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Monthly Archives: April 2012

Part 1 of a several part post

Introduction-What is the structure of Human Performance?

The definition of Human Performance: the part of human functioning that accomplishes tasks according to measurable standards of efficiency, completeness and accuracy. In other words, performance is that part of our function that literally represents the purpose of our lives. Forming a coherent and rational understanding of human performance seemed obligatory to me as a practicing clinician; I began this pursuit two years ago. As in all scientific and philosophic inquiries, I knew that I needed to find the right question to answer which, as always, meant going back to basics. Recalling that nothing can function without possessing structure my inquiry into the nature of human performance began with my asking myself the following question, “If our performance is a part of our function, what then is the structure of our performance?”

The structure/function relationship is the basis of all rational scientific thought. In essence, structure and function is the same thing.  Take a simple sheet of paper; when you place it on a flat surface it functions as something upon which you can write; fold it in a specific way, and it can fly like an airplane; crumple it tightly into a ball and you can toss it into a trash can ten feet away. Regardless of how many ways you may change the same sheet of paper, the relationship of its structure and function remains constant and immutable. While the proof of the existence of sub-atomic particles long ago disproved Plato’s conception of the atom as the smallest and indivisible form of matter, the concept that the structure of any physical object in the universe is inseparable from its function continues to hold firm and regardless of scale, whether sub-atomic, microscopic or astronomical. A single proton in its core, or nucleus, is all that separates the 112 individual elements on the periodic table from those to its right or left. The element, Hydrogen with a single proton in its nucleus functions perfectly as a trigger of an atomic reaction; inhale the next element to the right on the periodic table, Helium, which has two protons in its nucleus and you will speak with the voice of a Munchkin from the land of Oz; skip the next four elements and we come to the Carbon atom with its 6 protons, that functions as the exclusive template upon which all life on our planet was manufactured for 3.5 billion years and counting. Finally, on the astronomical scale, with a structure more than 1300 times the volume of Earth, Jupiter functions as a gravitational shield, protecting our relatively tiny world from catastrophic collisions with the orbiting debris left over from our solar system’s creation some 5 billion years ago. In essence, Jupiter’s structure provided the Carbon atom the opportunity to function as the designated element for all life on Earth. What’s more than its sublime, ubiquitous even poetic nature is the relevance of the structure-function relationship to our understanding human performance. What follows is the answer to the question that I asked my self two years ago, “just what is the structure of human performance?”

Human Performance; a window to Human Health

Human performance is an aggregate of actions or behaviors that take place exclusively in the physical world and it is executed entirely by the human body; its skeleton, muscles, joints and connective tissues. Examples of human performance include speech, driving a car and making love; separately or all at the same time. In turn, each of these constituent behaviors or actions is a direct reflection of an ever-changing or plastic structure of the human central nervous system (CNS). At the core of the brain’s plasticity is a process called, neurotransmission which is the communication via chemical-electrical signals between one brain cell, or neuron and another. In all there are one hundred billion such neurons originating in the human brain, each having as their final destination a muscle fiber somewhere in the human body. At the molecular level of this inter-neuron communication process are chemical-electrical messengers, or neurotransmitters each of which has a unique chemical structure limiting its interactions to only with, structurally compatible, molecules located on the surface of the neuron known as receptors There are trillions of these chemical-electrical signals communicated in the human brain every second, thus giving the brain a nearly fluid, or plastic molecular structure which over time actually change the visible, or macroscopic structure of the brain. Hence the recent addition of the term, neuro-plasticity to the vernacular of neuro-science.

Within this neuro-plasticity framework, we can conceptualize human health as the sum of all forces, internal and external, which affect the plastic molecular structure of an individual’s central nervous system. Examples include exposure to a stressor such as Hurricane Katrina or a medical illness such as an infection. The extent to which any such force, whether external or internal, will impact an individual’s performance is limited by, or is to the same exact extent to which this force impacts, or molds the plastic structure of the individual’s brain. Conversely, only if a given force, whether internal or external, impacts the plastic structure of an individual’s brain will it have any impact on an individual’s performance. Within this framework, which represents the consensus scientific view, health and performance are the structure and function, respectively of  any individual human being. Thus, an individuals’ health and performance are indivisible and direct reflections of each other.

My health-performance proof shows that an individuals performance is a surrogate for their health and vice a verse. The clinical implications of this relationship are profound and far reaching. My understanding of this fundamental relationship between our health and our performance has served as my main cognitive tool for providing medical care to my patients that is far above the prevailing standard of care in our healthcare system. In my next post I will show how this tool is easily scalable and can be applies potential to fundamentally  change our healthcare system for the better and enhance its real value.

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Mitchell R. Weisberg, MD, MP