Podcasts about hemiparesis

In today's episode Eoin speaks with Emma Bowditch.Emma was diagnosed with Type 1 Diabetes at the age of 12, but 10 years ago she had an experience with Transient Hypoglycemic Hemiparesis (“Hypo Paralysis”).This was a nighttime hypo that Emma had, which led to temporary paralysis on the left side of her body, often misdiagnosed as a stroke.As always, be sure to rate, comment, subscribe and share. Your interaction and feedback really helps the podcast. The more Diabetics that we reach, the bigger impact we can make!Questions & Stories for the Podcast?:theinsuleoinpodcast@gmail.comConnect, Learn & Work with Eoin:https://linktr.ee/insuleoin Hosted on Acast. See acast.com/privacy for more information.

Lots of stroke survivors joined the stroke club due to high blood pressure. I'm one of them. The biggest challenge with high blood pressure is that it doesn't hurt. Most people will feel no symptoms unless something goes terribly wrong. Or they might learn they have the condition if they get an annual physical. Because of the danger of high blood pressure directly, and because of the danger of other conditions that manifest as high blood pressure, it's important to check it regularly, and that doesn't mean you have to go to the doctor every week. You can find home blood pressure meters all over the place -- from Amazon to Costco to the corner grocery store. But which one is best? And what do you need to know if you've already had a stroke? This week, I'm joined by Carol Lucarelli of Omron Healthcare. Omron is a leading manufacturer of home blood pressure meters. In fact, one of their devices is sitting on the table next to me as I type this. It was that very device that gave me the 210 over 160 reading that kicked off my stroke story several years ago. More recently it read 134 over 77 -- not perfect, but still much better than the condition that collapsed my right middle cerebral artery. One reason I wanted to talk with Carol was that I heard about Omron's Going for Zero mission. The other reason is that I like tech and gadgets, especially when they can save lives. IMAGINE A HEALTHIER WORLD We believe the next generation won't be defined by age, but by a world without heart attacks or strokes. This is a world-changing mind-set we call Going for Zero™. We do our part through technology supporting personal fitness, heart health, healthy lungs and freedom from pain. You bring this commitment to life by understanding and sharing heart health with every step. https://omronhealthcare.com/generation-zero/ Carol joins us to talk about how these devices work, how they compare to the doctor's office, and why we should trust devices from Omron from wrist devices to upper arm cuffs to smart watches. If you don't see the audio player below, click here to listen to the conversation on the original site.   Click here for an AI-generated transcript Who is Carol Lucarelli? Carol Lucarelli is the Executive Director of Marketing and Ecommerce at OMRON Healthcare, the global leader in personal heart health and wellness technology. Lucarelli is a seasoned marketing professional with over 25 years of experience in the consumer packaged goods space. During her time at OMRON, Lucarelli has led the marketing initiatives for numerous product innovations, including the launches of HeartGuide Complete as well as VitalSight, OMRON's first remote patient monitoring service. Wrist vs Arm Home blood pressure monitors typically come in two types -- wrist or upper arm. The wrist mounted devices are typically smaller. You simply put it on your wrist, secure it, press a button, and raise your hand to get it at the appropriate level. The upper arm models will typically wrap around your bicep or upper arm. Some will have the guts of the device on the cuff; others will have a hose that goes to a device on your desk, table, or lap. In the past, I assumed the upper arm would be the more reliable device because that's what many medical facilities use. Over the past few years, though, I've seen more medical teams using the wrist versions for convenience. Carol also explained that whether it's wrist mounted or upper arm mounted, the devices are held to the exact same standard of accuracy. As long as a device is on the Validated Device List, you can assume the model is accurate. Ask your doctor if they have a recommendation. There are all sorts of health reasons why one style might work better for someone than another style. Different deficits after stroke may impact the choice. While cognitive, language, sensory, and pain challenges can all have an impact, hemiparesis - or limb paralysis - is probably the bigger factor. Once you choose your device, it's also a good idea to bring it with you the next time you go to the doctor. This way your doctor can double-check its accuracy against their own blood pressure equipment. While the Validated Device list ensures your model is generally accurate, this process ensures your particular meter is accurate. Hemiparesis recommendations Typically, we take blood pressure measurements on the left arm. It's closer to the heart and will provide a more accurate reading for non-stroke folks. After stroke, a stroke affected limb, however, doesn't have the same muscle activity of a non-affected limb. And that muscle activity affects blood pressure readings. That limb may also experience more edema or swelling due to less effective circulation, lymphatic draining, and other things. That can also impact the blood pressure readings. So, to correctly read blood pressure, you should take a reading on the unaffected side. A difference of 10 points between the sides is not uncommon. The other issue that impacts readings is arm position. The cuff where the reading takes place should be level with the heart. With an upper arm cuff, that's easy. With a wrist mounted device, it's more challenging. You have to be able to lift the wrist to the same height as the heart. Your arm is also supposed to be relaxed when you take the reading so it should be on a bed, table, shelf, or some other item to hold it at heart level. To get an accurate reading, the arm should not be held up under its own power. If you have a care partner who can fasten the device, great. Then an upper arm device can be easy to use. You don't need to worry about arm height because it's naturally at heart level. If the main unit connects via hose to the cuff, you can even use the unaffected hand to push the ON button. If you're by yourself, the problem is fastening the cuff in the first place. It took me several years after stroke until my left arm had enough strength and dexterity to tighten the cuff on my upper arm. Sometimes I still don't get it right and have to try again. Fighting with that costs energy and aggravation, which raises my blood pressure so now I have to take extra time to make sure I relax adequately to get an accurate reading. Once the cuff is set and I chill out a bit, I can get a good reading. A wrist cuff is easier to put on. It still requires a certain amount of dexterity and strength in my affected hand, but it's much less. And it's easier to reach the strap with my teeth, so I can use my bite to help tighten the straps. Then the trick is to get it at heart level. Sitting up can be tough because I have to use my affected side to lift my unaffected arm so I'm not messing with the reading by using the strength in the arm with the monitor. One solution to that which works with both types is to take readings in my recliner our lounge chair. I can get strapped in and then lay back with my arms in neutral positions and the device naturally at heart level, relative to the ground. So, putting the device on is likely easier with a wrist device. Getting an accurate reading is likely easier with an upper arm device. Of course, that all assumes I'm doing this by myself. If someone is able to consistently help, it changes that calculation a bit. Consider your goals, your deficits, and your doctors' recommendations. Try some different devices to find the one that you will use most consistently to generate the most accurate readings. Though the Omron Heart Guide wrist monitor / smart watch does activate my technolust… Getting Good Data Carol gave four recommendations for getting an accurate reading. First, sit upright in a hard-back chair. No slouching. This will give you a good base to start from, assuming your deficits allow you to do this. Second, be seated for 5-10 minutes before taking your reading. If you've been moving around from place to place or doing your sit-to-stand exercises for the day, your blood pressure will likely be elevated from that activity. Third, keep the cuff at heart level.  If it's an upper arm cuff, that's easy. If it's a wrist cuff, you may need to support the arm that's wearing the device. Fourth, keep your feet flat on the ground, assuming tone and spasticity allow that. Crossing your legs or ankles will restrict the flow of blood and reduce the accuracy of your readings. These tips will help you get readings, but more important than your exact posture is taking your readings in the same (or similar) posture each time to ensure consistency. Often the trends over time are more important than any particular reading. Validated Device List Whichever style of meter you choose, you want it to be accurate. And a good place to start is the Validated Device List. The Validated Device list is maintained by the American Medical Association. The devices on it have been evaluated by a third party to ensure they meet the standards for accuracy that doctors can trust. While Omron has a bunch of devices on this list, it includes plenty of other manufacturers, too. All of these devices will meet the minimum standards for accuracy. Consistency We end up talking about consistency a lot on this show. Carol talks about the importance of taking blood pressure readings consistently. The actual result often matters less than the trends over time. And the only way to spot trends over time is to consistently collect that data, like brushing your teeth. Consistency isn't just about blood pressure. Consistently executing a PT, OT, or SLP home exercise program is one of the keys to recovery. We talk about the thousands of reps needed for neuroplasticity over time, but it's the consistency that will make that happen. Doing 100 reps a day, every day will yield better results than doing 1,000 reps once a week. The core call to action for every episode of the show is, "Don't get best…get better." You don't have to become the best at anything to be successful; it's likely to be a fool's errand. Instead, just try to get a little better every day. Consistent work to improve just a tiny bit can add up to huge gains over time. What consistency lacks in flash and drama, it makes up for in long-term results. Hack of the Week Carol shared a couple tips and I have one of my own this week. First, use electronic reminders around the house. That could include smart phone alarms. Or it could be devices like the Amazon Alexa or the Google Home devices. Set those devices to remind you to check your blood pressure, take your medication, do your exercises, or whatever. Your brain is doing enough in recovery. If you can outsource some routine stuff to robots, go for it. When there are things about your devices that you don't like, let the manufacturer know. When enough people make suggestions or point out problems, then they may realize changes need to be made. If they don't hear from customers, or customers whose business they lost, it's a lot harder to make the most appropriate changes to the products. And, while I could be wrong (and hope I am) I don't think most medical device companies have folks with hemiparesis working in their engineering departments. Finally, my biggest struggle with an upper arm blood pressure cuff is tightening it adequately with my affected hand. My strength and dexterity are improving, but I still have a long way to go. One trick I have is to tighten it around my elbow and lower arm. I still can't tighten it all the way; it will be loose there. Once I have that secure though, I can slide it up to my upper arm (with effort). While it was loose on my lower arm, because my upper arm is bigger, it is now tight enough to get a reading without the machine throwing an error message. Links Where do we go from here? If you don't already have one, get a home blood pressure monitor from the Validated Device list and check your blood pressure consistently. The magic numbers you are looking for are 120/80. Share this episode and article with someone you know by giving the, the link http://Strokecast.com/Omron Subscribe to the Strokecast newsletter at http://Strokecast.com/News Don't get best…get better. More thoughts from Carol Lucarelli    

Pain sucks. Chronic pain sucks even more. And for many stroke survivors, this is now their life. Actress, artist, documentarian, and stroke survivor Maggie Whittum explored the world of chronic pain with us in episode 38 and with Barbie dolls filled with nails or covered in suffocating clay. Other survivors have talked about living with pain, even when there is nothing "wrong" with the limb.  View this post on Instagram A post shared by Maggie Whittum (@maggiewhittum) //www.instagram.com/embed.js And once you've lived with pain for several months you don't become accustomed to it. In fact, the nervous system increases  your response to pain. So what's going on here? The brain damage from stroke drives chronic pain in many survivors through a perfect storm of symptoms: Decrease in sensory filtering Increase in sensitivity Homuncular changes in the mind-body connection In this conversation, Physiotherapist and pain specialist Brendon Haslam joins us to talk about the nature of post stroke pain, how clinicians may treat it, why some medication work while others don't, and how, after stroke, we may no longer know just how big or small our hand is. If you don't see the audio player below, visit the original article page here. Click here for an AI-generated transcript Who is Brendon Haslam? Brendon is a physiotherapist and current PhD candidate with the University of Melbourne. Brendon has a particular interest in pain following stroke, and his PhD is focusing on identifying contributions to upper limb pain in stroke, and understanding possible neural networks involved in the pain experience.  The aim of this research is to increase understanding of pain following stroke, and subsequently develop effective interventions to manage the significant problem of chronic pain in stroke. What is chronic pain? Once someone experiences a pain for 3 months, it's considered chronic pain. The nature of chronic pain after stroke goes deeper, though. For one thing, we normally think of pain as resulting from tissue damage or injury. While sometimes joint injury, shoulder subluxation, tendonitis, and other conditions may be a factor, they don't tell the whole story. For example, lightly touching an affected limb may be extremely painful. Applying the exact same stimulus to and unaffected limb and an affected limb may feel like nothing on one side and extremely painful on the other, even if there is no physical difference in the stimuli. A stroke affected limb may just hurt for no obvious reason. And that can be what the survivor just has to live with. Over the last 20-25 years, as Brendon explains, our understanding of pain has evolved quite a bit. We no longer think of it as coming from specific pain receptors. Rather, it a broader sense of safety or danger to the body. And the more someone lives with chronic pain, the more sensitive the nerves at the spine will become to those sensations. Rather than learning to ignore the pain, we can become even more sensitive to it. One of the biggest challenges with stroke recovery is how the brain sometimes loses the ability to inhibit or disregard signals and data. In the case of chronic pain, the brain fails to disregard those signals as the spinal cord in effect raises the volume. In the case of tone and spasticity, as we learned from Dr. Wayne Feng, the brain loses the ability to inhibit signals from the spine to the affected limbs that drive tone. For some survivors, like artist Seth Ian Shearer and NeuroNerd Joe Borges, the stroke reduced the ability of their brains to filter out or inhibit external sensory input. The go out and about with sunglasses and earphones to navigate the world. Stroke is as much about the brain no longer stopping things as it is about the brain no longer being able to do things. And chronic pain falls right into these challenges. The Study I wanted to speak with Brendon after reading a study published in the journal Brain Sciences called “My Hand Is Different”: Altered Body Perception in Stroke Survivors with Chronic Pain. It's a fascinating look at how stroke survivors with chronic pain develop a false image of the affected hand. Our results support the hypothesis that individuals with sub-acute and chronic stroke who experience chronic pain are more likely to report changes in body perception (as indicated by presence of alterations in perceived hand size) than those without pain. Further, the frequency of altered body perception of the hand, and strength of the association were greater when the region included the hand. We've talked about the homunculus in previous episodes, and you can read more about the idea of the homunculus in this Strokecast article. Basically, the homunculus is a representation of the amount of neuronal real estate taken up by different body parts based on how much we use them and how we use them. For example, the thumb will occupy more space in the brain that the elbow. After stroke, our homunculus can undergo changes based on the injury and our new use patterns for our body. And among those changes are how we feel pain.  This study provides useful information in understanding that those changes take place. It reinforces the idea that pain is related to homuncular perceptions. And it further supports the perfect storm of chronic pain causes that we discussed in the episode. Hack of the Week Brendon's hack is to get into meaningful activities that bring you joy. Sort of like how Tawnie in the previous episode got into Mermaiding. There are lots of reasons to focus on activities like this -- whether that's volunteering in a community, playing a sport, creating art, developing a podcast or something else. Doing something deliberate and planning it gives us something to look forward to. Having a reason to get out of bed is super important, not only for stroke recovery, but for life in general. Making progress, striving, or even just doing something to improve your life and mood -- to bring joy is a powerful motivator to keep going. And for some folks, that means to just get to the next day. For other folks it's a way to change the world. Pursuing activities that bring genuine joy is a good thing in and of itself. But as Brendon points out, it has biological implications, too. It opens the proverbial "drug cabinet" in our brains to drive increased dopamine. This drives learning, which is the essence of stroke recovery -- teaching the brain to do the functions the dead brain cells used to do. Dopamine also drives the production of Gaba. And Gaba works to turn down the body's sensitivity to irrelevant information. Essentially, it helps the body inhibit some of the sensations that cause problems after stroke. Pursuing activities that drive joy addresses the challenges of stroke on multiple levels. Links Where do we go from here? To learn more about Brendon and see more of his research, visit his profile here. Share this episode with someone you know by giving the, the link http://Strokecast.com/pain. Subscribe to the Strokecast newsletter for periodic updates. Don't get best…get better More thoughts from Brendon

Andrew Stopps call stroke "The Gentle Assassin." Like many (but not all) of us, Andrew found it remarkable that stroke did not hurt. That's often the case with an ischemic stroke. Mine didn't hurt either, and I found it remarkable at the time. It was a profoundly interesting experience. Lack of pain doesn't mean lack of impact though. Andrew found his music career suddenly upended and his mosaic career suddenly suspended as his husband rushed him to the hospital. He lost (for now) the ability to play the clarinet. He discovered unexpected laughter and tears. And it redirected his life. Andrew and I talk all about his encounter with the Gentle Assassin in this week's conversation. If you don't see the audio player below, click here to visit the original blog post.   Click here for a machine-generated transcript Who is Andrew Stopps? Andrew Stopps has taught music for over 20 years in Australia, UK and New Zealand. His teaching experience ranges from a woodwind instrumental teacher and band director in rural South Australia to Head of Music at the Australian International Performing Arts High School in Sydney. In 2009 he moved to New Zealand and in 2012 he was a finalist for the NEITA Excellence in Teaching Award. He is the founder of the Wellington City Concert Band, NZ Youth Symphonic Winds and the Wellington Band and Orchestra Festival. He is also the founder of the Hoa Project that provides support and mentoring to music teachers around New Zealand. He has been a composer and arranger since high school and his works are performed by ensembles around the world. He has travelled to Washington DC for the World Premiere of my work “Welcome to Aotearoa” for concert band in 2019. This year his “Middle Earth Suite” is to be world premiered in Melbourne, Florida.  In November 2021 he experienced a mini stroke immediately followed by a massive stroke. He has made a 98% recovery using music therapy, brain plasticity, and with the support of his husband.  He continues to compose and is currently writing his book "In One Stroke". You can connect and chat with Andrew at andrewstopps.com "I am Andrew Stopps." Before going to the hospital, while struggling with language and dexterity, and while his brain was dying, Andrew still had one thing to do. He needed to declare his identity. He needed to write "I am Andrew Stopps," before heading out the door. Our personality, individuality, and human existence is dependent on our brain. In the middle of a brain attack, like stroke or brain tumor, all of those things are at risk. Many survivors have to reckon with the idea that they will never be the way they were; this experience has made them a different person. Dr. Debra Meyerson explored this whole question in her book, "Identity Theft: Rediscovering Ourselves After Stroke."* I spoke with Debra and her husband about the topic and her book in 2019. You can listen to that discussion here. Diaphragm and Core When we talk about left or right side weakness after stroke we're not just talking about arms and legs. The same weakness can affect our core muscles -- the ones in our chest and abdomen. Weakness there can make it harder to sit up, leverage those muscles to make a big effort, impact our breathing or even hinder digestion and elimination. The diaphragm is the main muscle that controls breathing. When it moves smoothly in one way, we inhale. When it moves properly in the other way, we exhale. When stroke weakens it, things get screwey. Most of us never think about our diaphragms. Andrew is different. Because he's a musician with a career playing an instrument that relies heavily on breath control, he was already intimately familiar with the functioning of his diaphragm and how it behaved differently after stroke. It resulted in unusual laughter, among other things. Because he was familiar with it, he could also focus his efforts on regaining control. Additionally, consider our previous discussion about the homunculus. Andrew likely has more brain real estate dedicated to his breathing and diaphragm. Deliberate, repeated focus means cells were firing together more often. And the cells that fire together, wire together. Emotional Lability and PBA Emotion lability and pseudo bulbar affect also came up in our conversation. This condition is common after stroke. It refers to how survivors may find themselves crying at the slightest provocation or laughing at inappropriate times. It's a result of the physical damage to the brain. I've certainly experienced the unexpected tears, especially in the early days. Especially interesting was when I would find myself weeping from simple physical exertion in PT. It was crying without emotional context in my case. I didn't feel sad, just curious. This can be frightening to both the survivor and their family, especially if prior to the stroke, the survivor was a fairly stoic person who showed little emotion. Now when the cry for little or no reason, it can really share them and their care partners up. The question of, "Am I now a person that cries over TV commercials?" Further feeds into questions of identity after stroke. Hyperbaric Oxygen Therapy Hyperbaric oxygen therapy involves spending a chunk of time in a oxygen-rich, high pressure chamber every day. Andrew paid out of pocket for this treatment in New Zealand, and feels it helped his recovery. Of course, he's also not sure if it was the actual therapy that helped or if it was more the isolated meditation time that made the difference. The science doesn't provide much clarity. HBOT does help with infections, post-burn treatment, carbon monoxide poisoning, nitrogen bubbles in the blood (the bends), and some other conditions. The lack of any rigorous, controlled, double-blind studies on the effectiveness of HBOT after stroke is an issue. It's an expensive, time consuming process with no significant evidence that it works. I spoke with Dr. Michael Bennet a few years back about the treatment. You can listen to that conversation here. He's an expert in and advocate for HBOT. His assessment was that he wished it worked, but the evidence doesn't support it. So does it work? Maybe. Did the HBOT drive Andrew's recovery? Or was it just time spent in the chamber alone with his thoughts? Or did it help his recovery because he believed it would? We don't know. That's why we need more double-blind controlled studies to figure it out. In the meantime, we do know that it is safe for most folks. If a person has the money to spare and doing HBOT will not take time away from traditional PT, OT, and SLP, then, sure. Go for it. And I hope it's successful. Hack of the Week Andrew shared two hacks this week. The firs is about yawning. It's fascinating the way  a body with hemiparesis reacts when we yawn. Andrew found he could get some minor control once a yawn or stretch caused his hand and arm to respond. In my case, in the early days, a yawn would pop my affected arm right up and my fingers would go full jazz hands. It makes sense when you think about it. The brain damage from stroke may impact higher level brain functions, but yawning is a more fundamental bodily function controlled by the brain stem or acted upon by the spinal cord. And when we get that movement, look at it, focus on it, and try to take advantage of it. The first time you may not succeed, but the tenth or hundredth or thousandth may be a different story. I t reinforces the idea that your hand still works fine. You just don't have control of it…yet. Andrew's second hack is to become like a kindergartener. Organize your home carefully with everything put away in a deliberate manner. After stroke, you can't go rummaging effectively though overstuffed drawers and cabinets and expect to find what you want. You don't have the time, energy, spoons, or dexterity for that. A place for everything and everything in its place is how to approach home organization, like a kid's classroom. Plus, clutter scattered about the place is not a good idea when you have mobility challenges. Survey Do you have thoughts about the Strokecast as a show? I want to hear about it. Please complete the listener survey at http://Strokecast.com/survey by March 31, 2023 to share your insight. I'd realy appreciate it. Links Where do we go from here? Check out Andrew's site, programs, and music by visiting http://AndrewStopps.com Share this episode with someone you know by giving them the link http://Strokecast.com/AndrewStopps Please complete the listener survey at http://Strokecast.com/survey Don't get best…get better. More thoughts from Andrew Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity. Musician, teacher, brain tumor survivor, and now stroke survivor Andrew Stopps joins us to talk about the gentle assassin that almost took his life, and how he's been recovering as we explore issues of post-stroke identity.

In our second episode covering hemiparesis, Sam & Dr Paul Sellors, Consultant in Stroke Medicine at Southmead Hospital in Bristol, finish off the discussion on examining our patient as well as covering the pertinent investigations, management steps, presenting your patients and the all important examiner questions. > > Sign up for Pastest HERE! <

Dr Paul Sellors, Consultant in Stroke medicine at North Bristol NHS Trust joins Sam to discuss the first steps in assessing a patient in PACES with hemiparesis! > > Sign up for Pastest HERE! <

Stroke survivors with physical deficits have to fight to get the muscles moving again. They also have to fight to stop some muscles from moving. Tone and spasticity are why our elbows curl, our fists squeeze tight, and our toes can curl under our feet so we crush our own toes as we walk. Dr. Wayne Feng is an expert in tone and spasticity after stroke and he joins us this week to explain how we can address these challenges If you don't see the audio player below, visit Strokecast.com/MSN/ToneBasics to listen to the conversation. Click here for a machine-generated transcript Who is Dr. Wayne Feng? From Dr. Feng's Duke Profile: I am the division chief for Stroke and Vascular Neurology in the Department of Neurology at Duke Health. I see stroke patient in the emergency department, inpatient service as well as in the outpatient clinic. I also treated post-stroke limb spasticity, a disabling complication after stroke. In addition to the patient care, I also run a brain modulation and stroke recovery lab at the Duke University campus to study stroke patients in my lab to develop new stroke recovery therapy. On my days off, my boys and I are big on fishing. I enjoy drinking and collecting tea. As a stroke doctor, I do not drink coffee at all (there is a reason for it). If you come to see, I will tell you. Current Appointments and Affiliations: Professor of Neurology, Neurology, Stroke and Vascular Neurology 2019 Chief of Stroke & Vascular Neurology in the Department of Neurology, Neurology, Stroke and Vascular Neurology 2019 Professor of Biomedical Engineering, Biomedical Engineering 2022 [youtube https://www.youtube.com/watch?v=SGeOGI2bry4&w=560&h=315] Tone and Spasticity Overview Mos of our limbs move because of the interaction between two types of muscles -- extensors and flexors. The flexors contract to bend a limb. The extensors contract to extend the limb. For example, the biceps are flexors. They pull our forearm up or into an angle. When people want to show off their arm muscle, the flex their arm -- they activate their flexors. The triceps on the back of the upper arm are extensors. When they activate, they extend the arm -- they pull the arm straight.  When flexors contract extensors relax. When extensors contract, flexors relax. That's how we control our limbs. After stroke, the flexors can activate on their own. And they can be, well, overenthusiastic, in those actions. That happens because the default behavior of the flexors is to be active and curl up. When we talk about curling up into the fetal position, that's most of our flexors activating. The reason we can go through life upright and with our limbs straight is that the cortex of the waking brain is constantly suppressing the normal contracting of the flexors. After stroke impacting the motor cortex of the brain, the corticospinal tract is disconnected. With that disconnect, the brain can no longer suppress the flexors so they do what they do -- they contract and curl and cause all sorts of problems. Peripheral vs Cortical Problems Categorizing issues as cortical or peripheral is a fancy way of saying brain or limb. A stroke is a cortical issue. The problem exists in the brain. That's where the disconnect happens. A peripheral issue is when something goes wrong in the limb. Shoulder subluxation, for example, is peripheral issue. Most PT and OT works with the limbs to treat the cortical issues. Tone and spasticity are caused by cortical issues. The long-term problems caused by tone and spasticity are peripheral issues. One of those peripheral issues is contracture. When tone and spasticity is severe and long term, the muscles, tendons, ligaments, and other soft tissue can actually shrink in the contracted position. When that happens, getting the extensors back online and suppressing the flexors no longer  helps. The limb can become almost permanently bent. Repairing peripheral issues, like contracture, may require surgery to sever and extend tendons and other tissue. Preventing and Treating Tone and Spasticity The first line of defense is in the immediate short-term after stroke. Getting the limbs moving and keeping them moving to drive the neuroplastic change of recovery helps. Beyond that, and once tone and spasticity set in, regular stretching is critical. A survivor needs to keep stretching those limbs to prevent contracture. That's why in conference calls and interviews, I'm often stretching my fingers back and my wrist back to counteract the tone and spasticity in my left arm and hand. Medication can help, too. Baclofen is a popular choice. It's basically a muscle relaxer that helps counteract the excessive action in my flexors. Some people find it can cause drowsiness so it's not the best choice for everyone. I tend to take my Baclofen before going to bed. If it makes me drowsy then that's great. It also helps reduce the tone I might experience overnight. For folks with severe tone and spasticity, a surgically implanted Baclofen pump can help. The medicine directly target the key muscles which means the patient needs much less medicine for a much greater impact. Since it is a low dose, it is less likely to induce the fatigue, too. Other medications to treat tone and spasticity include: Tizanidine Flexeril Gabapentin Botox, Dysport, and Xeomin are also treatments that can help. These are neurotoxins that a doctor can inject every three to four months. By delivering the toxins to the flexors, it reduces their ability to flex. That gives the extensors a chance to recover and rebuild a normal relationship. Of course, this is a short-term solution. Combined with exercise, it can definitely help. I'm probably overdue for my next Dysport treatment. Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery A promising area for relieving tone and spasticity is C7 nerve transfer. Recent studies are showing promising results. Neurosurgeons split the a nerve from the unaffected side of the brain that runs through the spine and reconnect half of it to the equivalent nerve on the affected side. The do this in the neck. Results show a quick reduction in tone and spasticity even in patients 15+ years after stroke. After a year, patients are experiencing improved use of the limb, too. The number of people in the studies so far is pretty small (36) and more research is needed. It is a promising result, though, and builds on techniques that have been used to treat non-stroke injuries. It also highlights the tremendous ability of the brain to adapt since now the unaffected side starts to control the affected side of the body. You can read a review of the technique and studies at the Journal of Clinical Medicine. Vagus Nerve Stimulation In 2021, I spoke with Dr. Jesse Dawson, a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital in Scotland about his research in Vagus Nerve Stimulation. This research is now being commercialized and used to treat patients in the US. The therapy involves surgically implanting a stimulator in a patient's chest that connects to the Vagus nerve. During PT or other exercises, the device sends an electric signal to the Vagus nerve. Stimulating the nerve while doing therapy has shown positive results in terms of limb use. It's interesting because it's not treating the Vagus nerve itself, but stimulating this nerve appears to make the other nerves in the brain more receptive to the therapeutic exercises. You can learn more about this research here: http://Strokecast.com/VNS. Survey What do you think of the Strokecast? Let me know what you like and what you would like to be different by completing the survey at http://Strokecast.com/Survey. I would really appreciate it. If you complete the survey by March 31, 2023, you could win a $25 Amazon gift card, too. Hack of the Week Hand grip exercisers are nice tools to encourage stretching and exercise throughout the day. These things are like a pair of pliers without the tool end. They are spring loaded. You squeeze them to exercise and they try to force your hand open. You can get them in a variety of strength levels. Start with light weight ones and move on to tougher ones as your strength improves. What I like about them is that closing a fist comes back before opening one. Closing your fist takes work. Opening your fist is often harder, but these gadgets force the hand open. So you get to practice the squeeze and you get a stretch into fingers, too, to address tone and spasticity. It's also one more way to reduce the odds of developing a contracture. Here are a couple options: https://strokecast.com/Hack/HandExerciserTraditional (Traditional design)* https://strokecast.com/Hack/HandExerciserAdjustable (Adjustable resistance)* Links Where do we go from here? Check out Dr. Feng's work at Duke University Share this episode with someone you know by giving them the link http://Strokecast.com/ToneBasics Complete the Strokecast survey at http://Strokecast.com/Survey Don't get best…get better More thoughts on Tone and Spasticity

A minor electric signal is all it takes to move a couple hundred pounds of human. When we walk, the brain sends a signal through the spine to the individual muscles of the legs, feet, and core to manage the complex orchestra of contraction and relaxation that makes balance and walking possible. After stroke, the brain may stop sending all or some of those signals. That breaks the ability to walk. It happened to me and millions of others. There is nothing wrong with my leg, though. The muscles, joints, tendons and nerves in my leg, foot, and core are all still there and as fully functional as they were before the stroke. They're just waiting for he signal from my brain which, in the beginning, never came. Rehab was about getting the brain to send that signal again. And it started sending some of it. It's not as complete as it used to be. Or as strong. But it's enough that I can walk with my cane and brace well enough, and not quite as well without my aids. But, again, it's a brain issue, not a leg issue. If you can send a signal to those muscles without the brain, can you effectively get those muscles to move and walk more effectively? Yes you can. That's what Neural Sleeve from Cionic does. In this episode, I speak with Cionic CEO and founder Jeremiah Robison about the Neural Sleeve, why it works, how stroke survivors can learn more, and how his daughter inspired this product. If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation. Click here for a machine-generated transcript Who is Jeremiah Robison? Jeremiah Robison is the Founder and CEO of CIONIC, an innovative company that builds lightweight and durable bionic clothing driven by powerful algorithms that adapt in real time to each individual's mobility needs. He started the company in 2018 after his daughter was diagnosed with cerebral palsy and he was frustrated at the lack of effective technology available to help improve her mobility. Four years later, CIONIC introduced the breakthrough, FDA-cleared Cionic Neural Sleeve, the first product to combine sensing, analysis and augmentation into a wearable garment. Prior to CIONIC, Jeremiah spent twenty years at the intersection of data, algorithms, and the human body, driving innovation in sensing and machine learning at Apple, Openwave Systems, Slide, and Jawbone. Jeremiah has a BS and MS in Computer Science from Stanford University. Jeremiah's daughter Jeremiah's daughter, Sofia, was apparently in a rush to meet this amazing world. She was born early, weighing just 2 pounds, 4 ounces. She developed Cerebral Palsy in the process. Cerebral Palsy (CP) and stroke are similar conditions. In fact, as Dr. Heather Fullerton explained in episode 49 ( http://Strokecast.com/PediatricStroke) roughly 50% of CP is caused by stroke in utero or shortly after birth. CP is the result of not enough oxygen getting to the right part of the brain at the right time of development. Brain cells die or don't develop or don't form the right networks the way they should. As a result, a child can develop any number of challenges around mobility, speech, dexterity, and more. Just like adults (and other children) with stroke. The damage from stroke in the brain is also, in part, due to lack of oxygen getting to the right parts when they need it due to a disruption in the blood supply. Stroke survivors have a lot in common with our neuro cousins in the CP and MS communities, to name a few. Jeremiah talks about wanting to help Sofiawith her gait, as any parent would. Jeremiah was in a position to do something about it, and the Neural Sleeve comes from that experience. Sofia herself is now 12 years old and has developed a presence on Instagram with the family's nonprofit at @WAWOSORG. Sofia shares her own inspirational tips and exercise strategies for other kids with CP or other disabilities. View this profile on Instagram WAWOS (@wawosorg) • Instagram photos and videos FES FES stands for Functional Electric Stimulation. I talked about the technology in more detail in episode 92 - Electrodes and a Stationary Bike — FES for Stroke Treatment. I've used eStim in therapy while I was inpatient and then at home, too. Devices are available on Amazon for $30-$50.* You put 2-4 electrodes on an arm or leg, roughly at either end of a muscle. The AA battery powered unit sends a minor electric signal to the electrode. The nerves at the end of the muscle detect it and think the brain is sending the signal. The nerve then contracts or relaxes the muscle. The muscle is doing the actual work. It can be a great way to help an affected limb get some exercise, stretch some tendons, and generally not waste away. In the shoulder, it can even treat subluxation. FES is the next level of eStim. Instead of just making the muscle move, it makes it, and other muscles move much more precisely to accomplish a specific function. In the case of Restorative Therapies, this was to coordinate movement to drive rahab. https://youtu.be/HJo07_JimOA Some of the more well-known FES devices are those from Bioness and Walkaide. They specifically stimulate the muscles that lift our toes (the dorsiflexors) to eliminate foot drop while walking. They are an alternative to an AFO. The look like a cuff that a person wears just below the knee. They work great for some folks, but not all. They're also not typically covered by insurance. I tried them both earlier in my post-stroke life. The Walkaide worked better on my gait, but at $5K-$6K to buy the unit (in 2019), I decided the benefit simply wasn't worth the cost for me. For others, the device is a great solution. Author Maddi Niebanck who survived a stroke at 22 and was in episode 97 uses the Bioness and is a big fan. The Neural Sleeve takes this technology further. As Jeremiah explained, the network of electrodes in the device means that precise placement is not as important. Software can adjust for that.  With its larger assortment of electrodes, it can also stimulate more muscles and address other aspects of gait. And it looks less like a home-release ankle monitor. The rental aspect of the Neural Sleeve also makes it more accessible to more folks, similar to the approach adopted by show sponsor Motus Nova for its rehab device. The best rehab gear is the gear you won't need forever, and that rental becomes much more compelling. At least under the American model of health care financing. Cionic Images You can get a look at the device in these images. Or visit http://cionic.com. No Plateau Podcast Many stroke survivors have heard of Saebo. The make a series of devices for survivors. One of them is the Saebo Step, which is an alternative AFO. They sent me one several months ago, and I use it as my summer AFO. Specifically, it's the one I use when I wear short pants or sneakers. They also have a podcast called the "No Plateau Podcast" which is a great name for a stroke oriented show. And I'm the guest on episode 6. It was a lot of fun and I didn't have to do the editing. In the episode, I share my stroke journey and we talk about the good, the bad, and the ugly of stroke rehab. We also talk about what I mean when I say, "Don't get best…get better." And we talk about some of the inequities affecting female presenting and BIPOC stroke survivors. You can listen right here. If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation. Or go directly to the audio at this link. And check out more episodes of the No Plateau Podcast on Saebo's website or in your favorite podcast app. Hack of the Week Jeremiah recommends patience. Recovery is a journey as we well know, and we can take it just a piece at a time. It's also important to capture the process in notes, video, audio, and/or pictures. As we make progress day-by-day we won't see it. It's only when we look back at our records that we see how far we've come. And of course this aligns well with the idea of "Don't get best…get better." It's that incremental progress that matters…little bits every day that over time add up to success and goal achievement. Links Where do we go from here? To learn more about Cionic, Jeremiah, and Sofia, visit http://Cionic.com or check out the social media links in the table above. Share this episode with someone you know by giving them the link http://Strokecast.com/ElectricPants Subscribe to the Strokecast newsletter at http://Strokecast.com/News Don't get best…get better.

Dr. Jennifer Daniels, Part Two Sept. 26 Florida caller says hurricane coming. What are nonperishable cholesterol sources? Fry up liver. Fill up cooler with ice, put liver and cholesterol foods in it, liver is good for 3 days. Get a portable grill with a tank. Make pickled eggs. How to make adequate online income? Start with a value. What do you have that is of value? How to communicate that value. Internet can amplify your value. Dr. Daniels' story of selling her turpentine report. White spots on nails, despite taking zinc daily. Bump on butt cheek – parasite? Ignore fingernail. Stop sitting so much. Put turpentine on the bump. Put castor oil on body, waist down. Do exercise, especially splits, to clean the lymphatics. Avoid sitting. Listener with stage 3 colorectal cancer and excruciating pain in abdomen and rectal area. Bedridden, vegetarian but takes dessicated liver. Cancer means there is a deficiency in the intestines. Cancer is an inability to repair, and the area collects trash, which is called a tumor. Is actually a parasite infection – tumor is a parasite condo. Take Ivermectin – body weight/10 = mg. of iVM to stop parasites from growing. Take once every 2 weeks. How did you get to that point? Vegetarian diet didn't have enough connective tissue. Eat cow small intestine, pressure cook 2 hours, in tomato sauce if tolerated. Dessicated liver if it helps to feel better. Cook half pound of each organ and drink the broth. Eat overcooked vegetables. 60 y.o. man with gallstones. Take bitters, sauerkraut juice, make stools soft. Liver flushes are stressful, require dehydration and malnutrition for a period. Could do 1-2/year. Cause of stones is dehydration and constipation. Put topical turpentine on painful spot. Helping a sprain with castor oil and turpentine. Shedding from the vaccines – real or fake? All live vaccines shed. Don't shun anyone who has been vaxxed. Keep your immune system where it's not compromised. Use turpentine from time to time. Grapefruit sized cyst on right shoulder blade in 5 year old girl. Has had it for 3 years. Look at BMs, up to 5/day, increase water. Put castor oil on her waist down for 3 days, then neck down for 3 days. Get her exercising out in a meadow. She's had a problem with eliminating waste. Hemiparesis from a stroke from stress, one BP med. What caused the stroke? She was dehydrated. Malnutrition from not enough cholesterol. Increase water intake. Increase BMs to 3/day. Vitality Capsules. 3 oz. liver twice a week, 2 oz. brain 2-3 x/week. Milk thistle – 1 tsp. in water up to 3x/day. Expedites removal of damaged cells. Paralyzed part needs range of motion movement 3x/day. Look at molecular hydrogen to help stroke patients. Lower back pain in 84 y.o. Grandma. Pain only appears in the morning or after movement. Insulin dependent diabetic. Read Candida Cleaner Report. Apply castor oil from waist down. Bend hip and knees towards head. Decrease insulin until blood sugar is 200, to allow for lower blood sugar from diet changes. Applying topical castor oil causes cell to detoxify. Asthma developing. Difficulty breathing. Works mowing lawns. Need to clean lungs out. Add 1 tsp. milk thistle in water, increase to 3x/day. Add supplements in Candida Cleaner report. Selenium, vitamin C, and biotin now available to VitalityCycles.com Cramps at night. Take 1 tsp salt, 1 cup water at bedtime. Also leave more next to bed during night. Uses iodized table salt.

Deb Shaw was at the top of her career, selling cybersecurity technical products to government customers for a silicon valley powerhouse. Things were going great. Then she had a stroke. And then she had another stroke. And then she had a third stroke, paired with a concussion. Since then, she started a nonprofit with her husband and has produced more than 10 booklets for stroke survivors to help them navigate their new lives. Recently, the American Heart Association named Deb their latest Survivor Hero. Deb shares her journey in this conversation. If you don't see the audio player below, visit http://Strokecast.com/deb to listen to the conversation.   Click here for a machine-generated transcript About Deb Shaw Deb Shaw is an inspirational three-time ischemic stroke survivor and the Founder & President of a nonprofit who remains steadfastly upbeat, despite her ongoing difficulties. Deb channeled her energy into creating “Champion the Challenges,” a nonprofit organization that helps motivate stroke survivors to pursue her three P's of a successful recovery: Patience, Positivity, and Practice. Be patient in everything, have a positive outlook, and practice your exercises every day. Deb founded and launched ChampiontheChallenges.org, a rapidly growing 501c3 focused on helping stroke survivors reimagine their stroke rehabilitation journey.  The website is filled with inspirational content, therapy ideas, and success stories all designed to encourage.  Deb has written 11 Quick Read Booklets ™ that are geared to inspire and educate the stroke community. The booklets are available on-line as flipbooks, or in print editions, all compliments of Deb. “Champion the Challenges” was started during Covid because she wanted to share the inspiration, motivation, technology, and helpful stroke ideas, all in one website. This is her way to give hope to many people needing to discover their inner strength. 3Ps Deb's approach to recovery is based on the three Ps: Patience Positivity Practice Patience with yourself is critical. While we are all trying to recover, it doesn't always happen as quickly as we would like. Sometimes we can't do things yet that we feel like we ought to be able to do. That's okay. It happens. Getting angry and frustrated with ourselves may be natural in the moment, but ultimately is not helpful. We need to be patient with our brains and our bodies to give them the space they need to heal and to relearn our lives. Positivity helps us get through the day. Negative feelings are natural and okay in the moment, and long term they can become a problem. Living in and dwelling in the negative is not going to get us where we need to be. A positive attitude and approach to our tasks and lives may not guarantee success, but I have never heard of someone succeeding while dwelling in a cloud of negativity. Practice is the other key element. A positive attitude may make recovery a possibility, but it's practice that can turn that possibility into actual success. Neuroplasticity is a powerful force in recovery, and building those new neural pathways requires thousands of repetitions of activities. It takes practice and then more practice. 2022 Stroke Hero Awards: Survivor Hero – Deb Shaw https://youtu.be/T7n4qx1JR-g Llamas and Alpacas For my Girlfriend's birthday, we went to Topstall Farm to visit play with llamas and alpacas. It's a short 1.5-2 hour drive from Seattle. The person who runs the farms limits groups to 6 people so we get a personal experience. She told us all about the critters and explained how they care for them.   Then we got up close and personal. We walked into the paddock and got to feed them by hand. One thing that amazed me was how soft the alpacas lips were as they took the pellets right from my palm. They were aggressive about getting to the food but gentle about taking it. After we fed the alpacas, we took the llamas for a walk. It was 2 people per llama. Cathy and I got to take Armando on a half mile hike around the property.  Armando wasn't terribly interested in the walk, but he went along with it. Every 20 or 30 feet or so he would stop and bend down to start snacking on some grass, as though to convince us he hadn't eaten in FOREVER. We weren't buying that however. The walk itself was a challenge because it wasn't a paved path or smooth trail. The ground was uneven and muddy in places, as you would expect. I managed pretty well with my cane (I used the cheap one), but I certainly got my PT in for the day. This is the alpaca I spent time feeding. His name is Woody. He's 14 years old and deaf since birth. His different color eyes are also a genetic quirk. Once we all wandered into the paddock with our bowls of food, Woody ignored everyone else and sauntered right up to me for his snack. Isn't it a coincidence that the disabled llama found the disabled human and decided to make a friend? Maybe, but I like to think he sensed a connection. If you want to get up close and personal with live, fluffy animals, and you happen to be in the Puget Sound region, head on over to Topstall Farm. Tell Armando, Woody, and (oh, yeah) their humans that I said, "Hi." COVID-19 It took more than two years, but COVID-19 finally got me. I was on a business trip in Hawaii. It was a successful trip, which was great. The day before I was supposed to fly home, I felt off, and not in a stroke-y way (you know what I mean). I took a rapid test. The instructions say to wait 15 minutes for a result. My test lit up brightly and boldly positive in less than 3 minutes. The next day, I visited a doctor's office for a PCR test to confirm. It confirmed. That meant cancelling my flight and isolating in the hotel for another 5 days. I probably could have gotten on the plane without telling anyone, but intentionally exposing 150 people like that seemed like the wrong choice. The CDC recommends 5 days of isolation. After that, if symptoms are mild, the CDC allows masked travel if necessary and recommends isolating as practical after that. You may think, "Awesome! Five bonus days in Honolulu!" Sounds great in theory, but, I was still not feeling well I couldn't leave the hotel room The beach and surf were tantalizingly close, but they just teased me from my city view room with a peek of the water. Housekeeping brought up a big table and put it in front of my door to signal that this was a quarantine room. They piled it high with towels, tooth brushes, and coffee packs so I would be all set to hunker down. I ordered all my food through Uber Eats. They would deliver to the front desk. The front desk would deliver to my blockading table. They would knock on the door and scurry away. I'd put on my mask, pop open the door and snatch my dinner. Then I'd go back to washing my underwear in the sink so I'd have clean clothes the next day. After 5 days, I was well enough to head back to Seattle. I'm still recovering. My voice is a little rough, as you may have heard in the opening and closing of this episode. I'm a little stuffed up. I still feel a little off, but for the most part I'm fine. I just need to get more sleep. My main concern at this point is not infecting Cathy so I'm masking up at home and sleeping on the couch. This could have been so much worse. And you know why this more of an inconvenience and not a full on health crisis? Because I got my damn vaccines! They may not have completely stopped the infection, but they gave my body the training and tools it needed to fight off this infection. I'm annoyed, but I'm not in a hospital on a ventilator. And I'm not knocked out. This is a big win during the pandemic. Hack of the Week Deb talked about 2 hacks this week. There is a lot of value in thinking about other people. I don't mean to compare ourselves to other people; that path leads to despair. Instead, think of how you can help other people, even if that's just a kind word. Brightening someone else's day can easily brighten yours as well. On the more concrete aspect of recovery, a towel can be a great tool to help with hamstring exercises. The hamstrings are the muscles on the back of your thighs. When they contract, they bend your knee and lift your heel towards your butt.  That bending is important for walking, stair climbing, balance, and more. Using a towel wrapped around your ankle can help you exercise your hamstrings to help them come back online consistently. Deb describes this in our conversation. I would add that this is a great process to discuss with your PT to make sure you know how to do this safely. The last thing you want is to fall and acquire another injury while rebuilding your life after stroke. Links Where do we go from here? Check out Deb's resources at http://ChampionTheChallenges.org Share this episode on your Facebook, Twitter, or Instagram account with the link http://Strokecast.com/Deb Subscribe to the free Strokecast email newsletter at http://Strokecast.com/News Don't get best…get better

"Communication is the process by which shared meaning is created."  CO 101 That's the first lesson we learned in Communications class back in college. Communication isn't spoken words or written words of photos or symbols or sounds or touches. Or even scents or tastes.  Those are all just vehicles for communication. They are the trucks intended to carry the freight of meaning from one person to another. After stroke, some of those trucks are no longer available. Aphasia and dysarthria may interfere with speech. Hemiparesis may interfere with writing or gestures. Sensory overload and attention challenges may interfere with listening. And yet communication continues. Because the other lesson we learned in the class CO101 is, "You can't not communicate." Combine those principles with the idea that your actions always speak louder than your words, and we have deeper understanding of how important it is for clinicians to think deliberately about the things they say and do when working with clients. Marabeth Quin and Physical Therapist Danielle Stoller joined me in this episode to share their stories and how they came to develop Expanded Practice -- a training program for clinicians that helps them tune their communication strategies to build better relationships with their patients. Note: This isn't the first time I talked about communication in an academic context. This was also something I talked about with Drs. Sara Parsloe and Patricia Geist-Martin in episode 111 at http://Strokecast.com/process. If you don't see the audio player below, visit the original post at http://Strokecast.com/ExpandedPractice.   Click here for a machine-generated transcript Who are Danielle and Marabeth? Danielle Stoller is a neuro physical therapist who helps stroke and brain injury survivors improve their lives through a holistic rehab approach.  Marabeth Quin uses the experiences and insights she has gained from her daughter's stroke recovery to improve therapist's understanding of the mental and emotional aspects at play in the recovery process.  Together they co-founded Expanded Practice. Expanded Practice Expanded Practice is the training organization that Danielle and Marabeth started  once they saw the need to help therapists connect more effectively with their patients. Their goal in part is to go beyond the technical details of the tasks that go into a session and to help therapists think more about the client experience -- to connect to the clients as individuals with specific therapeutic, emotional, and psychological needs. That's not about providing counseling per se; it's about understanding the patient and building a trusting relationship with them to promote a more effective session. In some ways it parallels the work I've done as a corporate training help folks learn how to sell technology products. It's not about the high-tech features of the product. It never is. It's about what those features and those products will do for the customer. Effective salespeople ask themselves, "How will this product or service make THIS customer's life better? How will this benefit them?" To answer that, they have to talk to their customers and ask questions. They put the focus on the customers' lives. That focus on the client is something Danielle and Marabeth teach to. As we talked about in the episode,  they teach therapists about the environment they create. If the therapist appears rushed or tense, that will affect the client's perception of what is happening. That increase in tension makes a session less effective. Here's how Marabeth and Danielle describe the program: Expanded Practice teaches physical, occupational, and speech therapists to start utilizing the power of positive mindsets and expectations in the recovery process so they can connect with their patients on a more significant level and help them reach greater recovery potentials.  Expanded Practice is passionate about improving the rehab experience for patients and therapists so both thrive and achieve the highest possible outcome. Stroke Awareness Month May is Stroke awareness month in the US. What does that mean for you? Well, whatever you want it to. It's a month when many survivors will share their stories or post on social media about how to recognize a stroke or just have personal conversations with others they are close to. Some may choose more subtle signs, like adding a stroke awareness frame to a Facebook avatar or wearing a red ribbon. Some may give a talk at school, church, or work to help raise awareness. And many folks will choose to treat it like any other month. What matters most is to treat it in the way that best supports your needs, goals, and recovery. And if you want to do something, but you're not sure what, you can always tell folks about your favorite stroke related podcast :). Or find a new stroke podcast to listen to at http://Strokecast.com/strokerelatedpodcasts. Hacks of the week Two guests again means 2 hacks. Marabeth makes a point of reminding us to keep going. The thing about recovery -- whatever part you're in -- is that it can be easy to stop and give up. It seems so enticing to do that somedays. It really does. But then you stop getting better. And you may get worse. Even when it's hard, you have to keep going. That's the only way to get to the better days that are coming. Danielle suggested looking at trees. Even better is getting outside into nature -- even if it's just a short time. There's research demonstrating this helps with recovery. Getting out and being near the grass and trees and plants helps. And it can be one of the cheapest things you can do to help your recovery. Links (If you don't see a table of links, visit http://Strokecast.com/ExpandedPractice) Where do we go from here? Check out the Expanded Practice resources above. Share this episode with the therapists in your life by giving them the link http://Strokecast.com/ExpandedPractice Subscribe to the Strokecast Newsletter at http://Strokecast.com/News Don't get best…get better.

Again and again, we learn the secret to stroke recovery is repetition. It's about doing the same movement or behavior again and again -- tens of thousands of times. In a typical session with an OT or PT, a patient might do the same exercise 30-60 times, which is a good start. But what if a therapist could crank that up to 1,000 reps an hour, or one every four seconds? Now you've got some interesting possibilities for recovery. Bionik, Inc makes devices and software that do just that. This week I talk with CEO Rich Russo about the InMotion Hand and InMotion Arm devices and how they work in conjunction with a therapist to help patients recover. Listen to the conversation here or in your favorite podcast app. If you don't see the media player below, visit http://strokecast.com/Bionik   Click here for a machine-generated transcript Who is Rich Russo? From the Bionik website: Mr. Russo Jr. has over 15 years of finance and accounting leadership experience and is a Certified Public Accountant. From March 2017 through November 2020, Mr. Russo was the Vice President of Finance and United States Chief Financial Officer, of IcarbonX, a privately held digital health management company specialized in artificial intelligence and health data, and a predecessor PatientsLikeMe. While there, he was responsible for, among other things, the merger of three companies, fundraising, and the ultimate dissolution of certain affiliated companies. From 2007-2016, Mr. Russo held various key leadership roles for Nasdaq-listed companies in life sciences, pharmaceutical and medical device industries. From September 2015 to October 2016, he served as Corporate Controller for Pieris Pharmaceuticals, Inc., a clinical stage biotechnology company, and prior to that, he had roles at Juniper Pharmaceuticals, a woman's health company focused on developing therapeutics, and Cynosure, a medical device company focused on aesthetic treatment systems. In each of these roles, Mr. Russo was responsible for all finance activities and SEC reporting, including partnering closely with management to ensure effective and efficient financial procedures throughout the organizations. Mr. Russo started his career in 2005, where he served as an auditor at Pricewaterhouse Coopers in the assurance group. Mr. Russo is a graduate of Bridgewater State University in Bridgewater, MA, where he graduated from a dual degree program, receiving his Bachelor of Science in Accounting and his Masters in Management and Accounting. Other Inpatient Solutions The Bionik system is one for hospitals and rehab units. The rapid reps help in partnership with the rehab professional. In that respect, it's similar to devices from Restorative Therapies. I talked with the team at Restorative Therapies in episode 92. You can find that episode here.  The key difference is that Restorative Therapies uses Functional Electric Stimulation (or FES) to activate a patients muscles. The Bionik solutions provide physical assistance to help the patient complete motions. They are different ways to stimulate the brain, increase repetitions, and drive the neuroplasticity that is so key to recovery. They are also both intended for use in a hospital or rehab facility with the help of a trained therapist. The other devices I talk about often, like those from sponsor Motus Nova and previous guests with Neofect and Racoon Recovery are for at home use, as a supplement to therapy provided at a medical facility, or as an alternative when those services are not available, for whatever reason. You can learn more about those devices by clicking the links on their names above or from the link table at the bottom of this post. The point of all these solutions is the same -- drive patient recovery through increased movement and repetitions to neureoplastically teach to brain how to access that limb once again. Hack of the Week Wear comfy socks. It's such a simple thing, but the right socks can make a big difference in how you feel. The right socks can wrap your feet well and wick away perspiration. They can protect your foot from rubbing against an AFO or the heel of your shoe. The wrong socks will keep you too hot or too cold. The wrong size will leave you with an uncomfortable wrinkle you walk on all day. If they're too slippery, you've got an additional safety hazard to contend with. The hospital socks they gave me in the hospital were terrible. The had the no slip dots, which was great, but they kept falling down and rotating around my foot. Part if it was they were likely the cheapest that met minimum standards. The other part is that I have large feet for my height (size 12). So my partner ordered me better hospital socks from Amazon,* which helped. For air travel after stroke, I have made a change to my wardrobe. I now wear knee-high compression socks.* They do a good job of preventing swelling in my feet and legs during long flights. And that helps to prevent DVT or deep vein thrombosis, which is where a clot forms in the legs and causes problems there, or breaks loose and lodges elsewhere in the body. That's how Ted Baxter had his stroke. I talked with Ted back in Episode 34. Relatively speaking, good socks are still fairly cheap. Try different ones until you find the socks that are best for your feet and life style. Good socks are worth it. Links Where do we go from here? Learn more about the work Bionik does at https://www.bioniklabs.com/ Share this episode with someone you know by giving them the link http://Strokecast.com/Bionik Subscribe to the Strokecast newsletter at http://strokecast.com/news Don't get best…get better.

I was saddened to learn of the passing of Peter G. Levine. Deb Battistella, OT and Cohost of the Noggins and Neurons podcast with Pete announced in the January 17 episode that Pete passed away following a brief illness. You can hear Deb share the news and her thoughts here. Pete is known in stroke survivor circles as the author of the book, "Stronger After Stroke" where he talks about therapeutic approaches and why the work. His focus has been to help folks with varying levels of paralysis after stroke to recover function and live their best lives. I share more of my thoughts in this episode: (If you don't see the audio player below, visit http://Strokecast.com/RememberingPeteLevine) Click here for a machine generated transcript I interviewed Pete in 2020 and found him to be down to Earth and passionate about supporting patients and survivors. He was fun and easy to talk with and I could feel the fire of caring he had for our community. Pete's approach was scientific. He was a strong supporter of Constraint Induced Therapy and at a more basic level, of the need to get in more repetitions -- thousands of repetitions -- to drive the neuroplastic changes in the brain that represent recovery. That also means he wasn't afraid to speak out about "treatments" that have not been scientifically demonstrated to be safe and effective. There are a lot of people out there making claims about miracle cures without the data to back up those claims, and Pete was a vocal opponent of those snake oil sales people. When Pete and I spoke, he summed up his approach to stroke recovery with these four lessons: Recovery takes a lot of repetitive practice. Recovery takes a lot of visualization. Don't expect miracles. Don't let the perfect be the enemy of the good. It's a simple approach that makes a lot of sense. It's not sexy or flashy or miraculous. It relies on hard, consistent work and stringing together a lot of minor improvements. There is no shortcut. His comments about visualization were especially interesting to me. Pete explained how the research has shown that watching someone walking or running activates the same parts of the brain as actually walking or running. It's why athletes and musicians visualize their performances before hand to improve their performance. And it's why I found value in visualizing my fingers moving as I tried to move them under the blankets while I drifted off to sleep at night. You can find my interview with Pete here at  Ep 115 — Stronger After Stroke with Peter G. Levine. We talk about his work and the science of recovery in much greater detail. If you've followed Pete's blog (Stronger After Stroke), read his book Stronger After Stroke, heard him talk or otherwise been inspired by or have memories of Peter that you would like to share, you can record or email them to Deb, his cohost, at this link. I'm sure she and Pete's family, friends and colleagues will definitely appreciate it. Hack of the Week This week, I'm sharing a hack I've discussed before, but it feels in line with Pete's approach to recovery. Try something with your affected limb three times, every time. For example, if you are left side affected, try turning a door knob with your left hand when it's time to open or close a door. Maybe you can't do it yet. That's okay. Just try. Use your unaffected hand to put your affected hand on the knob. Or do it with a light switch. Or picking up a cane. Or whatever. Try it three times each time the opportunity presents itself. After three times, if you haven't accomplished the task, that's fine. Then you can use your unaffected side to do it. The advantages of this approach are that it keeps your brain trying to use the affected side. It's getting in more attempts at repetitions and making the exercise part of everyday life, instead of restricting it to exercise time. And by limiting your attempts to three, you reduce the frustration of the limitation and can get on with living your life. You can try again later in the day. Links (If you don't see the table of inks below, visit http://Strokecast.com/RememberingPeteLevine) Where do we go from here? Check out Pete's blog here or find his book on Amazon here*. Do an extra set of reps in you exercise program in memory of Pete. Share your thoughts on Pete and his work here. Don't get best…get better.

In this episode, Rich meets Jackie O'Connor, who's YouTube channel talks about being a mum with hemiparesis. Jackie hopes to raise awareness for parents living with disabilities and her platform aims to help others in similar situations. Here is how you can find Jackie's YouTube channel Mrs Jackie O: https://www.youtube.com/c/Justadd-gingerCoUk Contact Jackie here: Instgram: https://www.instagram.com/mrs.jackieo_/Facebook: https://www.facebook.com/MrsJackieOFacebook: https://www.facebook.com/NewWaysNetwork TikTok: @Mrs.JackieO Jackie has also shared these links, please check them out: Websites / Groups: https://www.disabledparent.org.uk/ (no longer active but good for resources) FB: Disabled Parenting Project / Parents With Disabilities Instagram: https://www.instagram.com/stump_kitchen/ https://www.instagram.com/lizzy_bunton/ https://www.instagram.com/fashionbellee/ https://www.instagram.com/whentaniatalks/ Product Recommendations: Snugglebundl: https://snugglebundl.co.ukChicco Hug 4 in 1: https://www.chicco.co.uk/products/8058664093564.baby-hug-4-in-1.htmlJoie Mirus Scenic: https://uk.joiebaby.com/product/mirus/Bugaboo Donkey: https://www.bugaboo.com/gb-en/pushchairs/bugaboo-donkey-3-mono-seat-and-carrycot-pushchair-black-sun-canopy-black-fabrics-aluminium-base-PV002013.htmlSkip Hop Whale Tub: https://www.skiphop.com/skiphop-baby-essentials/V_235465.html To catch last weeks episode with Dr. Oleg, click here: https://youtu.be/uqpkvJJQ7NI_______________________________________________________________________ To find out more about Born Anxious, the clothing Rich wears in the episode, you can find them here:- https://www.bornanxious.co.uk/ To find previous seasons and episodes of the podcast, you can find them here:- https://www.youtube.com/channel/UC_OZaRIBsagfrQVfrKrDLYQ Thanks so much to Thom Burt & Andrew Brien from Songwriters Lounge for creating our new theme song. You can find their work here:- https://www.songwriterslounge.net/ Follow us and Reach Out: Website: http://www.insidetheorange.co.ukEmail: insidethisorange@gmail.com Instagram: https://www.instagram.com/insidetheorangeTwitter: https://twitter.com/OrangeWhatsFacebook: https://www.facebook.com/insidetheorangeAnchor: https://anchor.fm/inside-the-orange #insidetheorange #mrsjackieo #hemiparesis #podcast #podcasts #understanding #people #richstevens #interview #guest #disability #parenting #parent #youtube #youtuber #newwaysnetwork #applepodcasts #spotify #help #selfhelp #helpothers #awareness #acceptance --- Send in a voice message: https://podcasters.spotify.com/pod/show/inside-the-orange/message

  Click here for a machine-generated transcript   The name "Avrel" means either "Elven King" or "Wild Boar" depending on who you ask. Fortunately, while Avrel Seale is not boring, this multi-book author and stroke survivor is the guest on Strokecast this week. Our discussion of course covers Avrel's story, but we also get into a discussion about the nature of Generation X and how all this discussion of generations came to be. Avrel also has some great insights into the writing process. His latest book is "With One Hand Tied Behind my Brain"*, so after you listen to our chat, pick up a copy from your favorite book store. (For the full content, audio, and video in this story, visit http://Strokecast.com/Avrel) About Avrel From https://avrelseale.wordpress.com/bio/ Avrel Seale has authored 10 books, including memoir, humor, philosophy, history, religion, and unsolved mystery. He lives in Austin, Texas, with his wife, Kirstin, and three sons. In 2018 at age 50, Seale had a major hemorrhagic stroke that left him partially disabled. His story of survival and adaptation, With One Hand Tied Behind My Brain: A Memoir of Life After Stroke*, was published by TCU Press in 2020. His one-handed guitar playing was featured on NPR's All Things Considered. In 2017, his memoir Monster Hike: A 100-Mile Inquiry Into the Sasquatch Mystery* was published by Anomalist Books to positive reviews. Wendy Garrett of KCMO Talk Radio in Kansas City called it “fascinating and compelling.” Nick Redfern called it “highly entertaining … a witty, amusing, and adventurous saga.” Andrew W. Griffin wrote, “There is something Walden-ish about Monster Hike that I did not anticipate when I first picked it up … as much about ourselves and our place in nature as it is about ‘monsters.' ” And Loren Coleman named it one of the 10 Best Cryptozoology Books of 2017. Dude: A Generation X Memoir* was included in the Austin American-Statesman's “Best Books of 2008.” Staggering: Life and Death on the Texas Frontier at Staggers Point (2014) chronicles the arrival of Seale's ancestors in Texas in the 1820s and 1830s and the tumultuous events and brutal conditions of the pioneering years. Seale often writes and speaks about the Baha'i Faith. In addition to numerous articles about the religion, his books The Hull, the Sail, and the Rudder (2006)*, True Freedom and the Wisdom of Virtue (2007)*, and The Tree – A Spiritual Proposition (2008)* deal extensively with Baha'i concepts. Though predominantly a nonfiction author, he has written two novellas — the afterlife comedy The Grand Merengue* and The Secret of Suranesh*, which he originally wrote and co-produced as an independent feature film. His latest book, Nuts: Down the Nueces River With One Stroke, is awaiting publication. Seale grew up in McAllen, Texas, the son of writer Jan Seale, the 2012 Texas Poet Laureate, and composer and conductor Carl Seale. Earning a bachelor's of science in radio-TV-film from The University of Texas at Austin in 1989, he returned to the Rio Grande Valley, where he started his writing career as a reporter and a columnist for the McAllen daily newspaper, The Monitor. In 1992, he returned to Austin and served 16 years as editor of the UT alumni magazine, The Alcalde. From 2011-2015 he served as speechwriter for the president of The University of Texas. Since 2015, he has been a writer and editor in the university's news, marketing, and development offices. Subject Matter Expertise: Stroke Baha'i Theology 19th century East-Central Texas History Crypto-hominology (sasquatch/bigfoot) Persuasive Writing The University of Texas at Austin Homunculus The core principle of neuroplasticity is the cells that fire together, wire together. The more you do a thing, the more connections will form in your brain to do that thing again. More connections mean more real estate gets taken up in the brain for that task. A professional basketball player will have a lot more neural connections dedicated to free throws than I will. I might have two. And one of those is dedicated to spelling it. The metaphor of the homunculus is helpful in understanding how this impacts brain injuries. The homunculus is a representation of the brain and various parts of the body. The more you use a part of the body, the more neurons it takes up in the brain. For example, the hands and tongue take up more space in the than the elbow and pinkie toe. The more time and energy you dedicate to something, the more space in your brain is dedicated to that task. For example, a homunculus of my brain would likely show a much larger segment dedicated to speaking than to throwing a baseball. One way I think about how this applies to survivors (and I may be stretching the homunculus analogy) is that a skill from the prestroke days that a survivor was an expert at may come back before a skill one had limited experience with simply because despite the damage there were simply more nerves dedicated to it. As you continue to work on a skill post stroke, a larger portion of the brain will be dedicated to it. More nerves, dendrites, and synapses will become involved. This is neuroplasticity at work. Writing Plan Avrel writes books, writes speeches,  and writes lots of other stuff, too. He also teaches writing. Avrel's recommendation for anyone wanting to write a book is to make sure you have something to say. A typical non-fiction book is going to be somewhere between 60,000 and 120,000 words. To give you an idea of what that means, a typical episode of this show is 10,000-14,000 words. To find out if you have something to say, Avrel suggests writing a long essay about your experience -- about 8,000 words. If you can't get 8,000 words from your experience, maybe you don't know what you want to say, yet. That could change in the future, or you may find another platform for your story. And once you do get to 8,000 words, you have a thing that you can shop around to magazines or to flesh out further and turn into a book. That long form document becomes the foundation that you can build the rest of your narrative on. To learn more about writing a memoir, also check out my conversation with Christine H. Lee at http://Strokecast.com/writeyourstory Guitar Playing Back in episode 22, I spoke with Craig Martin from OnlineBuske.net. Craig was a British professional guitar player working at clubs and restaurants in Spain when he had his stroke. It took one of his arms and he had to learn to use it again to get back to his beloved guitar playing.  And then it happened again. Today, he plays guitar and sings. He posts some amazing videos on OnlineBusker.Net and uses them to raise money for stroke organizations around the world. You can hear that conversation at http://Strokecast.com/OnlineBusker The reason I mention that is Avrel is also a guitarist -- a one-handed guitarist. You can hear some of his playing at the end of the episode or check out this video: https://youtu.be/R8KvuFozFQE You can see more of Avrel's guitar playing on his YouTube channel. If you play guitar, I'm sure you'll be fascinated by his tutorials, too. Caffeinated Comics William Shatner released a new album and went to space. So that was my cue to join Jon Clarke on the Caffeinated Comics podcast to talk about it. Jon and I are long-time Star Trek fans and I've been fascinated by Shatner for years. In the beginning it was because of the combination of absurd projects he'd done combined with his reported arrogance and poor treatment of other Star Trek cast members. As we've all matured and I've read his memoirs and listed to his music and watched his talk show, I became fascinated in a different way. His latest album is called simply "Bill" and explores themes of depression, loneliness, guilt, connection, death, love, and horses. Some folks experiencing their own mental health challenges may find it triggering, but it's a fascinating piece of art. You can get the CD here* or find it in the streaming service of your choice. https://youtu.be/gpbtOksAuoE To listen to the conversation Jon and I have, click here, search for Caffeinated Comics in your favorite podcast app, or just click play below. https://rmpn-media.s3.us-east-2.amazonaws.com/cc/cc_249_101821.mp3 Hack of the Week Avrel's hack is all about playing the guitar. He's able to make the notes and chords by using hammer on and pull off techniques on the fret board. This works well on an electric guitar. You can see more of Avrel's guitar playing on his YouTube channel. He doesn't just play most of the songs. He also takes the time to demonstrate how he does it and teaches his hammer on technique. On some tracks, Avrel also uses a digital looing device to expand his playing further. Links Where do we go from here? Check out Avrel's website to learn more about his varied interests Share this episode with someone you know by giving them the link http://Strokecast.com/Avrel Subscribe to the free Strokecast email newsletter at http://Strokecast.com/news Don't get best…get better.  

  Click here for a machine-generated transcript.   Jo Ann Glim and her husband were enjoying the semi-retired lifestyle in their new, Florida home. They enjoyed day trips, volunteer activities, and other adventures. Jo Ann was starting a new temp gig at the Tropicana offices, and they were making all sorts of plans for the coming years .A blood vessel deep in Jo Ann's brain had other plans. It ruptured and damaged her Thalamus on her first day at a new temp job. Jo Ann would spend two weeks basically unconscious. With lots of work, determination, a a great team, she dove into her recovery. Twenty four years later, she joins us to talk about her journey, her writing, the risks of being a problem solver, and the things that helped along the way. Her book, Trapped Within: A True Story of Survival, Recovery, Love, and Hope* is available on Amazon. About Jo Ann Glim Jo Ann Glim was born in Chicago, Illinois to a military family and raised in Anacortes, Washington in the far reaches of the Pacific Northwest in a three-generational household. Even though the family was poor, she never knew it.  Poverty taught her life skills: self-sufficiency, creativity, and saving for a rainy day. Her childhood home was filled with love. Tragedy struck when she was fourteen and her mother passed away. Within three weeks, her grandparents were relocated to a nursing home in Illinois and she was taken in by her mother's sister. Everything she had known to be home was gone. ​After she finished school, Glim's career followed three paths: MEDIA - (as a disc jockey/copywriter) WSDM-FM Chicago, KMPX-FM San Francisco, and KIKI-AM Hawaii; and continued in COMMUNICATIONS - a forty-year freelance portfolio with credits including an award-winning column in fourteen northern Illinois newspapers; one-liners for nationally known comedians; monthly articles for Manatee County Florida's Chamber of Commerce Current magazine, to name a few. She took courses in BUSINESS MANAGEMENT - at a local college and after moving to the suburbs, began working for Kelly Services. Sixteen years later, she retired as an on-site Human Resources Manager responsible for the temporary needs of a Fortune 500 company. ​ She now lives in Florida with her husband, Bill, and their Scottish Terrier, Lucy. Her passions are writing, photography, and travel. She loves Chicago pizza, and is happiest travelling with her hubby, playing handbells, or on hiking trails with her camera and dog. Book Jo Ann sent me a copy of her book before we talked.  The book, Trapped Within: A True Story of Survival, Recovery, Love, and Hope*, chronicles her stroke and rehab experience. She gets deeper into her relationships with doctors, therapists, and her therapy roommate and shares fears, frustrations, and lessons learned along the way. Jo Ann writes with a crisp style that's easy to read. Her chapters are short. If you can read only a few pages without a nap, it's a nice choice. Or you can just read chunks of  it at one go. You can find Trapped Within on Amazon in paper or eBook versions. Check it out at http://Strokecast.com/TrapedWithin* "Trapped Within": Book Trailer Elizabeth Kubler-Ross and the 5 Stages of Grief Kubler-Ross wrote about grieving and death.  Recovering from stroke is similar, except instead of grieving over the loss of another person, we are grieving for the loss of our prior selves. Getting through that process takes time, but it also helps us adapt to the new life we have after stroke. The 5 stages of grief are: Denial Anger Bargaining Depression Acceptance. If you're struggling with moving on with your life a neuropsychologist or other counselor can help you navigate this path. Hack of the Week Lainie Ishbia from Trend-Able, who I spoke with in Episode 136 suggests that if you struggle with fastening buttons on a shirt, you can get around that. Just sew (or have someone else sew) the shirt closed at the buttons and turn it into a pull over. That way, you can still wear those stylish button down shirts without spending hours dealing with fussy closures single-handedly. Another option for those shirts, if you're not ready to get them sewn up, is to get a button puller*. This is an inexpensive device that makes it easier to fasten buttons with one hand. I use mine most when I'm trying to put my dress shirts on a hanger. Either way, you now have 2 fewer reasons to not wear that nice shirt. Links Where do we go from here? Check out Jo Ann's website at JoAnnGlim.com. And read more about her book at Strokecast.com/TrappedWithIn* Share this conversation with a friend by giving them the link Strokecast.com/JoAnn Subscribe to the free monthly Strokecast Newsletter to stay up to date on episodes and community news Don't get best…get better

  Click here for a machine-generated transcript.   At 30 years old, social worker Jeri Ward was incredibly busy. Perhaps too busy. Having a stroke was the not even on her radar. But then again, is it ever? Multiple hospital visits and a failed thrombectomy later, she found herself completely paralyzed and unable to speak for months in a hospital bed. Scared, bored, and frustrated she would go on to recover, win the title of Mrs. Ohio International, and partner with the American Heart Association to raise awareness of stroke in the general population. Jeri spoke to me for over an hour in the days leading up to the Mrs. International. About Jeri Ward Jeri Ward lives and works in Ohio. She built a busy career as a social worker, Autism specialist, and volunteer. Jeri was always on the go, with one project after another. In the midst of that hectic schedule she nourished her passion of pageant life and lived it for decades. In 2018, Jeri was crowned Mrs. Ohio America. Later that year, Jeri barely survived a massive ischemic stroke. She was locked inside her own body in an ICU bed for months. Gradually, she recovered her speech and movement. And she rededicated herself to the cause of stroke awareness and advocacy. In 2021, Jeri returned to pageant life, winning the title of Mrs. Ohio International with a new platform of raising stroke awareness and advocating for survivors both at home and around the world. She started the Lemonade Project to help folks learn and practice appropriate self-care. Jeri currently works at the American Heart Association as a Development Director. Mrs. International Pageant A  lot of folks have preconceived notions about pageant winners, and often those notions are not true. Jeri is the fourth pageant winner I've had the pleasure meeting. Marsha Scmid was a guest on the show a couple years back after winning the title of Ms. Wheelchair USA. It was a stroke caused by a chiropractor that her eligible for that pageant. Ina previous job, I had the pleasure of working with Hilary Billings, a former Miss Nevada. I interviewed Hilary for my other podcast, 2-Minute Talk Tips. You can hear that conversation here. And I went to college with a woman who would go on to become Miss Montana. They have all been some of the smartest, hardest working people I know. Really incredible individuals. The Mrs. International pageant, as Jeri describes it, puts a premium on contestants' platforms, a I don't mean their shoes. This was a great match for Jeri who has turned her stroke into a cause -- to take every opportunity she can to help with stroke education and advocate for survivors. Jeri did an amazing job at the finals, coming in in third place. She chronicled her journey on Instagram Ohio Legislation Jeri channeled her career experience, her stroke advocacy work, and the drive she uses in pageant life to help the Ohio State legislature pass SB21, which updates protocols for EMS. The short version is that this law will require ambulances to take stroke patients to an appropriate hospital, rather than the closest hospital. As we know, time lost is brain lost, and moving folks from hospital to hospital costs time, money, and long-term disability This legislation will help change that in Ohio. Hack of the week Explain things to people simply. Jeri talks about the headphones she wears due to her sensory processing challenges. She'll mention briefly why she wears them in meetings at work. Disclosing and talking about disabilities is a challenging subject. Outside of our doctors, no one is entitled to know our medical history. Even then, there are limits. There are lots of very good reasons for minimizing disclosure given how wide-spread ableism is in this world. At the same time, there's something to be said for acknowledging the elephant in the room. The elephant is metaphor in this case. Imagine you are having a conversation with a few people at somebody's home. You are not circus or zoo folks. Then an elephant walks into the room and just sits there. And no one says anything. How can anyone focus on the main thrust of the conversation? A fraking elephant just walked into the room! In order for conversation to continue, someone needs to say something about the elephant. Pretending it's not there isn't going to work. Once the owner/roommate of the elephant says, "Oh, that's just Bob. He's cool. So, anyway…" You may still have a lot of questions about Bob, but you can put those aside from now and get back to a productive conversation. When folks mention "the elephant in the room," they are talking about something that is big, unexpected, and that folks might want to ignore, but can't. Acknowledging the elephant lets us get back on track. Sometimes, all we need to do is acknowledge our elephants. When Jeri puts in her earphones in a business meeting, is that an elephant worth acknowledging? Often, yes. Should it be? Probably not. But someone who isn't familiar with sensory processing challenges may be speaking, see someone put on headphones and assume they are being blatantly rude and ignoring them in an aggressive manner. By telling people what you need, such as when Jeri mentions why she uses them without going into detail, it lets the meeting get back on track without someone taking offense. On another note, this is why it's important, if you're comfortable doing so, to share your story. To normalize disability and the tools we use to make our world more accessible. Canes and headphones and rollators and splints and service dogs may be elephants today, but they don't have to be in the future. Links Where do we go from here? Follow Jeri on Instagram at  MrsOhioIntl2021 Share this episode with someone you know by giving them the link http://Strokecast.com/Jeri Subscribe to the free, monthly Strokecast newsletter at http://Strokecast.com/News Don't get best…get better

  To read a machine-generated transcript, click here. Let's talk about bras! Specifically, dealing with bras one-handed! Don't worry. In this episode I don't opine on exactly what you put where to get the thing on. Instead, I talk with Rachel Whittaker, the Australian entrepreneur who turned a terrible situation into BraEasy -- The company in position to help bra wearers around the world. She tells us about her then 9-year old daughter stroke and how that led her to a bra the wearer could put on and take off easily with one hand Bio I am passionate about being a voice for people with a disability. After my daughter had a stroke during brain surgery to remove a brain tumor, I became very aware of the struggle that women have every day trying to put on a bra. So I invented an easier bra that can be put on with one hand.  We called it BraEasy.  I am the inventor and CEO of BraEasy Pty Ltd based in Melbourne Australia. How to Use It Here Jamie demonstrates how she puts on and removes the Bra Easy bra. https://youtu.be/KGuRFJIaHkk Models Bra Easy uses several models on their website, and most are not professional models. Because reflecting the customer base does not require professional models. Bra wearers of course come in all shapes, sizes, ages, colors, and limb configurations. So should the folks modeling the product. If you're interested in joining the models featured on the site and Bra Easy's social media, reach out to sales@BraEasy.com Links Where do We Go From Here? Shop for a Bra at http://BraEasy.com Model for Bra Easy if you are so inclined by emailing sales@BraEasy.com Subscribe to the free Strokecast newsletter launching this summer by visiting http://Strokecast.com/news Don't get best…get better

  Click here for a machine-generated transcript using Microsoft Word on the Web. The Motus Hand and Motus Foot from Motus Nova ("New Movement") are air-powered, robotic exoskeletons for in home therapy after a brain injury. Ella Sofia introduced me to the team a couple months ago, and they are now a sponsor of the Strokecast. I wanted to learn more about the product and the company so this week I talk with Motus Nova CEO David Wu. Bio Veteran entrepreneur with over a decade's worth of experience in tech startups focused on healthcare. Recipient of the 2020 Emory Entrepreneur of the Year award in Technology and 2019 Georgia's Most Innovative Tech Startup.  Does it make sense? When considering any therapeutic device, you need tp start with 2 questions: Is it safe? Does it work? Usually the first one is the easier one to answer. In the case of the Motus Hand and Motus Food, the US Food and Drug administration has approved them as class one devices. That means they are safe and effective, so we're off to a great start. You can go deeper, though, and look at the studies done at multiple hospitals and care centers. Here are some examples: https://motusnova.com/how-it-works/#studies Those studies can be helpful to share with your OT, PT, or physiatrist if you decide to ask your medical team (and it's always a good idea to ask your medical team). The other element I encourage folks to consider is the cost in time and dollars to get the benefit. Any treatment you pursue should be in addition to traditional therapies. Or it should take place when you are not already in outpatient therapy. And that's one advantage of the Motus solutions -- you don't need to replace your existing therapist with these devices. The main problem with outpatient therapy is that we don't get enough of it. Time and again, experts come on the show and explain we need to get thousands of reps in. Rewiring the brain is a brute force practice. We have to do the exercises and motions again and again and again to get better. You just can't achieve the scale required in a traditional outpatient therapy model. That makes the Motus devices a much needed supplement to regular therapy. That also means spending an hour a day on it while you listen to podcasts or watch TV is worth the time for most folks. Now we can consider the financial cost. The rental model incentivizes the patient to do the work, get better, and then return the unit. At roughly $99/ week, that will make sense to a lot of folks. Maybe not for others today, but for many it is an affordable safe, and effective solution for stroke recovery. Regression We talk about making progress through rehab a lot, but we don't often talk about the opposite -- regression. David told the story of a veteran who was making good progress in rehab and actually was able to get around with a walker until he went home. Once we go home, we get less therapy. And other things come up so we put off doing home exercises. Before we know it, we've missed a day. And then a week. And then is a month. We never decided to stop. We just...stopped When that happens, we get in danger of learned non-use. Or at least of progress goin backwards. Recovery isn't done or finished until the day we die. We have to keep doing the work. And the more work we do, the better our chances of recovery. Hack of the week The more our mind spins with thoughts, ideas, anxieties, embarrassing memories from 8th grade, and random TV theme songs ("Thhhhheeeeeee ship set ground on the shore of this…") the harder it can be to focus on recovery. Or even on a good night's sleep or a productive afternoon. Meditation is a powerful way to get control of our thoughts and brains again. It can help quiet the noise that burns energy and distracts us from what's important. In Carmen De La Paz's bonus hack this week, she explains that meditation isn't about a guru or a chant. It's about a straight forward element of focus. That means you can meditate while working on a thing, Or sweeping a floor. Or breathing. The key is to simply focus on one thing and let everything else pass from your mind. Links Where do we go from here? To see if the Motus Hand or Motus Food is right for you, visit http://Strokecast.com/MotusNova Subscribe to the free Strokecast Newsletter at http://Strokecast.com/News Find me on Instagram at http://Strokecast.com/Instagram Don't get best…get better

We continue our campaign to #EndNeurophobia, as Gabriela, Sherry, and Kaitlyn discuss a case with Dr. Aaron Berkowitz Download CPSolvers App here Patreon website Schema Kaitlyn Thomas Kaitlyn Thomas is a 3rd year medical student at Lake Erie College of Osteopathic Medicine at their Seton Hill campus in Greensburg, Pennsylvania. She is interested in medical… Read More »Episode 174: Neurology VMR: Right sided hemiparesis

Click here for a transcript generated by Microsoft Word on the Web. High Intensity Gait Training is a new research-based approach to Physical Therapy. Rather than focusing on the details of walking, it focuses more on the volume of steps — even if they’re not the cleanest steps.  It’s not just the steps, though. It’s also about getting the heart rate up safely. This therapy drives heart rates up to 65-85% of the max. And you know what? It works. Patients who go through this therapy walk faster. They walk further. Their sit-to-stand performance is better. It turns out the intensity primes the brain for the neuroplastic changes that work with the repetitions we need to do to acquire or re-acquire skills like walking. You can read one of the studies here. This week we learn about High Intensity Gait Training from Dr. Meghan Larson, PT, DPT, NCS. Not only is Meghan specially trained in this therapy, she is also the woman who taught me to walk at age 46. She was my inpatient PT back in 2017. And she continues to be an utter delight. Bio Dr. Meghan Larson, PT, DPT, NCS is a board certified Neurological Clinical Specialist Physical Therapist who completed her doctoral work at Columbia University and undergraduate degree at Gonzaga University. Currently, Meghan is a staff Physical Therapist at Swedish Medical Center Cherry Hill Campus in the Acute Rehabilitation Unit. She has previous experience in Neuro ICU, Neuro Telemetry, Long Term Acute Care and outpatient orthopedics therapy. Currently areas of interest and specialty are Stoke Rehabilitation, Vestibular Rehab, gait training and balance re-training. Meghan lives with her husband, two kids and dog in Seattle, WA. She enjoys cooking, running, hiking, traveling and spending time with her growing family. Education Doctorate Degree- Columbia University Undergraduate Degree- Gonzaga University Board Certification- Neurological Clinical Specialist Work Experience Current- Staff Physical Therapist at Swedish Medical Center- Cherry Hill Campus in the Acute Rehabilitation Past- Highline Medical Center- Regional Hospital Lead Therapist and Physiotherapy Associates Staff Physical Therapist Two Things Successful Patients Do Meghan works with a lot of patients. Some are more successful than others. What drives that difference? Meghan sees two things that the successful patients do First, they trust the process and the therapists. The therapists spend years studying this stuff. They push us. And sometimes we develop an intense dislike of them because they are pushing us so hard. But the thing I, most of them know what they are doing. They’re pushing us because pushing us works. So trust the therapists and the work they are making us do. The second thing successful folks do is they are kind to themselves. That doesn’t mean treating therapy as a vacation or not trying hard. It means trying and working and when failing, not beating themselves up. This stuff is hard. We are going to fail. That’s how we know we are trying. But thinking of ourselves as failures or getting angry with ourselves or engaging in negative self talk doesn’t help. We have to forgive ourselves for the things we can’t do — yet. Would you talk to another survivor the way you talk to yourself? Would you call someone the names that you call yourself? If not, then don’t treat yourself that badly either. Be kind to yourself.   Caffeinated Comics A couple weeks ago, I joined visited the Caffeinated Comics. We talked about the insurrection at the US Capitol and a lot about Star Trek. We also talked about Voice Over Artist Tom Kane who recently survived a stroke and now lives with aphasia. You can learn more about and listen to the episode here.   Hack of the Week If there is something you want to do after stroke, let your therapist know. If something gave you joy before your stroke, talk about it and dive into the resources available to help with it. Whether it’s a hobby, skill, or other passion, ask your therapists about it. They can help tune your therapy in that direction. They also just know stuff. They may be familiar with gear or techniques that can help. If you’re no longer in therapy, they may still be able to help. So shoot them a quick email. There’s help out there. Sometimes you just need to ask. Give it a shot. And here’s the thing — they want to hear from you even after you’ve finished therapy with them. Especially when they worked with you in the early days after your stroke. They saw you at the very early stages, and they are thrilled to see the progress you’ve made after a month, 6 months, a year, or more.   Links eghan (Fuchs) Larson, PT, DPT, NCS https://www.linkedin.com/in/meghan-larson-pt-dpt-ncs-6aa70940/ Academy of Neurological Physical Therapy http://neuropt.org Intensity Matters Campaign https://www.neuropt.org/practice-resources/locomotor BORG Scale https://www.sralab.org/rehabilitation-measures/borg-rating-scale-perceived-exertion Shirley Ryan Ability Lab https://www.sralab.org/ High Intensity Interval Training in Chronic Stroke (HIT) https://clinicaltrials.gov/ct2/show/NCT01958606 Variable Intensive Early Walking Poststroke (VIEWS): A Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/26338433/ Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke https://pubmed.ncbi.nlm.nih.gov/21914594/ Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury https://journals.lww.com/jnpt/Fulltext/2020/01000/Clinical_Practice_Guideline_to_Improve_Locomotor.8.aspx Emilee Mason on Strokecast http://Strokecast.com/Emilee Other Swedish team members on Strokecast http://Strokecast.com/TeamSwedish Bill on Caffeinated Comics https://radiomisfits.com/cc209/   Where do we go from here? To learn more about, or connect with Meghan, find her on LinkedIn here. Do you know a PT, physiatrist, or survivor who you think would be interested in High Intensity Gait Training? Share this episode with them by giving them the link http://Strokecast.com/HIT. Let your therapists know how you’re doing. Don’t get best…get better. Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.    

Hemiplegia is defined as paralysis on one side of the body caused by brain damage, while hemi- paresis is weakness or partial paralysis on one side of the body caused by brain damage, usually opposite the site of the cerebral vascular accident (CVA) or other brain injury (Woodsen, 2008, p. 1002). Certain impairments are associated with lesions in a particular hemisphere. For ex- ample, left CVA may cause right hemiparesis, aphasia or other communication deficits, and/or apraxia or motor planning deficits. Right CVA may result in left hemiparesis, visual field deficits or spatial neglect, poor insight and judgment, and/or impulsive behavior. This focuses on articles that discuss topics in relation to hemiplegia or hemiparesis. The topics most discussed are grip or grasp strength and force, reaching, shoulder pain, and bilateral movement. Other topics discussed include biofeedback, botulinum toxin A, constraint- induced movement therapy, contractures, fine-motor control, functional electrical stimulation, haptic training, neuroprosthesis training, physical fitness, postural stabilization, virtual reality, weight bearing, and wheelchair use.

27-year-old Emma Bowditch is today's guest. Emma suffered an episode of hypoglycaemic hemiparesis in her early 20s, during which half the body is paralysed as an additional symptom of a low blood sugar. Emma didn't have a label for what happened to her for years after, and reached out to me in a bid to raise awareness of this relatively undocumented experience.

Olivia and Emilee were my two, awesome inpatient OTs a couple years ago, and we stayed in touch after I left the hospital. One day, Olivia told me about the amazing new $40K rehab bike they just got. They were getting great results with patients. It’s too bad my stroke didn’t happen a year later. The new device was the RT300. It combines therapy, eStim, and data with exercise to help patients improve their core, their leg use, their arm use, or all three at once. So Olivia put me in touch with Restorative therapies. sStim The brain controls the muscles and makes us move by sending electrical signals through our nerves with various chemical processes. After stroke the brain may no longer be able to do that to certain muscles. That’s how we get paralysis, hemiparesis, and all sorts of similar issues. That also means that we can bypass the brain and move those muscles by sending an electrical signal directly to the nerves at the muscle to stimulate them to make them move. This is great because movement is important to both health and recovery. And that’s what eStim does. The most popular eStim for Stroke survivors is TENS. This is the type I used in the hospital and later at home. I attach a couple electrodes to my affected arm, and for 30 minutes, my hand will open and close. Or my wrist will go up and down. Or I’ll do something with my shoulder. Combining eStim with exercise is great therapy and promotes recovery. And the units cost about $40 on Amazon. FES is the type of eStim you’ll find in the Bioness products and the WalkAide. These devices use eStim to prevent foot drop and replace an AFO. The user wears it strapped below the knee as they walk, and it stimulates the muscle that lifts your foot as you walk. I tried them both and had some good results with the WalkAide. At $5,000, though, it didn’t make enough of a change in my life to justify buying it. IFES is the technology Restorative Therapies uses in their RT300 bike and Xcite treatment device. The use eStim on up to 12 muscles at once in a specific, timed pattern to accomplish a task. It’s complex, but it can help the brain relearn to do these things in the future. Restorative Therapies Team Jim Janicki is the President and CEO of Restorative Therapies. Jim has an extensive management background in sales, R&D,  and operations in the chemical, medical, diagnostic, pharmaceutical, and biotech industries. He joined Restorative Therapies in 2018. Wendy Warfield is the Clinical Education Manager. She makes sure that patients, therapists, physicians, and researchers understand how to most effectively use the Restorative Therapies devices. Wendy is well-suited for this role . She began working at an Occupational Therapist in 2003, and bring that survivor focused perspective to the work that she does. Me and the xCite Some weeks back, I got to try the xCite. I got to work with the reps Stephanie and Michael when they visited the Seattle areas. Unlike the bike, the Xcite is only for clinical use. It features a series of preprogrammed activities like reaching for a water bottle or brushing your hair. It fires the nerves in sequence so the muscles do what they need to do for me to complete the act. Here are some pictures and a video from my experience. Main menu on the Xcite highlighting different exercises loaded into the unit. Detailed menu on the Xcite allowing a therapist to enable or disable stimulation to specific muscles. Just a few of the electrodes on my arm. Stroke Stories On another note, Stroke Stories, a UK podcast focused on, well, stroke survivor stories, featured my story on episode 50. You can listen to it here: The show mostly features UK survivors, but more recently has been including folks from other parts of the worlds. I enjoy listening for the wide range of folks the bring on the show. It’s also different from other podcasts in that it features a narrator rather than a host and a guest. Basically, the person who interviewed me does not appear in the show. His job was to help me tell my story and get out of the way. In that respect, it’s more like a radio show. Definitely check it out and add it to the list of podcasts you regularly listen to. Hack of the Week Wendy’s hack for us is to keep moving. Movement is important to recovery. It keeps the muscles and tendons healthy and flexible. It’s important for cardio vascular exercise. Getting the appropriate exercise helps with heart health, blood pressure, and can reduce the risk of another stroke. Even if we have physical limitations today, moving as much as possible makes future recovery more realistic. While some exercises may be better than others, you don’t have to get caught up in details. The important thing is to just keep moving. Links Restorative Therapies on the web https://restorative-therapies.com/ Restorative Therapies on Twitter https://twitter.com/restothera Restorative Therapies on Instagram https://www.instagram.com/restothera/ Restorative Therapies on YouTube https://www.youtube.com/user/restothera Restorative Therapies on LinkedIn https://www.linkedin.com/company/restothera/ Restorative Therapies on Facebook https://www.facebook.com/restothera/ Kennedy Krieger Institute https://www.kennedykrieger.org/ RT300 https://restorative-therapies.com/ifes-systems/rt300/ Xcite https://restorative-therapies.com/ifes-systems/xcite/ TENS on Amazon https://www.amazon.com/s?k=tens&ref=nb_sb_noss_2 Emilee on Strokecast http://Strokecast.com/Emilee Lana Malovana on Strokecast http://Strokecast.com/Raccoon Dr. Shah and Sentinel Healthcare http://Strokecast.com/Sentinel Lauren Sheehan on Strokecast http://Strokecast.com/Lauren Bioness http://www.bioness.com/Home.php WalkAide https://acplus.com/walkaide Jim janicki on LinkedIn https://www.linkedin.com/in/jim-janicki-26884b/ Stroke Stories Podcast https://www.stroke.org.uk/life-after-stroke/stroke-stories-podcast Bill on Stroke Stories https://play.acast.com/s/strokestories/strokestoriesepisode50-billmonroe Where do we go from here? To learn more about the RT300 bike, the Xcite device, or Restorative Therapies, check out their website at  https://restorative-therapies.com/. Ask your PT or OT about their thoughts on IFES. Share this episode with someone in your life by giving them the link http://Strokecast.com/RSI Subscribe to Strokecast and Stroke Stories in your favorite podcast app so you never miss an episode Don’t get best…get better. Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

As stroke survivors, we have to find the #StrokePerks where we can. My GF recently hurt her ankle on the way to work. Fortunately, I have an assortment of canes that she can choose from to get around the apartment safely while she recovers. Keep Trying Getting from the car to the apartment, though, meant she had to use the can I had brought with me. Fortunately, I was able to walk a bit without it. As I walked down the hall, I reflected on my early days of recovery. I spent time going up and down that same hall with Elissa, my PT from Rehab Without Walls. It took a lot longer to cover that distance back then. And trying it without the can worked for only a few feet. Even a year ago, it took longer. Today, I need the cane to walk longer, faster, safer, with a better gait, and with less fatigue. The point is that I continue to get better. It's just a little bit at a time. And sometimes it's hard to notice. But it's happening. 28 months later. Anyone who tells you recovery stops at 6 months or 12 months is WRONG. That's utter nonsense. Recovery may be fastest early on, but recovery continues for years. But you cannot get better if you don't do the work or if you don't believe you can. The right, action-oriented attitude is essential to long term continued recovery. Focus on getting just a little bit better every day. Walking Predicts Return to Work A study recently published in the AHA Journal reports that post-stroke walking speed is an accurate indicator of whether a survivor will return to work: This study is the first to capture walking performance parameters of young adults who have had a stroke and identifies slower and less efficient walking. Walking speed emerged as the strongest predictor for return to employment. It is recommended that walking speed be used as a simple but sensitive clinical indicator of functional performance to guide rehabilitation and inform readiness for return to work post-stroke. You can read the full details here https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.025614 It's an interesting article, and the story has been popping up in various news feeds that I follow. I'm not sure how actionable this is, though. First, it doesn't appear to draw a distinction between knowledge work and physical work. It also doesn't appear to address the concerns of stroke survivors living with aphasia or other cognitive challenges who have no trouble walking. Really what they seem to be looking at is the cognitive load involved in walking and extrapolating from there. So this may be slightly useful early indicator in the early post stroke days, but when reading articles like this, there are a few things to keep in mind: Correlation does not equal causation. Headlines do not tell the whole story. Look at this stuff critically. Nuance does not fit nicely into bullet points. Eat More Bananas! A new study says eating more bananas will prevent stroke! Actually, it doesn't say that. But that's a headline you are likely to see. A study from the University of Alabama at Birmingham demonstrated that a lack of dietary potassium in mice led to hardening and calcification of arteries. Such damage to the arteries in humans can lead to stroke and heart disease. Here's what the article says: University of Alabama at Birmingham researchers have shown, for the first time, that reduced dietary potassium promotes elevated aortic stiffness in a mouse model, as compared with normal-potassium-fed mice. Such arterial stiffness in humans is predictive of heart disease and death from heart disease, and it represents an important health problem for the nation as a whole. The UAB researchers also found that increased dietary potassium levels lessened vascular calcification and aortic stiffness. Furthermore, they unraveled the molecular mechanism underlying the effects of low or high dietary potassium. So how do we get to the conclusion? We assume the mice model applies to humans. We assume we can get more dietary potassium by eating more bananas. We assume that more dietary potassium in humans results in less hardening of the arteries. We assume that less hardening of the arteries will lead to reduced risk of stroke in humans. Therefore eating more bananas leads to fewer strokes. Those facts may all be independently true. But at any point, that chain could break down and the results would not follow. So what do you do with this information? As a researcher, you might try more direct research to get to fewer links in the chain. As a consumer, look at what you can learn from. What is the benefit and risk of adopting this behavior? In this case: Bananas are tasty. Bananas are cheap. Bananas have minimal to no health risks for most people. Bananas may increase dietary potassium and that may reduce the risk of stroke. And have I mentioned that bananas are tasty? So eat more bananas. And have I mentioned you can eel them with one hand? #WeSpeakUpAgainstStroke For World Stroke Day, Joe Borges (@JoseSoRocks) and Nefre (@StrokeLifeAlive) are doing a campaign to raise awareness. And you can participate             View this post on Instagram                     My friends @joesorocks and @strokelifealive are working on an Awareness Campaign for Young Stroke Survivors for World Stroke Day in October.⁣⁣ ⁣⁣ Are you a #youngstrokesurvivor? ⁣⁣ You can take part in the campaign? ⁣⁣ ⁣⁣ Here are a few simple things you will need to do: ☑️Take a Black & White photo of you wearing a black or white shirt

Harrison's PodClass provides engaging, high-yield discussions of key topics commonly found on rotational and board exams in internal and family medicine.

In this fascinating and inspiring episode, Caroline Ramirez, TSC Mom & Licensed Professional Counselor discusses the impact of different types of trauma, shock trauma & developmental trauma, and how this is relevant to TSC. She discusses how we as parents can work with our children, to mitigate traumatic experiences which are often a part of TSC management and care and shares examples from her personal experience and successes with her daughter who had brain surgery at 15 months of age and had postoperative partial paralysis. She concludes by offering multiple practical suggestions & techniques for applying these practices in our own situations. As a body-oriented psychotherapist, she looks at how visceral reactions relate to mental health, as well as emotions and thoughts. Both of her primary ways of working were influenced by the research of Stephen Porges, who wrote the Polyvagal Theory.

In this fascinating and inspiring episode, Caroline Ramirez, TSC Mom & Licensed Professional Counselor discusses the impact of different types of trauma, shock trauma & developmental trauma, and how this is relevant to TSC. She discusses how we as parents can work with our children, to mitigate traumatic experiences which are often a part of TSC management and care and shares examples from her personal experience and successes with her daughter who had brain surgery at 15 months of age and had postoperative partial paralysis. She concludes by offering multiple practical suggestions & techniques for applying these practices in our own situations. As a body-oriented psychotherapist, she looks at how visceral reactions relate to mental health, as well as emotions and thoughts. Both of her primary ways of working were influenced by the research of Stephen Porges, who wrote the Polyvagal Theory.

On the inagural edition of the Defeating Disabilities podcast, hosts Keith Schlosser and Dakota Schmidt discuss the originial idea of the podcast and why its important to introduce a platform for people with disabilities, whether they be mental or physical, to talk about the issues that they go through on a daily basis when it comes to their work in the world of sports. Following that, Keith goes into a story about his recent struggles with left hemiparesis at this year's Vegas Summer League. Afterwards, Dakota discusses the daily struggles that comes from dealing with depression/anxiety. 

  Housekeeping Welcome to Week 5 of the Strokecast. What do you think so far? Let me know in the comments below, or email me at Bill@strokecast.com You may have noticed the "Bill Suggests" menu at the top of the page. That's a collection of books and tools related to stroke recovery or public speaking that I find useful. They are also affiliate links. That means that if you click on them Amazon will send me a portion of the sales for the next 24 hours. It doesn't change your pricing or impact you in anyway. If you see a link to a product on Amazon on this site, you can assume it's an affiliate link. In Episode 004 last week, I talked about my experience on the JoCo cruise with a focus on disabilities. I actually travelled with my friend Jon Clarke this year and we recorded an episode of his podcast over the course of several days. In it, he tries to figure out just what this whole cruise thing is. You can hear this discussion here, or subscribe to Caffeinated Comics in your favorite podcast app. Shoulder Subluxation The shoulder is a mess of a joint. When hemiparesis sets in, as happened after my stroke, it means the arm (and leg) on that side of the body stop working. Since the shoulder is such a complicated amalgam of muscle, bone, tendon, and ligament, it has to work right to stay together. Subluxation is basically what happens when the shoulder starts to pull itself apart. When this happens, it's difficult to exercise, it's difficult to get the rest of the arm back on line, and it can hurt. There are two main ways to prevent shoulder subluxation and to minimize it -- support and exercise. [ Bill wearing the GivMohr sling   Support is about minimizing gravity's insidious effects. It can include: Arm rests Pillows Wheel chair trays Slings (like the GivMohr I use) Tables Kinesio Tape Ultimately the way to address it for most folks is exercise. It's why I do things like: Shoulder shrugs Shoulder rolls Shoulder blade pinches Cross body reaching ...and more Long term, strength is key. To get the strength, Get the exercise Get the fuel Get the support Get the rest Hack of the week "]   Mop Holders are great tools for holding my cane. I have about 6 of them stuck up around my apartment in the living room, the bedroom, the bathroom, and near the dining table. I can easily clip my cane to the wall so no one trips on it, and I can still grab it easily and quickly when I want it. I also lose it less often since I know where to look. Where do we go from here? Do you have a story you'd like to share on Strokecast? Email me at Bill@strokecast.com. How do you deal with sublux? Let us know in the comments below. If you enjoy Strokecast, please subscribe to the show in your favorite Podcast app. If you use a cane, check out the mop holders you can mount around your home or office. Don't get best...get better.  

1/12/17 - In this episode of the BraceBlogger podcast, Clyde Peach, CO shares a SOAP note, an article and ad:The SOAP note is about the orthotic treatment of a7 year -old male with right hemiparesis. The ARTICLE from O&P News by Joe McTernan concerns the award of the new single, national recovery audit contractor (RAC) contract for O&P, DME, home health, and hospice claims. The AD is a scoliosis brace for adults.