No Plateau Podcast

Cryoneurolysis: The Next Frontier in Spasticity Treatment

Mon, 13 Apr 2026 09:27:00 -0000

In this episode of the No Plateau podcast, host Henry Hoffman sits down with physiatrist and researcher Dr. Paul Winston to talk about cryoneurolysis, an emerging treatment that is gaining attention in neurorehabilitation.

Dr. Winston breaks down how this minimally invasive technique works and why it is generating excitement among clinicians treating spasticity. Using a probe that delivers extremely cold temperatures, around −88°C, through gases like nitrous oxide, clinicians create a small “ice ball” around targeted peripheral nerves. This controlled freezing temporarily interrupts the nerve signals that drive muscle overactivity. The key advantage is that the nerve’s structure stays intact, allowing it to regenerate over time and creating a valuable window for rehabilitation and functional recovery.

Henry and Dr. Winston also explore how cryoneurolysis compares with more familiar treatments like botulinum toxin injections, nerve blocks, and surgical approaches. While some treatments chemically block or damage nerve signaling, cryoneurolysis uses a physical process that allows nerves to recover gradually.

Dr. Winston shares stories that will stick with you, the husband grasping his wife's hand for the first time in years, the 12-year-old boy applying his own deodorant, the patient who threw away his AFO and now runs through the neighborhood. These aren't just clinical successes; they're reminders of why we do this work. The conversation also highlights how collaboration between physicians, occupational therapists, and physical therapists can help patients make the most of this recovery window.

Listen to the full episode to learn how cryoneurolysis may reshape the future of spasticity treatment and what it could mean for your clinical practice or rehabilitation journey.

In This Episode

Podcast disclaimer (00:09)
Introduction to Dr. Paul Winston (01:21)
From dance to rehab (02:44)
How cryoneurolysis differs from cryotherapy (05:35)
How cryoneurolysis became part of Dr. Winston’s practice (09:11)
The first cryoneurolysis patient: eureka moment that changed everything (13:13)
Anatomy of a nerve: what actually happens during cryo (16:28)
Using ultrasound and electrical stimulation to target nerves (23:30)
Sensory vs motor nerves in cryoneurolysis treatment (25:58)
What spasticity really is beyond textbook definitions (30:02)
Comparing common spasticity interventions: Botox, phenol, and cryoneurolysis (33:44)
Choosing cryo vs Botox (38:35)
Toxin vs cryo: comparing mechanisms and applications (39:26)
How Botox works (41:33)
Contraindications and potential side effects of cryoneurolysis (43:21)
How therapists should use cryoneurolysis in rehab (50:01)
Real patient outcomes and functional improvements (56:01)
The future of cryoneurolysis in rehabilitation (01:00:53)
Understanding reducible deformity vs contracture (01:05:38)
Where clinicians can learn more about cryoneurolysis (01:07:56)

Our Guest

Dr. Paul Winston, MD

Dr. Paul Winston is a Canadian physiatrist and Clinical Associate Professor at the University of British Columbia specializing in neurological rehabilitation and spasticity management. Originally trained as a dancer at Canada’s National Ballet School, he brings a unique perspective on movement to rehabilitation medicine. He is widely recognized for advancing cryoneurolysis and is a co-founder of the Canadian Advances in Neuro Orthopedics for Spasticity Consortium. His work focuses on improving movement and quality of life for people living with neurological disabilities.

Resources & Links

Dr. Paul Winston on LinkedIn

Henry Hoffman on LinkedIn

Saebo

Spasticity Without the Plateau: Science, Access, and the Path Forward

Mon, 23 Feb 2026 07:00:00 -0000

In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors.

Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale.

The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix.

The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well.

In This Episode

Introduction to the No Plateau Podcast (00:00)
Meet Dr. Monica Verdusco Gutierrez (00:59)
Understanding spasticity: Definitions and misconceptions (02:59)
Assessing spasticity: Tools and techniques (08:35)
Treatment options for spasticity (12:38)
Neurolysis: Phenol, alcohol, and cryo (16:23)
The importance of functional goals in spasticity management (22:43)
Introducing the AAPM&R consensus guidance (24:39)
Getting feedback from patients and therapists (28:37)
Botox and other toxin treatments (29:07)
Exploring cryotherapy for spasticity (29:57)
Disparities in access to spasticity care (31:10)
Cost efficiency in spasticity management (36:56)
Caregiver challenges in managing spasticity (42:14)
Communication between therapists and physicians (44:47)
Future directions in spasticity management (51:20)
Conclusion and final thoughts (54:51)

Our Guest

Monica Verduzco-Gutierrez, MD

Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine.

Resources & Links

Henry Hoffman on LinkedIn

Saebo

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Stroke Guidelines 2023

Neurorehab Lessons Every New Grad Needs to Know

Sun, 25 Jan 2026 17:30:00 -0000

In this episode of the No Plateau Podcast, host Henry Hoffman sits down with occupational therapist, researcher, and educator Annie McCluskey to unpack the neurorehab lessons she wishes she had known as a new grad. With over 30 years of experience in stroke and brain injury rehabilitation, Annie brings a refreshingly honest perspective on how practice has evolved and where clinicians still get stuck.

They dive into big topics like becoming a true movement scientist early on, why repetition, intensity, and high dose practice matter from day one, and how fear once held therapists back from pushing patients hard enough. Why were we so cautious for so long? And what does the evidence actually say now? Annie challenges outdated habits like excessive hands on facilitation, routine splinting, and low rep sessions, advocating instead for task specific, meaningful practice that patients can carry beyond therapy hours.

The conversation also explores courage, having the confidence to question tradition, de implement ineffective treatments, and speak up in clinical settings. What should new grads stop doing immediately? And how can they collaborate more deeply with stroke survivors rather than prescribing one size fits all programs?

This episode is a must listen for students, new grads, and seasoned clinicians ready to rethink how neurorehab is delivered and how much better it could be.

In This Episode

Introduction to Annie McCluskey (00:00)
The Birth of Stroke Ed (03:03)
Lesson 1: Becoming a Movement Scientist (06:12)
Lesson 2: Repetition, Intensity, and High Dose Practice (12:42)
Lesson 3: Being Courageous in Clinical Decisions (25:34)
Introduction to Bo Bath Therapy (27:57)
Task-Specific Training vs. Bo Bath (28:49)
Challenges in Therapy Approaches (29:48)
The Evolution of Strength Training (31:05)
Hands-On Therapy and Its Limitations (34:46)
The Importance of Hand Function (36:51)
Collaborative Rehabilitation Planning (40:38)
Advice for New OT Graduates (44:23)
Resources and Courses for Therapists (49:01)
Conclusion and Final Thoughts (51:27)

Our Guest

Annie McCluskey, OT, PhD

Annie McCluskey is an occupational therapist, researcher, and educator with over 30 years of experience in stroke and brain injury rehabilitation across Australia, the UK, and internationally. She has published more than 70 peer-reviewed journal articles, contributed to multiple book chapters, and secured over $4 million in competitive research funding. Annie is the co-developer and director of StrokeEd, an education platform dedicated to translating evidence-based neurorehabilitation research into everyday clinical practice.

Resources & Links

Henry Hoffman on LinkedIn

Saebo

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Stroke Guidelines 2023

Restoring Movement vs. Adapting to Loss: Choosing the Right Path in Stroke Care with Amber Walter and Caitlin Wright

Tue, 23 Sep 2025 08:21:00 -0000

In this episode of the No Plateau Podcast, Henry Hoffman sits down with Amber Walter, Clinical Science Director, and Caitlin Wright, Occupational Therapy Advisor at Sheltering Arms Institute, to dig into one of the biggest debates in stroke rehab: should therapy focus on restoring movement, or teaching patients to adapt with compensatory strategies? But on the other hand, if therapy leans too much on compensation, are we robbing the brain of its chance to truly recover?

Amber and Caitlin share how Sheltering Arms has taken a bold stance by committing to a neuro-restorative model of care, one built on intensity, technology, and outcome-driven practice. They talk about the science of neuroplasticity, the dangers of defaulting to one-handed strategies, and why therapists need to start planting seeds of recovery early, even for patients with the most severe deficits.

Throughout the conversation, you’ll hear why high-repetition, evidence-based therapy matters, how technology extends what therapists can do, and why the future of stroke rehab depends on longer, more intensive sessions that focus on restoration, not just adaptation.

In This Episode

Introduction to Caitlin Wright and Amber Walter (00:00)
The Importance of Neuroplasticity in Stroke Recovery (05:23)
Challenges in Current Stroke Rehabilitation Practices (07:25)
Sheltering Arms Institute: A New Approach (12:46)
Implementing Restorative Therapy at Sheltering Arms (15:05)
Technology and Evidence-Based Practices in Therapy (20:30)
Evaluating and Treating Stroke Patients (24:13)
Therapist Fatigue and Technology in Patient Recovery (31:44)
Critical Components for Severe Impairment Recovery (32:34)
Balancing ADLs and Intensive Therapy (35:31)
Historical Perspective on Rehabilitation (37:25)
Innovative Approaches in Modern Rehabilitation (38:35)
Case Study: Remarkable Patient Recovery (44:18)
Implementing Evidence-Based Practices (55:38)
Closing Thoughts and Recommendations (56:04)

Our Guests

Amber Walter, PT, DPT, NCS, is the Clinical Science Director at Sheltering Arms Institute in Richmond, VA. She oversees multiple therapy disciplines and specializes in translating research into everyday practice to improve outcomes for stroke and brain injury survivors.

Caitlin Wright, MOT, OTR/L, is an Occupational Therapy Advisor at Sheltering Arms Institute. She is board-certified in physical rehabilitation and a certified brain injury specialist, with expertise in implementing neuro-restorative strategies to maximize recovery potential.

Resources & Links

Saebo

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Stroke Guidelines 2023

Unlocking Hope for Vivistim Therapy: Bridging the Gap from “Not Yet” to “Approved” with Amanda Saylor

Tue, 25 Feb 2025 11:40:53 -0000

In this episode of the No Plateau Podcast, host Henry Hoffman is joined by Amanda Saylor, an occupational therapist specializing in neurological rehabilitation, to discuss Vivistim Therapy, a groundbreaking treatment for chronic stroke survivors with upper limb deficits. Vivistim combines vagus nerve stimulation (VNS) with intensive therapy to enhance neuroplasticity and improve arm and hand function. Amanda shares her experience implementing Vivistim in her clinic, the science behind the treatment, and how it can be integrated into stroke rehabilitation.

"Vivistim is basically vagus nerve stimulation paired with therapy. It has to be—it cannot be one without the other."– Amanda Saylor

This episode highlights the importance of combining innovative technology like Vivistim with evidence-based practices to push the boundaries of stroke recovery. For therapists and patients alike, Vivistim offers a new avenue for hope and progress in the journey toward recovery.

"The success of Vivistim is only as good as the therapist that's going to be doing it. It’s the tool, but it’s the person behind the tool that makes the difference."

– Henry Hoffman

As Amanda and Henry discuss, the future of stroke rehabilitation lies in longer, more intensive therapy sessions and the integration of neurotechnology to enhance neuroplasticity.

"Patients need more time in therapy. We know they need more repetitions, and they can't always get those on their own."

– Amanda Saylor

In This Episode

Introducing Vivistim Therapy (00:39)
Meet Amanda Saylor: Professional Background (01:17)
Understanding Neuroplasticity and Stroke Rehabilitation (02:58)
The Role of Task-Specific Training in Recovery (04:21)
Challenges and Innovations in Stroke Therapy (05:59)
Diving into Vivistim Therapy (06:54)
Clinical Trials and Outcomes of Vivistim (18:40)
Insurance and Reimbursement for Vivistim (26:19)
Navigating FDA Approval and Reimbursement (30:18)
Identifying Ideal Candidates for Vivistim (30:49)
Accessing Vivistim Treatment (33:32)
Training and Implementation for Therapists (35:10)
Case Studies: Success Stories and Strategies (37:38)
Future Directions and Recommendations (54:06)
Conclusion and Contact Information (57:56)

Our Guest

Amanda Saylor, MOT, OTR/L, is an occupational therapist with over eight years of experience specializing in neurological and orthopedic rehabilitation. She works at AdventHealth in Orlando, Florida, and is a consultant for MicroTransponder, the company behind Vivistim. Amanda is passionate about stroke rehabilitation and shares treatment ideas and tips on her Instagram page, @neuro_ots, with her colleague Becca Carr.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Stroke Guidelines 2023

The Educators’ Role in Translating Evidence into Practice with Jessica Schmidt

Thu, 02 May 2024 10:52:28 -0000

Are you or someone you know working towards recovery and looking for effective ways to break through barriers? In the world of rehabilitation, evidence-based practices are making a significant impact, especially within the field of occupational therapy.

"We really have to take the time as educators to be willing to modify our courses, stay up to date on evidence, and make sure that we're using the best resources that are the most up to date." (17:45) - Jessica

In today’s episode of the No Plateau Podcast, we delve into the integration of evidence-based practice in occupational therapy education and clinical settings from our own perspectives. We tackle the challenges of translating research into practice, including the delay between discovery and implementation and the hurdles we clinicians encounter in keeping abreast of new information. We cover the initiatives we're taking at Concordia University to improve evidence translation, the significance of clinical practice guidelines, and the role we play as fieldwork educators. We also engage in the debate over whether to focus on ADLs or neuroplasticity post-stroke and discuss the use of assessments like the Fugl-Meyer. We recommend the ViaTherapy app as a tool for evidence-based stroke rehabilitation, sharing our insights and experiences with it.

"You can't get your arm and hand back if it's seven months, nine months, two years later; you missed a window. So focus on what matters the most, which is neuroplasticity." (24:25) - Henry

In This Episode

The need for evidence-based learning (00:00:32)
Challenges in implementing evidence-based practice (00:05:27)
Strategies for speeding up evidence translation in education (00:11:11)
Dealing with outdated practices (00:22:20)
Adaptive techniques and neuroplasticity (00:24:21)
Barriers in implementing evidence-based strategies (00:31:22)
Accessing clinical practice guidelines (00:37:58)
Impairment-based outcome measures (00:45:12)
ViaTherapy App and free resources (00:49:32)

Our Guest

Jessica Schmidt, OTR/L is an assistant professor of occupational therapy at Concordia University of Wisconsin. She earned her master's from the University of Wisconsin-Milwaukee, and her post-professional doctorate in occupational therapy from Rocky Mountain University School of Health Professions. She is a member of ACRM, AOTA, and WOTA. In clinical practice, Jessica specialized in treating adult neurological patients in acute care and inpatient rehabilitation settings. She is passionate about evidence-based practice, helping translate research into the clinic, and preventing healthcare worker burnout.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Closing the Gap on Subluxation with Jenna Barber

Mon, 09 Oct 2023 08:00:00 -0000

What steps are necessary to establish a program for managing shoulder subluxations in a healthcare facility?

In today’s episode, we dive into the topic of creating a stroke shoulder subluxation program in acute and subacute settings. This is a topic of interest for many therapists, yet it's often overlooked in most facilities. To shed more light on this topic, we are joined by Jenna Barber, who has successfully created a subluxation program at her facility.

“Most facilities are not preemptively addressing this issue. Why pass the buck to outpatient when you have the opportunity to attack it now?"

During our discussion with Jenna, we debunk the effectiveness of slings and taping in reducing or preventing subluxation. Instead, we emphasize that strengthening exercises, particularly for patients with volitional movement, are the most effective approach. We also highlight the importance of proper electrode placement during electrical stimulation (e-stim) therapy, focusing on the posterior deltoid rather than the supra. We stress the importance of evidence-based practice and the need for therapists to be trained and competent in using e-stim therapy.

"I don't know if I would change the program to maybe like shoulder e-stim program. I'm still debating on this one, but I really stressed in the beginning that it's not just shoulder subluxation, it's for those who don't have one yet to prevent one from happening."

Jenna explains the implementation process of the subluxation program for stroke survivors at Froedtert. Patients are evaluated on day one or two after a stroke to determine if they would benefit from the program. Regardless of whether the patient currently has shoulder subluxation or not, they start them on the program to prevent it from happening.

In This Episode

Introduction to Jenna and her subluxation program (02:08)
Subluxation and its effects (07:00)
Strengthening and electrical stimulation for subluxation mitigation (11:25)
Questioning the use of supra for shoulder subluxation treatment (12:19)
Jenna’s motivation to start the program (14:58)
The developmental process and challenges of starting a therapy program (17:00)
The synergy between nursing and therapist training in healthcare (20:45)
Contraindications for the subluxation program (24:29)
Managing the subluxation program at a large neuro hospital (30:20)
The waitlist issue (30:59)
Transition to subacute facilities (33:36)
Communication with subacute therapists (36:34)
How billing for unattended electrical stimulation contributes to therapist productivity (44:41)
Plans to expand the shoulder subluxation program (47:27)
The potential benefits of using tools like mirror boxes and mental practice (50:40)

Our Guest

Jenna Barber, MOT OTR/L, is an accomplished occupational therapist with a Bachelor's in Kinesiology from UW-Eau Claire and a Master's in Occupational Therapy from Concordia University Wisconsin. She excels at Froedtert & MCW, specializing in neuro and orthopedic conditions. Jenna is also an adjunct faculty member, recognized for exceptional patient care, and enjoys family time with her husband and two daughters.

Resources & Links

Henry Hoffman on LinkedIn

The ABCs of ABT with Darci Pernoud

Mon, 05 Jun 2023 08:00:00 -0000

This week, we are talking about activity-based training, what it is, what the benefits are, and how this practice's guidelines and progress compares against stroke therapy and patients. Darci Pernoud is an OT going on 18 years and has immense experience working with spinal cord injury patients in her very own gym. This week on the No Plateau Podcast, she speaks with Henry about ABT, patient recovery, and current state of spinal injury treatment and technology.

“A great deal has changed from where we are today than where we were 20, 30, 40 years ago. There is much more incomplete injuries, more people walking. I think it has a lot to do with continued research, continued thought process, how to push people hard. It's a very hot topic. I feel like right now in the rehab world is higher intensity pushing people harder to help create that change and drive home that neuroplasticity.”

Darci wastes no time in emphasizing the importance of activity based training also known as ABT. The benefits of this therapy are numerous and the impact on patient recovery and healing is immense.

“And so, by applying activity based therapy principles, that includes our health and wellness exercise measures, it's getting our bone density where it needs to be. It's getting our cardiovascular training where it is, it's getting our muscles stronger for resistance training, which is going to help with posture. So, it's going to help people look better. The benefits of exercise, getting circulation, getting all the right hormones, the growth factors, everything on a cellular level is going to be improved. So people are going to feel better, Their mental health is going to be better. That's going to affect their quality of life.”

In This Episode

Darci Pernoud talks about her medical background (01:31)
What is spinal cord injury and what are some of the common impairments? (04:17)
Darci describing Activity Based Training in detail (10:56)
The five main pillars of Activity Based Training (13:26)
Was ABT in practice when she graduated in 2005? (16:17)
The current guidelines and care expectations in terms of standpoint of frequency, duration and time (19:13)
Comparing the treatment and care between spinal cord and stroke patients (22.55)
The average length of stay for a spinal cord patient (24:49)
What happens when patients are discharged from the hospital? (26:48)
The average onset post recovery for Independence Rehab clients (28:42)
Darci talks about ABT benefits and the recommended cardiovascular and resistance training (31:45)
How popular and accessible are ABT gyms? (38:39)
Discussing OT and PT equipment and technology (40:43)
The current state of progress for spinal cord patients potentially walking again (44:55)
Darci discusses the progress of one of her clients (46:04)
Thoughts of patients doing Activity Based Training virtually or remotely from home (48:20)
How people can reach Darci or learn more about ABT therapy (50:59)

Our Guest

Darci Pernoud has been an OT for over 18 years. She started out as a dual diagnosis therapist working in-patient rehab, and eventually went through a day program, an out-patient program, post-op work and upper extremity limb data collection work. She started networking with an activity based therapy gym which closed during Covid, prompting her to become a gym owner, trying to help the community’s experience of neurodiagnosis, assisting them in their recovery journey.

Resources & Links

Henry Hoffman on LinkedIn

Optimizing Stroke Recovery with Cortney Jessee

Mon, 15 May 2023 08:00:00 -0000

In this episode, we delve into the critical nature of the first few weeks following a stroke and how the type of care and approach can greatly impact the outcome of a patient's recovery. Our guest, occupational therapist Cortney Jessee, provides a detailed overview of the inpatient rehab process, offering useful insights and tips for therapists, caregivers, and patients alike.

“The problem is that I think the whole purpose for this podcast being the no plateau podcast is again if we don’t start at those basics, we can’t get to our task specific training so how much are we being true proponents of the plateau. I think that’s the true plateau, not the myth of your first three months is where you are going to get the most outcome.”

Cortney stresses the importance of specific care within the first 72 hours post-stroke and the severity of subluxation in inpatient rehab. Drawing on her experience, Cortney elaborates on the need for proper positioning and understanding of anatomy to ensure optimal success for patients.

“If we know our anatomy and if we can show our caregivers and our patients what we are looking for in positioning and help them feel like they are not going to mess it up in what to look for; the outcomes are significantly more impactful. It also makes our jobs a lot more fun.”

Courtney highlights the impact of small things and offers practical tips for therapists to empower patients and caregivers. She also offers passionate words of encouragement for occupational therapists to embrace their impact on patients' lives and stresses the importance of consistency in a patient's recovery process.

“I just want to encourage any OT’s out there who are either starting their time in neuro or been doing it for a while that your jobs are impactful, no matter what part of recovery you are in someone’s stroke. And the little things matter. Going back to that 60-to-90-day mark, that’s wonderful. But how great would it be from days 0 to 30, to be a part of your patient’s foundation for optimal success. And I want therapists to feel empowered to do those small things for consistency in a patient's life and to give our caregivers and patients hope.”

In This Episode

Cortney Jessee's medical background and qualifications (01:25)
The patient's transition from acute stage to inpatient rehabilitation (09:26)
The critical 72-hour window after a stroke: common mistakes and best practices in hospitals (16:04)
An in-depth look at the Brunnstrom stages of recovery (20:15)
Separating fact from fiction: tackling the myths surrounding subluxation (24:50)
Activities for patients and caregivers to do in their rooms to aid in recovery (31:22)
Reviewing the studies conducted by Dr. Teazel (33:45)
Patient handoff and the role of transformative learning in transitioning to outpatient care (42:05)
Examining the 60-90-120-day timeline in stroke recovery (44:20)
Cortney's words of encouragement for occupational therapists (46:48)

Our Guest

Cortney Jessee is an experienced occupational therapist with over 6 years of specialized practice in inpatient rehab at Novant Health in North Carolina. Although she recently transitioned to outpatient neuro-rehab, she maintains a deep attachment to inpatient care and values the unique challenges and rewards it offers.

Resources & Links

Henry Hoffman on LinkedIn

Navigating Spasticity Treatment with Dr. Milton

Mon, 24 Apr 2023 14:23:29 -0000

The topic of today's discussion is spasticity treatment after stroke, a condition affecting up to 40% of first-time stroke patients. Our guest, Dr. Samuel Milton, specializes in this treatment and offers invaluable tips to patients and therapists. According to him, spasticity treatment after stroke requires clear objectives, cautious consideration of treatment options, and proper aftercare techniques to achieve the best possible outcomes.

“What’s really important when you are looking at a treatment plan is that you want to have a goal in mind. What are you, the therapist, the patient, and caregiver, what are you trying to accomplish?”

While some patients may be eager to rush into Botox treatment, Dr. Milton advises caution and consideration of visual markers to assess the rate of return before and after the treatment.

“In this business many times you find that when patients or loved ones go through a scenario like this, they want the opposite. So if their hand is starting to close all of a sudden they say well I need Botox. But at the same time their hand is just starting to close so I may not want to jump in there and necessarily do Botox especially if their range of motion is full. Now they are starting to get some rate of return. Let’s see where that return takes us. If there is a problem, we’ll address it. I generally don’t jump on that right away.”

After a treatment is done, proper aftercare is essential to ensure the highest rate of success. Dr. Milton stresses that the type of treatment is just as important as the technique used to apply it.

“My injection technique usually after I inject, I will pretty aggressively stretch the muscle because Botox diffuses pretty readily in the muscle and I do that to help with the spread of the muscle. Really spread the muscle out as much as I can after I do an injection.”

In This Episode

Dr. Milton talks about his educational background, medical expertise, and work practice (01:36)
How to best describe the medical condition of spasticity to patients (03:50)
Dr. Milton elaborating on why the flexors are typically the spastic muscles (05:18)
What types of spasticity treatments are currently available? (07:37)
Medication or Botox? How to determine who gets what? (09:00)
What are the side effects for taking medication for spasticity (09:53)
Explaining what intrathecal back pumps are (11:17)
Discussing Chemo denervation techniques and botulism (13:04)
What other local injections should one consider (14:39)
What every new stroke patient should know (13:04)
What treatments do Dr. Milton’s patients prefer? (16:39)
Using electric stimulation to speed up the reaction (19:51)
Different types of injections and Botox techniques (20:58)
Funding Botox for stroke patients (27:07)
Can we achieve the breakthrough to no spasticity? (31:56)

Our Guest

Dr. Samuel Milton is a highly experienced physiatrist with over 30 years of medical practice. He received his medical degree from Harvard University College of Medicine and has been working at Emory Healthcare in Atlanta, GA for over 20 years. During his career, he has been involved in teaching academic practice with inpatient and outpatient settings, but mostly running stroke rehab units. Currently, Dr. Milton manages the inpatient stroke unit at Emory and has an outpatient practice for patients with chronic stroke deficits.

Resources & Links

Henry Hoffman on LinkedIn

Integrative Health For Treating Aphasia with Abbe Simon

Mon, 03 Apr 2023 08:00:00 -0000

What does aphasia treatment look like?

In this episode, we talk with speech-language pathologist Abbe Simon M.A., CCC-SLP, whose professional work has been focused on helping to treat communication disorders, specializing in evaluating and treating aphasia.

“One of the most important things I must stress and hope that the listeners take away from this: Aphasia does not affect intellect, one’s intelligence, or the knowledge that’s stored in their brain before the stroke or other reason that happened to cause it occurred.”

With over 24 years of experience working with aphasia patients, Abbe shares with us common misconceptions about aphasia and communication disorders, as well as how aphasia is evaluated and treated.

“The last thing the brain wants is a compensatory strategy, but we need to acknowledge that some people’s brains or some brains actually want that - dare I say it - the easy way out, right? When we approach speech therapy to improve language, as you mentioned, occupational therapists can do or we, as professionals, can introduce compensatory strategies, or we can introduce restorative strategies - how can we restore something or regain its function….there’s nothing wrong with compensating…but it’s not maximizing neuroplasticity.”

Abbe also shares her perspective on various treatment methods for aphasia, her opinion on specific evidence-based approaches to treating and evaluating aphasia, and all the amazing work she does with iCommunicare.

“People do make huge strides…There ain’t no such thing as a plateau…There’s no plateau. I can work with someone who is 6 days, 6 weeks, 6 months, or 6 years post-stroke and who has aphasia, and they will make improvements if they want to.”

In This Episode

Abbe shares her background and career journey to starting iCommunicare (02:08)
The types of communication disorders Abbe helps treat as a Speech Language Pathologist (04:17)
How speech therapists evaluate and treat aphasia traditionally and currently (06:00)
Where is the cutoff to shift from traditional treatment to modern technological treatments with aphasia patients? (14:10)
Constraint-Induced Language Therapy (CILT) with aphasia patients: does it work? (20:02)
Why is CILT not as popular as Constraint-Induced Movement Therapy (CIMT)? (24:20)
What are the expectations of patients and outcomes experienced with aphasia? (27:10)
Can we bridge the gap between Occupational Therapists and Speech-Language Therapists with cross-therapeutic interventions? (31:01)
Abbe’s top recommended technology tools for treating aphasia (37:25)
Abbe’s company iCommunicare, and her integrative health coaching work (39:49)

Our Guest

Abbe Simon is a speech-language pathologist and integrative health coach with over 20 years of experience helping adults with aphasia and communication disorders take back control of their life and overcome the barriers of these disorders.

Abbe believes everybody can improve their aphasia if they are motivated and willing to try. She also believes that small wins build momentum and encourages patients to keep pushing to improve. Abbe’s focus is client-centered and emphasizes creating outcomes that go beyond just the treatment room.

Abbe lives in North Carolina, where she runs iCommunicare, an aphasia rehabilitation private practice combining evidence-based programs and integrative health coaching principles to improve aphasia.

Resources & Links

Kleim and Jones article (2008): Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage

Henry Hoffman on LinkedIn

A Safe Return to Home Life with Jessica Miller

Mon, 13 Mar 2023 08:00:00 -0000

Jessica Miller, neuro-based occupational therapist and founder of Pathways Neuro Rehabilitation & Education, is back for another No Plateau Podcast episode!

If you’re an avid listener, you’ll remember Jessica from the first season when she came to discuss the importance of comprehensive education for caregivers and patients. With her experience as an OT, she’s walked through the transition back to home life with countless families, so she knows which tools are the most effective and helpful for patients settling back into their homes.

“The hospital in in-patient rehab will help them get a wheelchair, and maybe if they need a hospital bed or something like that, but all these other things that we’re talking about today, they might get touched in a discharge recommendation list on the day they leave… But they don’t really have enough time, so I’m glad that we’re doing this.” – Jessica (3:27)

In this episode, we break down various durable medical equipment (DME) available on RehabMart to help caregivers and survivors transition back home after a hospital stay and the five major steps patients must work through upon arrival.

“I have seen so many loved ones purchase so many items because they just want to help in any way they can… I know it comes from a place of love, and I want you to have support in that. If you aren't sure if something could be helpful, I would say take it to your friendly OT…” – Jessica (40:49)

In This Episode

(2:37) The scope of education for caregivers
(5:22) The five steps that occur when transitioning back to home life
(8:25) Ramps, thresholds, and equipment for “Getting Home Safely” step
(12:03) Navigating the “Taking a Shower” step
(17:36) Tools to utilize during the “Getting Dressed” step
(21:59) “Taking a Nap” must-haves for patients and caregivers
(26:19) DME to support “Eating in Your Own Home” while still exercising the affected side

Our Guest

Jessica Miller is an OT and certified brain injury specialist with 19 years of experience working with stroke survivors. She is also the founder of Pathways Neuro Rehabilitation and Education, which helps treat stroke patients in their own homes and helps therapists grow their skills.

Resources & Links

Henry Hoffman on LinkedIn

The Importance of Mental Health Care with Keith Taylor

Mon, 20 Feb 2023 08:00:00 -0000

After a stroke at 38, Keith Taylor struggled to rebuild some of his life and move through recovery. As he worked to process his identity and the entire experience, a dark season of depression followed. In this episode, he’s joining me to discuss surviving his stroke, picking up the pieces after the fact, and how he came to found Strength After Stroke, a mental health resource and program for fellow survivors.

“It was right in that time period that I thought, ‘Wait a minute. I’m here for a reason. There’s something that’s happened here that’s caused this for me, and I’m not going to allow it to take over. I think it’s a message that tells me that it’s time to get some things put in place for others.’ And that’s what I went to work on.” (9:51)

When Keith was in recovery, he discovered an obvious need for mental health care for survivors. While physical care and rehabilitation were top of mind, psychological health was less of a priority. He touches on how this realization came to him, how it helped him create various resources for survivors, caregivers, and families, and where he hopes to take these programs in the future.

“The mental health aspect, I feel like there is still a huge hole… That gap is huge, and we have to fill that gap.” – (18:47)

In This Episode

(0:43) Life before Keith’s stroke and the state of his professional life
(2:38) The day of Keith’s stroke
(5:35) The deficits at the time of the stroke, the emotional ramifications, and where he is years later
(8:47) How he coped with the obstacles that came and the realization he had about his experience
(10:27) Why he chose not to share his suicidal thoughts with his wife and how long it took to find his way to the other side of that depression
(15:20) The intricacies of Keith’s care after his stroke and the lack of emotional care
(19:14) When Strength After Stroke began
(20:48) How the BASE Program works, the mission behind it, and his hope for the future

Our Guest

After surviving a stroke and struggling with his mental health and suicidal thoughts, Keith Taylor made his way to the other side of that depression and decided to use his experience to help others. He founded a mental health resource and program called Strength After Stroke to help others through that season of depression after a stroke.

Resources & Links

Henry Hoffman on LinkedIn

Understanding the Biber Protocol with Teresa Biber LoMonte

Mon, 06 Feb 2023 08:15:57 -0000

Welcome to Season 2 of the No Plateau Podcast! We’re excited to kick off this next season with speech and language pathologist Teresa Biber LoMonte to discuss how she developed the Biber Protocol and the ways it’s actively helping individuals and stroke survivors recover.

Teresa specializes in working with patients that experience facial paralysis, dysphonia, and dysphagia, and she begins by breaking down the misconception that this issue is primarily physiological.

“Eating is incredibly important to our social well being… Everything revolves around food. Every culture has very specific foods that are associated with the celebration, you know, of their culture… It’s a substantial impact on the quality of life of any human being.” (4:18)

As she worked in settings with occupational and physical therapists at the beginning of her career, she realized that there was a gap in the care for her patients and couldn’t understand why electrical stimulation wasn’t being used for the part of that body that she worked with.

“The next words out of my mouth were, ‘Why don’t we have access to this,’ number one, “in the speech pathology community?”, and ‘Why can’t we use this for our patients with swallowing disorders and facial paralysis?’” (20:55)

She has a huge heart for the lives and families of her patients and believes in continuing to advance her knowledge so she can eliminate gaps in the healthcare system. Tune in to the first episode of the season to hear about her journey to where she is today and how her protocol is changing lives.

In This Episode

(1:09) Teresa Biber LoMonte shares her background
(2:28) Dysphagia 101
(6:02) The prevalence of dysphagia
(7:59) Common strategies that therapists utilize
(12:35) Different interventions for dysphagia
(18:28) What is the Biber Protocol?
(26:13) Teresa’s journey after initially discovering this technique
(32:07) What makes the NMES protocol unique
(38:00) Pushback on NMES
(42:28) The necessary steps to utilize the protocol

Our Guest

Teresa Biber LoMonte is a language and speech pathologist that developed The Biber Protocol after discovering that electrical stimulation was not being utilized for individuals experiencing facial paralysis, dysphonia, and dysphagia. She believes in constantly advancing her skills and knowledge to help her patients regain the ability to speak, swallow, and communicate.

Resources & Links

Finding Hope and Knowledge in Recovery with Skip Batchelder

Mon, 09 Jan 2023 06:00:00 -0000

What comes after you survive a traumatic stroke, and how do you get the information you need to recover?

Author, graphic artist, blogger, and founder of the Stroke Angel Project Skip Batchelder and his family were met with that same uncertainty after he survived his stroke in 2021. It became evident to Skip pretty quickly in the busyness of his hospital stay that there was a lack of accessible and easily understood resources for stroke survivors.

“You can google until the cows come home, but finding what you need and how you can collect that information so that you can actually perform the duties that you need, both personally and within your team, that doesn’t come that easily.” (22:17)

As he accumulated resources through his recovery, he had a desire to share the things he'd learned and the material that truly helped him through everyday life after this major event. This desire grew into the project Stroke Angel, and he chose a name that would simultaneously generate hope and honor the friend who saved his life.

“The theme of Stroke Angel is, ‘Let my recovery be your hope.’” (35:45)

Today, we discuss Skip’s stroke, his recovery, how Stroke Angel began, and how he’s doing currently, 17 months later.

“Never give up. You can’t give up. You can have bad days. I had bad days. My caregivers had bad days. But you just gotta rally and just keep at it.” (41:04)

In This Episode

(1:57) Who is Skip Batchelder?
(3:15) Life before Skip’s stroke and warning signs
(4:59) The stages of Skip’s stroke and the angel that saved him
(14:57) The recovery journey and adjusting your attitude
(22:00) Collecting information about what’s happened/what you need
(23:43) Inpatient rehab, expensive therapy equipment, and old-school techniques
(29:44) Skip’s transition to outpatient
(33:52) How Skip is doing 17 months later
(34:57) The Stroke Angel Project
(40:56) “Never give up.”

Our Guest

Author, graphic artist, web blogger, and founder of Stroke Angel, Skip Batchelder suffered a terrifying stroke in 2021, recovered, and then resurfaced on the other side of that experience with a desire to help others through this traumatic event. In an effort to alleviate stress and uncertainty during other people's stroke experiences, Skip created Stroke Angel. Stroke Angel holds a variety of resources for stroke survivors and their families that can aid them in the recovery process, offer emotional support, and foster hope for life after a stroke.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Skip Batchelder’s LinkedIn

Stroke Angel

Chasing Your Goals Post-Stroke with Austin and Chris Harrell

Mon, 26 Dec 2022 09:00:00 -0000

What Austin and his father Chris Harrell thought was a typical July day in North Carolina became a life-changing moment when 18-year-old Austin suffered a stroke.

On today's episode, they discuss Austin’s stroke, Chris’ transition to becoming a caregiver, what he felt when his son was in the hospital, and how their dynamic influenced Austin’s recovery process.

“The idea of walking into the recovery room to see my son after that surgery, I had a very hard time. I really couldn’t bring myself to do it initially.” – Chris (13:54)

They go on to share their commitment to Austin’s recovery, the improvements they saw along the way, and how Austin’s decision to attend college classes, read out loud, and engage with other students helped him develop his speech and communication skills.

“The big thing about rehab, it has to be meaningful. You can’t just go in there and do reps. It’s not just about doing reps; it’s got to be meaningful reps.” – Chris (27:39)

Their journey is one of dedication, hope, and inspiration, so listen in to hear about Austin and Chris’ impactful story.

“Believe you can reach your goals, and never give up.” – Austin (39:51)

In This Episode

(1:24) Chris shares Austin’s stroke experience
(6:37) Austin’s condition post-stroke and transition to Duke
(13:38) Following the craniotomy and into the next few weeks
(18:51) Austin’s Atlanta team
(20:07) Seeing improvements and creating routine for recovery
(26:44) Chris’ caregiver training and Austin’s schooling
(31:04) How Austin’s doing today
(33:02) Austin’s future plans
(34:33) Chris offers a few words of encouragement to caregivers

Our Guests

Stroke survivor Austin Harrell and his father Chris Harrell live in North Carolina and are an inspiring illustration of the power of dedication, love, support, and endurance. After Austin survived a stroke at 18 years old, he and his family worked hard in his recovery journey with great success, and he also holds an associate's degree. Currently, Austin works at a coffee shop called Esteamed Coffee which offers individuals with disabilities a chance for meaningful employment.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Friends of Austin Harrell

35th Triangle Heart Ball

Austin Sings the National Anthem for the Durham Bulls Baseball Club

A Caregiver’s Perspective with Jeri Goldstein

Mon, 12 Dec 2022 07:58:23 -0000

How do we connect with and support those who have survived a stroke on the long road to recovery?

On today’s episode, career development coach and author of Stroke Dialogues: Conversations with Dad Jeri Goldstein discusses how she cared for her father after his stroke, how her memoir came to fruition, and how her background informed the way she approached his recovery.

“It’s also the enthusiasm with which the patient comes to the process. So if the patient is dependent on everybody else to do everything else for them, and they don’t take ownership of the recovery process. And so that’s why I made it a part of our process that Dad took ownership of how he wanted to recover.” (22:59)

As she worked with her father on strengthening his communication and motor skills, she collected a series of intimate, endearing, and generally valuable exchanges with her father that became the basis for her memoir.

“It was when I was home in Virginia that I was remembering all these conversations… I remembered, you know, words and who said what, and I thought, ‘I gotta write this down,’ because this was really fascinating to me.” (29:14)

While she breaks down what worked for her and her family in her father’s recovery journey and the specifics of his condition, she also shares how her hopeful attitude influenced both her mindset and his.

“I came up with a little tongue twister for him to work on his ‘P’s, and it was like ‘When you are positive and patient, when you are persistent and practice, full recovery is possible, and anything is possible.’” (46:56)

In This Episode

(1:33) Jeri recalls her father’s stroke in 2012
(4:18) First conversations after the stroke
(6:53) Jeri’s background and her father’s career
(12:39) Lingering deficits and mobility development
(14:51) Understanding neuroplasticity, repetition, and accountability
(24:11) Her father’s improvement during recovery
(28:36) The inspiration behind Jeri’s book and what readers can expect
(33:38) Memory challenges after the stroke
(34:36) A unique method of communication
(37:44) Exercising patience and watching her father’s communication skills develop
(42:39) A cautionary tale
(46:16) Jeri, Pete, and Henry’s hopeful last thoughts

Our Guest

Jeri Goldstein is a career development coach and author of Stroke Dialogues: Conversations with Dad, a powerful memoir on her dad’s recovery journey after his stroke in 2012, the battles she faced as his caregiver trying to cope with his hindered communication due to Aphasia, and all that she learned from the experience. She relocated to Florida to take care of her father and still lives in the Delray Beach area.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Jeri Goldstein’s Stroke Dialogues: Conversations with Dad

Stroke Dialogues Website

The Pathways Toward Recovery with Jessica Miller

Mon, 28 Nov 2022 09:00:00 -0000

As medical science progresses, there are more and more resources, tools and education available for stroke survivors and caregivers.

But for OTs, continuing education can be hard to come by, or difficult to apply to the real-life patients they’re assisting.

Today’s guest, Jessica Miller, is an OT and certified brain injury specialist who experienced this firsthand over her 19-year career – and she’s started Pathways Neuro Rehabilitation and Education in order to help mentor and support other OTs.

“The problem was when I went back to the clinic, I had all this good stuff and maybe I didn't have a patient that it was appropriate for. So I kind of had to tuck it away, put a tab on the binder and hope I could remember it when the time came. So I'm really taking that approach and I'm applying one of the strategies that we learned to help folks with their memory and their attention. And we're applying it to us therapists because we know neuroplasticity is not just a brain injury thing. It's a brain thing. And it's how we learn.” – Jessica (09:36)

In this episode, Jessica discusses the impetus behind Pathways, how mentoring other OTs works (and why), her hopes for the future of stroke recovery and more.

In This Episode

(02:57) Jessica’s calling to mentor other OTs
(08:49) How OT mentorship works, and the STAR method
(14:03) Pathways’ target OT
(21:55) Old school OT techniques vs modern approaches
(27:51) Jessica’s results-driven therapeutic activities for stroke survivors
(31:37) The caregiver challenge
(35:14) Jessica’s “magic wand moment” for the future of stroke recovery

Our Guest

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Jessica Miller

Follow New to Neuro for free education and inspiration on Instagram: @new.to.neuro

OTs can book a mentoring session or check out upcoming continuing education courses at: www.PathwaysNeuroRehab.com

And any therapists listening are more than welcome to join our New to Neuro Facebook Group.

Keeping the Motivation with Christopher Gaskins

Mon, 14 Nov 2022 21:39:03 -0000

The stroke recovery process can be frustrating and overwhelming. What can survivors do to stay motivated? And how can caregivers know when to give them that little nudge forward?

Today’s guest, Christopher Gaskins, is a neuroscience and cognitive science PhD candidate, a neurorehabilitation OT, a certified stroke rehabilitation specialist, and the founder of two neurotherapy-based companies. He’s also worked in veteran centers like Walter Reed National Military Medical Center, and spent time overseas helping those without access to medical care.

Christopher knows what it takes to motivate a stroke survivor forward – and has seen miracles happen when they begin to motivate themselves.

“A lot of my patients call me a hard charger [because] I push them. I often feel that yeah, they can do more than what they think they're capable of. But when we push them that extra, you know, five, 10%, they can do it. Then that raises that threshold a little bit higher. And you just keep on incrementally, pushing them a little bit past what they're capable of, and they're able to continually go further and further. … They’re able to kind of keep on going and keep on pushing themselves.” – Christopher (33:24)

In today’s episode, Christopher also talks about the benefits of using video to monitor patients’ progress and push them forward, how he encourages non-compliant patients, the origins of his two neurotherapy companies, and more.

In This Episode

(04:16) The origins of Christopher’s passion for neuroscience, and his work at Walter Reed
(07:52) Helping a patient understand what’s next in their stroke journey
(09:57) Using video to motivate patients towards progress
(15:48) Why Christopher started GoTHERAPY, Inc
(23:11) Outpatient care vs in-clinic care
(28:38) Helping non-compliant patients
(34:13) The most inspirational stroke survivor of Christopher’s career
(37:15) Christopher’s hopes for the future of stroke rehab

Our Guest

Christopher Gaskins is a neuroscience and cognitive science PhD candidate at the University of Maryland. He is also a neurorehabilitation occupational therapist and a certified stroke rehabilitation specialist. In 2019, Christopher founded concierge neurorehabilitation company Neurosuite, where he serves as CEO.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Christopher Gaskins LinkedIn: https://www.linkedin.com/in/christopher-gaskins-ms-otr-l-csrs-876113179

Neurosuite: https://linktr.ee/neurosuite

Knowing Stroke with Michael Garrow and David Dansereau

Mon, 31 Oct 2022 08:08:08 -0000

For many of us, the first time learning about stroke is after one has already happened. And when you’re trying to understand all the complexities, while dealing with doctors and insurance and the day-to-day obligations of life, it can be hard to see a way forward – whether you’re a caregiver, or just experienced a stroke yourself.

Today, we’ll get to hear from two guests whose individual stroke experiences allow them to speak uniquely about both sides of the stroke journey, as a survivor and as a caregiver.

David Dansereau is a licensed physical therapist, clinical PT consultant and stroke survivor. His stroke came after he’d already established himself in the physical therapy world – so he’ll be sharing his insights on stroke recovery from the remarkable perspective of a professional with lived experience.

Michael Garrow, on the other hand, grew up as a caregiver to his mother, who had a stroke at 28. He’ll share what he’s learned over his decades of caregiving, including how to optimize the caregiver-survivor relationship, how to navigate all the obstacles that arise once in-home care begins and ways to make the recovery easier both for yourself and your stroke survivor.

In This Episode

(03:28) David’s story
(06:20) How experiencing a stroke changed David’s approach to caring for his stroke patients as a physical therapist
(08:22) David’s stroke journey and recovery
(12:11) The biggest recovery challenge David still faces
(14:32) Michael’s background, and how he connected with David
(19:57) The unique challenges faced by stroke caregivers
(25:21) Michael’s advice for physical therapists preparing caregivers for their new role
(28:12) “The future of stroke recovery is in the home”
(30:20) Michael’s experience as a stroke caregiver for his mother
(36:01) The future of the Know Stroke podcast

Our Guests

Michael Garrow is a Digital Product Manager with CVS Health, and a co-host on the Know Stroke podcast. Michael grew up caregiving for his mother, who experienced a stroke at 28.

David Dansereau is a licensed physical therapist, nutritionist, clinical PT consultant and stroke survivor. He is also the founder of Know-Stroke.org, and a co-host on the Know Stroke podcast.

Resources & Links

Believing in Stroke Recovery with Michael and Jennifer Erwin

Mon, 17 Oct 2022 08:00:00 -0000

For many stroke survivors and their families, the stroke recovery process can feel isolated.

After leaving the hospital, finishing as much outpatient therapy as your insurance (hopefully) allows, and finding an at-home care routine, the road to healing can start to look lonely.

“I could see in his eyes, like he was still with me, you know, even though he couldn't communicate and he had no idea what was going on. I knew I could only live in that moment. I knew I could not go. I could not think further than that. I knew I had to just live in that very moment. I was just here for him and making sure he felt the support and he didn't give up.” – Jennifer (05:52)

Today’s guests, Michael and Jennifer Erwin, have used their experience with stroke to help ease the journey for other families.

Michael’s major hemorrhagic stroke in 2017 inspired them to start the BELIEVE Stroke Recovery Foundation, a nonprofit that provides financial assistance to help stroke survivors access continued rehabilitation services.

Today, Michael and Jennifer join us to talk about their journey – including their experience with outpatient care, the questions they recommend asking of potential PTs, their advice for families recovering from stroke, how the BELIEVE Foundation began, and more.

“Nothing is more entitled to an individual than realizing self in self independence. So you need to realize that really, to be excited about life again. They estimate so many stroke survivors are very depressed. I'll never forget the first time after I walked, I went to a sports bar. It was the first time I've been to a sports bar in two years. And I sat there right in front of all the TVs and I was all by myself and I got to do what I enjoy. And that is the best thing for all people to try and gain that back.” – Michael (42:56)

In This Episode

(01:16) The story of Michael and Jennifer’s stroke journey
(05:52) The aftermath of Michael’s stroke, and how life changed
(07:46) Michael’s first three days post-stroke
(09:01) Jennifer’s most heartbreaking moment at Michael’s bedside
(12:00) What the doctors and PTs got right, and where they fell short
(15:15) Michael and Jennifer’s outpatient experience
(18:43) Asking the right questions before starting rehab
(22:50) The skills Michael’s PTs focused on restoring first
(29:30) Jennifer’s advice to families recovering after stroke
(35:12) The BELIEVE Foundation
(42:31) Michael and Jennifer’s message of hope

Our Guests

Michael and Jennifer Erwin are the founders of the BELIEVE Stroke Recovery Foundation. After only two months of outpatient rehab, Michael’s insurance ran out. Determined that no family should go without access to stroke rehabilitation services, Michael and Jennifer started the BELIEVE Foundation in 2019, two years after Michael’s hemorrhagic stroke.

Resources & Links

Saebo’s Stroke Survivor Support Group

Jennifer Erwin on LinkedIn

BELIEVE Stroke Recovery Foundation Launch Event on YouTube

Rehab: The Good, The Bad, and The Ugly with Bill Monroe

Mon, 03 Oct 2022 08:00:00 -0000

A lot of us dream of being the best – and unfortunately, a lot of us end up disappointed.

But what if we started dreaming instead of simply being better? Just a little bit, each day, better than we were the day before?

For stroke survivors, this small change in thinking can mean a huge difference. It has for our guest Bill Monroe, who survived a blood clot in his basal ganglia in 2017.

Today, Bill joins us to talk about surviving his stroke, his ongoing experience with rehab, and how he learned that better is actually more important than best.

“If you can just get a little bit better every day, just the tiniest amount over time, that's going to add up to tremendous progress and you can be successful. You can get a little bit better or you can make efforts to get a little bit better each day. So we've reduced now the odds of failure, we've reduced the chances of being in that negative place of losing as part of this process, because that's the thing. As long as you're making that effort to get a little bit better, that's gonna add up over time.” – Bill

Bill also tells us how he launched his podcast, Strokecast, which aims to build a community to help other stroke survivors live their best lives.

“At one point I was asking one of the therapists in the hospital about a support group that met down the hall and she didn't even know it existed. So there's all these different silos that are out there. And one of the things I wanna do with [Strokecast] is to help break down some of those silos and help people communicate more across these different constituencies and share these perspectives. … I would love to help more and more people learn from them and get value from my experience. So hopefully they don't have to go through this themselves.” – Bill

In This Episode

(03:21) Bill’s stroke story
(08:03) Bill’s career prior to his stroke
(12:41) How Bill decided to launch his podcast, Strokecast
(14:16) Micro goals and small victories
(21:22) Rehab: the good, the bad and the ugly
(29:34) Areas of stroke rehab Bill wants to innovate
(38:37) The future of Strokecast

Our Guest

Bill Monroe is a stroke survivor and host of the podcast Strokecast, which uses his extensive background in public speaking to help other stroke survivors live their best lives.

Launched a year after his own stroke, Strokecast frequently interviews researchers, disability activists, doctors, and other people whose unique insights can assist stroke survivors on their journey. Bill also explores topics like neuroscience, recovery, rehab and more.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Optimistic Stroke Support with Carolyn Brown

Mon, 19 Sep 2022 08:00:00 -0000

It takes nerve to start your own company – and when you start a nonprofit, more than a little heart.

Occupational therapist Carolyn Brown is the founder and executive director of StrokeOT, a nonprofit which began as a pilot program during her capstone research as a doctoral student in 2020.

Since then, it’s blossomed into a major resource that helps stroke survivors around the world access invaluable virtual health, exercise and lifestyle support.

In today’s episode, Carolyn tells us more about StrokeOT, the gaps StrokeOT fills for underserved patients and why a nonprofit for stroke survivors is so critical in today’s healthcare climate.

“What I was finding through years of working in outpatient was there was a huge gap in services for stroke survivors that were number one, prematurely discharged because A), their deductibles were too high, or B) that whole philosophy that still seems to be ingrained in so many clinicians’ heads are that there's this plateau in progress after your first year and you're not gonna continue. And I've never believed in that. There's so much research that shows likewise.

So what I did for my capstone thesis was to create a free program for underserved stroke survivors after they've been discharged from therapy. So I did an outcome measure based on the success of the program. It proved to be very successful. And from that became the sort of the groundings of stroke OT.” – Carolyn

Carolyn also shares about the tremendous value of community-based rehab programs, why emotional buy-in is such a profoundly important part of the healing process, how OTs and caregivers can keep their patients and loved ones thinking positively, and which rehab gear to grab and which to ditch.

In This Episode

(02:49) Carolyn’s background as an OT, and her journey from COTA to PhD
(07:12) The genesis of StrokeOT
(10:33) The future of community-based rehab programs
(12:40) The “magic recipe”
(15:17) The bright spots and challenges facing the neuro rehab industry today
(19:37) The right – and wrong – therapy equipment to buy
(25:13) How Carolyn keeps her patients optimistic
(31:56) How to find the right OT
(32:53) Carolyn’s predictions for the future of stroke rehab

Our Guest

Carolyn Brown (OTD, OTR/L, CLT) is the founder and executive director of StrokeOT, a nonprofit that helps stroke survivors access virtual health, exercise and lifestyle support.

With over 27 years working with stroke survivors, Carolyn specializes in neuro-developmental treatment, the Lifestyle Redesign® model, constraint-induced movement therapy, and Saebo orthotics.

In addition to her work at StrokeOT, she has also served as a clinical instructor at Quinnipiac University for the past 5 years.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Search for the Best Stroke Recovery Equipment

Mon, 05 Sep 2022 08:00:00 -0000

You know what they say about when you’ve seen one stroke survivor?

You’ve seen one stroke survivor.

In other words, nobody who’s had a stroke is the same – and no approach, tool, or exercise is ever quite one-size-fits-all, either. What works for one patient might not be right for another.

As therapists and caregivers know, this can be extremely frustrating.

So today’s episode is for people who just finished the inpatient part of rehab, are headed home, and have no idea what to do next.

Henry will use his 25 years of experience in OT to set you up for outpatient success – you’ll find out which products to use, which to stay away from, which services might meet your needs and how you can decide what will best help you or your loved ones during your stroke rehab journey.

In This Episode

(02:28) The first days after stroke
(07:48) Robotic gloves
(10:42) Leg lifts and ADLs
(11:59) Exercise balls
(13:23) Tape and slings
(16:41) MirrorBox therapy
(18:15) Grip strengtheners
(19:43) Muscle massagers
(21:21) Arm bikes
(25:07) Rechargeable infrared electric fingerboard
(28:22) Shoulder stretchers
(30:44) E-stim
(37:30) In-shoe foot drops

Resources & Links

Saebo’s Stroke Survivor Support Group

PubMed (National Library of Medicine)

EBRSR (Evidence-Based Review of Stroke Rehabilitation)

The Next Dimension Rehab with Tiffany Topp

Mon, 22 Aug 2022 08:00:00 -0000

In 2022, mobile therapy is the name of the game – not only for patients, but for the OTs who treat them.

Today’s guest, OT Tiffany Topp, started mobile therapy practice Next Dimension Rehab in 2020, and has seen the difference firsthand.

“Patients, when they're coming out of the hospital, they've been told things like, ‘Well, you know, whatever you have after three months is pretty much what you're going to get,’ which is totally not true. Totally not true. And the thing that is most important is the mentality of the patient. If they can see themselves getting better, if they can see themselves moving their arms and they have the drive to get better, that is like more than half the battle. So if they're willing to work, then I will give them as much as they want to work.” – Tiffany

In this episode, Tiffany talks with us about the differences she sees between in-home therapy vs clinic, her goals for stroke patients in the first 10 days of rehab, the power of positive mentality, and the role of a good OT in a patient’s healing process.

“The biggest role, I believe, as a therapist being on the very, very frontline is you're the first person that they really encounter in their journey and education is the biggest thing. Just making sure that they understand what a stroke is and, and how it's happened and educating the family on what to expect next, because the whole rehab process can be so confusing.” – Tiffany

Tiffany also shares her favorite ways to help her patients with reps and accountability, how mobile rehab also benefits patients with co-existing conditions, like age, weight or lymphedema, and her predictions for the future of stroke rehab.

In This Episode

(03:03) Tiffany’s journey as an OT, and her new rehab practice
(06:16) The difference Tiffany sees between the patients she helps in the hospital system and in mobile therapy
(07:58) Tiffany’s approach to patients in the first 10 days
(10:41) How patient mentality affects outcome
(11:43) In-home therapy vs clinic
(15:19) The overlap between physical and emotional therapy
(19:54) The best way Tiffany’s found to communicate with patients, monitor accountability and track reps
(24:15) Tiffany’s experience and training with lymphedema, which many stroke patients also have
(27:54) The future of stroke rehab

Our Guest

Tiffany Topp (OTR/L, CLT-ALM) started Next Dimension Rehab in 2020, an occupational therapy practice specializing in neuro rehabilitation, lymphedema management, and upper extremity orthopedic impairments, where she uses Saebo stroke rehabilitation technology.

Tiffany received her Bachelors of Science in Exercise Physiology and her Masters of Science in Occupational Therapy from West Virginia University.

Resources & Links

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Next Dimension Rehab

Life After Strokes with Guy and Jane Harvey

Mon, 08 Aug 2022 08:00:00 -0000

What does recovery look like six years after two strokes?

In our inaugural episode, we talk with Guy and Jane Harvey, whose lives suddenly changed in 2016 when Guy experienced two strokes within a month.

“When he was in rehab, [the therapists] asked him what he wanted [to achieve], but I don't think they ever thought he was gonna get there. They kept saying … ‘you're probably gonna be in a chair for the rest of your life.’”

With hard work and support from Jane, Guy proved them wrong. Today, they share with us what’s changed most about their lives since the strokes, resources for stroke survivors and Jane’s tips for caregivers.

“[Recovery] doesn't just happen within the therapy sessions. It's every waking moment, especially at the beginning. It's like, ‘Oh, you're having trouble with this. How can I figure out a way to help you with that trouble [so] that you are making those accomplishments? I could do everything for you, but then I'm gonna be doing everything for you forever. And that's not who he wanted to be.”

Guy also shares his perspective on their recovery journey, his hope for the future and the strategy he relies on for overcoming plateaus.

“The biggest thing that I find is that when I start to find myself plateauing or I seem like I'm not doing anything, I change it up. I was walking around the block the other day and this lady came out and ran towards me and said, ‘I cannot believe how much you've improved in the last year!’ And I said, ‘I thought I'd stopped.’

The thing is, you will be the last one to see progress.”

In This Episode

How a cut on his hand led to Guy’s strokes (01:34)
Guy and Jane’s resource recommendations for stroke survivors and caregivers (07:45)
How Jane learned on the fly to help Guy with at-home therapy (11:43)
What’s changed the most for Guy and Jane since the strokes (14:42)
Jane’s strategies and lessons for caregivers (17:10)
Adaptive equipment that helped Guy become more independent (20:53)
The Brunnstrom approach to stroke recovery (28:51)
Guy’s strategy for conquering plateaus (34:12)

Our Guests

Guy Harvey is a two-time stroke survivor. His strokes, which occurred – unusually – within a month of each other, were brought on by a cut to his hand that led to a serious heart infection.

Guy is supported in his stroke recovery by his wife, Jane, who also served as his caregiver and at-home therapist.

The Harveys live in Canada where they run JGH Rehabilitation and Consulting Services, a Health Canada-licensed importer and distributor of medical devices for stroke recovery.

Resources & Links

JGH Rehabilitation and Consulting Services
Guy’s Recovery
Walking 4 months post-stroke
Walking 4 years post-stroke

The Future of Neuro Rehab with Doro Zuleger

Mon, 25 Jul 2022 07:58:48 -0000

What should every stroke patient know about the road to recovery?

According to today’s guest, occupational therapist and Neuro Hub founder Dorothee “Doro” Zuleger: much more than hospitals and insurance companies tell them.

“There's no guidance. There's nothing. That's where it's so important that all the clinicians and the different settings start to collaborate more. So we have a better handoff and provide … a roadmap in recovery. What can I expect? How do I look? How can I advocate for myself?

So I feel like that's on us therapists to provide them with all the resources that are out there to at least navigate a little bit better through that territory.”

In this episode, Doro explores what she’d change about how insurance companies handle neuro rehab, the importance of micro goals in therapy and the biggest obstacle occupational therapists face in treating stroke survivors.

“I think that's the biggest challenge in stroke rehab, that there's not a one-size-fits-all. We need to tease out what fits every client and package it together.”

We also discuss the most important thing every first-time stroke patient should understand about recovery.

“[Patients] don't realize what the recovery process is going to be like. They don't understand that they are gonna have mini plateaus, but they can break through those plateaus.”

In This Episode

Doro’s background as an occupational therapist and the inspiration behind starting The Neuro Hub (03:12)
Doro’s ideas for new approaches to stroke recovery, especially for survivors and families with no prior stroke history (04:37)
Occupational therapists’ role in the rehab process and why insurance companies need to change (05:47)
Doro’s approach to setting patient expectations and providing encouragement (12:09)
What every new stroke patient should know (13:14)
Stages of recovery and the role of visualization (16:51)
The relationship between sleep, nutrition, and recovery (19:13)
Long-term goals, short-term goals, and micro goals in therapy (20:35)
The future of neuro rehab technology and digital therapeutics (23:25)
The biggest challenges facing neuro rehab (31:21)

Our Guest

Dorothee “Doro” Zuleger (MOT, OTR/L, CBIS, DRS) is the founder of The Neuro Hub, an advanced neurological therapy and rehabilitation center located in Central Florida.

She is a graduate of Adventist University of Health Sciences and specializes in providing hands-on, evidence-based approaches to neurological rehabilitation.

Resources & Links

The Plateau Myth

Mon, 11 Jul 2022 16:12:00 -0000

Every 45 seconds, somebody, somewhere, has a stroke.

That’s about 80,000 stroke patients each year, many of whom are pushed out of therapy before they’re fully recovered.

These people are still capable of living an active lifestyle – they just may not know how.

In this series sneak peek, you’ll get an idea of what the No Plateau Podcast is all about – challenging the status quo in neuro rehab, providing research-based solutions, understanding the process of neuroplasticity and what you can do to drive your brain into new recovery after stroke.

“Our goal at the end of every one of these episodes is for a patient to say to themselves, ‘Hmm, I didn't know that was available.’ Or ‘That patient really inspired me, I'd like to learn more and I'm gonna go ask my therapist,’ or ‘I'm gonna do some more research online if I'm not currently in therapy and find out what's out there.

I'm gonna be re-energized to get back out there and take control of my life.’”

In This Episode

Who this podcast is intended to help, and what you can expect in future episodes (01:09)
How the healthcare system can limit stroke patients’ recovery (02:38)
Henry’s background as a stroke and neuro rehab expert (03:40)
The genesis of Henry’s stroke rehabilitation company, Saebo (05:10)
Challenging basic theories of neuro rehab (08:13)
“Patients do not plateau – treatment options plateau patients.” (09:33)

Resources & Links

“Stronger After Stroke” by Peter Levine