"The human immune system makes my head explode," Pulitzer Prize-winning journalist Matt Richtel recently told a University of Alabama at Birmingham freshman seminar on immunology. "This is by far the hardest subject I have ever had to explore."

Richtel, a longtime New York Times reporter, was explaining why he wrote his general interest book "An Elegant Defense -; The Extraordinary New Science of the Immune System," which the class was reading.

Richtel's curiosity began when his boyhood buddy Jason Greenstein, "the best kind of jock," got cancer in his 40s.

"He had 15 pounds of cancer, went into hospice and was supposed to die," Richtel said through a video link with the UAB Honors College freshman seminar. However, when Greenstein -; who had "nine toes in the grave" -; got experimental immunotherapy, the cancer disappeared, though Greenstein later died. "I didn't understand," Richtel said. "What is this thing called the immune system, that they can tinker with to keep us alive?"

Indeed, what is this thing, which is so complex and important in human health, development and disease? The UAB seminar freshmen are just beginning to scratch its surface.

In many ways, immunology is as challenging a major as neuroscience, another undergraduate major found in the UAB College of Arts and Sciences and at many other colleges.

Both the nervous system and the immune system are composed of a widespread network of organs, tissues, cells and soluble mediators that work together. Both systems interface with every organ in the body, as well as each other. Each plays critical roles in health and disease, and both require years of study for a student to grasp how the system works, and to tread a landslide of nitty-gritty mechanistic interactions that regulate normal function, or that misfire to cause disease, dysfunction and, sometimes, death.

Yet the two majors have a difference. Neuroscience is far more obvious. Each of us knows we have a brain. We daily experience five senses that report the world around us and convey pleasure or pain. Many of us have relatives or older friends who suffer the visible signs of neurodegenerative disease.

Immunology lacks this focus. Where or how does the immune system operate? What are its components? For most of us, the immune system is a vast, foggy landscape where many important things happen beneath our notice.

These differences explain, perhaps, why the number of neuroscience undergraduate majors has boomed in the past three decades, while in-depth immunology undergraduate majors still remain few. One of the few is UAB's major, begun in 2017.

The UAB immunology joint-health program in the UAB Department of Biology and Department of Microbiology is a four-year curriculum. After the freshman UAB honors seminar, full-semester courses include current topics in immunology, the innate immune system, the adaptive immune system, the microbial pathogen-immune system interaction, and immunologically mediated diseases.

The education is wide-ranging, and students also work in laboratories, readying themselves for careers in the health professions or research.

Immunology, by nature, is interdisciplinary. It requires a knowledge of cellular and molecular biology, genetics, biochemistry, physiology, and anatomy. Freshmen are introduced to medically related conceptual frameworks that continue through the four-year curriculum -; how immunology relates to vaccines, emerging infectious diseases, autoimmunity, allergy, transplantation, cancer and immunotherapy. Students learn how the immune system is relevant to health and disease."

Lou Justement, Ph.D., the teacher, along with Heather Bruns, Ph.D., of the honors seminar. Both are microbiology faculty in the UAB School of Medicine

Richtel took a different approach. Rather than write an immunology textbook, he put faces on the role of immunology in health and disease. Parts of "An Elegant Defense" tell the stories of Jason, Bob, Linda and Merredith, and the burdens they faced -; Hodgkin's lymphoma, HIV infection, rheumatoid arthritis and lupus. Richtel also relates surprising twists and turns for basic researchers who studied the immune system. "It's a story," he writes at one point, "that begins with a bird, a dog and a starfish."

During the video Q&A with students, Richtel wore a UAB T-shirt. Most of the UAB students asked how he reported and wrote the book. "One of the hardest things to do when writing is to find your framework that will pay off the reader as you promised," he said.

And Richtel asked questions right back, offering guide stones of advice for the students:

UAB freshman Chandni Modi was one of the enthusiastic participants in the Q&A with Richtel. Afterward, the Indian Springs School graduate said, "Honestly, at the beginning of my high school senior year, UAB wasn't one of my top choices. However, after I started comparing my options, UAB was the only school that offered immunology as a major, and UAB offers so many ways to get involved in research."

"Also," she said, "I appreciated how diverse the university students and faculty are."

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UAB seminar on the extraordinary science of the immune system - News-Medical.net

Seven young women die weekly in Liberia because they can't get to hospital to birth their babies, which also results in the tragic death of their child.

A small British Columbian charity is hoping to help change this heartbreaking reality with an incredible Christmas gift that will greatly help expectant mothers in the West African country a fully outfitted ambulance.

Korle-Bu Neuroscience Foundation is sending the brand new obstetrics-focused ambulance to Liberia this week to help ensure women can make it to the hospital during their most critical moments of childbirth. The foundation has been helping to enhance healthcare in West Africa through medical equipment donations, missions and surgeries since 2002 and has now turned its attention to this critical need.

Marj Ratel, foundation founder, said pregnant women had almost no support when something went wrong during childbirth, and many died on the roadside trying to reach a hospital.

The charity shipped a previous ambulance to Liberias Ministry of Health in February and officials quickly discovered the need among pregnant women was alarmingly high.

"More than half of all emergency calls for our first ambulance were related to obstetrics," Ratel said.

"This ambulance is the best Christmas gift I can imagine.

The $40,000 ambulance is being donated to the foundation by Nanaimo-based international air medical transportation company Lifesupport Air Medical Services, Inc.

Graham Williamson, Lifesupport president, will also create a new obstetrics curriculum to train Liberian first responders and paramedics, whom he plans to personally instruct with members of his Critical Care Transport Team while overseas in the New Year.

At the moment, specialized neuroscience and maternal healthcare are virtually non-existent in the region.

We realize the immediate need is to get expectant mothers to the hospital quickly, while also providing front line training in emergency obstetrical care to the dedicated and fledgling group of new paramedics in Liberia, Williamson, a licensed Canadian paramedic said.

Even if the ambulance cannot transport the patient quickly enough, we will be equipping these dedicated first responders and paramedics with the skills they need to help expectant mothers and their newborns right away, by providing critical life-saving interventions before arrival at the hospital."

The new ambulance will be transported to Liberia via shipping container with an incubator, neurosurgical microscope, and other lifesaving medical supplies thanks to sponsorship partners.

While the charity now has a second ambulance to help, it is still critically in need of donations to provide the training for West African paramedics and health workers, and allow KBNF to operate into 2020.

The charity is short $50,000, which is needed to fund its next training mission and transport shipments of supplies to make the ambulance a success.

Were asking Metro Vancouver to step up this holiday and make this Christmas miracle last, Ratel said.

The charity traces its beginnings to Vancouver Coastal Health in 2000, when Ratel and three neuro nurses launched a partnership with a West African neurosurgeon aimed at building neuroscience care abroad.

Since 2002, the foundation has shipped more than $17 million worth of medical equipment to West Africa, performed hundreds of neurosurgeries for patients and offered training to thousands of healthcare workers. VCH continues to donate used medical equipment to KBNF, which is shipped to Africa.

Find out more about the charity here.

Read the original article here.

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This small B.C. charity is sending a life-changing Christmas gift to West Africa - Vancouver Courier

A pioneering electrical spinal implant being developed at the University of Alberta could soon be getting patients with life-changing injuries up and walking again. So far, the device has proven to be effective in trials on macaque monkeys, but the researchers are hopeful that it will be available for use on human patients in as little as a decade.

We think that intraspinal stimulation itself will get people to start walking longer and longer, and maybe even faster, said lead researcher Dr Vivian Mushahwar, of the University of Albertas Neuroscience and Mental Health Institute. That in itself becomes their therapy. Theres been an explosion of knowledge in neuroscience over the last 20 years. Were at the edge of merging the human and the machine.

The device features hair-like electrical wires that plunge deep into the spinal grey matter, sending electrical signals to trigger the networks that already know how to do the hard work.

To work alongside the implant, the team created a map to identify which parts of the spinal cord trigger the hip, knees, ankles and toes, and the areas that put movements together.

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People tend to think the brain does all the thinking, but the spinal cord has built-in intelligence, Mushahwar says. A complex chain of motor and sensory networks regulate everything from breathing to bowels, while the brain stems contribution is basically go! and faster! Your spinal cord isnt just moving muscles, its giving you your natural gait.

Being able to control standing and walking would improve bone health, improve bowel and bladder function, and reduce pressure ulcers, the researchers say. For those with less severe spinal injuries, an implant could be therapeutic, removing the need for months of gruelling physical therapy regimes that have limited success, they add.

The team say they are now going to focus on refining the hardware further by miniaturising an implantable stimulator and getting approval from Health Canada and the FDA for human trials. The first generation of the implants will require a patient to control walking and movement through physical means, but longer term, the implants could potentially include a direct connection to the brain, they say.

Imagine the future, Dr Mushahwar said. A person just thinks and commands are transmitted to the spinal cord. People stand up and walk. This is the dream.

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Micro implants could restore walking in spinal injury patients - sciencefocus.com

Citing research conducted at eleven different universities, the author of a new book entitled, "Consciousness, The Hard Problem Solved," reveals what the findings if that research clearly indicate, in the aggregate, to be the origin of consciousness.

Richmond, VA, December 14, 2019 --(PR.com)-- What scientists today call the Hard Problem is devising a theory to explain how the brain creates consciousness. For the past hundred years or more, ever since Scientific Materialism has dominated the field of science, scientists have been trying to determine how matter is able to create consciousness. This is because the implication of Scientific Materialism from a philosophical standpoint is physicalism, the metaphysical thesis that everything is physical, and that there is nothing over and above the physical. Therefore, mind or consciousness, the sense of awareness and being that each of us has, must be produced solely by the brain, which according to Materialism is comprised of unthinking matter.

In his new book, "Consciousness, The Hard Problem Solved," Amazon bestselling author, Stephen Hawley Martin offers a solution, citing the findings of research conducted at the University of Virginia, the University of California at Berkeley, the University of Munich, the University of Maryland, The University of Maryland at Baltimore County, Yale University, the University of Tasmania, Duke University, the University of Marbury in Germany, Atlantic University, and Columbia University to back up his claim.

Martin said that in spite of findings that are virtually impossible to refute, he expects push-back from some religious leaders as well as from ardent Scientific Materialists because the solution he offers challenges certain tenets held by each group. He said this is to be expected and quoted the 19th century German philosopher Arthur Schopenhauer [1788-1860] as having said, All truth passes through three stages: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident.

Martin said, I can say from experience that Christian fundamentalists and many Materialists appear to be in the ridicule-to-violently-oppose stages concerning what seems obvious to me is the source of consciousness. However, having had conversations with dozens of cutting-edge thinkers while developing my theory, I am certain it is only a matter of time before the origin I have identified is accepted as self-evident by open-minded individuals who think for themselves.

"Consciousness, The Hard Problem Solved" is published by The Oaklea Press Inc. in Kindle, ASIN: B081LPPD8G, for $3.99 and in trade paperback, ISBN-10: 1708969233, for $9.99. The Oaklea Press (www.oakleapress.com) was founded in 1995 and publishes primarily business management, metaphysical, and self-help titles.

Contact Information:The Oaklea PressSteve Martin804-218-2394Contact via Emailwww.oakleapress.com

Read the full story here: https://www.pr.com/press-release/801569

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New Book Explaining the Origin of Consciousness is Now a Bestseller in the Neuroscience Category on Amazon - Benzinga

Aspen Neuroscience, a new San Diego biotech company working on stem cell treatment for Parkinsons disease, has come out of stealth mode and raised $6.5 million to pursue clinical testing for its therapy.

Co-founded by well-known stem cell scientist Jeanne Loring, Aspen Neuroscience proposes creating stem cells from modified skin cells of Parkinsons patents via genetic engineering.

The stem cells, which can become any type of cell in the body, then would undergo a process that makes them specialize into dopamine-releasing neurons.

People with Parkinsons lose a large number up to 50 percent at diagnosis of specific brain cells that make the chemical dopamine.

Without dopamine, nerve cells cannot communicate with muscles and people are left with debilitating motor problems.

Once these modified skin cells have been engineered to specialize in producing dopamine, they can be transplanted into the Parkinsons patient to restore the types of neurons lost to the disease.

The reason we called it Aspen is because l was raised in the Rocky Mountain states, said Loring. When there is a forest fire in the Rockies, the evergreens are wiped out but the aspens are the fist that regenerate after the burn. So it is a metaphor for regeneration.

Aspen still has a long way to go before its proposed therapy would be available to Parkinsons patients. It has been meeting with the U.S. Food and Drug Administration to provide animal trial data and other information in hopes of getting permission to start human clinical trials.

But the company expects the earliest it would get the go-ahead from FDA to start human trials would be 2021.

Loring has been working on the therapy for eight years. She is professor emeritus and founding director of the Center for Regenerative Medicine at the Scripps Research Institute.

Loring co-founded the 20-employee company with Andres Bratt-Leal, a former post-doctoral researcher in Lorings lab at Scripps.

Joining them as Aspens Chief Executive is Dr. Howard Federoff, former vice chancellor for health affairs and chief executive of the University of California Irvine Health System.

Federoff said the company is the only one pursuing the use of Parkinsons patients own cells as part of neuron replacement therapy.

Aspens proprietary approach does not require the use of immuno-suppression drugs, which can be given when transplanted cells come from another person and perhaps limit the effectiveness of the treatment.

Aspens approach is a therapy that is likely to benefit from the fact that your own cells know how to make the best connections with their own target cells in the brain, even in the setting of Parkinsons disease, said Federoff. So when transplanted it is able to set back the clock on Parkinsons.

In addition to Aspens main therapy, it is researching a gene-editing treatment for forms of Parkinsons common in certain families.

Aspens research work up to now has been supported by Summit for Stem Cell, a non-profit on which provides a variety of services for people with Parkinsons disease.

The new seed funding round was led by Domain Associates and Axon Ventures, with additional participation from Alexandria Venture Investments, Arch Venture Partners, OrbiMed and Section 32.

Aspens financial backing, combined with its experienced and proven leadership team, positions it well for future success, said Kim Kamdar, a partner at Domain Associates. Domain prides itself on investing in companies that can translate scientific research into innovative medicines and therapies that make a difference in peoples lives. We clearly see Aspen as fitting into that category, as it is the only company using a patients own cells for replacement therapy in Parkinsons disease.

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Aspen Neuroscience gets funding to pursue personalized cell therapy for Parkinsons disease - The San Diego Union-Tribune

In an area spanning 300 by 300 micrometers, this image highlights neurons in the motor cortex captured while a mouse performs a lever-pressing task. The brighter neurons were actively firing when the image was taken.Credit: Komiyama Lab, UC San Diego

If you think of the human brain as a computer, its hard not to be impressed.

It can perform well over a trillion logical operations per second. Its compact, fitting neatly inside the skull. It uses as much power as a light bulb, and it has a seemingly endless capacity for data storage.

Despite massive investment in recent years, humanitys knowledge of the brain, which has about 86 billion neurons and more than a quadrillion synapses (or connections), is relatively limited.

To better understand the organ, a University at Buffalo-led research team has been awarded a $2 million National Science Foundation grant to build an interdisciplinary research program that explores how the brain learns and stores information.

Our brains provide us with near-infinite capacity to learn and better understand our world, yet its the organ that we know least about, says the projects lead investigator Rudiyanto Gunawan, associate professor of chemical and biological engineering in the UB School of Engineering and Applied Sciences.

Gunawan says the project could ultimately inspire new computer architectures, leading to more powerful and efficient supercomputers, as well as new treatments for disorders responsible for memory loss, such as Alzheimers disease.

Establishing a truly brain-like platform would have a massive impact, said Takaki Komiyama, a professor of neurobiology (Division of Biological Sciences) and neurosciences (Department of Neurosciences, School of Medicine) at the University of California San Diego. For neuroscience, that could be a unique system on which we can perform precise manipulation experiments at will to understand the critical features of brain circuits. The platform could also be developed into neuromorphic computing and data storage devices.

Co-principal investigators (in alphabetical order) also include Claudia Mewes, associate professor in the Department of Physics and Astronomy at the University of Alabama; Linbing Wang professor of transportation infrastructure and systems engineering in the Charles E. Via, Jr. Department of Civil and Environmental Engineering at Virginia Tech; and Ying Zhang, associate professor of cell and molecular biology in the College of Environment and Life Sciences at University of Rhode Island.

The team will focus on the motor cortex, a portion of the brain responsible for the planning, control and execution of voluntary movements. Research in this region of the brain in mice has shown neuronal activity associated with motor skill learning.

When presented with a new task, the firing of connections between neurons appears random. As the task is repeated, neuronal activity in this second phase of learning spikes. That is followed by a third phase in which a consistent pattern of neuronal activity emerges that is unique for each mice.

As the brain learns, it finds the most efficient networks to process and store information, says Gunawan. We want to know how this happens so we can incorporate this knowledge into artificial devices that will help us solve some of societys most pressing problems.

To accomplish this, researchers are planning whats been described as a neuromorphic platform, which essentially is a system that simulates the brain, or parts of it.

The platform the team intends to create will focus on hundreds of neurons. Eventually, the researchers hope to expand this model to 10,000 neurons.

There has been an explosion of neuroscience data in recent years thanks to major initiatives underway in the U.S., Europe, Japan and elsewhere that will aid the teams work.

The team will develop artificial intelligence algorithms to analyze countless microscopic images and single neuron molecular profiles that have been generated from brain networks in mice.

From these data, researchers plan to create large-scale biochemical models which illustrate neuronal activity. To further validate and emulate how neurons behave, the team also plans to develop a spintronic device thats capable of producing complex computer simulations of brain activity.

The overarching goal, Gunawan says, is to create a multidisciplinary and robust platform for studying the brain. This could lead to brain-inspired devices for information processing, data storage, computing and decision-making.

The human brain is roughly 12 orders of magnitude more efficient than state-of-the-art supercomputers. Imagine if we could translate that efficiency in computer architectures, he says.

While advanced supercomputing has endless possibilities, especially as it relates to medicine and pharmaceuticals, the platform itself could be beneficial for researchers studying brain disorders, he says.

The ability to accurately simulate neuronal activity as it relates to memory loss, cognition and other behaviors is of paramount importance to developing new treatments for many of the most devastating neurological disorders facing society, he says.

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UC San Diego Neurobiologist Part of $2 million Project to Study Brain, Motor-skill Learning - UC San Diego Health

RIT will use a substantial gift of real estate in Penfield to expand the universitys research and educational offerings in ecology, agriculture, sustainability and other fields. Amy Leenhouts Tait and Robert C. Tait have gifted to the university their 177-acre property, which will be dedicated as the Tait Preserve of RIT.

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New applied cognitive neuroscience course offered at RIT | College of Science - RIT University News Services

Becker's Healthcare named the following organizations to the 2019 edition of its list "100 hospitals and health systems with great neurosurgery and spine programs."

The organizations featured on this year's list have extensive neurosurgery and spine programs, providing treatment and cutting edge research into brain and spine disorders. Many hospitals and health systems featured have earned top honors for medical excellence, outcomes and patient experience in their spine and brain surgery departments.

To develop this list, the Becker's Healthcare editorial team examined national rankings and awards for neurosurgery and spine care. The editorial team examined U.S. News & World Report national rankings for neurology and neurosurgery; CareChex national and regional rankings for neurological care and Blue Distinction Center for Spine Surgery designation to develop this list. Please contact Laura Dyrda at ldyrda@beckershealthcare.com with any questions about this list.

Note: Hospitals cannot pay for inclusion on this list. Organizations are presented in alphabetical order.

Abbott Northwestern Hospital (Minneapolis). At Abbott Northwestern Hospital's Spine Institute, physicians treat more than 4,000 patients annually. The hospital has been designated as a Blue Distinction Center for Spine Surgery by BlueCross BlueShield of Minnesota. With five area partners, Abbott Northwestern Hospital was ranked on U.S. News & World Report's list of 50 best hospitals for neurology and neurosurgery in 2019-20.

AdventHealth Orlando (Fla.). AdventHealth's Neuroscience Institute provides comprehensive care to patients with brain and spinal disorders. The health system's brain tumor team includes 12 physicians, and the spine team features 15 physicians that aim to stay at the forefront of spinal treatment. With an elite team, U.S. News & World Report ranked AdventHealth Orlando among the 50 best hospitals for neurology and neurosurgery for 2019-20.

Ascension Seton (Austin, Texas). Physicians at Ascension Seton's Brain & Spine Institute specialize in minimally invasive and complex surgery for patients suffering from problems with their brain, spine, cerebrovascular system and peripheral nerves. Spine, orthopedic and neurosurgeons at the hospital have been recognized nationally and internationally for pioneering new treatments and research. The Seton Brain & Spine Institute has five locations offering neurosurgery across Texas.

Atrium Health (Charlotte, N.C.). Atrium Health offers one of the region's largest neurosurgery specialty programs. The health system's spine institute has been recognized by Blue Cross Blue Shield as a Blue Distinction Center for its quality care and outcomes. An early adopter of minimally invasive and robotic surgery, Atrium Health's Neurosciences Institute has 20-plus years of groundbreaking investigator-initiated and industry-sponsored clinical trials.

Barnes-Jewish Hospital/Washington University School of Medicine (St. Louis). The Barnes-Jewish & Washington University Spine Center receives patient referrals from all around the world. As a result, it has grown into one of the largest clinical spine practices in the nation. U.S. News & World Report ranked Barnes-Jewish Hospital and Washington University School of Medicine among the top 50 hospitals in the nation for neurology and neurosurgery, and the top hospital in Missouri for those specialties in 2019-20.

Barrow Neurological Institute (Phoenix). Physicians at Barrow Neurological Institute oversee more than 8,000 admissions and perform more than 5,000 neurosurgeries annually more than anywhere else in the U.S. There are 26 neurosurgeons, nine neurosurgery fellows and 28 neurosurgery residents on staff at the hospital. As one of the leading spine organizations in the world, U.S. News & World Report named Barrow Neurological Institute among the top 50 hospitals in the nation for neurology and neurosurgery in 2019-20.

Baptist Medical Center Jacksonville (Fla.). Surgeons at Baptist Medical Center have teamed up with Baptist MD Anderson Cancer Center in Jacksonville to conduct clinical trials related to brain and spine tumors. Along with its extensive brain and spine tumors division, Baptist Medical Center Jacksonville has a robust stroke and cerebrovascular care team and four neurologic oncologists. Neurosurgeons at the hospital's Stroke & Cerebrovascular Center are participating in more than 20 ongoing clinical trials.

Baylor St. Luke's Medical Center (Houston). Baylor St. Luke's Medical Center created its Neurosciences Institute in 2013, and it has since has been accredited by DNV GL Healthcare as a certified comprehensive stroke center. Baylor St. Luke's Medical Center neurosurgeons have also helped the hospital receive the Gold Plus Quality Achievement Award from the American Stroke Association. Baylor St. Luke's Medical Center was recognized in 2019-20 by U.S. News & World Report as one of the best hospitals in the nation for neurology and neurosurgery.

Beaumont Health (Southfield, Mich.). Beaumont Health was the first hospital in Michigan to create a pediatric stereo-EEG epilepsy surgery program to pinpoint seizures and cure drug-resistant epilepsy. The hospital's neurosurgery team is researching stem cell regeneration and spine reconstruction. Additionally, as a leading hospital for orthopedic surgery, neurosurgery and neurology, Beaumont Health has a leading spine team with on-call surgeons who can be at the hospital in 15 minutes no matter the time of day.

Beth Israel Deaconess Medical Center (Boston). All physicians at Beth Israel's Spine Center are board-certified and faculty of Boston-based Harvard Medical School. In total, there are four neurosurgeons and three orthopedic spine surgeons. To make care more accessible, Beth Israel Deaconess Medical Center has opened six spine centers throughout Massachusetts that provide comprehensive care patients in Boston and the surrounding area.

Boston Children's Hospital. The spine division of Boston Children's Hospital collaborates with the hospital's department of neurosurgery to treat complex spine conditions. Boston Children's Hospital has a complex cervical spine program as well as a spine and sports program. As a leading hospital for orthopedics and spine in the U.S., Boston Children's has various study groups, including a spinal deformity group whose Scoliosis Outcomes Database is cited in more than 45 abstracts and 15 peer-reviewed publications annually. In 2019-20, U.S. News & World Report ranked Boston Children's No. 1 in the nation for pediatric neurology and neurosurgery.

Brigham and Women's Hospital (Boston). The Comprehensive Spine Center at Brigham and Women's Faulkner Hospital brings together neurosurgeons, orthopedic surgeons, and specialists in pain management, physical medicine and rehabilitation. Brigham and Women's Hospital has five other spine centers throughout Massachusetts. U.S. News & World Report ranked the hospital among the top 20 in the nation for neurology and neurosurgery in 2019-20.

Carilion Clinic (Roanoke, Va.). The 1,026-bed Carilion Clinic hospital system provided care to nearly 1 million residents of Virginia and West Virginia in 2018. Touting around 13,320 employees and nine hospitals, the health system has 732 physicians across 77 specialties. Surgeons at Carilion's Institute for Orthopaedics and Neurosciences perform approximately 300 minimally invasive spine procedures annually, and it has the region's only deformity correction program for both adult and pediatric patients.

Cedars-Sinai Medical Center (Los Angeles). Serving more than 1 million patients annually at more than 40 locations, Cedars-Sinai Medical Center has more than 4,500 physicians on staff. The Cedars-Sinai spine team has 26 spine surgeons, assisted by eight advanced care providers. The health system is active in research efforts, hosting an array of clinical trials. Cedars-Sinai splits its spine care between four locations, including the Cedars-Sinai Spine Center and the Cedars-Sinai Kerlan-Jobe Institute. U.S. News & World Report ranked Cedars-Sinai as the No. 12 hospital for neurology and neurosurgery for 2019-20.

Cincinnati Children's Hospital Medical Center. Established in 1883, Cincinnati Children's Hospital Medical Center has more than 600 beds and around 1.3 million patient encounters in fiscal year 2017. The hospital's Crawford Spine Center was recognized by U.S. News & World Report as among the best hospitals for pediatric neurology and neurosurgery for 2019-20. The hospital is also involved in spine research, focusing on endoscopic technology, scoliosis correction and guided spine growth.

Cleveland Clinic. Featuring both a robust clinical program and a comprehensive spine research lab, Cleveland Clinic's Center for Spine Health sees thousands of patients annually. The Center for Spine Health has three specialty departments to address lower back pain, spinal deformity and spine tumors. Cleveland Clinic has 14 spine surgeons on staff, 14 medical/interventional staff members and 13 advanced care providers in its Center for Spine Health. The center is also testing robotics and is in the midst of a cervical spondylotic myelopathy surgical trial. U.S. News & World Report ranked Cleveland Clinic No. 10 in the nation for neurology and neurosurgery in 2019-20.

Dartmouth-Hitchcock Medical Center (Lebanon, N.H.). Dartmouth-Hitchcock developed its Center for Pain and Spine to meet the needs of its patient population, which comprises about 1.9 million people across northern New England. Anthem BlueCross BlueShield named the center a Blue Distinction Center for Spine Surgery for its commitment to good patient outcomes. U.S. News & World Report recognized the hospital as the highest performing neurosurgery institute in New Hampshire in 2019-20.

Duke University Hospital (Durham, N.C.). Duke University Hospital's comprehensive spine institute has 106 physicians on hand to provide an array of spine-related treatments. The spine team at Duke performs more than 1,200 spine surgeries annually. The hospital equipped all its surgery centers with intraoperative imaging equipment to ensure all procedures and physicians have access to real-time imaging information. U.S. News & World Report named Duke its No. 1 hospital in North Carolina and among the top 25 hospitals in the nation for neurology and neurosurgery in 2019-20.

Emory University Hospital (Atlanta). With its six locations throughout Atlanta, Emory University Orthopaedics & Spine Hospital offers patients comprehensive treatment options. Emory's neuroscience program will soon be headlined by the Emory Musculoskeletal Institute in Brookhaven, Ga. The institute broke ground in October 2019 and will be a 180,000-square-foot center dedicated to spine care. Emory University Hospital planners incorporated several environmentally conscious features into the institute. U.S. News & World Report ranked Emory among the top 50 hospitals in the nation for neurology and neurosurgery in 2019-20.

Froedtert & the Medical College of Wisconsin (Milwaukee). Froedtert & the Medical College of Wisconsin is the region's only academic regional medical center. Froedtert physicians see patients across the greater Milwaukee suburbs. Froedtert has four locations that specialize in spine care, including the outpatient clinic SpineCare. In 2017, Froedtert physicians treated 8,606 patients through its neurosurgery program.

Geisinger (Danville, Pa.). Founded more than a century ago, Geisinger has provided care to central Pennsylvania residents for generations. At the forefront of its neuroscience program is the Geisinger Neuroscience Institute. Employing a combination of treatment methods including microsurgery, minimally invasive surgery, robotic surgery and image-guided surgery, Geisinger has 24 providers on its neurosurgery staff. The health system is also on the forefront of innovation in healthcare delivery, with its ProvenCare program offering refunds to spine patients dissatisfied with their care. Geisinger is also a Walmart spine center of excellence, meaning the retail giant sends patients from across the country to undergo spinal evaluation and surgery at the health system.

Hackensack (N.J.) University Medical Center. Hackensack University Medical Center offers a robust program for neurosurgery care, including the Orthopedic Institute, which has more than 50 physicians on staff. Healthgrades has recognized Hackensack University Medical Center with its Cranial Neurosurgery Excellence Award for the last four years, and U.S. News & World Report ranked Hackensack as high performing for neurology and neurosurgery in 2019-20.

Henry Ford Hospital (Detroit). With more than 35 physicians specializing in spine and related specialties on staff, Henry Ford draws patients in Detroit and its greater suburban locations to its Henry Ford Spine Centers. In 2017 alone, Henry Ford surgeons performed some 75,000 surgeries across its 200 care sites. U.S. News & World Report ranked Henry Ford among the top 50 hospitals in the nation for neurology and neurosurgery in 2019-20.

Hoag Health Network (Newport Beach, Calif.). Hoag Health Network offers numerous spine programs, including care at Hoag Orthopedic Institute. In 2018, the institute reported 3,246 hospital spine procedures, as well as 180 ambulatory procedures. Hoag has two acute care hospitals, 11 urgent care centers and eight health centers it staffs with a team of more than 1,700 physicians and 6,000 employees. U.S. News & World Report ranked Hoag Hospital among the top 50 hospitals in the nation for neurology and neurosurgery in 2019-20.

Hospital for Special Surgery (New York City). Holding the No. 1 U.S. News & World Report ranking in orthopedics for 10 consecutive years, HSS surgeons perform more than 32,000 procedures annually. In 2016, the hospital reported 469 non-cervical spine fusion cases, which was well above the 48-procedure average for New York state. The hospital also focuses on research, with a 300-plus member research department that has a $45 million grant portfolio and $25 million in industry funding. Current spine-focused projects include studying spine instability, developmental deformity and tissue degeneration.

Houston Methodist Hospital. For nearly 30 years, Houston Methodist Hospital has been on the forefront of spine and neurosurgical care. The hospital is home to the center for neurodegeneration, which is comprised of 11 labs staffed with researchers working on therapies for chronic paralysis and neurologic loss. The hospital has 14 neurosurgeons on staff and was among the top 50 hospitals in the nation for neurology and neurosurgery by U.S. News & World Report for 2019-20.

Huntington Hospital (Pasadena, Calif.). Spine surgeons at Huntington Hospital specialize in treating spinal degenerative diseases such as deformities, lumbar stenosis and traumatic disorders. The hospital is home to a 32-bed orthopedic and neurological nursing unit, a 24-bed rehabilitation unit, an outpatient neurophysiology lab as well as angiography suites. In 2019-20, U.S. News & World Report ranked Huntington Hospital among the top 50 hospitals in the nation for neurology and neurosurgery.

Inova Fairfax Hospital (Falls Church, Va.). Inova Fairfax hospital is home to the largest neurological practice in the Washington, D.C., area. Nine Inova neurosurgeons perform more than 3,000 cases a year. The Inova team was the first in Northern Virginia to conduct MRI-guided surgeries to treat Parkinson's disease and a brain tumor. The Inova Neuroscience and Spine Institute has 12 specialized treatment programs and was awarded The Joint Commission's Gold Seal of Approval for its cervical and lumbar spine surgery program.

IU Health (Indianapolis). IU Health's Neuroscience Center offers patients treatment across a variety of neurological specialties, including oncology, spine surgery, stereotactic and functional neurosurgery, trauma treatment and pediatric neurosurgery. IU Health's team of neurosurgeons are at the forefront of using new technology for improving outcomes. Researchers at IU Health are currently pioneering four clinical trials on epilepsy and hematoma evacuation.

Jefferson Health (Philadelphia). Jefferson Hospital for Neuroscience is the only hospital in the Philadelphia region dedicated to neuroscience, and is one of the busiest academic neurosurgical programs in the U.S. The neuroscience program has five surgeons on staff, and in 2015, was the first in the region to offer deep brain stimulation. In 2019-20, U.S. News & World Report ranked Jefferson Health-Thomas Jefferson University Hospital among the top 50 hospitals in the nation for neurology and neurosurgery. The health system also has a robust spine program, with its spine surgeons completing around 7,000 procedures each year at inpatient and ambulatory locations. It was also the first in the country to enroll a patient in the INSPIRE 2.0 clinical trial examining treatment for spinal cord injury.

Johns Hopkins Medicine (Baltimore). Physicians in the department of neurology and neurosurgery at Johns Hopkins Medicine have been treating patients since 1889, and now perform more than 4,000 operations and 30,000 outpatient consultations each year. The Johns Hopkins Carnegie Center for Surgical Innovation, a collaboration between the departments of neurosurgery and biomedical engineering, is working on new technology to make spine surgery safer through image-guided interventions. Johns Hopkins neurosurgeons are actively researching and conducting clinical trials on Parkinson's disease, dementia and brain cancer. The Johns Hopkins Hospital was ranked No. 1 in the in the nation for neurology and neurosurgery in 2019-20 by U.S. News & World Report.

Kaiser Permanente Los Angeles Medical Center. Kaiser Permanente's neurologists and neurosurgeons perform hundreds of complex procedures each year in one of the nation's busiest neurosurgical centers. The health system's 70-year history gives it a leg up in educating the next generation of specialists through neurology and neurosurgery residency programs, as well as a neuroanesthesia fellowship program. Kaiser's Los Angeles Medical Center houses the health system's comprehensive spine surgery department as well as a radiosurgery program dating back to 1989.

Keck Medicine of USC (Los Angeles). The USC Spine Center aims to deliver a coordinated, conservative approach to spine care at four locations in the greater Los Angeles area. Specialists at USC Spine Center are all fellowship-trained faculty members at the Keck School of Medicine of USC and have collectively gained an overall patient satisfaction rating of over 4.5 out of 5 stars. USC Spine Center, which is part of USC Orthopaedic Surgery and USC Neurological Surgery, is recognized as a Blue Distinction Center for spine surgery by Blue Shield of California. Additionally, Keck Medicine of USC was ranked No. 16 in the nation for neurology and neurosurgery by U.S. News & World Report.

Lehigh Valley Health Network (Allentown, Pa.). Lehigh Valley Health Network's spine and neurology services are provided through its Institute for Surgical Excellence, where surgeons perform over 35,000 surgeries annually 70 percent more than other centers in the area. The system boasts the region's only spine neuronavigation system, as well as a 14-bed neuroscience intensive care unit. With surgeons currently involved in at least five clinical trials focused on neurology, Lehigh Valley Health Network offers patients unique opportunities to undergo new treatments in addition to surgery.

Lifespan (Providence, R.I.). With six experts on its surgical team, Lifespan's Comprehensive Spine Center is affiliated with the Providence-based Warren Alpert Medical School of Brown University, giving patients access to advanced technology and treatments. Operating at both Rhode Island Hospital in Providence and the newly opened Newport (R.I.) Hospital, the Comprehensive Spine Center is housed within the Norman Prince Neurosciences Institute. Lifespan's 13 neurosurgeons perform about 2,000 procedures annually, and they're researching the use of microelectrode arrays in epilepsy, light treatments for neurological disease, and deep brain stimulation for Alzheimer's patients.

Loyola University Medical Center (Maywood, Ill.). As an academic medical center with researchers involved in nearly 200 clinical trials, Loyola University Medical Center leverages unique neurosurgical techniques such as deep brain stimulation and stereotactic radiotherapy. Each year, Loyola's highly experienced surgeons perform over 1,000 cranial surgeries and collaborate on about 150 cranial-base operations at the Center for Cranial Base Surgery, which features a fully equipped speech and swallowing laboratory. With a 13-bed neuro intensive care unit, Loyola was ranked No. 28 in the nation for neurology and neurosurgery by U.S. News & World Report for 2019-20.

Massachusetts General Hospital (Boston). Massachusetts General Hospital's neurosurgery department performs more than 4,000 procedures every year and was the first to use deep brain stimulation to reduce epileptic seizures. MGH's team of 20 faculty neurosurgeons and 20 residents in training oversees 86 dedicated beds and a 22-bed ICU. Home to the nation's largest hospital-based neuroscience research program, MGH is committed to studying rare disorders of the nervous system, neurodegenerative disorders and effective ALS therapies. U.S. News & World Report ranked Mass General among the top 20 hospitals in the nation for neurology and neurosurgery in 2019-20.

Mayo Clinic (Rochester, Minn.). Mayo Clinic is one of the premier institutions for neurosurgery in the nation, with its Rochester location ranked No. 2 for neurology and neurosurgery by U.S. News & World Report in 2019-20. Neurosurgeons annually perform 7,000 procedures at its three campuses in Arizona, Florida and Minnesota. The health system is also on the forefront of neurosurgical research and currently has 31 clinical trials open for participation as well as a registry for primary spinal tumor research.

Medical University of South Carolina (Charleston). The Medical University of South Carolina's spine center team is a designated Blue Distinction Center for spine surgery, a mark of demonstrated quality outcomes. The hospital has $9 million in technology development funding through an in-house innovation program called Zucker Institute for Applied Neurosciences, a technology accelerator embedded within the health system to move new neuroscience innovations into the clinical settings quickly. The Medical University of South Carolina's spine program was one of the first in the state to offer patients endoscopic spine surgery, and it plans to expand its endoscopic and minimally invasive spine outpatient offerings.

MedStar Georgetown University Hospital (Washington, D.C.). The 609-bed MedStar Georgetown University Hospital has a multidisciplinary spine center and offers comprehensive neurosurgery services, including a pediatric neurosurgery program. It includes 12 neurosurgeons and spine specialists, of which five are trained in minimally invasive spine care. Its minimally invasive spine specialists have performed thousands of procedures, from discectomies to decompressions. In 2019-20, U.S. News & World Report named MedStar Georgetown University Hospital high performing in neurology and neurosurgery, as well as one of the best regional hospitals in the nation.

Memorial Hermann-Texas Medical Center (Houston). Memorial Hermann-Texas Medical Center includes the Memorial Hermann Orthopedic & Spine Hospital to offer patients the latest in spine care. The Memorial Hermann Orthopedic & Spine Hospital features 64 private patient rooms, eight two-room suites and 10 surgical suites. Patients coming to the medical center can also receive care at the Mischer Spine Center, where neurosurgeons perform more than 3,000 spine surgeries annually. The Mischer Spine Center is affiliated with Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center, which offers opportunities for patients to receive the benefits of cutting-edge research. There are 25 spine and nerve research clinical trials in progress or recently completed at the Mischer Neuroscience Institute.

MemorialCare (Fountain Valley, Calif.). Spine care at MemorialCare is offered by a multidisciplinary team of neurosurgeons, orthopedic surgeons and nonoperative specialists. Patients seeking care have the option of going to one of three California-based locations, in Long Beach, Laguna Hills or Fountain Valley. Two MemorialCare hospitals are ranked high performing in adult neurology and neurosurgery by U.S. News & World Report. The Spine Center at MemorialCare Long Beach Medical Center recently acquired robotic navigation technology to enhance precision in spine surgery.

Michigan Medicine (Ann Arbor). Michigan Medicine's neurosurgery department celebrated 100 years of offering adult and pediatric neurosurgical care last year. It includes 24 clinical faculty and eight research faculty members. Michigan Medicine's neurosurgery department also has a mission to educate and train the next generation of neurosurgical and spine care specialists via its residencies and fellowships. Its neurosurgeons are involved in an outreach program, Project Shunt, that offers neurosurgical care to children in Guatemala. U.S. News & World Report ranked Michigan Medicine No. 19 on its list of the 50 best hospitals for adult neurology and neurosurgery in 2019-20.

Milton S. Hershey Medical Center (Hershey, Pa.). Milton S. Hershey Medical Center offers spine and neurosurgery services via its spine center, which includes a 25-person care team. The spine center has developed a "back coach" program, which offers information and resources to those suffering from chronic back and neck pain. The hospital also has a robust neurosurgery research faculty that includes 17 members focusing on several key research areas, including using 3D models to understand tumor growth.

Montefiore Health System (New York City). Montefiore Health System aims to be at the forefront of neurosurgical research and care with eight comprehensive care centers and 12 neurosurgeons on staff. Earlier this year, Montefiore held its first pediatric neurointerventional symposium, which included experts from the U.S. and Canada. Montefiore Medical Center, the health system's flagship, was ranked among the top 50 hospitals in the nation for adult neurology and neurosurgery by U.S. News & World Report for 2019-20.

Moses H. Cone Memorial Hospital (Greensboro, N.C.). The 517-bed Moses H. Cone Memorial Hospital has received several recognitions for its spine care services, including being ranked No. 1 in the state for medical excellence in spinal surgery and spinal fusion by CareChex in 2018. Blue Cross and Blue Shield of North Carolina also designated the facility a Blue Distinction Center + for spine surgery last year. The hospital offers major interventional neuroradiology and neurosurgery treatments with a multidisciplinary team of neurologists, neuroradiologists other nonoperative specialists to ensure comprehensive care. Cone Health includes 19 orthopedic spine surgeons and neurosurgeons.

Mount Sinai Hospital (New York City). The Spine Hospital at Mount Sinai offers the full spectrum of cervical, thoracic and lumbar spine care. It includes 16 orthopedic and neurospine surgeons who provide care along with a team of nonoperative spine specialists. The hospital is also a preferred spine care site for retired NFL players. The health system has a strong foundation in research through various programs, including the Friedman Brain Institute, an interdisciplinary clinical and research hub focused on brain and spinal cord disorders. U.S. News & World Report ranked Mount Sinai Hospital among the top 20 hospitals in the nation for neurology and neurosurgery in 2019-20.

NewYork-Presbyterian/Weill Cornell Medical Center (New York City). NewYork-Presbyterian/Weill Cornell Medical Center's Weill Cornell Brain and Spine Center includes 24 neurosurgeons, neuroradiologists, neuropsychologists and neuroendocrinologists, who offer clinical services, conduct research and train students, residents and fellows. Patients receiving care at the center have access to the latest research-based medicine, including access to 16 neurosurgery-focused clinical trials. NewYork-Presbyterian was ranked No. 4 on U.S. News & World Report's 2019-20 list of the 50 best hospitals for neurology and neurosurgery.

Northwell Health (New Hyde Park, N.Y.). Northwell Health's Institute for Neurology and Neurosurgery includes a multidisciplinary team that offers a wide array of clinical services, and in collaboration with the Feinstein Institutes for Medical Research, the physicians and scientists conduct research and clinical trials that advance the field. U.S. News & World Report ranked Northwell's North Shore University Hospital among the top 50 hospitals in the nation for neurology and neurosurgery, while also distinguishing Lenox Hill Hospital in New York City as high performing in the specialty for 2019-20.

Northwestern Memorial Hospital (Chicago). Northwestern Memorial Hospital includes 38 neurological surgery and spine surgery specialists. It also offers a combined orthopedic spine and neurosurgical spine fellowship to train the next generation of spine and neurosurgeons. Earlier this year, the hospital launched the Northwestern Medicine Hispanic Brain and Spine Tumor Program in Chicago, which aims to reduce barriers to specialized care for the Hispanic and Latino population. U.S. News & World Report ranked Northwestern Memorial Hospital No. 5 on its list of the 50 best hospitals for neurology and neurosurgery in 2019-20.

Norton Healthcare (Louisville, Ky.). Norton Healthcare is home to the Norton Leatherman Spine Center, serving patients in Louisville and southern Indiana. Specialists at Norton Leatherman Spine perform more than 4,000 surgeries annually, and patients see its providers there more than 30,000 times a year. The fellowship-trained specialists at Norton Leatherman Spine have an average of 20 years of experience and focus on research as well as training the next generation of spine surgeons. The hospital has trained more than 100 spine surgeons who are practicing across the country.

NYU Langone Health (New York City). NYU Langone Health's neurosurgery department consists of more than 20 full-time clinical and research faculty members who take on other physicians' most complex surgical cases. Combined with the system's orthopedic spine surgeons, NYU Langone supports about 2,700 spine procedures per year. Its spine center is equipped with robotic technology and a 3D platform for planning and performing surgeries and provides operative and nonoperative treatment for about 18,000 adults and children annually. NYU Langone Hospitals is ranked No. 9 among U.S. News & World Report's top 50 hospitals for neurology and neurosurgery.

Ochsner Medical Center (New Orleans). Ochsner Health System's neurosurgery program stands out for various reasons, including being the only such program in Louisiana and one of only five U.S. centers to offer in-utero surgery to repair spinal bifida in babies during pregnancy. Each year, neurosurgeons across Ochsner Health System perform more than 1,500 adult and pediatric surgeries. The health system's spine and back care program is also highly rated, earning five stars from Healthgrades. Ochsner Medical Center, part of Ochsner Health System, is among the nation's top 50 hospitals for neurology and neurosurgery, according to U.S. News & World Report's 2019-20 rankings.

Ohio State University Wexner Medical Center (Columbus). Ohio State University is the home of an 87-bed, 60,000-square-foot brain and spine hospital that includes specialized units for stroke care, neurotrauma and traumatic brain injuries and spinal cord injury. The university also houses one of the nation's only centers that pursue innovative projects and research through the Traumatic Brain Injury Model Systems program, which is sponsored by the National Institute on Disability and Rehabilitation Research. Additionally, the university has the only rehabilitation program in central Ohio certified to handle traumatic brain injury. In 2019-20, U.S. News & World Report recognized Wexner Medical Center as high performing in adult neurology and neurosurgery.

Oregon Health & Science University Hospital (Portland). Oregon Health & Science University Hospital has pioneered innovation in neurological surgery, including North America's first deep brain stimulation surgery, the world's first neuronal stem cell transplants and an intraoperative MRI facility. It also has a leading neurosurgery training program and advanced fellowships in skull base and vascular, functional and pediatric neurosurgery. The hospital is ranked No. 44 among U.S. News & World Report's top 50 hospitals for neurology and neurosurgery in 2019-20.

Penn Medicine (Philadelphia). Penn Medicine neurosurgeons perform more than 5,000 operations annually at the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Presbyterian Medical Center, Penn Medicine Virtua Neurosciences and the Children's Hospital of Philadelphia. Penn Medicine's neurosurgery department also includes a research program led by basic scientists in brain, spine and nervous system diseases and disorders. Penn Medicine researchers are working on a prognostic blood test that would detect and measure neuronal proteins in the cerebrospinal fluid. In 2019-20, U.S. News & World Report ranked the health system's Pennsylvania Hospital No. 31 in the nation for neurology and neurosurgery.

ProMedica (Toledo, Ohio). ProMedica is a health system with more than 794 hospital beds serving 27 counties in Ohio and southeast Michigan. The system includes the ProMedica Wildwood Orthopaedic and Spine Hospital, which is designated a Blue Distinction Center for spine care by the Blue Cross Blue Shield Association and earned the 2018 Press Ganey Guardian of Excellence Award for physician engagement. The system's ProMedica Toledo Hospital also offers advanced navigation and robotics for complex brain and spine surgeries; it became the first in Ohio to offer the 3D mapping technology in 2017.

Rush University Medical Center (Chicago). Rush University Medical Center is one of the top 10 hospitals in the nation for neurology and neurosurgery, according to U.S. News & World Report. Its neurosurgery program consistently reports the most neurosurgical discharges in the Chicago area. In 2018, the health system reported 4,334 neurological surgery outpatient visits focused on the brain and 6,498 outpatient neurological visits focused on the spine. The health system also has a robust spine and back care program, with 12 physicians and surgeons increasingly moving toward minimally invasive and outpatient procedures. The health systems surgeons aim to stay at the forefront of patient treatment and participate in clinical trials investigating degenerative disc disease treatment, registry data for metastatic spine tumors and spinal stenosis treatment with new technology.

Saint Barnabas Medical Center (Livingston, N.J.). Saint Barnabas Medical Center houses the 22-physician neurological team of RWJBarnabas Health, the largest healthcare system in New Jersey. The Saint Barnabas Institute of Neurology & Neurosurgery is a level 4 epilepsy center with nine physicians focused on excellence in clinical care as well as clinical research. The hospital also has an innovative spine surgery department that has used a microdiscectomy technique developed by a member of its team to treat more than 500 patients. Saint Barnabas is recognized as high performing in neurology and neurosurgery by U.S. News & World Report.

Saint Luke's Hospital of Kansas City (Mo.). Saint Luke's Marion Bloch Neuroscience Institute has an advanced comprehensive stroke center accredited by the Joint Commission that leads the region in endovascular interventions and outcomes. It provides advanced stroke care to more than 2,000 patients annually, and the integrated spine program earned designation as a Blue Distinction Center+ for Spine Surgery by Blue Cross Blue Shield Association. Saint Luke's Spine Surgery Program has earned the Joint Commission's Gold Seal of Approval of Spine Surgery Certification. The system also has a level 4 comprehensive epilepsy center and a seven-member neurosurgeon team. For 2019-20, Saint Luke's Hospital of Kansas City was named among U.S. News & World Report's top 50 hospitals for neurology and neurosurgery.

Scripps Health (San Diego). Scripps Health offers neurosurgery and follow-up care at five San Diego County locations. At Scripps Health locations, physicians offer advanced techniques and technology, including minimally invasive brain surgery treatments and a robotics platform. Programs of Scripps Green Hospital and Scripps Memorial Hospital La Jolla ranked among U.S. News & World Report's top 50 hospitals for neurology and neurosurgery in 2019-20.

Spectrum Health (Grand Rapids, Mich.). Spectrum Health's neurosurgery department specializes in disorders affecting the central nervous system and offers services at five centers across Michigan, including a level 4 epilepsy center. Spectrum Health is also home to Helen DeVos Children's Hospital, which has the only pediatric neurosurgery program in the region. As the largest hospital group in West Michigan, Spectrum Health has been ranked among America's 50 best hospitals by Healthgrades for four consecutive years and has 1,600 physicians focused on more than 110 specialties.

St. Luke's Boise (Idaho) Medical Center. St. Luke's Boise Medical Center is part of the nonprofit St. Luke's Health System, Idaho's largest, comprising 14 hospitals. St. Luke's Boise, which includes four neurosurgery centers and three spine clinics in Idaho, has been ranked as a top 100 hospital by IBM Watson Health. After doubling the number of referrals to its spine care clinic in 2018, the hospital plans to open another location in 2020.

Stanford (Calif.) Health Care. The Stanford department of neurosurgery is composed of 61 neurosurgeons who perform 4,000 neurosurgical operations annually. It was named the No. 9 hospital in the nation for neurology and neurosurgery by U.S. News & World Report in 2019-20 and its stroke center was the first in the nation to be certified as a comprehensive stroke center by the Joint Commission. The department has 30 active labs researching topics including brain injury, deep brain stimulation, brain tumors and epilepsy.

Stony Brook (N.Y.) University Hospital. Stony Brook University Hospital's Neurosurgery Spine Center is a tertiary care academic medical center that has been named one of America's 100 Best Hospitals for stroke care by Healthgrades for five consecutive years. Stony Brook has more than 70 labs researching topics including spine and brain trauma, stroke and multiple sclerosis. The Neurosurgery Spine Center is the only practice in Suffolk County with two full-time pediatric neurosurgeons, and the adult neurology center sees more than 18,000 patients per year.

Sutter Health (Sacramento, Calif.). Eleven hospitals within the Sutter Health network a 24-hospital, nonprofit health system with more than 12,000 physicians received recognition from the American Stroke Association for providing a high level of stroke care in 2019. Eden Medical Center in Castro Valley, Calif., was named one of America's 100 Best Hospitals for stroke care by Heathgrades in 2019. Sutter Medical Center in Sacramento, Calif., also earned recognition as high-performing in neurosurgery by U.S. News & World Report in 2019.

Swedish Medical Center (Englewood, Colo.). Swedish Medical Center serves as the Rocky Mountain region's neurotrauma provider and has spine experts who perform an average of 90 spine surgeries per month. Part of HCA's HealthONE, Blue Cross Blue Shield Association designated it a Blue Distinction Center for spine surgery, and UnitedHealth Group designated it a Center of Excellence for spine surgery. It serves as the region's referral center for the most advanced stroke treatment and was the state's first Joint Commission-certified comprehensive stroke center.

Texas Children's Hospital (Houston). Texas Children's Hospital was the first hospital in the world to use real-time MRI-guided thermal imaging and laser technology to treat epilepsy. Named the No. 3 best neurosurgery center on U.S. News & World Report's 2019-20 list, the hospital performs more than 950 neurosurgical operations every year. It was also the first hospital to use a device similar to a pacemaker in the brain, which recognizes oncoming seizures and prevents them.

The Christ Hospital (Cincinnati). The Christ Hospital Joint & Spine Center is a seven-story facility with 14 operating rooms, four of which are dedicated solely to spine surgery. The Joint & Spine Center also offers physical, occupational and speech therapy services and physicians dedicated solely to joint, spine and brain care. Founded more than 125 years ago, The Christ Hospital has performed more spine procedures than any other hospital in the Cincinnati area.

Tulsa (Okla.) Spine & Specialty Hospital. Founded in 2002, Tulsa Spine & Specialty Hospital has a national reputation top-level patient care. It was named one of America's 100 best hospitals for spine surgery by Healthgrades. The physician-owned hospital was also honored with the Cigna Center of Excellence designation in 2018 for orthopedic back surgery and earned five stars from Healthgrades for spinal fusion in 2018. The hospital has 13 dedicated spine surgeons who perform minimally invasive procedures.

University of California San Diego Health. UC San Diego's neurosurgery division was founded in 1971 and features four intraoperative MRI and CT suites, destination skull base tumor programs and neurocritical care units. The division collaborates regularly with the UC San Diego School of Medicine, San Diego-based Scripps Research Institute and the Salk Institute for Biological Studies in La Jolla, Calif., and received $30 million in funding from the National Institutes of Health in 2018. It was ranked among the top 50 hospitals in the nation for neurology and neurosurgery in 2019-20 according to U.S. News & World Report.

UCI Health (Irvine, Calif.). UCI Health is the only academic health system in Orange County, Calif., and UCI Medical Center's neurosurgery department was recognized as high performing by U.S. News & World Report in 2019-20. The department of neurological surgery includes Orange County's first comprehensive stroke center, granted certification by The Joint Commission, as well as active research in neuro-oncology and spinal cord injury. The department frequently collaborates with other research organizations, such as UC Irvine's Reeve-Irvine Research Center, which is working to find new treatments for spinal cord injury.

UCLA Medical Center (Los Angeles). As UCLA Health's flagship hospital, UCLA Medical Center's neurosurgery department has ranked as one of the top neurosurgery programs in the nation for over 20 consecutive years by U.S. News & World Report. The department has its own neurosurgery app designed for patients with information about their physicians, procedures and hospital amenities. UCLA's Spine Center is also designated a Blue Distinction Center for Spine Surgery by Blue Shield of California.

UCSF Medical Center (San Francisco). The department of neurological surgery at UCSF Medical Center has 14 specialties, including pediatric neurosurgery. In 2011, the department developed the Quality Improvement and Patient Safety initiative with the goal of becoming a national leader in neurological surgery quality. The hospital is piloting an enhanced recovery after surgery pathway for cranial surgery as well as an opioid stewardship program. UCSF's Spine Center is also one of the largest spine centers in the country and sees over 10,000 patients a year. The department of neurological surgery at UCSF was recognized in 2019-20 as one of the top three neurosurgery programs in the country by U.S. News & World Report, which also ranks the UCSF Benioff Children's Hospitals among the top hospitals for pediatric neurosurgery in the nation.

UF Health (Gainesville, Fla.). The UF Health Spine Program provides comprehensive outpatient and inpatient treatment options at one location that features 17 neurosurgeons, three neurosurgery ORs, two neurosurgery hybrid interventional ORs and 48 private ICU patient rooms. The hospital provides complete spine services including the treatment of degenerative spinal diseases, spinal tumors as well as craniocervical junction anomalies and performs more than 1,000 procedures annually. For its 2019-20 rankings, U.S. News & World Report named UF Health Shands Hospital in Gainesville the No. 2 hospital in Florida, and it was ranked among the top in the nation for neurology and neurosurgery.

UK HealthCare Albert B. Chandler Hospital (Lexington, Ky.). UK Neurosurgery features nine neurosurgeons providing care for complex conditions including spinal tumors and deformities, stroke, ALS, and epilepsy. UK HealthCare Albert B. Chandler Hospital was ranked the No. 1 hospital in the state for neurology and neurosurgery by U.S. News & World Report's best hospitals survey for 2019-20. UK Neurosurgery collaborates with the UK Kentucky Neuroscience Institute on several research initiatives and is currently enrolling participants in ALS and epilepsy clinical trials.

UNC REX Hospital (Raleigh, N.C.). REX Neurosurgery & Spine Specialists features a team of 12 orthopedic spine and neurosurgeons providing comprehensive neurosurgical care including spinal fusion, minimally invasive spine surgery and reconstructive spine surgery. The department performs thousands of procedures each year and has been certified as a comprehensive stroke care center by The Joint Commission since 2011. UNC REX bolstered the department in the past year with the addition of an on-site spine physical therapist and a spine navigator to determine whether patients need imaging, surgery or physical therapy.

University Hospitals (Cleveland). The staff University Hospitals includes 11 orthopedic spine and neurosurgeons focused on providing exceptional patient care. The University Hospitals Spine Institute collaborates with the UH Neurological Institute, which features 13 centers of excellence and provides innovative neurosurgical therapies including CyberKnife, Gamma Knife and the NeuroBlate System. University Hospitals Cleveland Medical Center was ranked among the best hospitals for neurology and neurosurgery in the nation by U.S. News & World Report in 2019-20.

University of Alabama Hospital at Birmingham. UAB Hospital at Birmingham is widely recognized for its spine care and brain cancer research, and its specialists treat more than 4,000 patients annually. UAB Neurology and Neurosurgery has eight comprehensive divisions and seven centers that care for 26,000 patients per year. The neurosurgery department is also responsible for around 5,000 procedures annually for both pediatric and adult patients. It features research faculty and physician scientists who collaborate to advance research in conditions such as Parkinson's disease, spinal cord injury and neurovascular disorders.

University of California Davis Medical Center (Sacramento). Spine and neurosurgeons at UC Davis Medical Center actively participate in research and clinical trials spanning a range of areas including lumbar fusion, traumatic brain injury and thoracic spinal cord injury. UC Davis Health's neurosurgery department features 13 physicians on its clinical faculty and its brain tumor program incorporates 19 physicians from several subspecialties to provide optimum care for adult and pediatric patients with tumors of the nervous system. The UC Davis Medical Center ranked among the best hospitals for neurology and neurosurgery in U.S. News & World Report's 2019-20 list.

University of Colorado Hospital (Aurora). UCHealth Spine Center at the Anschutz Medical Campus is staffed by renowned spine and neurosurgeons who have built a comprehensive and award-winning program. The hospital is certified by The Joint Commission as a comprehensive stroke center and its epilepsy program is rated as a Level 4 center by the National Association of Epilepsy Centers and earned the 2019 Get With the Guidelines Stroke Gold Plus Elite Plus award from the American Heart Association and American Stroke Association for outstanding care. The department of neurosurgery features 23 physicians and U.S. News & World Report ranked UCHealth University of Colorado Hospital among the best in the nation for neurology and neurosurgery for 2019-20.

University of Iowa Hospitals and Clinics (Iowa City). The UI Spine Center has a robust program with 10 orthopedic spine and neurosurgeons who participate in next-generation surgical technology investigations to stay on the forefront of spine care. The hospital has earned the Blue Cross Blue Distinction Center+ designation for spine surgery and the University of Iowa Carver College of Medicine is often ranked in the top 10 in National Institutes of Health funding for faculty members, including neurosurgery. The neurosurgery department specializes in the surgical treatment of degenerative spine pathology, epilepsy, brain and spinal cord tumors and was designated a center of excellence by the Parkinson's Foundation in 2018.

University of Kansas Hospital (Kansas City). The department of neurosurgery at the University of Kansas Medical Center is equipped with virtual reality systems and a 3D printer to assist neurosurgeons in planning procedures and training physicians in the latest technology. The hospital includes 11 neurosurgeons and a 14-physician neurosurgery residency program. It also has a robust spine center, the Marc A. Asher, MD, Comprehensive Spine Center, which opened in 2008 and includes 27 exam rooms, four diagnostic rooms and a 4,000-square-foot outpatient rehabilitation gym.

University of Miami (Fla.) Hospital and Clinics. Neurosurgeons at University of Miami Hospital and Clinics see more than 14,000 patients and perform over 4,000 procedures annually. The hospital was named among the best hospitals in Florida by U.S. News & World Report in 2019-20 and scored as a high-performing facility in the departments of neurology and neurosurgery. The hospital integrates the latest innovations into its neurosurgical research programs including robotics, 3D interoperative imaging and deep brain stimulation.

UW Health (Madison, Wis.). The neurosurgery residency program was founded at the University of Wisconsin's department of surgery in 1942 and has been in operation ever since. UW Health features 14 neurosurgeons, 12 research faculty and two fellows. Neurosurgeons in the department see more than 1,200 brain tumor patients per year in collaboration with the UW Carbone Cancer Center. The department focuses on both clinical and investigative aspects of care for neurological diseases and is currently participating in a range of clinical trials involving brain tumors, stroke, spinal cord injury and cervical spondylotic myelopathy.

University of Utah Hospitals and Clinics (Salt Lake City). University of Utah Hospitals and Clinics provides the full spectrum of neurosurgical care to patients with cranial and spinal diseases and disorders. The faculty includes 25 physicians who provide a range of services including cerebrovascular, spinal, functional, traumatic, tumor, and pediatric neurosurgery. Physicians at the hospital are actively involved in clinical trials with current projects including pediatric neurosurgery and venous thromboembolism.

University of Virginia Medical Center (Charlottesville). Spine specialists at the University of Virginia Medical Center, in partnership with colleagues from the neurosurgery department, perform more than 1,500 spine procedures each year. The medical center's neurosurgery department is led by Jeffrey Elias, MD, who was honored as the 2018 Edlich-Henderson Innovator of the Year by the UVA Licensing & Ventures Group. At the university, Dr. Elias pioneered the use of focused ultrasound to treat essential tremor and led a clinical trial that resulted in FDA approval of the treatment.

UW Medicine (Seattle). The department of neurological surgery at UW Medicine is the primary referral center for patients in Washington, Wyoming, Alaska, Montana and Idaho who have complex neurological conditions. Twenty neurosurgeons, 15 neuroscientists and 79 adjunct clinical research faculty staff the department, and an additional 20 physicians are in its neurological surgery residency program. The neurological surgery department's outreach initiatives include National Institutes of Health-sponsored brain injury research in five Latin American countries.

UW Health (Madison, Wis.). In 1993, spine specialists at UW Health developed a minimally invasive treatment for spinal fusion surgery, becoming one of the first institutions to perform the procedure in the world and solidifying the health system as a leader in minimally invasive spine surgery. In addition to spine, providers at UW Health care for more than 1,200 brain tumor patients each year, working with the UW Carbone Cancer Center when additional treatment is needed. For 2019-20, U.S. News & World Report listed UW Health among the top 50 hospitals in the nation for neurology and neurosurgery.

UPMC (Pittsburgh). Part of the UPMC Neurological Institute, the UPMC department of neurosurgery is one of the largest academic neurosurgical providers in the nation, with more than 11,000 procedures performed annually. Among its accolades, the department ranks as one of the highest in the country in National Institutes of Health funding, and the department's chair, Robert Friedlander, MD, was elected to the National Academy of Medicine in 2018. U.S. News & World Report ranked UPMC's Presbyterian Shadyside hospital in Pittsburgh among the nation's top 50 hospitals for neurology and neurosurgery for 2019-20.

UR Medicine (Rochester, N.Y.). Patients across New York's Finger Lakes, Southern Tier and Western New York regions are served by UR Medicine Neurosurgery. At UR Medicine's Spine Center, physicians see more than 19,000 patients annually. In 2019, researchers led by the director of the hospital's department of neurosurgery's Translation Pair Research Program were selected to help the National Institutes of Health create a nonaddictive treatment for pain through clinical trials.

UT Southwestern Medical Center (Dallas). The Peter O'Donnell Jr. Brain Institute, part of the department of neurological surgery at UT Southwestern Medical Center, ranks No. 15 in the nation for neurology and neurosurgery, according to U.S. News & World Report's 2019-20 list. The department's neuro-oncology program is supported by the Annette G. Strauss Center for Neuro-Oncology and collaborates with the Harold C. Simmons Comprehensive Cancer Center. In 2018, the Decherd Foundation awarded the hospital an endowment to create an annual award to recognize exceptional care for neurotrauma patients at UT Southwestern's teaching hospital, Dallas-based Parkland Memorial Hospital.

Vanderbilt University Medical Center (Nashville, Tenn.). In addition to 21 residents, the neurological surgery department at Vanderbilt University Medical Center has 16 physician faculty members who are part of its 32-member advance practice and research team. The department sees more than 5,000 surgeries and procedures each year. In 2019, neurological surgery researchers at Vanderbilt, supported by the National Institutes of Health, for the first time found improvements in brain networks after surgery in 15 people with temporal lobe epilepsy.

VCU Medical Center (Richmond, Va.). With a 13-physician faculty, the Virginia Commonwealth University department of neurosurgery at VCU Medical Center is home to a new concept of outpatient medicine for orthopedic and neurological conditions. The VCU Health Neuroscience, Orthopaedic and Wellness Center, dubbed the "N.O.W. Center," aims to offer patient-centered care, using new software to help providers manage patients' progress during visits. The neurosurgery department at VCU Medical Center has been recognized by U.S. News & World Report, which named the hospital among the top 50 in the country for neurology and neurosurgery for 2018-19.

Vidant Medical Center (Greenville, N.C.). Vidant Medical Center is home to the only neuroscience intensive care unit in eastern North Carolina, as well as a specialized neuroscience rehabilitation unit. The hospital's neurosurgery department has 19 physicians and healthcare professionals. In April 2019, one of Vidant's neurosurgery department members co-authored a 12-month study of the use of a new neuro-spinal scaffold to treat acute thoracic complete spinal cord injury.

Wake Forest Baptist Health (Winston-Salem, N.C.). Every year, physicians at Wake Forest Baptist Health's spine center perform more than 1,000 surgeries on patients in need of treatment for back and neck disorders. Wake Forest Baptist Health is home to one of the nation's leading Gamma Knife Centers and is one of the few centers in the country to use deep brain stimulation to treat movement disorders, brain tumors, depression and Tourette syndrome. Additionally, the hospital's neurosurgery department has two neurosurgeons who specialize in pediatric care.

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100 hospitals and health systems with great neurosurgery and spine programs | 2019 - Becker's Hospital Review

Sana, a petite 31-year-old French woman with curly brown hair, is strapped to a chair at the Clinical Center at the National Institutes of Health. In front of her, a desk. Surrounding her, 12 infrared cameras tracking her every move. The test is about to begin.

On the desk, a black cylinder stands upright. Its topped with a silvery plastic ball. Heres the challenge: Shes asked to touch her nose and then touch the ball in front of her. Easy. She touches her nose. She touches the ball.

Now comes the hard part.

A lab technician tells her to close her eyes. He places her finger on the ball, and then moves it back to her nose. He lets go and asks Sana to do it herself while keeping her eyes closed.

Suddenly, its like the location of the ball has been erased from her mind. She gropes around, swinging her arm widely to the left and the right. When she manages to touch the ball, it seems like an accident. She struggles to find her nose on her face, outright missing a few times.

Its like I am lost, she says, through an interpreter. When her eyes are closed, she doesnt know where her body is in space.

Try this task for yourself. Place a drinking glass in front of you. Touch the top of it a few times with your eyes open. Then try to find it with your eyes closed. Chances are you still can.

When we close our eyes, our sense of the world and our bodys place in it doesnt disappear. An invisible impression remains. This sense is called proprioception (pronounced pro-pree-o-ception); its an awareness of where our limbs are and how our bodies are positioned in space. And like the other senses vision, hearing, and so on it helps our brains navigate the world. Scientists sometimes refer to it as our sixth sense.

Proprioception is different from the others in a key way: It never turns off, except in very rare cases. We know what silence is when we cover our ears, we know what darkness is when we shut our eyes.

Sana is one of the few people in the entire world who knows what its like when the proprioceptive sense is turned off. Another is her older sister, Sawsen, 36, who was also undergoing the testing at the NIH, in August. She, too, has trouble finding her nose in the dark.

At home, Sawsen says, if the power goes out and shes standing up, I fall to the ground. The feeling is as hard to imagine as it is to describe. Its as if you had a blindfold and somebody turned you several times, and then youre asked to go in a direction. The first few seconds, you dont know what direction youre going in. Pure disorientation.

The sisters, whose last names Im not using for privacy reasons, also share another curiosity: They cant feel a lot of the things they touch. Even with my eyes open, when I touch the little ball, I dont feel it, Sawsen says.

Of all the senses, touch and proprioception are arguably the least understood. But in the past decade, neuroscientists have made huge breakthroughs that reveal how touch and proprioception work. That has led to hopeful insights that could yield better ways to treat pain and better prostheses for amputees. Its also given us a more complete understanding of what it means to be human and experience the world through a body.

Sana, Sawsen, and a handful of similar patients are ideal subjects for scientists who study touch and proprioception. Theres nothing unusual about their muscles or their brains. Theyre simply missing one tiny, but hugely consequential, thing: a molecule-sized receptor that acts as the doorway through which physical forces enter the nervous system and ascend into conscious awareness. The receptor is called piezo2, and it was discovered just 10 years ago.

The missing molecule essentially leaves them without the eyes of the proprioceptive system. It also leaves their skin unable to feel some specific sensations.

These patients are rare the NIH team and their colleagues around the world have identified only 18 cases, with the first two documented in the New England Journal of Medicine in 2016. They are the equivalent of identifying the first blind person, or the first deaf person, Alexander Chesler, a neuroscientist at the NIH who has been working with Sana, Sawsen, and the others, says. Here are people who, based on what we understood of the molecule at the time, would be touch-blind.

The effects of the condition can make it hard for people to control their bodies, particularly when their vision is occluded. And the symptoms of this rare genetic disorder are often misdiagnosed, or go undiagnosed for years.

By studying them, neuroscientists get to probe the essential functions of touch and the proprioceptive system, and also get to learn about the brains remarkable ability to adapt.

Carsten Bnnemann is a detective of neurological medical mysteries. When children have neurological conditions that are difficult to diagnose, he swoops in to try to crack the case. We look for the inexplicable, Bnnemann, a pediatric neurologist at the National Institute of Neurological Disorders and Stroke, says.

In 2015, one such mystery brought him to Calgary, Canada, to examine an 18-year-old woman with a strange disorder. She could walk she learned around age 7 but only when she looked at her feet. If she closed her eyes while standing, shed collapse to the floor. It was like her eyesight contained the power to turn on a secret switch and give her control over the body part she gazed upon. Out of sight, her body was beyond her control.

And when I examined her, I realized that she had no ... proprioception, Bnnemann says. When her eyes were closed, she had no sensation of her doctors gently moving her fingers up or down. But the absence of awareness wasnt just in her finger joints. She had no sense of movement in her elbows, her shoulders, her hips in any joint in her body.

Though it is often not in our conscious awareness, proprioception still serves a critical function. If you want to move in a coordinated fashion, you have to know where your body is at all moments, says Adam Hantman, a neuroscientist at the Howard Hughes Medical Institute who studies proprioception. You could look at your limbs, but that means you cant look at other things. Proprioception allows our eyes to pay attention to whats going on outside our bodies.

To make the diagnosis, Bnnemanns team sequenced the girls entire genome and found a mutation on genes that code for a touch receptor called piezo2. In 2015, piezo2 was still new to science.

Before that, scientists had known for a long time that all kinds of special nerves are devoted to sensing the outside world. If nerves are the wires that transmit information from the world to our brains, these receptors are the switches the first cog in the biological machine where the electrical signals originate.

The landmark discovery of piezo2 happened at the Scripps Research Institute, where researchers had spent years prodding cells with tiny glass probes. (When poked, the piezo receptor produces a small electrical current. Piezo is Greek for to press.) The researchers found two receptors piezo1 and piezo2. When cells that contain these receptors are stretched, the receptors open up, letting in ions and setting off an electrical pulse.

Piezo1 is implicated in our bodys built-in blood-pressure monitoring systems, as well as other internal systems that rely on pressure sensing. Piezo2, further research revealed, is a molecule critical for both touch and proprioception, a gateway through which mechanical forces begin their journey into our consciousness.

In 2015, scientists were just starting to figure out what piezo2 did in mice, let alone humans. Bnnemann had to study up, and he returned to the NIH in Bethesda, Maryland, and emailed Chesler, who was studying mice whose genes had been modified to lack piezo2. Bnnemann emailed him about the patient, as well as another an 8-year-old girl in San Diego they had identified as having the mutation.

And that made me basically fall out of my chair and run up to his office, Chesler says. Id never had the opportunity to ask my mice just to describe what their life was like, what their experience was like, ask them questions.

Sana and Sawsen, like Bnnemanns first patient, were born with a genetic mutation that makes their piezo2 genes non-functioning. And thats left them with lifelong impairments with their proprioception, touch, and movement. Both women can walk a bit on their own, but use electric wheelchairs to get around. Both live independently. Sana is a clinical psychologist, and Sawsen heads up a camp for children with disabilities.

They dont know life with proprioception, which makes it hard for them to even describe what they lack. I have no good comparisons, because Ive always been this way, Sana says.

Of the few cases of people without proprioception in the medical history literature, the most famous was of Ian Waterman, a British man whose neurons sensing touch and proprioception were damaged by an infection. It left him without any feeling or proprioception from the neck down, though he could still move his body. It was a limbless limbo, the neurologist Jonathan Cole wrote in a medical biography of Waterman.

Waterman clearly had nerve damage. But until about a year ago, Sana and Sawsen never really knew what was wrong with them. Then, they tested positive for a mutation on their piezo2 genes, and that led them to Bonneman and Cheslers ongoing research on how piezo2 functions in the human body. So far, the researchers have seen a dozen patients who have non-functional piezo2 receptors.

Touch is a very complicated sense, since there are so many forms of it, each relying on slightly different systems of nerves and receptors.

Just appreciating all the things we can feel can invoke a sense of awe. If one of us snuck up behind you and moved a single hair, you would immediately know it, Chesler says. This is one of the most amazing biological machines.

In many ways, the sensory information we get from our bodies is much more varied than the information we get from our eyes, ears, and mouths.

For instance, heat and cold sensation work on different nerves than light touch sensations, and use different receptors (some of which were also only recently discovered). Pain, itch, and pressure are distinct too. There are also some touch sensations that are dependent on context. Think of how the feeling of a light touch of a T-shirt on your body fades from your awareness the longer you wear it. Or how, during a sunburn, wearing that T-shirt suddenly becomes unbearable.

Without piezo2, the sisters cant feel light, gentle touch, particularly on their hands and fingers. Sawsen tells me that when she puts her hand into a pocketbook, I will take my hand out of the bag thinking Im holding something, and my hand is empty, she says. She cant feel the objects, and she doesnt know where her hand is. So a pocketbook might as well be a black hole when shes not directly looking into it.

But the sisters can feel heat and cold. They can feel pressure. And theyre not immune to pain. Particularly, they can feel sharp sensations.

Sawsen has taken up sharpshooting as a hobby (to relieve stress) and has outfitted the trigger of the weapon with a hard-edged rectangular piece. When she digs her finger into the edge, she can feel it.

That type of pinching pain must begin its journey into the nervous system by a receptor other than piezo2. So when youre pinched, that feeling, we dont understand at the molecular level whats going on to activate your neurons, Chesler says. Thats surprising. How the acute pain of stepping on a LEGO brick exactly enters our nervous system is still a scientific mystery in the year 2019.

They can feel that type of pain, but they cant feel another called tactile allodynia. Thats when light touch sensations, which are normally pleasant, become painful. (In the lab, researchers create tactile allodynia by rubbing skin with capsaicin the spicy chemical in hot peppers.)

Another mystery: The patients can feel when their skin with hair is stroked, like on their arms. But strangely, they cant seem to feel individual hair movements. We dont know how they do it, Chesler says. Which is to say: Neuroscience doesnt understand, completely, how this sensation is generated in the body.

Its these insights that could lead to some practical outcomes of this research: Namely, new ways to treat pain. Scientists hope by identifying the receptors that bring physical sensations into our bodies, they can learn to augment them, perhaps turning them off when theyre causing pain.

That is the dream of pain research, Chesler says. Can we get away from these really coarse ways of looking at pain, and understand it at a more mechanistic level? If you dont know the receptor responsible for sharp pain, for instance, you cant design a drug to turn it off.

Touch is complicated. Proprioception might be even more so. But in studying it, researchers may yield discoveries and applications that stretch far beyond the human body.

Deep in all our muscles are fibers called muscle spindles: This is a bundle of fibers and nerves that record muscle stretch. On the nerves endings of the muscle spindles, yes, youll find piezo2. When the muscles are stretched, others contract, and piezo2 then transmits all that information to your spinal cord to determine where your limbs are.

Whats amazing is how every muscle in your body is sending out this information all the time. Your nervous system somehow processes that massive amount of data without any conscious work on our part. How could it possibly be conscious? Youd go wild from information overload.

Just think of what it takes to sit up straight. All the muscles in your back have to relay the right information so you can keep all the bones of your spine in line. The piezo2-less patients dont have that. They have scoliotic posture because they dont have the muscles in their back telling their brains how to align their spine. (Many of these patients, Im told, are also malpositioned in the womb before birth, or are born with hip displacement thats how fundamental of a sense proprioception is.)

Lacking the primary input for proprioception, Sana and Sawsen have to concentrate hard to not feel disoriented. Sometimes, Sana says, just her hair getting in the way of her eyes will cause her to lose orientation of where her body is. The same can happen if someone gets too close to her face, blocking her peripheral vision. Which means she needs to concentrate extra hard if she wants to kiss someone.

Its still a deep mystery how the brain pulls together all the sources of proprioceptive information so effortlessly.

The most amazing this about it is how utterly flexible it is, says Adam Hantman, a neuroscientist at the Howard Hughes Medical Institute who studies proprioception. You can ask me to reach out for a cup, and say, Dont do it in any way youve ever done it before, and without practicing, I could snap my hand around upside down, put it behind my back and reach that cup. Ive never done that action before in my life, and I could do it without practice.

And there are so many beautiful complications in this research still not well understood by scientists.

Scientists generally regard touch and proprioception as different systems. But they can overlap to a certain extent, says Joriene De Nooij, a neurology researcher who studies proprioception at Columbia University. Receptors in the skin contribute to our understanding of where our limbs are. When youre walking theres all these pressure receptors in your feet that will be activated every time you take a step, she says. And that also gives our brains information about where the body is.

We have so, so many inputs into our sensory system that give us feedback and orient our minds to what our bodies are doing. Learning how the brain actually pulls this off what are the algorithms it uses to build these models and utilize them will help us make better machines, Hantman says.

Particularly, it may help researchers make better prosthetics that are directly controlled by an amputees nervous system. The machines are pretty good at taking a signal from the brain and making the prosthetics move, he says. But we really havent done that great a job closing the loop, getting sensory information back.

The brain also does another thing involving proprioception that researchers deeply want to understand: How it compensates in the face of loss, like in the cases of Sana and Sawsen.

The muscle spindles and other nerve endings explain how proprioception works in the body. But even stranger is how it manifests in our minds.

I keep thinking about what happens when I close my eyes and reach for something. Theres a glass out in front of me on my desk. I can still grab it with my eyes closed. Im trying to concentrate on the thought of where the glass is in space, and dissect it: What exactly am I experiencing in this moment?

Its like trying to describe a daydream. You know its there. It seems real. But it has no form. Its consciousness, says Ardem Patapoutian, a neuroscience researcher at Scripps, whose lab first discovered the piezo receptors. A physical aspect of consciousness, he says, is informed and shaped, in part, by proprioception.

In reporting this story, Ive come to think of the process by which the brain creates consciousness as a kind of wizard or conjurer stirring a potion. The wizard takes sensory inputs from our bodies: like touch, temperature, joint awareness, mixes it in with our thoughts, our emotions, and our memories, our predictions about the world, and throws it in the cauldron to generate our consciousness. A whole sense of self emerges from these disparate parts. Its greater than the sum of the parts, and singular.

But its not like if youre missing an ingredient, the potion goes bad. Sana and Sawsen are missing information from their piezo2 receptors, but their minds still use other ingredients to compensate. Theyre as conscious as anyone else.

Chesler believes the sisters brains still generate a map of their body. They just have to use other inputs, like their vision, or other sensations, like heat and cold, or painful touch.

Like a blind person with an attuned ear, they use their other senses to compensate for what they lack. When Sana was reaching out for the cylinder with her eyes closed, she says she was trying to feel a draft from a nearby air conditioning duct. She remembered it felt colder by the ball and was trying to find that cold spot.

Whats going on in their brains to construct their body image in the absence of information that we rely on so steadily? This question is one of the most important ones we could be asking about this sense, Chesler says, and one that Im hoping, in the next few years, my lab will actually start addressing.

But you dont need a study to see this is true: The human mind has remarkable resilience.

You get used to your own body, Sawsen says. You learn to cope with the materials you have access to.

Brian Resnick is a senior science reporter at Vox, covering psychology, space, medicine, the environment, and anything that makes you think, Whoa, thats cool.

Correction: An earlier version of this story misspelled the name Sawsen.

Link:
Proprioception is our silent sixth sense. Neuroscience is just beginning to understand it. - Vox.com

Michigan State Universitys Board of Trustees today authorized a $10.3 million project to update the infrastructure and functionality of the Eppley Center in the universitys Business College Complex.

The 58-year-old building will be reconfigured to bring undergraduate advising and other student academic support services, as well as computer labs, into one location a move made possible by the recent completion of the Edward J. Minskoff Pavilion.

Because the buildings original mechanical systems are inefficient or inoperable, the center will receive safety and energy efficiency improvements including LED light fixtures, fire alarm and suppression systems and heating and cooling systems.

"It is vitally important that the critical support services our students need are as accessible as possible, said Broad College of Business Dean Sanjay Gupta. We've made a commitment to align our facilities to promote student success, and this investment will deliver on that for years to come.

Trustees and other leaders also recognized 17 students with academic achievement awards for earning 4.0 GPAs at the close of their last semester at MSU. Also honored were the universitys 20th Rhodes Scholar and 19th Marshall Scholar.

Rhodes Scholar Anna Esenther is a 2019 Honors College graduate with degrees in economics, psychology, history, education and statistics. She will study economics at the University of Oxford and hopes to leverage her selection to amplify the voices of teachers and underrepresented populations in economics.

Marshall Scholar Emily Steffke is an Honors College senior majoring in neuroscience in the College of Natural Science and English in the College of Arts and Letters. She is an undergraduate researcher at MSUs Institute for Quantitative Health Science and Engineering.

It is such a pleasure to acknowledge and congratulate such an impressive group of scholars, MSU President Samuel L. Stanley Jr., M.D., said. Their accomplishments reflect so well on the university and illustrate the caliber of our programs and students.

President Stanley and several trustees also welcomed new trustee, Renee Knake, who was appointed earlier this month by Gov. Gretchen Whitmer.

Ms. Knakes experience in higher education, ethics and diversity issues will be great assets in supporting our efforts to build a safer, more respectful and more welcoming campus while striving to enhance student success and improve our community, Stanley said.

Other board activity included:

The next board meeting will be Feb. 14, 2020.

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Trustees approve project to update the Eppley Center - MSUToday