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In this episode you will:  Learn about how the Aphasia-Friendly Reading Approach was developed. Hear about the importance of actively engaging care partners in therapy through this storytelling approach. Learn the importance of celebrating stories and how to host your own version of a Waffle Night.   Katie Strong: Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a  member of the Aphasia Access Podcast Working Group. I'm also a faculty member at Central Michigan University where I lead the Strong Story Lab. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Harold Regier and Dr. Erin O'Bryan. We'll be talking about the Aphasia-Friendly Reading Approach that Harold developed for his wife, Rosella, who had aphasia and how Dr. O'Bryan took this approach into the lab to refine it for clinicians to use in sessions. Before we dive into the conversation, let me share a few details about our guests. First a bit about Harold. Harold R. Regier, B.S. Ed., BDiv. Theol., is a retired minister with a career path in programs addressing social justice issues. In retirement, his spouse, Rosella, had a stroke resulting in aphasia. His passion shifted to becoming an aphasia care partner focused on helping to recover language and communication skills. He is the author of “A Decade of Aphasia Therapy,” subtitled “Aphasia-Friendly Reading: A Technique for Oral Communication,” published in 2021.  Our second guest is Dr. Erin O'Bryan. Erin is an Assistant Professor in the Department of Communication Sciences and Disorders at Wichita State University, in Wichita, Kansas. Her major research, teaching, and clinical interests focus on helping people with aphasia communicate through scripts, stories, and phrases and teaching students and care partners how to support communication. Dr. O'Bryan directs the Wichita Adult Language Lab whose current projects focus on supported storytelling and Melodic Intonation Therapy. Welcome Harold and Erin. I'm looking forward to our conversation today. Erin O'Bryan: Thank you, Katie! I've been listening to Aphasia Access Podcasts for years, and so many of my heroes have been interviewed in this series. It is really an honor that you invited Harold and I to be on the podcast today! Katie Strong: I am so excited for our listeners to hear about how the Aphasia-Friendly Reading Approach was developed and expanded. This work is near and dear to my heart – particularly in this unique way of developing and telling stories. I feel compelled to disclose to our listeners that I am grateful to have been involved in this work as it was refined for clinical environments. So, I am going to come right out and say, this is my bias. Harold, I'm a big fan of yours and the Aphasia Friendly Reading Approach and of you Erin for how you brought this approach into the lab and studied it so that clinicians can use this approach. So, now let's get started! Harold, can you share a bit with us about how the Aphasia-Friendly Reading Approach came to be? Harold Reiger: Sure. Thank you so much, Dr. Strong, for the privilege of being here to share just a bit of our story. You know, Rosella and I would have celebrated our 65th wedding anniversary if she had stayed with us just a few weeks longer. We had a very long and very happy marriage. She used to kid me, “We've been together so long we know what the other person will say before he or she says it.” Well, actually, aphasia kind of shattered that theory. But maybe there was a little bit of that was true. Well, anyway, Rosella was a retired public-school teacher with part of her career also involving children's curriculum development. She led many workshops, was a storyteller, and was a frequent guest speaker. Communication and broad coalitions were a strong suit for her. So, aphasia, loss of language was a huge loss for her. Perhaps that sets the stage for working so hard to restore some major storytelling. But I'm sure this is the same kind of feeling that every person who is a care partner with the person with aphasia has. How did we discover a technique for storytelling through oral reading? Really, I think I just stumbled into it. The cues came from Rosella. She could say many words. She had a strong voice, but she did not put words together in a way that made it possible for a listener to understand what she meant to communicate. So, I was highly motivated, wishing there was a way to help her tell her stories. Looking back, I now can see three of what I call ‘indicators' that led me to the technique that I eventually called Aphasia-Friendly Reading. They were painting, reading, and church liturgy. So let me explain. Indicator number one, completely on her own, Rosella began to paint. Just shy of two years after her stroke, Rosella began to paint. She painted for four years. She painted 250 paintings. The choice of her subjects were all hers. Objects, scenery, flowers, roadside sightings, trips and vacations, past memories. And yes, stories, family stories, stories that she didn't have words to tell, but she could tell them with a brush. She gave every picture a title or caption, signed it, and dated it. And somehow she found those one, two, or three words to intelligibly, that is accurately, identify the picture that she had just painted. But after four years of painting those pictures, she put her paintbrush down, never to pick it up again. And yet I kept remembering that she was able to identify pictures accurately using those few words to explain what it was that she was telling with her pictures. But then indicator number two came, reading periodicals and books. She underlined periodicals with many circles, much underlining. For a long time, Rosella delved through as many as 40 or 50 books per month. She turned every page, but did she understand what she was reading? Frankly, I often wondered and doubted it. One day, Rosella was reading orally beside me, and I pressed my iPhone video button. Listen to just a few seconds of that reading. And while you listen, think of two questions. Could you understand what she was reading? What was the story that she was trying to tell? And secondly, do you think that Rosella was understanding what she was reading? So listen to that clip. Excerpt of Rosella reading from a book. You heard Rosella reading the story of she and her sister, Anna Grace, requesting radio station KNEX out of McPherson, Kansas to surprise their mother by playing it for her birthday. It was a song that the girls knew that their mother loved. And you heard her read those words, “I love those dear hearts and gentle people.” And then as she continued reading the lyrics of that song, she exclaimed, “Oh, Harold”, which was her way of saying how excited she was to recall that particular story. Now, that explanation, of course, was not in the book. Then there was a third indicator that I recognized, and that was liturgical reading. One day in church we were reading a call to worship displayed on the screen. We were reading responsibly with the leader reading the first line and the congregation reading the second line. I glanced to my side and was surprised to see Rosella reading with the congregation. Maybe it was only the first three or four words of the line, but she read these words accurately. A light went on in my mind. Might this be a hint of how to help Rosella participate in oral reading? Short sentences read with a co-reader who read every other line and written in an easy to follow format? And so I adapted various psalms into very short lines formatted for us to read responsively. I read the first line, she read the second. The result was amazing success. Let me just illustrate by us reading just a very short psalm for you. This is Psalm 150 that Rosella and I will read together. H: Praise the Lord! R: Praise God in his sanctuary. H: Praise God in his mighty firmament. R: Praise Him for his mighty deeds. H: Praise the Lord for his greatness. R: Praise him with the trumpet. H: Praise him with the lute and harp. R: Praise him with the dance. My thought then was, could we try to write other stories and read them in what I began to call Aphasia-Friendly Reading format and style? And so, I began in earnest to try to write other stories. Short sentences, familiar words, larger font. Each line considered a sentence, even if it was only one word. Label the first line H for Harold and the second indented line R for Rosella. As I started reading and continued to read every other line, this could set the tone, the rhythm, and the pattern for saying every word clearly. I thought it was time to try. And then I began to wonder, is there a setting that we could read stories to others? Could we create an audience in some way? When COVID hit, of course, I could not see Rosella in person anymore, for an entire year we were separated. And the only contact we had was FaceTime telephone calls. And those were really a disaster because we found it very difficult to communicate with each other when Roselle was not able to understand me and I wasn't able to understand her, except when we read Aphasia-Friendly stories. And so, I wrote many stories during that year. And we read those stories then as our connection during our FaceTime calls. And somehow we were able to survive COVID. But it was after COVID then that we were able to again get back together occasionally. And I would bring her back to my apartment. And there I would invite friends, usually a couple or two individuals to come over and I would serve waffles. I'm not a kitchen person, but I could make waffles. So, we'd have a simple meal, a simple supper that we could visit with each other and talk about anything that we would like. And Rosella almost always simply said, “I remember exactly”. Because as others told stories that she was familiar with, she could comment that way. Otherwise, her conversation skills were not there. So that was our first hour that we would spend together simply informally visiting with each other. And the second hour that we spent together, we would go to what I would call “my theater,” our living room with a 50-inch television. And there we could read Aphasia-Friendly stories. I would stream the story to the television set. I would have them formatted so that there would be an H for Harold, an R for Rosella, and we would read the story so that the folks who were listening and watching could see the story as well as hear the story. And if we made any mistakes, they could make the corrections in their own mind. There was a way that she was able to, again, participate. It's worth telling. But there was one waffle evening when she turned to me, and said, “China”. I knew she had a story in mind, but her look said, “you tell it. I can't do it.” And so, I did. It was a story about a cracked tea cup And so I decided certainly next Waffle Night we need to let her help tell that story of the cracked tea cup. Here is that story. Cracked Tea Cup. H: This is as story of a cracked tea cup. R: Harold and I were youth sponsors. H: Rose was one of the youth. R: Winifred was her mother. H: She invited me to her home. R: “Thank you,” she said. H: “Thank you for being Rose's sponsor.” R: We visited. H: Before leaving, she said R: “Let me pray for you.” H: It was a pray of blessing… R: …for our work in Mississippi. H: Then she added, R: “Wait!” H: “I have something for you.” R: She got a tea cup. H: Erland brought it to me from China. R: It's cracked. H: Put it in your china cupboard. R: You'll never use it. H: “But you'll remember be when you see it.” R: Sixty years are gone. H: This tea cup is still in my china cupboard. R: And I remember Winifred. H: It reminds me R: Of the grace, H: Of the affirmation, R: Of blessing, H: Of the seminary president's wife.   And so those Waffle Nights became the favorite parts of our week when we could spend time with friends and Rosella could be part of the conversation by reading stories together with me. Katie Strong: So beautiful! This is really just a fabulous way of having such a natural thing, a shared meal, a celebration to share stories. And it sounds like everybody enjoyed Waffle Nights. So, thank you for sharing, Harold. Erin, I was wondering if come into the conversation a bit more and tell us how you got involved with Harold and the Aphasia-Friendly Reading Approach? Erin O'Bryan: Thank you, Katie. Even though I've heard Harold's story so many times, I still get teary every time I hear him talk about their year of not being able to see each other during COVID and the Waffle Nights that were just so wonderful. So, I met Harold in 2019 when I first became an Assistant Professor after 10 years of working as an SLP in healthcare. And Wichita State already had a weekly aphasia group, and I couldn't wait to meet the members. So, I went to aphasia group and there I met all of the care partners in the observation room and Harold showed me a video of him and Rosella reading a story together. I had been watching Rosella in the aphasia group and I'd seen that most of her utterances were short one- to two-word phrases and that much of her communication was nonverbal. But then in the video, she was reading full sentences aloud, taking turns with Harold. And what really struck me was that she was so motivated and happy to read the story. I was so impressed. Harold asked me, “Do you think that other people with aphasia could benefit from doing this?” So many thoughts were running through my mind as we were having this conversation. Earlier in 2019, I had visited Audrey Holland, who was one of my mentors when I was in grad school at University of Arizona. And we'd actually set up this meeting through an online Scrabble chat. She invited me to her home. Katie Strong: How very ‘Audrey'. Erin O'Bryan: Yes, it was lovely. And I got to visit her with all her kitty cats. So, I asked her advice because I was applying for an Assistant Professor position after 10 years of working in health care. And I remember that she was so excited about her speechpathology.com video series and the related book that she was working on with Roberta Elman that she liked to call the Social Imperative of the LPAA, which I believe is the subtitle of that book. And Katie, I think you were a part of both the video series and the book. Katie Strong: I was, yes. Erin O'Bryan:  Well, Audrey just loved that. She was so excited about that, and she told me to learn everything I could about the LPAA. And she said, “I must join Aphasia Access.” She said, “that's where all the important work is happening.” So that year I listened to loads of Aphasia Access podcasts, and I got very familiar with the Chapey and Colleagues LPAA Values chapter. So then as I'm sitting there talking to Harold, I'm thinking about the LPAA value, everyone affected by aphasia is entitled to service. So, I mean, who is affected more than a spouse? So definitely I was thinking about having the care partner being involved seemed like a wonderful thing. And I was also thinking that Harold and Rosella's approach shared so many similarities with Script Training, which I have loved and have been using in healthcare care since grad school. And there also are similarities with ORLA and Multiple Oral Rereading. And all of these are evidence-based treatment approaches. So, I felt pretty confident that Aphasia-Friendly Reading could be a very valuable intervention. So, I said to Harold, “I'd like to try using your approach with other people with aphasia and their care partners in our clinic”. And Harold was happy for us to try it. Katie Strong: I love that. I love that. And just for our listeners, we'll put some links and references in the show notes for some of the approaches like ORLA and Script Training that Erin has mentioned in addition to Harold's book and some other some other resources too. Erin O'Bryan: Yes, thank you, Katie. Those are all wonderful resources for people to be looking at. So, my grad students and I started a pilot study with a woman with aphasia and her husband. And they were actually friends of Harold and Rosella's from their aphasia group. We use the pseudonyms Cora and Dave when we describe them in our papers. It became clear that we needed to make a few adaptations to Harold's approach for use in the clinic. For one thing, I wanted the person with aphasia to have the largest role in selecting the story topic and deciding what she wanted to say. For our first session, we asked Cora and Dave to bring ideas for a story that Cora wanted to tell. And we also suggested they consider bringing some related photos. In our first session, Cora, Dave, my grad student, Addison, and I all sat around the table and together we brainstormed about the story. Cora wanted it to be about a Caribbean cruise that she and Dave had gone on. She brought photos from that trip. Dave helped with supplying names and information about places that Cora wanted to talk about. Places from their shore excursions, such as having their picture taken with a donkey in St. Thomas and visiting the Bomba Shack on the island of Tortola. We got Cora's feedback on every line that was proposed, fine-tuning the story until Cora liked every line. And we also adjusted some of the lines to make them easier for her to say. So once Cora and Dave were happy with the story, we helped them practice during our sessions, one hour per week with my grad student, Addison and I at the clinic. And we gave a printout of the story and a practice log to record notes about their home practice. In this first pilot project, Cora and Dave practiced their story for eight sessions until Cora said she was ready to plan their story sharing celebration. Then they shared their story with their friends in aphasia group. And the clinicians and the other people with aphasia in the room were just amazed. And other people in the aphasia group said, “I want to do that!” So, after two people with aphasia and their care partners did Aphasia-Friendly Reading projects, I wrote a manuscript reporting the pilot results. And Katie, I had seen online that you were an editor of Perspectives at the time. So, I emailed you my manuscript and asked if it was appropriate for Perspectives. And you emailed me back and said, “let's meet online and talk about it.” I was so delighted that you were interested in my project. You suggested that I consider exploring the value of the intervention by interviewing the participants. And I didn't know anything about qualitative research. But, Katie, you helped me write great interview questions for the care partners. And you helped me learn thematic analysis so we could find the themes in the care partner's quotes. And so, after learning from you, I have come to love the thematic analysis process. I really think it leads to deep listening. What we learned from the interviews is that the care partners felt empowered by being included in the intervention and the care partners really valued the collaborative nature of the storytelling project and especially that the intervention was so different than the previous therapy experiences that they had had because it was person-centered, it was fun, and they got to share their story with other people in their lives. So, then the three of us, Harold, Katie, and I wrote our first article about Aphasia-Friendly Reading and it's published in Aphasiology and the title is, “I wasn't just sitting there”: Empowering care partners through the Aphasia-Friendly Reading Approach. And then in 2023, the three of us went to Boston and presented it at ASHA. Katie Strong: Thanks for sharing that, Erin. You know, I think the experience of the care partners saying that therapy was fun important to note. And Harold has mentioned that Rosella thought it was fun, and the other participants thought it was fun. And I guess I just want to bring home that hard work can, can still be fun or therapy can be fun. And especially when it comes from the person with aphasia and their care partners. The topics are generated by the client and care partner. They're sharing things that are really important to them that have happened in their past. I love it. Erin O'Bryan: And one of the care partners even said that they learned better when it was fun. Katie Strong: I love it. Fantastic. Erin, I was wondering if you could share some tips for clinicians who might be listening that are thinking about how they might be able to incorporate this Aphasia-Friendly Reading Approach into their practice. Erin O'Bryan: Thank you for asking, Katie. So, in the past year, you and I have been talking about how we want to make it as easy as possible for clinicians to use our storytelling approaches in regular clinical settings, outside of research. And we really want clinicians to realize that it takes almost no time to prep for a person-centered storytelling session. You just have to go into the session ready to actively listen to what the person with aphasia wants to say. I love the acronym PULSE that you and Barbara Shadden wrote about in your paper, The Power of Story and Identity Renegotiation. And then in our paper, we reviewed PULSE again. So just for our listeners, I'm going to go through it real quickly because I think these are great things for clinicians to keep in mind. The P in pulse is for partnerships, partnering with the person with aphasia. And in the case of Aphasia-Friendly Reading, the clinician partnering with the care partner also. The U in pulse is for uniqueness. So, the clinician should be prepared to help the person with aphasia tell their unique story. The L is for listening. The clinician needs to learn how to really listen. And S is for supporting the person with aphasia in telling their stories. For example, using communication ramps in Supported Conversation for Adults with Aphasia strategies to support communication. And then finally, the E impulse is for explore. So as a clinician, be ready to go off-road with your client to explore the story that they want to share. And as a clinician, know that it's okay, even it's great for you to do that. Katie Strong: I love that. I love that. Erin, I guess that leads us into sharing that we do have a paper that came out in 2024 called Person Centered Stories on the Main Stage in Intervention, which highlights examples from three different story projects, including Aphasia-Friendly Reading. So, we'll link that to the show notes as well. Erin O'Bryan: Yes, and this year at ASHA 2024, Katie, you and I are going to be also giving a talk about this work called Elevating Person-Centered Stories to the Main Stage in Aphasia Intervention. And we are looking forward to presenting this work hopefully to an audience of clinicians. Katie Strong: Yes, yes, we hope to see folks in Seattle for sure. Well, I want to bring back both Harold and Erin into this conversation. And I think one of the things that I've recognized through this collaboration that you and Harold and Rosella and later on I got to be a part of is that we really are all better together. And I was hoping each of you could take a moment to share how this work has changed your thinking or maybe some ideas about sharing with others about what you've learned from this collaboration. Harold Regier: Well, for me, one of the things that I think I really learned from this is that we care partners need the therapist and the therapist needs us care partners. And there are more ways in which we can work together than perhaps sometimes we have done it when we have just been sitting there. And so, I really, I'm so pleased to be able to feel that that we care partners are more involved or can be more involved in the whole therapy process than what so often we have been. But I think that one of the things that the therapist needs to help us understand is when is it appropriate for us to be part of the process and when it is not appropriate for us to be part of the part process. It's not a matter of us being there all the time and sometimes being in the way. So, I think that kind of very frank candid conversation with us would help us understand that. And I certainly understood better that that the role of the care partner in terms of helping the person with aphasia be able to communicate better is very different from the role of the therapist. I never tried to be the person who was the teacher, trying to let Rosella know how she should do better and how we might be able to improve our reading. We just did it and it came out the way it came out. But then when I see how Erin was working with other clients and the persons with aphasia and the family members together identified the stories that they were interested in putting together, and the therapist helped put that together into words that they then could repeat or share together and in a storyline, that that is the place where I think we can be so much more collaborative with the therapist in a process like that. So I just always was telling myself, “Don't be a therapist. Don't be a teacher. Don't try to say, well, you can do better than that. Just simply do what is natural.” And then I wish that the therapist would take the other role and really work hard to help the person with aphasia do better with their reading and their performance. We didn't do our reading for production. We did it for fun, as you were saying earlier. And then we did it because we wanted to share that fun and that experience with others. And that was so very, very satisfying for us. Those are some of the thoughts that have come to me in terms of the relationship between therapist and care partner. Katie Strong: Thanks Harold. Yeah, Erin, any thoughts? Erin O'Bryan: I've learned so much from this collaboration. From Harold, I learned what a difference it makes when a care partner puts so much time and thought into supporting their partner with aphasia's communication and her quality of life. Also I've seen how much Harold has done and I hope that me you know as a busy professor stopping and taking the time to tell him that I saw so much value in what he was doing at home with Rosella reading those videos together. I hope that this helped him realize that it was valuable to share. And I'm thrilled to say that Harold has been going around the state of Kansas giving talks about aphasia at colleges and senior living facilities. He's doing so much and I love to see that. And from collaborating with you, Katie, I've learned the importance of making the story sharing a really beautiful celebration honoring the person with aphasia and you know bringing special things like favorite food treats, beverages, flowers, and especially inviting the people that are important to the person with aphasia. We've now had five or six story sharing celebrations. It seems like everyone is more beautiful than the last. I've learned so much about that. And I've also learned that qualitative research helps me capture the meaningfulness of these projects and the meaningfulness as we're working with people with aphasia and that this research can be so fun and rewarding. Katie Strong: I love that. I love that. As I was listening to you, Erin, respond to Harold, it just sounds like together we can validate one another. The work that you're doing, you were doing with Rosella, Harold is very validating and then Erin bringing it into the lab to test it out and it's all beautiful. It's, it really is. And I guess as I reflect on this thought about what I've learned is to reiterate, Erin, something you said, that listening to family members or care partners and the ideas that they have to engage their loved ones in communication activities are so powerful and taking that time even if you are busy to listen and think and validate and see how that connects to the existing evidence-based literature. I think is really powerful. But I also think that there's this collaboration and the combination of care partners and clinicians and researchers. And of course, the person with aphasia at the center of all of that, making a powerful team to develop innovative methods of storytelling is really one of my big takeaways from all of this. Erin O'Bryan: Yes, that's wonderful. Harold Regier: I would like to give kudos to the therapists who worked with Rosella over the many, many years. Ten years of aphasia therapy, four of which were one-on-one, six of which were part of a support therapy group. Those therapists were such relational people, such encouraging people, and also knew the techniques that work in therapy. So, I wanted to say that those years were very, very meaningful, very, very helpful, and helped us with the day-to-day kind of living with hope, with the expectations that things can continue to get better. Katie Strong: Thank you, Harold. Yeah. Erin, any other thoughts as we wrap this up today? Erin O'Bryan: Well, I just wanted to say that I would never recommend that all intervention involve the care partner because I understand that it's good for the person with aphasia to get one-on-one time with the clinician. But don't forget that that care partner is often with the person with aphasia almost 24/7 and we may only see them one or two hours a week. So, it's so important that we do more to really educate the care partner about how to acknowledge the competence of the person with aphasia and really how to support their communication. So that's why I really want us to do more with in involving the care partner and in intervention. So, I'll get off my soapbox. Thank you, Katie, for letting us share about this project that I love. Katie Strong: I'm so delighted that we could have this time together today. Harold, thank you for your generosity and sharing your ideas and Rosella's stories with us and this beautiful work of Aphasia-Friendly Reading and Erin for your work in the lab and bringing it to the clinic. On behalf of Aphasia Access, thank you for listening. For references and resources mentioned in today's show, please see our show notes. They're available on our website, www.aphasiaaccess.org. There you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, I'm Katie Strong. Thanks again for your ongoing support of Aphasia Access. Contact information for Guests – Harold Regier hrregier@cox.net  Erin O'Bryan, PhD., CCC-SLP erin.obryan@wichita.edu  Resources Aphasia Institute's Introduction to Supported Conversation for Adults with Aphasia (SCA™) eLearning. https://www.aphasia.ca/health-care-providers/education-training/online-options/ Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000).Life Participation Approach to Aphasia: A statement of values for the future. The ASHA Leader, 5(3). https://doi.org/10.1044/leader.FTR.05032000.4 Cherney, L. R. (2010). Oral reading for language in aphasia: Impact of aphasia severity oncross-modal outcomes in chronic nonfluent aphasia. Seminars in Speech and Language, 31, 42–51. https://doi.org/10.1055/s-0029-1244952 Cherney, L. Babbitt, E., Oldani, J., & Semik, P. (2005). Efficacy of repeated choral reading for individuals with chronic nonfluent aphasia. [Clinical Aphasiology Paper]  http://aphasiology.pitt.edu/1548/  Kaye, R., & Cherney, L. R. (2016). Script templates: A practical approach to script training in aphasia. Topics in Language Disorders, 36(2), 136–153. https://doi.org/10.1097/2FTLD.0000000000000086 O'Bryan, E. L., Regier, H. R., & Strong, K. A. (2023). “I wasn't just sitting there”: Empowering care partners through the Aphasia-Friendly Reading approach. Aphasiology. https://doi.org/10.1080/02687038.2023.2272956 O'Bryan, E. L., & Strong, K. A. (2024). Person-centered stories on the main stage in intervention: Case examples from the My Story Project, Aphasia! This Is Our World, and Aphasia-Friendly Reading. Perspectives of the ASHA Special Interest Groups. https://pubs.asha.org/doi/10.1044/2024_PERSP-23-00272 Regier, H. (2021). A Decade of Aphasia Therapy: Aphasia-Friendly Reading: A Technique for Oral Communication. Independently published Available on Amazon Strong, K. A. & Shadden, B. B. (2020). Stories at the Heart of Life Participation: Both the Telling and Listening Matter. Chapter 5. In A. L. Holland & R. J. Elman (Eds.) Neurogenic communication disorders and the Life Participation Approach: The social imperative in supporting individuals and families (pp. 105-130) Plural Publishing. Strong, K. A & Shadden, B. B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. ASHA Perspectives, SIG 2, 5, 371-383. https://pubs.asha.org/doi/pdf/10.1044/2019_PERSP-19-00145 Youmans, G., Holland, A., Munoz, M. L., & Bourgeois, M. (2005). Script training and automaticity in two individuals with aphasia. Aphasiology, 19(3/4/5), 435–450. https://doi.org/10.1080/02687030444000877

In this episode, Dr. Victoria Maizes and Dr. Andrew Weil explore the revolutionary work of Dr. David Berceli, creator of Tension and Trauma Releasing Exercises (TRE). Dr. Berceli shares his insights on neurogenic tremors, explaining how this natural, self-regulating mechanism helps the body release deep stress and trauma. Drawing on his extensive professional experience in war zones and traumatic events, Dr. Berceli discusses the healing power of tremors, the role of community in recovery, and the body's innate ability to discharge accumulated stress. This episode sheds light on the practical applications of TRE for trauma recovery and stress reduction, providing valuable insights for those seeking accessible and powerful tools for healing.

In week three week, host Paul Wirkus, MD, FAAP, and Glen Lau, MD, will be discussing neurogenic bladder in chiHave a question? Email questions@vcurb.com. Your questions will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode, I sit down with Carolyn Barnwell, a documentary filmmaker turned Stress Resilience Coach, who has dedicated herself to helping people process trauma through body-based approaches. After witnessing profound trauma in her career, Carolyn turned to Tension and Trauma Releasing Exercises (T.R.E.), a method she's been using for 18 years to reset the nervous system by inducing natural tremors. Carolyn shares the science behind 'neurogenic tremors' and how they help humans and other mammals release the effects of stress and trauma. You'll learn: Why stress and trauma are stored in the body and why traditional talk therapy may not be enough How tremoring works neurologically to help the body process stress and trauma The strategic use of T.R.E. to induce tremors and promote healing How T.R.E. has helped people struggling with PTSD, chronic pain, and other challenges Carolyn's personal journey from documentary filmmaker to Stress Resilience Coach Join us to explore how the body's natural mechanisms can promote healing and resilience, and discover how Carolyn is helping others ‘Shake Away Stress' in her powerful work.  

Contributor: Taylor Lynch, MD Educational Pearls: What is Central Cord Syndrome (CCS)? Incomplete spinal cord injury caused by trauma that compresses the center of the cord More common in hyperextension injuries like falling and hitting the chin Usually happens only in individuals with preexisting neck and spinal cord conditions like cervical spondylosis (age-related wear and tear of the cervical spine) Anatomy of spinal cord Motor tracts The signals the brain sends for the muscles to move travel in the corticospinal tracts of the spinal cord The tracts that control the upper limbs are more central than the ones that control the lower limbs The tracts that control the hands are more central than the ones that control the upper arm/shoulder Fine touch, vibration, and proprioception (body position) tracts These sensations travel in separate tracts in the spinal cord than the sensation of pain and temperature Their pathway is called the dorsal column-medial lemniscus (DCML) pathway This information travels in the most posterior aspect of the spinal cord Pain, crude touch, pressure, and temperature tracts These sensations travel in the spinothalamic tract, which is more centrally located These signals also cross one side of the body to the other within the spinal cord near the level that they enter How does this anatomy affect the presentation of CCS? Patients typically experience more pronounced weakness or paralysis in their upper extremities as compared to their lower extremities with their hands being weaker than more proximal muscle groups Sensation of pain, crude touch, pressure, and temperature are much morelikely to be diminished while the sensation of fine touch, vibration, and proprioception are spared What happens with reflexes? Deep tendon reflexes become exaggerated in CCS This is because the disruption in the corticospinal tract removes inhibitory control over reflex arcs What happens to bladder control? The neural signals that coordinate bladder emptying are disrupted, therefore patients can present with urinary retention and/or urge incontinence What is a Babinski's Sign? When the sole of the foot is stimulated a normal response in adults is for the toes to flex downward (plantar flexion) If there is an upper motor neuron injury like in CCS, the toes will flex upwards (dorsiflexion) How is CCS diagnosed? CCS is mostly a clinical diagnosis These patient also need an MRI to see the extent of the damage which will show increased signal intensity within the central part of the spinal cord on T2-weighted images How is CCS treated? Strict c-spine precautions Neurogenic shock precautions. Maintain a mean arterial pressure (MAP) of 85-90 to ensure profusion of the spinal cord Levophed (norepinephrine bitartrate) and/or phenylephrine can be used to support their blood pressure to support spinal perfusion Consider intubation for injuries above C5 (C3, 4, and 5 keep the diaphragm alive) Consult neurosurgery for possible decompression surgery Physical Therapy References Avila, M. J., & Hurlbert, R. J. (2021). Central Cord Syndrome Redefined. Neurosurgery clinics of North America, 32(3), 353–363. https://doi.org/10.1016/j.nec.2021.03.007 Brooks N. P. (2017). Central Cord Syndrome. Neurosurgery clinics of North America, 28(1), 41–47. https://doi.org/10.1016/j.nec.2016.08.002 Engel-Haber, E., Snider, B., & Kirshblum, S. (2023). Central cord syndrome definitions, variations and limitations. Spinal cord, 61(11), 579–586. https://doi.org/10.1038/s41393-023-00894-2 Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMSIII  

Shannon Wallace asks Tufan Tarcan all about his team's workshop taking place at this year's ICS annual meeting in Madrid.https://www.ics.org/2024/session/7769 Early registration for ICS 2024 Madrid is now open at www.ics.org/2024The ICS annual meeting is the must-attend, multidisciplinary event for clinical and research scientists interested in: Urology Urogynaecology Female and functional urology Gynaecology Bowel dysfunction Neurourology Pure and applied science Physiotherapy Nursing Geriatrics The ICS 2024 Madrid conference fosters collaboration between all disciplines involved in continence care.

This episode on neurogenic bowel explores the differences between neurogenic bowel and a typical functioning bowel, common symptoms, and addresses the crucial aspects of bowel management. From strategies and goals to challenges and misconceptions, we'll cover it all with Dr Mandy Rounds and Nurse Practitioner Dr. Maryellen Kelly.

In this episode of our podcast, we sit down with Mohammed Salah, the first certified TRE (Tension and Trauma Releasing Exercises) provider in the Arab region and the founder of TRE Arabia. Mohammed shares his transformative journey with TRE, starting from his initial skepticism to how it profoundly changed his life, leading him to spread the practice across 22 countries. He discusses the benefits of TRE not just for trauma recovery but as a holistic tool for enhancing overall well-being, including better sleep, reduced anxiety, and improved physical health.Mohammed and Alex delve into the upcoming TRE initiatives aimed at broadening the reach and understanding of TRE in the Arab world. They highlight the significance of the five-day TRE workshop in Dubai, which marks a pioneering step towards integrating TRE into various sectors such as healthcare, emergency services, and athletics. Furthermore, Mohammed outlines the structure and goals of the online TRE certification training for the Arab region, emphasizing the importance of making TRE accessible to a diverse audience, from professionals experiencing burnout to individuals seeking personal growth.The conversation also touches on the broader vision for TRE Arabia and the potential of TRE to foster resilience and healing across cultural and professional boundaries. Mohammed's commitment to training more TRE providers in the Arab region is a testament to his belief in TRE's power to improve lives. The episode is a compelling invitation for listeners to explore TRE, whether as a tool for personal development or as a pathway to becoming a certified provider.Key Highlights:00:00 Introduction and Background01:31 History and First Experience with TRE09:33 Work in Rehab Centers14:02 Teaching TRE in Chiang Mai16:38 Bringing TRE to the Middle East24:07 Founding TRE Arabia24:43 Teaching TRE in Jeddah25:07 Introduction to TRE in Jeddah26:21 Mission and Vision for TRE Arabia27:14 Certifying Providers in the Middle East28:13 Expanding TRE in Riyadh29:05 Targeting Specific Groups for TRE30:26 Making TRE Accessible to Everyone32:15 Certifying Trainers in the Region33:06 Applicability of TRE in Different Settings34:34 Compassion Fatigue and Hospital Systems35:32 TRE for First Responders36:22 TRE for Athletes37:14 TRE for NGOs and Refugees39:32 Benefits of TRE for Everyone41:30 Finding Home Within Yourself43:27 Fascination with Personal Stories and Experiences45:22 Acceptance and Results of TRE47:27 Upcoming TRE Workshop in Dubai49:10 Module 1 Certification Training in July51:27 Expanding TRE in the Arab Region51:52 Closing RemarksLinks and Resources: TRE Workshop in DubaiDates: May 27th to May 31stLocation: Kan Yoga Wellness Center, DubaiDetails: A five-day workshop open to everyone, with specific days dedicated to different groups such as hospital staff, athletes, police officers, and others. The workshop will feature Dr. David Bercelli, the founder of TRE, along with eight TRE providers from TRE Arabia and other regions.TRE Online Certification for the Arab RegionModule 1 Dates: July 19th and July 20thFormat: Online, conducted in EnglishInstructors: The certification will be led by Mohammed Salah, in collaboration with other experienced TRE professionals.

In this episode, we review the high-yield topic of⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Neurogenic Tumors⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Oncology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

In this episode of the Red Beard Embodiment Podcast, host Alex Greene sits down with Siv Jøssang Shields, a chiropractor based in Voss, Norway, to delve into her journey towards building Integrated Human, a transformative platform combining various therapeutic practices. Siv shares her profound experiences with the neurogenic tremor mechanism, highlighting its role in her chiropractic practice and personal growth. The conversation sheds light on how her quest for deeper understanding and effective healing modalities led her to integrate techniques such as Transcendental Meditation, HeartMath, and ultimately, SOMA Breath into her work. Siv's story is a testament to the power of curiosity and the pursuit of holistic health, underscoring the innate force of nature within us all that facilitates healing and transformation.The podcast explores the serendipitous intersection between Alex and Siv, united by their shared interest in the therapeutic applications of TRE (Tension & Trauma Releasing Exercises) in their respective fields. Their paths crossed thanks to the guidance of David Berceli, the founder of TRE, who recognized the potential for their collaboration. This meeting of minds sparked a journey into exploring the integration of neurogenic tremors with other therapeutic modalities, aiming to enhance the scope and effectiveness of somatic healing practices. Alex and Siv are currently embarking on an innovative project that integrates SOMA Breath workshops into the Red Beard Somatic Therapy offerings, aiming to create a holistic healing experience that harnesses the combined power of neurogenic tremoring and breathwork. This collaboration seeks to delve into the vast potential of human healing and transformation, providing participants with a unique confluence of techniques designed to foster personal growth and enhance wellbeing. The initiative represents a pioneering step towards holistic health, combining Alex and Siv's expertise and shared vision for advancing somatic therapy practices. For those interested in experiencing this transformative approach firsthand, we encourage you to join the upcoming workshops and become part of a community exploring the frontiers of healing and self-discovery. Stay tuned to Red Beard Somatic Therapy's platform for more details on how to participate in these groundbreaking sessions.Key Highlights:00:00 Intro00:21 Innate Force of Nature00:50 Siv's Background Introduction01:23 Maharishi University Meditation02:13 TRE and Clinical Applications03:05 Siv's Therapeutic Journey06:05 Influence of Transcendental Meditation08:35 Chiropractic Career Shift10:10 Practice in Norway11:15 Introduction to Neurogenic Tremoring14:55 Meeting Stephen Porges17:46 Incorporating TRE in Practice20:19 Integrated Human Project28:22 Neurogenic Integration Collaboration31:12 Educational Platform Goals37:13 Connection with David Bercelli42:02 Combining Breathwork and TRE48:18 Experimenting with Red Beard Audience51:17 Music and Rhythms in HealingLinks and Resources:  Website: https://integrated-human.com/Join the SOMA Breath Introductory Workshop with Siv Jøssang Shields : https://www.redbeardsomatictherapy.com/workshops Video Editing by Mohammad Ali: https://www.behance.net/mohammad_alimalik 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: August 24, 2017 Fainting spells are surprisingly common--even among United States Marines. This week, we explore the mechanisms underlying loss of consciousness in your everyday patient. And your everyday soldier. Produced by James E Siegler. Music by Jason Shaw, Andy Cohen, Kai Engel, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008;358(6):615-24. PMID 18256396Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 2005;111(22):2997-3006. PMID 15939833Sonnesyn H, Nilsen DW, Rongve A, et al. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord 2009;28(4):307-13. PMID 19828952Wolters FJ, Mattace-Raso FU, Koudstaal PJ, Hofman A, Ikram MA; Heart Brain Connection Collaborative Research Group. Orthostatic hypotension and the long-term risk of dementia: a population-based study. PLoS Med 2016;13(10):e1002143. PMID 27727284  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: August 10, 2017 Spinal cord injury can be a devastating problem for patients. There is often significant weakness and loss of sensation and coordination, and some patients may never walk again. Almost everyone knows this. But what about the other spinal cord functions that we don't often talk about? In this week's episode, we review how the spinal cord controls bladder function and why it's important to know what happens when this circuitry is interrupted. Produced by James E Siegler. Music by Andy Cohen & Steve Combs. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am 2007;18(2):255-74. PMID 17543772Seth JH, Panicker JN, Fowler CJ. The neurological organization of micturition. Handb Clin Neurol 2013;117:111-7. PMID 24095120de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol 2015;5(1):327-96. PMID 25589273  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Dr. Donald Spaner sits in with us for the month of November to talk all of the levels and types of shock.  There's a lot to unpack in this episode! Assessment, prevention and treatment of. Cardiogenic shock  Hypovolemic shock  Anaphylactic shock  Septic shock  Neurogenic shock  Distributive shock

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Red Beard Embodiment Podcast, host Alex Greene sits down with Jonny Miller, a breath worker, coach, educator, and host of the podcast Curious Humans. They dive into a conversation about breathwork, embodiment, and nervous system mastery. Jonny shares insights from his online course, Nervous System Mastery, and discusses the importance of nervous system regulation. Tune in to explore the power of embodiment practices and trauma healing in finding our ground and creating connection in an ever-changing world.

In this episode, join hosts Alex and Richmond as they dive into the topic of embodiment and what it means to live and exist as a human organism. They explore the broad definition of embodiment and how it encompasses every aspect of our lives. From origin stories to the dance between external focus and internal being, this conversation is filled with insights and perspectives that will leave you pondering the mysteries of life. So grab a cup of tea, sit back, and join us on this enlightening journey of self-discovery. Don't forget to like, comment, and subscribe for more thought-provoking episodes!Links for Richmond:TREAustralia.comTREcourse.comChapters:[00:03:10] Wonder of movement.[00:06:16] Spontaneous body movements.[00:07:05] Spontaneous involuntary movement.[00:11:14] The body's ability to heal.[00:15:48] Spontaneous movement through meditation.[00:19:39] Enjoy the ride.[00:23:54] Release from physical tension.[00:26:09] Connecting with unresolved patterns.[00:29:07] Embodiment and Spontaneous Movement.[00:33:09] Falling into flow states.[00:37:48] Stress and trauma model.[00:42:12] Connection between TRE and meditation.[00:44:34] Vipassana TRE retreats.

Registration for ICS 2023 Toronto is now open at www.ics.org/2023/register The ICS annual meeting is the must-attend, multidisciplinary event for clinical and research scientists interested in: Urology Urogynaecology Female and functional urology Gynaecology Bowel dysfunction Neurourology Pure and applied science Physiotherapy Nursing Geriatrics The ICS 2023 Toronto conference fosters collaboration between all disciplines involved in continence care.

When you have to go, you have to go! Your intermittent catheter shouldn't hold you back or make your bladder management routine difficult. Luckily, closed system intermittent catheters can be used from virtually anywhere with comfort and can make planning ahead easier, allowing you to focus on what's important. During this episode, guest Bob Vogel will do a deep dive into closed system intermittent catheters for men, which are all-in-one catheter and bag solutions. As an intermittent catheter user with a spinal cord injury, Bob will cover the most frequently asked questions and concerns about closed systems and offer his time-tested advice and best practices to make the cathing experience as convenient and comfortable as possible.If you're new to using an intermittent catheter, Coloplast Care can help! You can sign up for Coloplast Care for free by clicking here or calling 1-866-226-6362.Access more bladder and bowel resources here.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Bob is a SpeediCath® catheter user who has received compensation from Coloplast to provide this information. Each person's situation is unique, so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.Coloplast provides this information for your general reference related to the reimbursement of Coloplast products only. Reimbursement, coverage, and payment policies can vary from one insurer and region to another and may change over time. Coloplast does not guarantee coverage or payment of products.

In this episode, Dr. Mandy Rounds, a Research Scientist, is joined by Morgan Kane, a pediatric occupational therapist, to explore the transformative role of occupational therapy in helping children manage neurogenic bladder.Morgan shares how occupational therapy interventions equip children with skills and strategies for independent toileting routines and bladder care. From teaching proper hygiene techniques to addressing motor skills, problem-solving, and anxiety reduction, occupational therapists play a crucial role in empowering children with neurogenic bladder.The discussion also highlights the collaborative nature of managing neurogenic bladder, with a focus on the multidisciplinary approach involving urologists and occupational therapists. This collaboration improves outcomes for children while minimizing complications. Overall, occupational therapy emerges as a vital component of a comprehensive treatment plan, enhancing functional outcomes, confidence, and the overall quality of life for children and their families.

Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a faculty member at Central Michigan University where I lead the Strong Story Lab. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Mary Ann Eller. We'll be talking about incorporating the Life Participation Approach to Aphasia (better known as LPAA) in Acute Care Settings. Let me first tell you a bit about our guest.   Mary Ann Eller, MA, CCC-SLP is the Assistant Manager for Rehab Services in the Speech and Language Pathology Department at Duke Regional Hospital in Durham, NC. She has worked in the Duke University Health Care System since 1989. She specializes in evaluating and treating adults with neurogenic and swallowing disorders in acute care and inpatient acute rehab. Her current professional passions are finding functional, practical, and patient-center approaches to the care of people with aphasia, dementia and all cognitive/communication problems.   In this episode you will: Receive a permission slip to do secret therapy. Hear about how the Life Participation Approach to Aphasia Core Values can be implemented into acute care. Understand how implementing the Life Participation Approach to Aphasia supports the Joint Commission standards on health literacy. Be empowered to welcome interruptions and struggles and embrace the messiness and the creativity and the joy of using LPAA in acute care.   Katie Strong: Welcome Mary Ann! I'm just so excited to have this conversation with you today! And we were just in Durham, at the Aphasia Access Leadership Summit, where you showcased your beautiful city. Thanks for hosting us.   Mary Ann Eller: I'm really excited to be here and very honored that you asked me to do this podcast.   Katie Strong: Well, I'm excited for people to hear about your thoughts. And as we get started, I wondered if you could share a bit about your own speech language pathology journey, and about the hospital setting you work in.   Mary Ann Eller: I grew up in Pittsburgh. I went to the University of Pittsburgh for my undergraduate and graduate degree and then I went to the Shock Trauma Center in Baltimore for my CFY. And that's where I fell in love with acute care, you can't get more acute than that. Then I moved to Durham, North Carolina and I have worked at Duke since 1989, which is 34 years if you're counting. And I started when I was five! It's been a great experience. I've worked mostly in acute care and acute inpatient rehab. When I was new in my career, I loved the excitement of acute care. And I think as I grew older, I fell in love with rehab because I have more personal experiences with being in the hospital and with myself and with my parents. I just saw how important effective communication was at that time in people's lives. And that's what I really want to talk about today.   Katie Strong: Yeah, I'm excited for this conversation. And as we dig in a little deeper, tell me how you became interested in applying the Life Participation Approach to Aphasia (LPAA) to acute care settings.   Mary Ann Eller: Yeah, this is an interesting story to me. At the University of Pittsburgh, Audrey Holland was there at the time. As people who know her and her work, she is known for being extremely functional. So, I sort of grew up professionally knowing that being functional was the way to go. That was in the late 80s, so the LPAA had not been developed yet, which was around the year 2000, I believe when the impairment-based focus of therapy was recognized as not meeting the mark. It wasn't really helping people where they were at. And so, this LPAA not being a therapy approach, but more of an idea. LPAA is a philosophy of treatment, not a specific treatment approach. So, we could still use the treatment approaches that we knew and were evidence-based, but the philosophy of what we are using them for became more widely known in 2000. So, I didn't know about LPAA until about five years ago, even though I was familiar with being functional. So, in my little isolated world, I wasn't doing CEUs on aphasia because I needed to be a generalist. I had, by that time become a manager in the department and needed to stay up to date on swallowing and dysarthria and cognition. So, I wasn't really in the world of aphasia. So, I continued to do impairment-based therapy for a long time.   But I did secret therapy, which I knew is what Audrey would want me to do. And it was, I would do the things that I knew the patient and the family needed me to do but I'd feel a little bit guilty doing it because I knew it wasn't “evidence- based.” And I wasn't doing the, you know, Response Elaboration Training, or whatever it was that I had learned, but I would meet their needs. So when, about five years ago, I went to an Aphasia Access Conference and Audrey was there, and I got to see her again. And she remembered me, which was really an honor. I was validated that the things that I had been doing in just my nature were correct. They were the best thing for the patient. That was really validating. I was always, and I'm saying this for any clinician who's out there listening, to not be afraid. I was afraid that I was doing it wrong. And I had been doing it for many years, had lots of experience, but I didn't want to get around other professionals that were more recognized in the field, because what if I was doing it wrong? Or what if there was a new approach that I didn't know about? And when I got there, it really wasn't that atmosphere at all at Aphasia Access. It was very welcoming, and it was very validating. And I realized that a lot of my instincts were right.   Katie Strong: I love it. So, it's almost like the LPAA shone a light on that secret therapy, and really validated you.   Mary Ann Eller: It sounds so funny that “secret therapy” but it's really what it felt like. So, I got to bring it out into the open and it was a secret no more.   Katie Strong: Yeah, I love it. Well, I mean, obviously, then you feel like LPAA has value. Do you think LPAA has a role in acute care? And how do the Life Participation Approach Core Values apply to this setting?   Mary Ann Eller: That was a great thing that I had to work out in my brain. Absolutely, it has a role in acute care. What I was learning about LPAA, when I first started learning, was a lot of information for when the clients were further along down the line. So, they were in the community, and they were participating in their goal setting, and they were deciding, “hey, I want to go back to work.” And that's what the speech pathologist was working on. And those things were wonderful, but that's not the setting I was in. So, I started to think about how these Core Values can apply to acute care. The Core Values, I'll read some of them right here, there's five of them. The first Core Value of LPAA is that “the goal is an enhancement of life participation.” So, when you're waking up with a stroke, and aphasia, the life you have to participate in is in a hospital bed. So yes, that applies. Number two, “all those affected by aphasia are entitled to service.” You are entitled to service if you have aphasia, in addition to swallowing and dysphagia services. That's important too, but you are entitled to service if you have aphasia, you don't skip it in acute care. Number three, “both personal and environmental factors are targets of assessment and intervention.” That is a lot of what I do in acute care with LPAA, I am looking into the environment, which includes the nurses and the nursing assistants, and the family, and the call bell, and the bathroom and all of those things that are in the environment. And that is what I am targeting and that's LPAA. Number four, “success is measured by documented life enhancement changes.” It is an enhancement of a person's life, like if they can use a call bell and get to the bathroom. If you've ever been in that situation, that is the most important life-enhancing really, lately. And then number five, “emphasis is placed on availability of services as needed at all stages of life with aphasia.” That includes the beginning, so yes, it absolutely has a place in acute care.   Katie Strong: I love this. I feel like it's preach, you're preaching it girl. You know, it's just, I mean, I think for many, many years, we've thought about, “oh LPAA is just something that you do after you try everything else.” I love hearing you talking about bringing it into acute care just right from the beginning, it's so important.   Mary Ann Eller: If I could say one more thing, I think the weight of responsibility for setting goals is one of the things that's talked about in LPAA. You want to be partners with the person who has aphasia in goal setting. And of course, you want whatever it is that they want to work on to be the center. However, when you wake up with aphasia and you have no experience with it whatsoever, you can't expect someone with aphasia to be able to set their goals of communication at that moment. So, I think that that's the biggest difference with the approach and thinking of LPAA. In acute care, the responsibility is more so on the clinician and the family to get to know the person and what's important to him and set the goals at that stage. Slowly educating and then giving the responsibility over to them as soon as possible to set the goals.   Katie Strong: Beautiful, beautiful. We talked about it earlier, the importance of being able to communicate effectively in your health care setting. And one consideration for LPAA is that JCAHO, or the Joint Commission has placed a real high value on environments that support patients and having conversations about their health care to understand their health status and engage in their own health care decisions. Could you talk about how LPAA supports the Joint Commission standards on health literacy?   Mary Ann Eller: Yes. And let me just say, for people who aren't familiar with hospitals, the Joint Commission is the regulatory board that comes in once every two or three years, and they tell you whether your hospital can continue to operate or not. So, the standards are very, very important. And I'm going to read you one of the standards that they have, and I think every speech pathologist is probably going to be, as they hear the standard, is going to be like “Well, wait, that's not really happening with my people with aphasia”. And I think that's where a real opportunity lies for us. You, I think, are attaching the standards?   Katie Strong: Yes, I'm going to. I'll put them in the show notes so listeners can check them out and we'll have a link to the standards there.   Mary Ann Eller: Okay, so one of the standards says that patients are expected to receive information about their care so they can make an educated decision, be listened to by their providers, and the hospital is required to identify patient communication needs and provide services to meet them. And so, you think about maybe someone who speaks another language, or maybe someone who is deaf, or someone who is illiterate. And those are all most of the things I think that people think about when they read that standard. But this also includes people with dementia, and people with aphasia, because you have that diagnosis, doesn't mean that you're unable to communicate. It means that you need special supports to be able to communicate and a lot of healthcare providers are not aware that speech pathologists can offer that support. And so, I think that's where a lot of our work lies.   There's a quote that I like to use in my talks, it's by George Bernard Shaw, it says, “the single biggest problem in communication is the illusion that it has taken place.” And think that there are so many boxes that are checked in acute care, like “the nurse provided education on stroke, and how to prevent further strokes.” And they check the box, and they do a great job, I'm not getting down in that. But if you have aphasia, you did not receive that communication, she communicated it to you. I communicated something to you but that doesn't mean that you received it. And people when they have a stroke, or a brain tumor, whatever it has that produced aphasia, you and their families are in a state of shock, so you're not able to absorb the information. So, I think that that is one thing we need to really be cognizant of when we are trying to change the culture of a hospital.   Katie Strong: Absolutely. And I was thinking of some of the materials you sent me to take a look at in preparation for our conversation today like that Joint Commission talking about communication requiring that two-way process of expressive and receptive or receiving and understanding, you know. That information is really important, very important.   Mary Ann Eller: Yeah, yeah, absolutely.   Katie Strong: And I think sometimes too, we know that our clients or our patients that we are working with take more time to be able to understand what's going on with them and their health care.   Mary Ann Eller: Yeah, and a lot of times what we use to make that happen isn't really that complicated. It often involves slowing down, turning off the TV, sitting down at eye level, and stopping periodically to say, “did you get that?” and “repeat that back to me.” And that's for everybody, not just people with aphasia. It seems like it should be common sense, but it's really not. People in hospitals, especially in the last three years, have been under a lot of pressure and have to do a lot of things. And so, communication can often get lost.   Katie Strong: Absolutely. All this sounds great Mary Ann, but what do you think might prevent some SLPs from embracing LPAA framework in acute care settings?   Mary Ann Eller: That's such a good question because I went through that for 20-30 years, I guess. I didn't embrace it because I didn't know about it. I think that one of the biggest things is being at the Aphasia Access Conferences. I loved it and I loved having the honor of presenting last time we had it, but I just thought, “gosh, I want this to get to people who don't know about it.” Because there are tons of clinicians who maybe hear about it in grad school and perhaps, they go out to their placements and the supervisors maybe don't know about it. And so, they don't put it into practice, or they don't know exactly how to integrate it into practice. I think that number one, that's the biggest thing that's going to prevent clinicians from using it is because they don't know about it.   I think the other thing is that the “secret therapy” that I talked about is realizing, and if nobody's given you this permission slip, I am giving it to every clinician out there. Here is your verbal permission slip, please treat the communication elephant in the room. Whatever it is with somebody in acute care. If they are struggling to order a meal, if they are struggling to call the nurse, if they're struggling with telling you something or talking to the person beside the bed, that's what you work on. Work on what is right in front of you. You don't have to complete an entire Western Aphasia Battery. You don't have to make sure that you have them name 10 things. Those things all have a place, and I think we can fit evaluation and treatment in, but please deal with the person who's right in front of you, not the agenda that you brought into the room. So, there's your permission slip. I think people don't know how to document it and that's okay. I have a couple suggestions a little bit later when I talk about that. I think they feel it takes too much time and it really doesn't, I think you can do these things instead of the big agenda that you brought into the room. I think these people are going to be dealing with aphasia for a long time. And so, they will get to a speech pathologist who will do the more standard evidence-based treatments when they're appropriate. I'm not saying they're never appropriate, sometimes they are. But in my experience of 34 years, a person in acute care with aphasia needs a ton of education, a ton of successes, and just a lot of validation that here's your recovery process, here's what's going to happen. They are in shock, and they don't know how to deal with things, and I think we are the ones who are speaking to that. Everybody else has their silo that they're speaking about with their blood pressure and their arm and their leg and all of these things. But communication is the soul of a person and I think reassuring those sorts of things and giving them successes at that stage is really vital. So yes, that's your permission slip.   Katie Strong: Yeah, yeah, received. And we're going to make lots of copies of that permission slip and mail them out to everybody. So, you touched on this a little bit, but we'd love to hear some ideas that you have about how to incorporate LPAA principles into acute care.   Mary Ann Eller: Here are some practical things. Honeycomb Speech Therapy is a great service that sent out or made available some free checklists for different settings. I downloaded one of those and so that's a good place to start. So, there's, I'm looking at it now, the Functional Needs Checklists by Setting and looking through using call light, using the menu, asking medical questions, and following safety precautions. I think as a clinician, starting to think through your aphasic patients in acute care by communication need versus impairment.   The other thing I'll say that's a really good way to incorporate this is whatever templates you're using in your electronic medical record. The way that we have done ours in the past has been by impairment because that's how we're trained. “How can you talk?” “How can you comprehend?” “How can you read?” “How can you write?” And in our brains we're pulling it together and we're knowing how this might affect their ability to use the call bell. But I think using a table or a checklist that automatically makes you have to pull it together and give a set of supports that will enable the person to do that or not, depending on how severe they are, is one way to make sure that that you incorporate LPAA.   Katie Strong: I love that. And I love the shout out to Honeycomb and Sarah Baar. We actually had her on the podcast. It's been a couple of years, but I think it's Episode 57 if listeners want to check out a little bit more of hearing her thoughts. But I agree, helping yourself be a little more strategic about how you're going to address all of these areas. Because, as you said earlier time is I mean, time is essential everywhere but in acute care, it's really the big commodity.   Mary Ann Eller: Yup. Another thing is to welcome interruptions because when you're in acute care you will be interrupted. And the nurse will come in to give meds and I think to go into a patient's room open for whatever happens. So that when the nurse comes in and gives meds, you are demonstrating some supported communication techniques. So maybe you always have a pad of paper and a pen or a whiteboard. And so, you write down the medicine, and then you ask the nurse, “what's the medicine for?” and they say, “blood pressure,” and then you write down blood pressure, you show it to the patient, and they nod. And then they have experienced what JCAHO was asking us to do, which is communicating what's happening to them. And not only has that happened, but you also are educating the nurse to see how successful that communication is when you write down a word, for example. Welcome the interruptions to show communication.   I've had doctors come in and explain what's going to happen next for their discharge and I write that down or slow it down or whatever the support needed is. Same with social work. There are so many opportunities to use functional communication and LPAA in acute care. As I was thinking through this question, one of the most effective ways that I remember using it in my recent past is with a patient that had Wernicke's aphasia. And it was at the height of COVID, so everybody had masks on, including her. And she was very, very fluent, and she could not understand spoken language, I mean, lots of it. She could walk, you know, and that made all the more frustrating for her, they'd say, “you can't walk by yourself, you need to sit down.” Well, she didn't understand what they were saying. So, she might say in return, “fine, how are you?” And so, people thought that she was crazy. She was not crazy, she had Wernicke's aphasia. She did not understand spoken language. And so, when we finally got the consult after the woman was put in a Posey Bed, I was able to tease that out. I was able to educate the staff on “hey, if you do X, Y, and Z,” which included writing down what you're saying, a key word, then she can look at it, she can look at the context, and she can follow your directions. And it was the biggest difference. I mean, speech pathologists really do a great service for people with aphasia in acute care. So, those are just a couple of things that I thought of.   Katie Strong: I love it. I love it. Well, you alluded to it earlier, but I'm going to invite it back into the room now. That is the elephant in the room, hello dysphagia. How does an acute care SLP balance the needs of the patient with dysphagia and also support communication issues as well?   Mary Ann Eller: That is a good question, and I don't find it difficult at all to do that. And the reason I don't find it difficult is because I've embraced some messiness in my evaluations.   Katie Strong: Tell me more!   Mary Ann Eller: And sometimes that's hard to do, especially early in your career. Or if you are a very focused kind of Type A organized person, which a lot of speech pathologists are and that's why we're so good at our jobs. But it is a little bit messy. And what I mean by that is, you can easily do both at the same time. You can evaluate dysphagia and you can evaluate their language. You can have them following commands with your clinical swallow even though you're not saying hold up two fingers and point to the window or whatever you were taught. You can say, “hey, would you pick up that glass of water?” without pointing to it and see if they do it. You can ask them open-ended questions and closed-ended questions to see what kind of language they have. While you are writing your recommendations on the whiteboard, you can have them read it back and assess their reading in that way. There's lots of things that you can do to assess both at the same time. So, it really doesn't take that much more time, it just takes a difference in how you think about it.   Katie Strong: Powerful stuff. Yeah. I love that it's not, doesn't have to be mutually exclusive, and couldn't and shouldn't be. I'm sure our listeners would be interested in exploring some of the resources that influenced your thinking about this topic of LPAA. Would you be willing to share a few?   Mary Ann Eller: So, one that I read 8 or 10 years ago was by Lyn Turkstra. And I talked with her about this at a conference once and it was really interesting. It's on Inpatient Cognitive Rehab, Time for a Change. I can't remember the year that she published it.   Katie Strong: I think I've got it here, it's 2013. And listeners we'll have all these resources in the show notes for you, too. But yeah, it's a 2013 publication.   Mary Ann Eller: I talked with her about it at a conference once and she said that she really kind of had a hard time getting it published because it was so against the grain at the time. And basically, what it was is inpatient rehab, for those of you who don't know, is after acute care oftentimes. So, it may be within a week of having a stroke and maybe you stay for two weeks at this point. So, within the first month of having a stroke and having aphasia. So, Lyn Turkstra's thinking was, we're programmed and taught to do things in a world of rehab that used to be months long and now it's only a couple of weeks and now earlier than it used to be. So hey, why don't we focus on some other things like education and laying the foundation and making sure that there's a therapeutic alliance with speech therapy so that the person knows, you know, down the line, this is the person you're going to go to and have a good experience with that. That was the first paper that got me thinking.   And then after I started going to the Aphasia Access a few years ago, I looked up an old paper of Audrey Holland's that was Early Aphasia Management and Acute Care. And that was in 2001 that she wrote that. That talks about a lot of the same things, is that we don't have to do an entire Western Aphasia Battery, but let's take care of their actual needs in acute care.   I loved Roberta Elman's CAPE checklist and I felt kind of dumb when I went to Aphasia Access and I started asking people, “hey, I'm in acute care, and I'm thinking about XYZ.” And they said, “oh, well, that's what CAPE does.” And I was like, “what's CAPE?” I just didn't know. And CAPE stands for, it's a checklist of four interventions, C is connect with the person with aphasia, A is augmentative communication, P is partner training, and E is education and resources. Basically, it's if you do these four things in the very early stages, then you've got your bases covered. And it's like, Oh, that's awesome. I wish I would have thought of that. I'm just glad she did.   Katie Strong: Before you move forward, I just want to say thank you for being so open about feeling uncomfortable that you didn't know things. And I guess from my aspect, I think it's also for maybe listeners who are not practitioners but are researchers putting frameworks out there. We really need to be better at getting our work out to the people who can implement it, you know? So, I mean, I think it takes both sides of things to really get it. You can have beautiful, evidence-based work but if it doesn't get into the hands of the practitioners who are using it, it just doesn't matter. So, thank you for being so open about that and I hope that, I'm thinking that it probably resonates with a lot of the listeners here too. That you know, we don't always know what we don't know.   Mary Ann Eller: Yeah, yeah. Thank you for that. You know, it's funny, because even yesterday, I have a lady who has been in the rehab unit for a really long time, for a variety of reasons. But she has pretty severe aphasia, and I was looking over these notes for this conversation today and I realized as I went through the CAPE that I didn't provide her with any educational resources. It's like, wait a minute, I didn't do this. And it's just, you get caught up in the day-to-day things, even if you're invited to do a podcast about it. And sometimes it's just one of those things. Nobody's perfect. But I think if we can have some standards in front of us and go back to them, that we're going to do a great job, that the frameworks are out there. And I guess the other paper I wanted to mention was also by Roberta Elman it's, “Are we missing the forest for the trees?” and I love that.   Katie Strong: It's a great title.   Mary Ann Eller: Yeah. It was like, okay, we're doing all this stuff for aphasia but the person can't communicate when they get home. And I really, really liked that stark reality and I looked back on a lot of my patients, and I'm like, “ wow, I did a great job while they were in rehab.” But I wonder how they're doing at home because I didn't really work with her husband that much. And that is a failure on my part. And, you know, we do better the next time. But those are the things that really influenced how I thought about this.   Katie Strong: Fantastic. Well, we'll make sure to have links to all of those articles and resources in the show notes. Mary Ann, you've been thinking about applying LPAA in your acute care work for a while now. Do you have any ideas that you could share with us that you have in the works in your own practice?   Mary Ann Eller: Yeah, I have a couple. Well, one of the things that I did and it's a very specific intervention, is I developed a Picture Menu because I was doing a lot of work with dementia care and nutrition because of an initiative in our hospital with geriatric care. And dementia is a place where nutrition is often overlooked because they're usually in acute care because maybe they fell or lots of reasons. And the tray ends up getting put in front of them but because of their dementia, they don't eat it and then they start getting sicker and sicker. So, because of that, I realized, even if they could eat, they might not want the tuna fish sandwich that's in front of them, because that's the standard tray that you get if you don't order your meals. And they don't order their meals because they can't communicate. You know, it's not just dementia, it's people with aphasia. And our menus were extremely word based. They were great but they had a lot of words to them. And if you can't read it for a variety of reasons, maybe you're blind, maybe you speak a different language, maybe you're illiterate, all different reasons. Then the person comes up to your bed and takes a really great bedside order like a waitress on an iPad, but again, all words. I teamed up with some people at my hospital and we went down to the kitchen, and we took pictures of all the items on the menu, and we put it on a big giant, laminated menu that we bring to the bedside and have them point to it. So yeah, and I've trained the patient menu techs, the people who actually take the orders, to use it. So, it's a work in progress because it's an extra step but yeah, it's really useful for the people that can use it. So, that's one thing.   The other thing is the idea that I had, and it is not flushed out at all. I'm just gonna like put it out there and if somebody wants to steal it and do it before I do, feel free. But in my hospital, which is Duke Regional Hospital, it's part of the Duke System, but it's a smaller community hospital made up of about 380 beds. A couple of brilliant speech pathologists teamed up, and developed a trach team. And the trach team consisted of a pulmonologist and a respiratory therapist and a PT and an OT and the main players that revolve around trachs. And through a lot of hard work, they were able to do some culture change and practice change and get these patients with trachs taken care of through weekly rounding and all sorts of focus changes. And I thought, why can't we do that for people with aphasia? Or communication, just have a communication team? And I don't know what it's going to look like yet but why can't we get the players? I mean, maybe it's just the speech pathologist. But identify in my hospital through speech pathology consults, okay, here are the most vulnerable people to not get their needs met in acute care because they have global aphasia or severe dementia and they're on our caseload. Let's put them on a special list and let's give them special attention in some way and have a communication team. And as you round on these patients, you let the rest of the hospital see you doing this. You let them see how to intervene with these people. And it catches on so that they then learn these techniques, whatever they may be. We act as advocates for these people that are particularly vulnerable. Again, I don't know how it's going to work yet, but that's an idea.   Katie Strong: Yeah, I love it. And I would love to hear how it unfolds, so.   Mary Ann Eller: Me too.   Katie Strong: Yeah. Okay. I'd like to take it a little bit further because you're the manager of a department, right? So, talk about maybe a few tips in transitioning to an LPAA focus with a staff that isn't particularly familiar with that philosophy.   Mary Ann Eller: That is a really great question, and there's not one answer. And I'd love to bring in your friend, Natalie Douglas, in implementation science to speak on this. I'll tell you what I did and then I'll tell you what a bigger department might do. I have myself and five full-time speech pathologists, We all have varying levels of familiarity with LPAA and we all have been practicing in some form or fashion. So, I did an anonymous survey, and I asked some questions like, “how comfortable are you seeing people with aphasia?”, “have you ever heard of LPAA?”, “how comfortable are you using supported communication techniques?” And I did it anonymously because everybody is not going to want anybody else to know that they're not comfortable with it. So, even if there's just one person on my team who doesn't know LPAA or who isn't comfortable, I don't know who it is, I have an idea, maybe. But I'm going to put it in front of everybody and say, “hey, there's one person on our team who's not comfortable, let's focus on this.” And so that's what I did. My team is fantastic and they are very open.   And so that's what we did. We had some focus teaching on it we watched some of the Aphasia Access videos on supported communication and LPAA. And then we changed our templates to include some tables that I talked about before that have the checklists on them. I think though, and I had a conversation last night with Kim Irby who is the interim chief over at ‘Big' Duke who has like, I don't know, 40 or 50, speech pathologists. And I asked her, I said, “what have you used with bigger departments?” And she had a really good point, she's like, “you know, education alone is not enough, it's not going to produce a behavior change. People are going to think their behavior is changing and they're going to think, through doing LPAA, and they might be. But really, you have to have people be able to be in the moment with a coach and do it together.” That can be tricky. I mean, you've got people with varying levels of comfort, varying egos, varying all sorts of things. And so, she and I thought, you know, I think probably the most practical way would be to educate and then pair people up together as peers and see a person with aphasia. Try things together then come back and let's all talk about it. It's not, “hey, I'm going to go with you as your boss and make sure you're doing this right.” That would be like totally not cool. So, I don't know, again, I want Natalie to tell me how to implement this.   Katie Strong: We all want Natalie to tell us what to do, for sure. But I love this idea of learning together, right? That you're not imposing “this is what you have to do.” But really, you know, because I do think that the LPAA approach takes your own style...Each person delivers it in a different way, right? And it's different with each patient that you're with because it's personalized.   Mary Ann Eller: Absolutely. And you can't teach that. It's not an agenda, it's an attitude and an openness, armed with the goals that you have, and armed with the core values of LPAA.   Katie Strong: Yeah, I do really love and thinking back to the Turkstra article you were talking about and just that importance of therapeutic alliance with our discipline, right? So that then later on, they think about speech pathology as a positive resource to help. Beautiful. Okay, Mary Ann, as we wrap up, do you have any final thoughts you'd like to share with our listeners?   Mary Ann Eller: I want them to remember the permission slip I gave them. I didn't give it to them, Audrey Holland gave it to them in 1989. Okay. And we're carrying it forward and there is a permission slip to work on the communication elephant in the room. Whatever it is, that is your goal. I think, I guess in my mind, early aphasia intervention should be guided by the person with aphasia's need in the moment first, then the bigger picture. I go in with a really, really loose agenda and I'm open to anything. I welcome interruptions and struggles and I think that that is the messiness and the creativity and the joy of using LPAA in acute care.   I've been a patient in the bed for health reasons and I've sat next to my parents in the bed. I think that once you do that you realize how not only practical but necessary it is that we change our focus on communication at this stage of recovery. Because you don't care what the doctor knows, you care that the doctor cares and can explain it to you in a way that you can make your decisions. And that's the power we have. We've all had health care workers and seen them who have been outstanding and who have been terrible. I think we obviously want to be outstanding. And it doesn't take a lot to be outstanding when you know what your job is, which is to help the person with aphasia to communicate and to be understood in whatever supported techniques that we have and that is our job. And I think that is an amazing privilege. Really, I look at it as a privilege. We are inserting ourselves into a person's worst day and we are the person that walks in there and has the power to help them do two of the most important things, eat and communicate.   Katie Strong: I agree.   Mary Ann Eller: So, I think that those are pretty powerful and I think that it's a real privilege to be able to do that.   Katie Strong: Thank you, thank you. I feel like you've just given us some gold that we need to really admire and take out and show off. Right? That we need to let all of it shine and really take these important pieces about changing our practice in acute care. And really helping people be able to understand and have conversations about their health care so they can participate in really important conversations that impact their life.   Mary Ann Eller: I hope so, I hope so. And I'm not a researcher, I have not done papers and you know, all of those kinds of things. And I used to feel a little bit intimidated by that. It's like, well, do I really have anything to say? And I realized as time goes on, it's like, yes, absolutely. And I want to really reach out to the clinicians that are listening to this. Please use your voice. Please reach out for partners. If you hear somebody at a conference or you reach out to me if you want to, if you're listening to this. Just grow your knowledge and grow your ability to this great job that we have.   Katie Strong: Thanks for a real, practical and inspirational conversation.   Mary Ann Eller: Well, thank you for letting me have it.   Katie Strong: Thanks, Mary Ann.   On behalf of Aphasia Access, we thank you for listening to this episode of Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to check out our growing library of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Guest Contact Information   Email Mary Ann at mary.eller@duke.edu   Resources   Aphasia Access LPAA Training Videos (LPAA 101, LPAA, Core Value, Communication Access- Fundamental Techniques) https://www.aphasiaaccess.org/videos/ Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000). Life Participation Approach to Aphasia: A statement of values for the future. ASHA Leader, 5(3). https://leader.pubs.asha.org/doi/10.1044/leader.FTR.05032000.4 Elman, R. J. (2014). Aphasia intervention: Are we missing the forest through the trees? 44th Clinical Aphasiology Conference, St. Simons Island, GA. http://aphasiology.pitt.edu/2529/ Elman, R. J. (2020). C.A.P.E.: A checklist of four essential and evidence-based categories for aphasia intervention. Chapter 2. In A. L. Holland & R. J. Elman (Eds.) Neurogenic communication disorders and the Life Participation Approach: The social imperative in supporting individuals and families (pp. 21-52) Plural Publishing. Holland, A. & Fridriksson, J. (2001). Aphasia management during the early phases of recovery following stroke. American Journal of Speech-Language Pathology, 10(1), 19-28.https://doi.org/10.1044/1058-0360(2001/004) The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. Turkstra, J. S. (2013). Inpatient cognitive rehabilitation: Is it time for a change? Journal of Head Trauma Rehabilitation, 28(4), 332-336. https://doi.org/10.1097/htr.0b013e31828b4f3f     If you liked this episode – more listening… Additional Aphasia Access Conversations Podcast episodes relating to the topic of acute care and applying LPAA to different settings.   Episode #57 Patient-Centered Home Programs Across the Continuum of Care for Individuals with Aphasia: A Conversation with Sarah Baar.   Episode#99 Communication Partner Training for Health Care Professionals with Dr. Jytte Isaksen   Episode #38 Broadening the Role of the SLP in Acute Care Assessment: A Conversation with Robyn O'Halloran   Acknowledgements – A special thank you to Amanda Zalucki from the Strong Story Lab at Central Michigan University for their assistance in the transcription of this episode.

Do you feel exhausted all the time? Are you struggling with juggling everything on your plate? Do you miss having the energy to do the things you love? Our ancestors lived in a time where fight or flight mode ended after a day's hunt. In today's world, however, we have to be “on” at all times, leaving no time for our bodies to rest and recover. Chronic stress wreaks havoc on your immune systems, causing inflammation and exhaustion. The result? No energy to enjoy your life. In this episode, I chat with Kathleen Keller of Vitality about TRE® (Tension, Stress & Trauma Release Exercise) a set of innovative exercises, that assist the body to tremor naturally like you would at the gym, and thereby let go of tension, trauma and stress. I really enjoyed this episode because I learned about an easy, non-pharmaceutical way to heal my body of stress and trauma. If you are looking for tips to get you started, or tips to help you heal from anxiety, PTSD, stress and much more, then you want to listen to this podcast to learn about TRE®.  Episode Highlights with Kathleen Keller: What is TRE®  Benefits of TRE® How TRE® works to alleviate stress Connect with Kathleen Keller via: - Website: https://kellermethodvitality.com/  - Linkedin: linkedin.com/in/kathleen-keller-115408b0 - Facebook: https://www.facebook.com/kellermethodvitality/ - Email: Kathleen.kmv@gmail.com - Telephone: 1.403.615.5776 You'll walk away from this episode clear and confident about the next steps to take and if TRE® is for you.  Rate, Review & Subscribe on Apple Podcasts and Spotify "I love Dr. Adeola Oke and the Wellness Surge Podcast"

The U.S. Department of Veterans Affairs (VA) provides lifelong healthcare services to eligible military veterans at approximately 1,700 VA medical centers and outpatient clinics across the country. While there are many similarities between VA medical centers and any other healthcare facility, there may be some differences accessing bladder and bowel management products through the VA. Guests Dave Merhar and Diana de Avila are veterans with neurogenic bladder and bowel who use intermittent catheters and Peristeen® Plus Transanal Irrigation System to manage the conditions, and guest Danette Brooks is a Coloplast employee. Both Dave and Diana have extensive experience navigating the VA medical center to access their preferred bladder and bowel management products, and Danette is an expert on Coloplast products. In this episode, they'll answer common intermittent catheter and Peristeen Plus product access questions, provide considerations for other veterans managing neurogenic bladder and/or bowel, and help explain veterans' rights to products that meet their needs. Download the podcast guide, request samples,* and access more bladder and bowel resources here!If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for Coloplast Care for free by clicking here or calling 866-226-6362.****Samples available with valid prescription only. Limitations apply. The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Dave and Diana are SpeediCath® catheter and Peristeen® Plus Transanal Irrigation System users who have received compensation from Coloplast to provide this information, and Danette is a Coloplast employee. Each person's situation is unique, so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.Coloplast provides this information for convenience and your general reference only. It does not constitute legal advice or a recommendation regarding clinical practice. Reimbursement, coverage and payment policies can vary from one insurer and region to another and is subject to change without notice. Coloplast does not guarantee coverage or payment of products and Coloplast makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare, VA, insurers, or other payors as to the correct form of billing or the amount that will be paid.

In this week's podcast, Neurology Today's editor-in-chief discusses the increased use of antipsychotics during the pandemic and an associated greater risk for dementia, determining the best biomarkers when considering lecanemab for Alzheimer's, and a novel approach for managing uncomfortable neuropathic symptoms.

In this episode, Dr. Salima Brillman discusses:   The what and why of nOH (neurogenic orthostatic hypotension)  Treatments for nOH  In the moment tricks for managing nOH episodes  How to talk to your doctor about your symptoms  The effect of food and lifestyle choices on nOH    Click here for the accompanying blog post to this episode where you will find any mentioned links and resources, the video recording, and more. 

When considering a treatment strategy for a patient with neurogenic bladder dysfunction, which of the following are the LEAST important goals to consider? Find it all out in this podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.

School-age children are busier than ever making friends, playing sports, and excelling in school – and for the Gagnon family, managing neurogenic bladder and bowel is another important aspect of their busy schedule. Luke Gagnon is an active 9-year-old who stays busy with multiple sports, friends, and school. He was also born with spina bifida and neurogenic bladder and bowel. Early in their journey, Luke's parents helped him use an intermittent catheter and they managed his neurogenic bowel using enemas – which his dad Stefan says was not only ineffective, but also resulted in nausea and vomiting. In their search for a better bowel management method, their family found Peristeen® Transanal Irrigation System (now Peristeen Plus), which they've successfully used for about 5 years. As Luke got older, his parents also wanted to empower him to self-manage his bladder routine, which included helping Luke understand why and how to effectively catheterize and practice with their supervision. By the age of 6, Luke had mastered self-catheterization, which helped him feel independent and confident. In this episode, special guests Stefan and Luke will share their advice for managing neurogenic bladder and bowel along with their tips for training and fitting it into a busy lifestyle – with the goal of providing hope, encouragement, and best practices to other kids and families.  If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for Coloplast Care for free by clicking here or calling 866-226-6362.Access more bladder and bowel resources here.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Stefan is the father of Luke, a SpeediCath® catheter and Peristeen® Plus Transanal Irrigation System user, and they have received compensation from Coloplast to provide this information. Each person's situation is unique, so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

Join us as Dr. Sicolo shares her expertise, experience, and factors to consider when using Transanal Irrigation as a treatment option for neurogenic bowel dysfunction. Guest bio: Dr. Sicolo is the Clinical Assistant Professor of Pediatrics at the Keck School of Medicine at University of Southern California. She serves as the Medical Director of Gastrointestinal Neuromuscular and Motility Disorders Program at Children's Hospital Los Angeles. Her areas of special interest include chronic intestinal pseudo-obstruction, general gastroenterology, motility studies & children with Spina Bifida. She is passionate about education and sharing her expertise with patients and other clinicians.  Visit https://www.coloplast.us/professional/ for more educational offerings. 

The teenage years are often fraught with new challenges for parents, like navigating changing social and interpersonal dynamics, but for families managing neurogenic bladder and bowel the obstacles are multiplied. For Carolina, a Coloplast employee whose daughter Maya was born with spina bifida and neurogenic bladder and bowel, helping Maya independently manage her bladder and bowel routine and live a full life was a primary concern after her diagnoses at the age of 6. In those early years, Carolina recalls the daily struggles of unsuccessful intermittent catheterization – which negatively impacted Maya's social, physical, and emotional wellbeing. Eventually, Carolina found a new urology nurse who shared different catheter options and provided training and education, which was a turning point for Maya. Now, Carolina embraces Maya's condition, and Maya is living her best teenage years. During this episode, Carolina will share the ups and downs of her family's bladder management journey to adolescence and how she's advocated for accommodations to support Maya's independent, full teenage life.Access more bladder and bowel resources or request samples* here!If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for Coloplast Care for free by visiting www.bladder.coloplastcare.us or calling 866-226-6362.****Samples available with valid prescription only. Limitations apply. The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Carolina is a Coloplast employee and parent of a SpeediCath® catheter and Peristeen® Plus Transanal Irrigation System user. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

Contributor: Meghan Hurley, MD Educational Pearls: Syncope is defined as a loss of consciousness with an immediate return to baseline Differential is broad Cardiogenic Structural (aortic stenosis, HOCUM, etc.) Electrical (long QT syndrome, Brugada, etc.) Neurogenic/neurovascular (brain bleed, etc.) Seizure Everything else Hypoglycemia, anemia, and bleeding into the abdominal cavity are some potential causes to rule out Vasovagal Diagnosis of exclusion Work Up EKG Good H&P Labs especially Hb and glucose References Morris J. Emergency department management of syncope. Emerg Med Pract. Jun 2021;23(6):1-24. Reed MJ. Approach to syncope in the emergency department. Emerg Med J. Feb 2019;36(2):108-116. doi:10.1136/emermed-2018-207767   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

Join Caroline for Part 5 of our “What Is Aging?” series covering the digestive system, as well as bowel and bladder continence. We discuss common age related changes like nutrient absorption, digestive motility, constipation, and incontinence. We also talk about the role of physical therapy and health coaching in improving these systems with age.    Courses:  Modern Aging: Physiological Processes and Societal Responses   Related Episodes: Ep 32 Aging Bones and Joints Ep 33 Aging Muscles Ep 34 Aging Nervous System Ep 35 Aging Heart and Lungs Further Reading: Soenen, S., Rayner, C. K., Jones, K. L., & Horowitz, M. (2016). The ageing gastrointestinal tract. Current opinion in clinical nutrition and metabolic care, 19(1), 12–18. https://doi.org/10.1097/MCO.0000000000000238 Ranson, R. N., & Saffrey, M. J. (2015). Neurogenic mechanisms in bladder and bowel ageing. Biogerontology, 16(2), 265–284. https://doi.org/10.1007/s10522-015-9554-3    Work with me  https://carolinemorris.com   

In this episode, we're going to continue discussing our crisis checklists and the ones that relate to distributive shock specifically. Let's talk about what happens during neurogenic shock by discussing a case involving a 34-year-old male that came into the ER after a motor vehicle crash. We'll talk about what you should do if you face this scenario and lay out the checklist to help prioritize care for this patient.   Here are some of the things you'll learn on this show: The details for today's case study and how to set priorities. (3:00) Pathophysiology of neurogenic shock. (6:28) The signs and symptoms that come along with this. (9:43) Breaking down the treatment needed. (13:45) Things to be worried about. (17:26) Vasopressor support, (21:15) Differential diagnoses we should be considering. (26:50)   About our hosts: https://kpatprogram.org/about-the-school/faculty.html  Visit us online: http://beyondthemaskpodcast.com  Get the CE certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf

 Join us as Dr. Sicolo shares her expertise, experience, and factors to consider when using Transanal Irrigation as a treatment option for neurogenic bowel dysfunction.Guest bio: Dr. Sicolo is the Clinical Assistant Professor of Pediatrics at the Keck School of Medicine at University of Southern California. She serves as the Medical Director of Gastrointestinal Neuromuscular and Motility Disorders Program at Children's Hospital Los Angeles. Her areas of special interest include chronic intestinal pseudo-obstruction, general gastroenterology, motility studies & children with Spina Bifida. She is passionate about education and sharing her expertise with patients and other clinicians.  Visit https://www.coloplast.us/professional/ for more educational offerings.

 The Bladder Buzz team is “buzzing” about this podcast- gene therapy for neurogenic bladder!Dr. Argy Stampas interviews Dr. Philippe Chambon, Founder and CEO of EG 427, a French biotechnology company that is pioneering a new treatment strategy for management of neurogenic bladder. Take a listen to hear what all the buzz is about!

During this episode, guest Lori Neal will share her family's bowel management journey after her son Julian was born with spina bifida. Early on, enemas were the only option available to manage Julian's condition, and Lori recalls they were a nightmare. After they stopped working when Julian was five, Lori first tried to create a makeshift system to help her son, but this didn't quite meet his needs. Desperation sent her to social media, where she learned about the Peristeen® Transanal Irrigation System – and the rest is history. Lori will share her and Julian's journey and provide valuable advice, best practices, and encouragement for parents who are caring for a child with neurogenic bowel.If you or a loved one have neurogenic bowel, you may have questions about how to manage the condition and what treatment options are available. It can be difficult – and we're here to help! Our Coloplast® Care program can share clinician-validated education about managing a neurogenic bowel to help you become confident in your routine. If you have questions about Peristeen® Plus and if it might be right for you, call 1-855-605-7594 or click here.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Lori is the parent of a Peristeen Plus Transanal Irrigation System user who has received compensation from Coloplast to provide this information. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

Over 150,000 Americans live with spina bifida, a birth defect that mainly affects the spine and can cause neurogenic bladder or bowel. Sarah was born with spina bifida at the L4/L5 and L5/S1 levels, resulting in a neurogenic bladder and bowel. Sarah has been using the Peristeen® Transanal Irrigation System since 2015 and has recently started using the updated Peristeen® Plus system. She will share her journey through treatment techniques that ultimately led her to Peristeen Plus, along with her tips, advice, and best practices for using the system. If you have neurogenic bowel, you may have questions about how to manage your condition and what treatment options are available to you. It can be difficult – and we're here to help! Our Coloplast® Care program can share information about managing a neurogenic bowel and help you become confident in your routine. If you have questions about Peristeen Plus and if it might be right for you, call 1-855-605-7594 or click here.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Sarah is a Peristeen Plus Transanal Irrigation System user who has received compensation from Coloplast to provide this information. Each person's situation is unique, so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events. 

A review on risk stratification for patients with neurogenic lower urinary tract dysfunction Speaker: Anne P. Cameron, MD, FPMRS

Thomas Cloyd, a digital healthcare professional living in California, reflects on the road to independence after a spinal cord injury at the C5/C6 level left him quadriplegic. After his injury in 2012, Thomas went on to earn a Master of Business Administration from the University of Minnesota Carlson School of Management and found a job in California away from his strong support network back home in Minnesota. Despite moving far from home, Thomas now lives independently and has been able to develop a routine to catheterize on his own – which he believes is a major reason he's been able to live the life he wants. Thomas will share his catheterization best practices, tips and tricks, and advice to help others on the road to independence. If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for Coloplast Care for free by visiting www.bladder.coloplastcare.us or calling 866-226-6362.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Thomas is a SpeediCath® Compact Set user who has received compensation from Coloplast to provide this information. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

Being differently abled in the workplace can be challenging – you might face obstacles that make it difficult to achieve your full potential, which is why having the tools to advocate for yourself and your needs is so important. Guest Bianca Faith Johnson is an ambitious New York native who is also a lawyer, Master of Business Administration candidate, and ordained reverend. Since becoming a paraplegic at the T4/T6 level, Bianca has continued to pursue her diverse passions and excel in the workplace. She will share how she's advocated for herself and for her needs at work, along with adjustments that helped her succeed. She will also share how she fits intermittent catheterization into her life as a busy professional and advice to help make it easier. If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for Coloplast Care for free by visiting www.bladder.coloplastcare.us or calling 866-226-6362.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Bianca is a SpeediCath® Compact Set Female user who has received compensation from Coloplast to provide this information. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

In case you missed the first AVMA convention after the COVID hiatus, Dr. Heller and his guests -- Amy Lloyd, VMD, Chaundra Schofield, VMD, and Kelly Dunham, DVM -- cherry pick some of the interesting tidbits they gathered from the lectures they attended in Philly. Show notes: Toxicity: a. Don't ever give cats hydrogen peroxide!!!! Hemorrhagic gastroenteritis/death. NO SAFE AT HOME REMEDY in cats. b. Use dexdomitor 7mcg/kg IM to cause 81% of cats to puke. Hydromorphone SQ can also work 75% of the time. Xylazine less likely. c. Cholestyramine is a great drug to use when trying to detox a patient who ingested a drug or poison that undergoes enterohepatic recirculation. It's a bile acid sequestrant. d. ILE – Intravenous Lipid Emulsion – helps draw out fat soluble toxicants. (most commonly made of soy bean oil) – great for marijuana toxicosis. Hyperlipidemia: a. Fenofibrate (micronized form) 4-10mg/kg BID – should resolve 80-100% of cases by 1 month. Will require lifelong therapy. b. Low fat diet will treat only 25% of cases. Dermatology update: a. Chlorpactin – study showed powdered chlorine 0.4% solution kills MRSP topically in just 10 secs. Chronic UTI: Nitrofurantoin – given nightly for 4 months can help with deep seeded chronic infections. Feline arthritis: a. Dr. Kristen Shaw gave some great resources for both vets and owners to help to identify cats affected by arthritis during her lecture: i. zoetisus.com/oa-pain/feline-exam-videos.aspx (you can also link to dog OA resources from here) ii. Catoachecklist.com iii. Solensiavetteam.com Carrie Jurney gave a lecture on CPR for the veterinary soul – she broke down veterinary personality types, individual tendencies as well as common work place stressors. a. Two great resources she suggested for suicide prevention training were: b. QPR training – www.qprinstitute.com c. American foundation for suicide prevention – https://afsp.org/ d. www.betterhelp.com/nomv - Get matched with a licensed therapist and enjoy a FREE MONTH of professional online counseling e. Psychology today's therapist finder Many filters including language, gender (including option or non-binary), insurance type, price, ethnicity served, sexuality, and faith Injection site sarcomas a. Can include extraskeletal osteosarcoma (I did not know this!) b. 1-2-3 rule: 1. Increasing in size after 1 month 2. Larger than 2 cm 3. Still present 3 months after vaccine c. 42% recurrence rate with COMPLETE EXCISION d. 21.7% metastatic rate Mary Telle – Keratoconjunctivitis Sicca a. **Neurogenic can be caused by long-term otic preparations like Osurnia and Claro** i. Other causes include trauma, neoplasia, otitis, hypothyroidism ii. Usually unilateral and associated with a crusty ipsilateral nostril iii. Pilocarpine 2% ophthalmic solution given orally at a dose of 1 drop per 10 kgs PO bid to start, but may need to increase based on response iv. Since it is a parasympathomimetic drug, need to watch for toxicity including salivation, vomiting, diarrhea, bradycardia, and weakness

The American Urological Association (AUA), in partnership with the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) released the 2021 clinical guideline for the diagnosis, evaluation, treatment and follow-up of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) in adults.NLUTD is a term used to refer to the abnormal function of either the bladder, bladder neck and/or its sphincters related to a neurologic disorder. Prior terminology commonly used "neurogenic bladder" to describe this condition. With the understanding this is not an issue confined to the bladder, NLUTD is now the preferred way to describe the various voiding issues seen in patients with a neurologic disorder.The focus of this guideline is on the evaluation, treatment and follow up of care for adults with NLUTD. A total of 60 recommendations, including those associated with initial evaluation, autonomic dysreflexia, urinary tract infections, non-surgical and surgical treatment options, as well as follow up and post treatment care are reflected within this new clinical guidance.Highlights include:An algorithm that allows for risk stratification of patients with NLUTD (low-, moderate- or high-risk), helping guide appropriate follow-up and surveillance.Recommendations on which patients need to be monitored for autonomic dysreflexia (AD) during procedures and how to intervene if AD occurs.UTI recommendations focusing on issues such as not treating asymptomatic bacteruria, not obtaining screening urinalysis or culture in asymptomatic patients and the consideration of daily antibiotic prophylaxis for NLUTD patients who manage their bladder with clean intermittent catheterization and have recurrent UTI.Treatment options to improve bladder storage parameters such as oral therapies (antimuscarinics and/or beta-3 agonists) or, if oral therapies fail, onabotulinumtoxinA to improve bladder storage parameters, decrease episodes of incontinence, and improve quality of life measures.David A. Ginsberg, MD is the Chair of the guideline development panel and Professor of Clinical Urology at the University of Southern California, Keck School of MedicineSeth Cohen, MD is an Assistant Clinical Professor of Urology and specialist in Female Pelvic Medicine & Reconstructive Surgery at City of Hope follow him on Twitter at https://twitter.com/drscohen?lang=en

Nearly 1 million Americans live with Multiple Sclerosis (MS), and for many, the disease may cause bladder or bowel issues. MS warriors Julie Stamm and Diana de Avila join us to discuss how their diagnosis impacted bladder and bowel function, their journey exploring treatment options, and how they've adapted today. When Julie Stamm was diagnosed with MS in 2007, one of the most troubling symptoms was bladder dysfunction. After the initial devastation of learning that she would have to use intermittent catheters, Julie's perspective shifted as her catheterization routine helped her continue the activities she enjoys. For Diana, an artist and disabled veteran, finding a noninvasive option to treat neurogenic bowel was paramount. Diana will share how her current treatment regimen has helped her continue pursuing her passions as a digital fine artist working in fractal geometry, augmented reality, and algorithmic art.To try free samples* of SpeediCath® Compact Female mentioned in this episode, visit https://products.coloplast.us/coloplast/continence-care/speedicath/speedicath-compact/speedicath-compact-female/ or call 1-866-226-6362.If you have a neurogenic bowel, you may have questions about how to manage your condition and what treatment options are available to you. It can be difficult – and we're here to help! Our Coloplast® Care program can share clinician-validated education about managing a neurogenic bowel to help you become confident in your routine. If you have questions about Peristeen® Plus and if it might be right for you, call 1-855-605-7594, or visit https://www.coloplastcare.com/en-US/bowel/.*Samples are available with a valid prescription only. Limitations apply.  ***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Diana is a Peristeen® Plus Transanal Irrigation System user and Julie is a SpeediCath® Compact Female user who have received compensation from Coloplast to provide this information. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

Adjusting to using an intermittent catheter can be difficult at the beginning – but it gets easier and can even improve quality of life and support independence. Join Bianca Faith Johnson and Thomas Cloyd as they share their catheterization journeys – from the initial shock of learning they'd have to use intermittent catheters, to how they were trained, and how they've incorporated it into their everyday routine. They'll also share their favorite tips and advice for both male and female intermittent catheter users.If you're new to using an intermittent catheter, Coloplast® Care can help! You can sign up for FREE by visiting www.bladder.coloplastcare.us or calling 866-226-6362.***The material shared within this podcast is for educational purposes only and is based on the personal experiences and learnings of the presenter. Thomas and Bianca are SpeediCath® Compact Set users who received compensation from Coloplast to provide this information. Each person's situation is unique so your experience may not be the same. Talk to your healthcare provider about whether this product is right for you. Nothing within this podcast is intended to be used as medical advice or used to diagnose, treat, cure or prevent any disease. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.

The Real talk: Bladder & Bowel conversations podcast is brought to you by Coloplast® Care, a product and lifestyle educational support program for intermittent catheter and Peristeen® Plus Transanal Irrigation System users. Beginning to use an intermittent catheter or managing a neurogenic bowel may be challenging – you might have questions about your new routine, troubleshooting, and lifestyle – and we're here to help. We believe having real, honest conversations about bladder and bowel management can improve wellness, reduce stigma and foster peer-to-peer support. Join us in conversations with community advocates and thought leaders to gain insights about lifestyle, products, and mindset. Let's have a real talk.  Visit www.bladder.coloplastcare.us for more product and lifestyle educational resources, or call us at 866-226-6362.***Information from Coloplast Care is for educational purposes only. It is not intended to substitute for professional medical advice and should not be interpreted to contain treatment recommendations. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis.

Dr. Mandy Rounds, a Research Fellow at MedStar National Rehabilitation Hospital, interviews Dr. Katie Forster, a pediatric hospitalist and researcher at University of Pittsburgh School of Medicine about the findings of the article, “The association between urine neutrophil gelatinase-associated lipocalin (urine NGAL) and UTI in people with neurogenic lower urinary tract dysfunction”. They discuss the importance of this new type of biomarker (uNGAL) and the implications it has for UTIs in those with neurogenic bladder. To access this journal article, click here:https://www.nature.com/articles/s41393-020-00552-x

Dr Rose Khavari joins us to discuss the intricacies of managing patients with neurogenic urinary dysfunction and where we are headed.

Dr. Mandy Rounds, a Research Fellow at MedStar National Rehabilitation Hospital, interviews Dr. Argy Stampas an Associate Professor in the Department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth and the Director of Spinal Cord Injury Medicine Research at TIRR Memorial Hermann about his article, “Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder: A Randomized Control Pilot Trial”. They discuss this type of tibial nerve stimulation intervention that has been used in other populations and how it is now being used to improve bladder function in those with neurogenic bladder. To access this journal article, click here:https://www.sciencedirect.com/science/article/abs/pii/S1094715921019917?via%3Dihub

Dr. Rena Malik MD discusses Neurogenic lower urinary tract dysfunction 5/21/20