the mobile style. Why do we need to talk with someone soo urgent while driving? That too when riding a scooter. The auto gears have rear brake on left & front brake with accelerator on the right. So many accidents of skid & fall happen cause left hand is occupied holding the mobile phone and the person tries to stop urgently with the front brake accelerating at the same time. Not only are cell phones a huge distractors while driving, they are also potential hazards for accidents. And if cell phones are not enough, we see two riders on two bikes chatting with each other riding in middle of busy streets & increasing the temperaments of the other drivers. Guys…. Drive on the same bike na…

When driving the car, I used to get soo annoyed on the way the two wheelerwalas come in front & drive soooo slow. But while driving a two wheeler I realized how unstable it feels to drive on wet roads with all loose gravel lying on it. I’ve seen riders skid & fall soo bad, especially while driving at fast speeds on a curve, it really makes me wonder, is this thrill worth the fractures & the pain??? Rash driving, breaking signals, riding triple seat we feel it’s a thrill. One of my friend told me that I’m missing the thrill of my life & am too “darpook” cause I don’t do anything of this. I took him to our hospital trauma ward & showed him all the two wheeler accident cases & told him, I’m happy as I am missing this thrill as well.

Whatever it is, problems are many & solutions few. In a city with poor public transport systems, costliest petrol prices & highest two wheeler producers, using these machines of health “disbenefits” seem to be the only solution for the masses. But whatever it may be, rules & regulations are meant for our own health & safety. There are a few factors which may not directly be in our control. But most of the factors associated with riding a two wheeler are definitely in our own hands. Use of helmets, following the traffic signals, avoiding rash driving & triple seat riding, regular vehicle servicing, following speed limits (if any), riding on the roads (and not from footpaths & wrong side), avoiding lane cutting may not just serve only to improve this beautiful city. It will also contribute to improvisation of our health & cutting down of our health costs which happen just cause of small negligence from our part. I know it is easier said than done. 

But I have surely realized & understood what a brave breed of people live in Pune & live their lives riding two wheelers. All I can say is, I salute the brave two wheeler riders of Pune.