Psyc: Efficient Thinking

Efficient Thinking

Efficient generally refers to performance with the least amount of waste or sometimes the ability to avoid waste. The term efficient is very subjective to context and observations regarding use.  Two of the subjective measurements are the consumption of resources and the use of resources to meet a goal. Each are perceptions on the same consideration, one view is from the producer and the other from the customer.  Efficient thinking in mind and the brain is similar. The neurobiology of the brain produces thoughts, and the neurocognition of the mind consumes the thoughts.

Waste has some negative connotations, e.g. trash, but a wastebasket is very efficient for collecting trash. In production companies, the consumption of resources manufactures a product. In manufacturing, quality is an efficiency statement that appears to be a perception measurement about resource depilation that occurred to make the finished goods. Customers who purchase the goods make a quality assessment to buy based on their judgment the goods meet the perceived use of their personal resources,

Illumination is the waste of electric power applied to a light bulb. A 10 Watt light bulb is more efficient than 100 Watt light bulb regarding power consumption. However, from a different perspective, the illumination produced by 100 Watt bulb may be more efficient to reduce the darkness. In energy consumption,  watts is a measurement of the waste cost associated with the power to produce electricity. Energy company uses waste consumption to make money. The more waste, the more money

MS: Think Outside the Box

Think Outside the Box

HERO:

The word hero is an acronym that means, Help Everyone, Respect Others. You show respect by giving your time, your talent, your treasure, and most importantly, your tenacity. Never quit until we find the cure for MS. Thank you for coming, each of you is my hero.

The current dialog on MS has two principal author perspectives. The clinical view and the MSer self-view, or the "them" or the "me" perspective. When I talk about MS From the Insider-Out, I try to have the "us" perspective.  I just look at MS magazines, the principal authors were from the clinical view. Sometimes, the magazine will have an MSer personal story as the me-too story.  The them pronoun can be a logical context syllogism when referring to people with MS as the object of the article. Them, you, us and me are just perspectives of the MS box. The clinical views, them and you, see the MS box from the outside. The MSer views, us and me, is from inside looking to see out. The MS box does not have walls, rather, the clinical perspective is looking at a pool of water, and MSer perspective is living in the pool. The water is not water, it is MS.

The idea of "MS From the Inside-Out" is different than other dialogs. It is a cross between the clinical and the personal.  

Before MS forced me into disability, a big part of my career was working on international standards for electrical engineering. The job was to architect information models. Everybody is an information molder. Every profession has sets of information models that become the rules of the job. An MD diagnosis of illness. A CPA reconciles charts of accounts. Parents, children, artist, CEO, researcher, pastor, politician, gas station attendant, hermits, blue-collar, white-collar, gray-collar, everybody operates within tribe information models. Characteristics, personality, craft, relationships, and awareness emit from information models.  This email is an information model.

Think of “MS From the Inside-Out” as the middle-ground information architecture of MS life.

Here is a challenging information model question I asked many doctors and others, some of whom were at the meeting.

a. What not is fatigue is ___________?

b. What is not fatigue is ___________?

These are information architect style questions. 

The answer for a. is the opposite. 

The answer for b. is a description. 

My Inside-Out journey began with another question, “What did MS steal from me?” While looking for what MS stole, I discovered the MS thief left fatigue tracks. You may think everybody knows MS causes fatigue. That is true, the difference is my discovery personified MS as thief and fatigue is evidence not a symptom.

The challenge question makes a case statement where the fatigue evidence may find what the thief stole..

All the "pros" answered with descriptions of fatigue. Never the opposite.

A survey using the challenge questions. While not necessary, add one more question.

c. What is your connection to MS. Answer One or more.
___MSer.         How long since diagnosis? ______
___Care giver. How long providing care? __________
___ Medical doctor.
___ Ph.D. not medical.
___ Medical or Ph.D. staff
___ Therapy. What type? ________
___ Community Provider?  What type ________
___ Trainer. What type? _______
___ MS Support Organization.
___ Other connection. ___________
___ No connection.

As an experiment, read the InfoMS "Focusing on Fatigue"  to look for an answer to the challenge question.

I did find an answer. I am a fan of letting others seek their answers. My answer took me two years working on and off to find.

CPA Hint. What not is a net asset is ________
               What is not a net asset is  ________
               😀The answer is not a not for profit

The MS Society Communications Editor and some Society staff rejected MS From the Inside Out. Not everyone is in favor of a new MS box. 

A box has 4 observer perspectives. 

 - The outside perspective sees the box. 

 - The inside perspective sees the box. 

 - The outside-in perspective is a guess about what is on the inside. 

  - The inside-out perspective can see both sides. 

Hence, the expression, thinking outside box. Some people think MSers belong in a box. Open a box the lid to discover a music box.

In 1989, at 40, I was diagnosed with MS. I worked as an advisory engineer at IBM. Then in 1995, MS forced me to surrender my career. In 2005, I started to change my relationship with MS. The process took a few years, eventually, I invented a training program called Connection Toning. All of my MS education was a clinical perspective. (Most of the Brain Hearth  program was from the clinician perspective.) This perspective is absolutely necessary. As time passed, I realized as an MSer, I have a different perspective. I called my perspective, "MS From the Inside Out" and the clinical perspective, "MS From the Outside In."

However, both perspectives are about MS.  I needed a model that includes both. This blog explains:

https://ideas.resipso.com/2019/10/multiple-sclerosis-ms-from-inside-out.html

The Outside-In MS dialog is lesion, inflammation, and scar.  However, I know something is wrong before going to a neurologist. I gave that knowledge a name, irritation. I know the lesion will cause neuro-psych damage I called stigma.  I named the Inside-Out dialog lesion, irritation, and stigma.

https://ideas.resipso.com/2019/11/multiple-sclerosis-ms-attack-zones.html

Psyc: Tribal Bullying

DRAFT:


What are your opinions on bullying by tribes? As members of society we all live in tribes.

Tribe examples include family, work, church, city, sports teams, gangs, cliques, organizations, income, discrimination profiles, political parties, military, demographics, national pride, etc.

When my daughter was in middle school, the in-girls clique bullying was terrible.

When I was in grade school we lived on the wrong side of tracks and we were poor. The kids from the "the north side of Colfax" did name-calling, shoving, ridiculed, and ostracized my brother, my sisters, and me. We were not the only school kids who the bullies attacked. Colfax was a label of convenience, rather, in reflection, we were poor, but not in poverty. I suspect other branding like patched clothes,  paper bags not lunch boxes, heritage, grammar, size, clicks, and family advertised labels for bully aggression. I remind myself, the sins of youth are not the sins of adults. Years later, after meeting the bullies from my youth, they had none of that character. 

Tribes have four actions, recruit, inclusion, exclusion, and expelling.

Tribe behavior includes identity, defense, ranks, sustainability, contribution, commitment, boundaries, dues, events, charter, fraternity, and attraction.

During a person's lifetime, the person will be a member of many tribes. Tribe membership can come and go, rise and fall, persist or fail. Membership changes are fundamental to the tempo of life and death. From the time of birth, we build membership in the tribe of self. When I die, I will be a member of a US veteran's gravesite. 

Bullying is the use of force, coercion, or threat, to abuse, aggressively dominate or intimidate. The bully's behavior often repeats and becomes habitual.

Questions:

Besides mobbing, what are the other profiles for tribal bullying?

What is the self-defense for tribal bully attacks?

Dirty Doubles Stud Poker

Feature: Dirty Doubles Stud Poker 

In 1998, when a few of us got together is to play nickel, dime, quarter poker, I invented the dirty doubles poker game. Many card games use partners as part of the gameplay. 5 card stud poker intrigued me as an oppunitity to devise a partner type game for poker. 

Dirty Doubles is a stud poker game in which each player has the possibility to gamble with 6 up cards in a hand 1-6-1. The deal remains 1-3-1, but by random selection each player has a partner where both partners share the other partner’s up cards. Each betting player can use a combination from 5, 6, 7, or 8 cards to make a 5-card poker hand. The hand should be played with and even number of players, preferably 6, however, a variation can be played with an odd number of players.

The Game:

Each player has a partner. The stud up cards are shared between each partner in thus increasing the possible winning hand combinations. For example, in 1-3-1 five-card stud, the partners each have 2 down cards and share the 6 up cards to develop a winning hand. Betting intensity draws more commitment to remain in the hand.

 Table terms:

·   Mud is the name for the 6 up cards.

·   Dirt is the name for the partner’s 3 up cards.

·   Prospect is the name for the player’s 2 down cards.

·   Water is the money in the bet pot.

·   Slush is the alphabet suit rank, clubs (lowest), diamonds, hearts, spades.

Strategy:

Gameplay follows traditional betting and order of play. The betting deal is one card down, three up, one down (1-3-1). All players see all the up cards. Each partner’s betting tactics are as an individual player.

Order of play:

The first deal is non-betting and determines partners. On the first deal, the dealer in left to right order, deals each player an up card. 

·         When any two players have a pair, those players are the dirty partners.

·       This continues in rotation until each player has a partner.

·         When all players have a partner, the deal stops.

·         The dealer collects the cards, shuffles, and deals as any stud game.

·         Deal, play, betting protocol, and raises proceed as any 5 card stud game.

Because six cards are face-up, five up cards may be a rank order pat hand. However, each player still has two prospects down cards to improve the pat hand. The prospect cards may improve the rank order. If the rank order remains the same, prospect cards may use the suit rank to substitute for a rank card. The suite order is alphabet order, clubs (lowest), diamonds, hearts, spades (highest). If the pat hand stands the final call, the players split the pot.

However, the partners continue to play until the last call requests all players to show their hands. If the partners with a pat hand defend against other players, the winning partner is the one with the winning 5 card hand.  If the other players fold, the partners bet and play against each other. Both partner’s up cards contribute to a winning hand. Every game has one winner. The better must declare the play’s 5 cards from the two down cards two and six up. Cards do not self-declare.

Dirty play happens when one of the partners decides to fold, then the other partner my choose to play or fold the up cards. If a partner chooses to play the folded hand, the player partner must match all checks and bets to folded hand just as if the folded player hand was still in the game. Normally, raises are not allowed on the folded player’s cards. Before the first deal, the dealer may announce dirty raises allowed.

Number of players:

Odd: When an odd number of players wish to play dirty doubles, the seat to the right of the dealer is the odd player hand called the slop player. The dealer passes out the partner's hand just as if a person was sitting in the chair. When a player pairs with the odd hand, the partner may choose to play just like a folded hand where checks, bets, and raises would be played by a real players.

Only 2: When 2 players wish to play dirty doubles,

The challenge:

Dirty doubles increase game intensity by distributing winning hand, prospect combinations increases pot growth and raises player psychology attention. Since the first deal determines partner section and dirty double card play position order, traditional stud betting tactics dynamics change due to up card locations.

Dirty Doubles introduces the concept of prospect bidding. Normal poker odds are a frequency based on a deck of 52 cards with four suits of the same 13 values. In dirty doubles, the deck size for a poker hand increases by 3 times the number of players. A game of six players is a 70  poker deck where  3 times 6 plus 52  is in play 70 cards. While the dirt cards are from the same standard deck, the dirt’s suit and face values are essentially random arbitrary hand fulling opportunities*. 

Nasty dirty doubles:

Normal dirty doubles play is with the stud up cards. Nasty dirty doubles in 1-3-1 stud allows the betting partner to play the last down card from the other partner’s hand. The last down card stays down and unknown to the betting partner.  All payers may look at their 5^th card. Before the 5^th card bets, the betting partner may declare his down card as nasty and chose to risk play using the partner’s unknown 5^th  card. The other partner’s hand becomes the moral hand.  The betting partner uses hid 1-3 cards and the moral hand’s 3 up card and the down card. The moral hand down card stays unknown to the betting partner until the game’s last call.  When players declare their poker hand, the betting partner declares using the last four cards from the moral hand and the first four cards from the nasty hand. The moral hand down card may or may not be in the declared poker hand.

*Random as cards dealt in play rotation (horizontal), arbitrary as a dirt set (vertical) in the mud.

 [JF1]

Veteran: First Principles of Veteran Benefits

Veteran: First Principles of Veteran Benefits

Anytime an area of interest transforms into another area of interest, the process of transformation requires three steps. The first step is accepting the original area of interest, the last step is generating the intended area of interest. In between are the transformation rules. The rules act as a catalyst where the meaning of the original can become intended. The process of information transformation happens everywhere.

As you read these words, the eyes scan the symbols and transform the words into thought. In between are the multiple transforms where each transformation rules contribute to the eventual intended area of interest. In arithmetic, the predicates, add, subtract, equal are the rules for transforming numerical values. First-principles is another name for the intermediate rules. Each principle is a valid test for both the original and the intended area of interest.   

For veterans' benefits, the Law is the original area of interest with the statutes contained in US Code Title 38, Veterans' Benefits.  In most cases, the intended area of interest is the Title 38 Code of Federal Regulations Veterans' Benefit used to define the business practices of the  Department of Veteran Affairs (VA).  Title 38 also establishes the United States Court of Appeals for Veterans Claims (CAVC) with statues from 38 U.S.C.  7251–7299. The Department of Veteran Affairs operates as an Executive Department of the United States President.  The Court of Appeals for Veterans Claims operates as a Federal Court, not as part of the VA.

The CAVC charter is Title 38 Statues. The Count has intermediate rules that are the principle to transform the Statues into the Count's judicial practices. The VA creates the regulations without intermediate rules where the regulation is in the VA's business interest  Therefore, the regulation may not be in the veteran's interest.  

The First Principles (or Rules)

This is my proposed list of the missing first principles. The list begins with the missing definition for Title 38.  

1. Title 38 USC Veterans' Benefits is Congress's lifetime wellness grant of benefits to each honorably discharged veteran for the veteran's national service with the Department of Defense. 
2. Title 38 statutes define the grant's services.
3. Congress allocates funds from the Federal Budget to pay the fees for the services.
4. A veteran's benefit is the paid fee for a Title 38 service.
5. By Law, the veteran owns all benefits.
6. The DVA and the Court of Appeals for Veterans Claims are Title 38 services.
7. Veteran disability compensation is a Title 38 service.
8. The DVA is an agent of Congress to administer the Budget's allocation and to provide Title 38 services.
9. Title 38 is a set of business rules for Title 38 payouts.
10. Once a veteran always a veteran.
11. To receive Title 38 services, the veteran must register as a client with DVA.
12. The DVA is not a veteran, therefore the DVA cannot own benefits. 
13. The DVA is an agency, not a club, veterans are clients, not members.
14. In all agreements between the veteran and the DVA, the veteran is always the first party principal. 
15. For veteran's medical treatments at a community provider, the DVA establishes an expressed agency with the provider thereby the medical expense is the same as if the treatment occurred at a DVA facility. 
16. A medical expense is a fee for medical service.
17. A treatment for an episode-of-care may include one or more medical expenses. Medical trauma may include one or more episodes-of-care. 
18. The purpose of insurance is to reduce the insured liability. The payout from the insurer is the insured's property.
19. An insurance company may act as the insured's agent to make claim payments. The payment is exactly the same as if the insured paid the claim.
20. The Goodwill Grant is the veteran's volunteered permission given to the DVA to used the veteran's private insurance for cost recovery at a DVA faculty. The grant permits the DVA to be a principal to make cost recovery claims with the insurer. 
21. The DVA has a fiduciary trust responsibility to use the Goodwill Grant's private information only within the DVA and not with any DVA's agents. 
22. The DVA may assist Congress in determining a veteran's eligibility for a particular service, once eligible, the DVA cannot deny the service as a veteran's benefit.
23. All veterans at the time of active duty discharge are eligible for Title 38 benefits and may register with the DVA for Title 38 services.
24. The DVA cannot deny an honorably discharged as a client.
25. The veteran has the responsibility to use Title 38 services for the veteran's wellness.      

The First Test of a Regulation

For a regulation to be valid, the regulation must pass the Title's wellness test (Rule 1).

Does the regulation provide for the wellness of the veteran?

If the regulation does not pass the test, the regulation fails the purpose of Title 38 and therefore the regulation does is not comply with the Law. While the DVA is a business operation, the DVA must conduct its operations as an agent of Congress. Rule 1 states the purpose of Title 38 is to provide services for veteran's wellness. Rule 1 applies to the DVA. 


                                    

About Me: My Multiple Sclerosis Story

About Me: My MS Story

My name is Joseph. In 1989, I was diagnosed with multiple sclerosis. Since then, my MSer story has traveled many roads. Today, I will share the story of some of my adventures. I want to thank each of you for being here. Whenever we can come together to hear and discuss MS, I believe each of us receives energy to continue the adventure. 

Almost every story has a hero. My story has many. I was born in a small town in central Nebraska. We lived on the old family homestead farm without indoor plumbing or running water; three years later, when we moved to the big house, my mother told my dad she wanted an indoor toilet and water in the house. I can still see dad’s solution: a 50-gallon drum on the roof with a hose piping water from the well and electric cord attached to the stock tank heater keeping the drum’s water from freezing. By the time I was seven, I had three sisters and a brother, and we left the farm and moved to Denver. 

Life with MS is like farming; praying each year that the crops don’t fail, yet knowing it’s going to happen sooner or later.

I remember my grandfather, who was one of my first heroes, telling me, “Joseph, I had a great life. Farming is hard. We struggled through the Depression. We have a great family. I started with my dad’s horse to plow fields. We bought land, tractors, and cars. We replaced oil lamps with light bulbs. We went from listening to the radio to watching television. I got to see a man walk on the moon!” Just as he was a farmer, he planted that memory in me. Personally, when I am older and my daughter is grown, maybe I will have a grandchild who I can tell, “I had a great life. I received the cure for multiple sclerosis!” 

In 1968 at 18, I enlisted in the Marine Corps, which began my career working on computer-based Tactical Data Systems. I loved the technology, and I was never bored because there was always something to learn. In 45 years of working with computers, I experienced many changes first hand. The early computer programs were modified by re-wiring circuits, then machine-level switches, hole punch cards, monitors, mainframes, PC, PDA, cell, and so many other great inventions that changed our lives. MS cut that journey short.

Everyone with MS remembers their first relapse and the scared feelings after the diagnosis—“You have MS.” For me, those words came in 1989, while I was living in New York. When I was still single, after a long business trip to Japan, I was happy to be home, but also very tired. I was going down to the basement where I kept my office, and I slipped and rolled down the stairs. I lay there for 30 hours, thinking I’d broken my back, and then somehow found the strength to get up to drive myself to the emergency room. To this day, I have no idea why I didn’t call an ambulance. I’ve since learned that it’s okay to ask for help.

While I was in the hospital, the doctor told me X-rays showed a lesion on my spine at the back of my neck that looked like cancer. I was still in pain and the doctor’s words didn’t register. Meanwhile, my left hand was numb, and my arm was curled to my chest, frozen, unable to move. The doctors recommended surgery, saying the paralysis would kill me. Tests done the night before showed the lesion was shrinking and they decided not to operate. After days of testing and no clear diagnosis, incredibly, I was sent home under the care of my neurologist. 

Three months later, I was stumbling and dragging my left foot. An MRI showed new scarring in the brain and my neurologist confirmed the diagnosis — multiple sclerosis. When I was first diagnosed, some people would shun me, not come into my office, walk out of meetings, or not shake my hand. I remember well those first days of being shunned. I didn’t blame them. At the time, truthfully, I didn’t know any better myself. MS is something to fear, but it is also something to understand. 

Every MSer I have talked to has experienced some denial. My father showed me the courage and my mother cured my denial. One day while shopping for new shoes the numbness in my fingers made it difficult to tie the laces. Mom saw me struggling and noticed a clerk some feet away. In a clear, distinct voice said, “My son has MS, he needs help getting these shoes on.” Mom did not know it. But, my mother's love cured my denial with a few simple words. 

In 1993, I began taking a disease-modifying drug to help control my disease by reducing the frequency of relapses. But by 1994, I was no longer able to work. On December 8, 1994, the doctor told me I had no choice but to retire or be confined to a wheelchair. As I was walking out the door, I had to hold on to the wall to stop me from falling. I was in shock. I cursed, “Damn it MS! You stole my career. You stole my life.” The walk to my car took forever. January 1, 1995, was not a happy New Year.

The next month, I met Debra, the woman who would become my wife. She refused to give up on me, and two years later, we were married. From the moment we met, she became my hero. I also say, she became my “Happy Heart.” I went from age 46 to 16—I would leave love notes on her car and sign them with a heart that had a smiley face inside. One day, she asked me what that was and I said, “Well, that’s my happy heart.” 

My wife and I had been married for seven years, and my daughter was about five. At that time, I had numbness throughout my left side, and I used a cane in my right hand to help me walk. One day, my wife said, “Joseph, you don’t hold my hand anymore while we’re walking.” I started analyzing what she said, and I answered as an engineer, “Well, I don’t get any charge out of it.” She was hurt, and said, “I can’t believe you just said that to me.” I was surprised, too. Several months later we went to the Can-Do program at the Jimmie Heuga Center in Vail. We were listening to a lecture, not specifically on this topic, but we both had a revelation and realized a truth about MS numbness. One of the reasons for holding hands is that it feels good. Because my hand was numb, the emotional mental impulse to reach out and hold her hand got lost because of the MS. I realized it was numbness and had nothing to do with my love for my wife. We’ve worked around it…sometimes we’ll be walking and she’ll bump me and I know what that means. It elevates my awareness.

After 19 years of living with MS, my physical condition had become very stressful. I was putting on weight. Walking was fearful. After my first relapse, I walked almost everywhere with a cane. By 2008, at times, a second cane was close at hand. The situation was worsening. My excuse was MS. My daughter was getting older and my wife was taking on more responsibility. I started to change my thinking, creating a desire to overcome my lack of mobility. What followed were days, then months, and then years of personal training. I have biked five MS 150s, and two 400 mile multi-day treks, and broken both my arms. 

In 2013, I started to lose the feeling in my right foot, making it difficult to slip my feet into the bike pedals. My normal way of getting on the bicycle was to lay it down, stand on my “MS” leg, and swing my good leg over. And then stand the bike up. But this relapse made it impossible for me to do that, and that was my second worse day with MS. All that training, all that work, all those perfect miles: Gone.

After two weeks, with treatment, I noticed gradual improvement; however, the damage was done by that relapse still kept me from cycling. I still look at my bikes. I look out the picture window, look at the mountains, and watch great riding days pass, determined to someday ride again. 

Our journey with MS is mapped by relapses and remissions. With the modern treatments for relapses, the personal challenge is to stay in remission. Each day of remission is a chapter in a hero's journey. I’ve learned that one of the hardest things to overcome is myself; but I’ve also come to realize that I, too, am a hero on a journey. Every person with MS lives their own hero’s journey. The day you hear the words, “You have MS” the story began. Along the way, we meet mentors, support partners, treatments, remissions, and the disease. Because we adapt, the journey continues. MS is just an excuse for an adventure. 

For me, the word “hero” stands for “Helping Everyone Respect Others.”  Remembering how I was once shunned, I educate others that MS may be something to be afraid of—but it’s also something to understand. You can be your own hero by being proactive, discover, learn and know all your options for your MSer life. I’m grateful to my wife and my daughter, and to all the heroes I’ve met along the way. And, each of you—you are all my hero, too. 

Multiple Sclerosis: MS fatigue is an MSer's best friend

MS fatigue is an MSer's best friend.

Connecting to fatigue is one of the hardest MSer challenges. Often without warning, MS fatigue invades activities. Even with life skill management and avoidance techniques, the fatigue monster can find a way to hack into any activity.  This interloper action provides many reasons to consider the fatigue invader an enemy. In systems design, anything that causes a breach in system security is an interloper. As good as any system can possibly be, an interloper demonstrates an opportunity for improving security. An interloper that penetrates enough to cause damage means recovery actions.  While the interloper attack is cursed, the attack triggers opportunities to make a better system by improving security and recovery plans.

MS fatigue is an interloper attack on our body’s systems. We curse its existence as an enemy to our health. But if we step back and look a the attack as defining a breached area in the bran due to the MS lesions. The fatigue points to a place where adaptive techniques can aid damage recovery. As an MSer we can acknowledge MS fatigue as a foe, but also, we accept fatigue as a friend because it is showing us where we can adapt.

MS fatigue is an MSer's best friend.

MS-induced fatigue is the only true impact maker for lesions.  MRI shows where a lesion occurred. Neurologist tests are clinical fatigue tests. 

MS lesions result in 3 types of axon damage, nerve fiber fatigue, axon loss and ephaptic conduction* or simply high impedance opens and shorts.  Each of these exhibit as MS fatigue. *ephaptic conduction, as in cable theory,  means crosstalk due to loss of myelin via electrical fields.

The single measurement instrument of MS fatigue is the MSer themselves.   The body's built-in instrumentation is the main reason MS fatigue is the MSer's friend.  The life skill is to recognize friends and foe. I know first hand how easy it is to make MS fatigue the foe. Whereas in reality, your friend is telling you where the danger exists. 

The "walk out the door" example uses perceived exertion as the instrument to find the lesion trauma area. 

Imagine yourself sitting in a chair, looking at the morning sky out the door.  You decide to go outside to experience the day. To walk out the door 3 conditions must exist. First, you must have the physical prowess to stand up, next you need the neurological coordination to walk, and third, you must have the cognitive resources to plan the walk. ( Some people may lack the mobility to actually get up and walk, but still, imagine you can.) The example is a way the identity the source of fatigue. 

Physical prowess examples are body system works for strength, flexibility, and endurance. Physical fatigue exhibits as things like sweating, thirst, breathing, stiffness, strain, relaxing, nourishment, and sleep.

Neurological coordination is messaging  between the CNS and the PNS  nervous system

Cognition is the analytical mind that plans and executes activity.