Podcasts about OTS

PelviCon '26 speaker Amy Stein has been one of the pioneers of modern pelvic health.She founded Beyond Basics Physical Therapy, one of the largest cash-based pelvic health practices in the country, authored the groundbreaking books Heal Pelvic Pain and Beating Endo, and has spent more than two decades helping shape the future of pelvic rehabilitation. In this conversation, we talk about how far our profession has come—from a time when there were only a handful of pelvic health courses available to today, where thousands of clinicians are entering the field every year.We also dive into:✅ How Amy built Beyond Basics into one of the country's premier pelvic health practices✅ Why collaboration—not competition—is the future of pelvic health✅ What's changing in our understanding of endometriosis✅ Why every patient deserves a multidisciplinary team✅ The importance of mentorship and lifelong learningAmy will also be joining us at PelviCon 2026 to present two incredible sessions:

Next of Kin After Stroke: When Your 19-Year-Old Has to Decide For You Kylie Ralston was 56, living alone in Sofia, Bulgaria, and getting back into shape after a divorce. Three mornings a week she ran. On the morning everything changed, she was doing a local park run with her friend Rebecca when she slowed to a walk, then tried to run again and couldn’t. “It was like the message wasn’t getting through from my brain to my legs,” she says. No headache. No fatigue. Nothing that felt like an emergency. She finished the run, registered her time, and went home. It wasn’t until she collapsed getting out of the car that anyone understood what was happening. By the time Kylie reached hospital, she had suffered a left frontoparietal haemorrhagic stroke, a spontaneous brain bleed roughly 7.5cm across, with none of the usual risk factors. No high blood pressure. No cholesterol history. No aneurysm, no AVM. She was placed in an induced coma for four days. When she woke, she couldn’t move her right side, and she couldn’t speak. What “Next of Kin” Really Means When a Stroke Hits Abroad Kylie was a permanent resident of Bulgaria, not a citizen, divorced from her daughter’s father, and living on her own. When the hospital needed someone to authorise emergency surgery, there was exactly one person available to make that call: her daughter, then 19 years old, splitting her time between her separated parents’ homes. It’s a detail easy to skim past, but it sits at the centre of this episode: next of kin isn’t a role most of us think about until a hospital needs an answer immediately. Kylie hadn’t nominated her daughter out of any formal planning process; it simply fell to her, because she was the only adult relative in the country who met the age threshold. A 19-Year-Old Signing Consent-to-Operate Forms Kylie’s friends contacted her daughter directly. She rushed to the hospital, and unconscious, unable to advocate for herself, her mother’s care now depended on decisions made by a teenager under enormous duress. Kylie’s first memory afterward is her daughter arriving in the ICU in a hairnet and scrubs, holding her hand, telling her she loved her. It’s the kind of moment that rarely makes it into conversations about stroke recovery, because the focus so often lands on rehabilitation milestones: walking, speaking, returning to work. But before any of that, someone has to be legally empowered to say yes to surgery, and for Kylie, that someone hadn’t expected the responsibility for another few decades. The Gap Between Acute Surgery and Real Rehabilitation Bulgaria’s acute care, Kylie and her friend Nicole Nott both stress, was world-class surgery within roughly two hours of the stroke, the kind of outcome her friends still describe as a miracle given the size of the bleed. What came next was a different story. In the public hospital, physiotherapy visits totalled two sessions. There was no speech therapy. After 14 days, still unable to move her right side or speak, Kylie was expected to go home. Her partner, Guido, refused to accept it, and the couple began privately funding rehabilitation themselves. This is a distinction worth sitting with if you or someone you love is navigating stroke recovery in a country or even a region with limited public rehab funding: acute survival and functional recovery are not the same fight, and they are not always resourced the same way. When a Friend Becomes the Rehab Team Nicole Nott, an occupational therapist and Kylie’s friend since they were 16, found out about the stroke through a message she initially suspected was a scam. Within days she’d cleared her schedule and flown from Australia to Bulgaria. What she found in the private rehab hospital was a caring but under-trained care team, kind staff with, as Nicole puts it, “no rehab expertise.” Nicole spent close to two weeks restructuring Kylie’s room and routine around basic stroke rehabilitation principles: approaching from Kylie’s affected right side to address her spatial inattention, built-up cutlery to force use of her weaker hand, a balloon tapped back and forth for shoulder strength, word games layered on top for speech practice, pegs and curtains repurposed into arm exercises. She also pushed back hard against hospital staff who tried to stop her from helping Kylie transfer to a shower chair or toilet, at one point being told outright she wasn’t permitted because she was a woman. Her single goal before flying home: get Kylie toileting independently again, for dignity as much as mobility. Kylie called her from Dubai airport, mid-transit, to tell her it had happened. Living With Aphasia Fourteen months on, Kylie’s right-side weakness has largely resolved. What remains, she says, is the hardest part: expressive aphasia. “I can’t express myself like I used to.” It’s a small, telling detail of the condition that even the phrase “I can’t” is itself shaped by the aphasia; the words available to describe the loss are affected by the loss. The Unexpected Gains Both women point to what came out of the crisis alongside the hardship: Kylie’s relationship with her daughter deepened. Her circle of friends in Bulgaria proved itself in ways she hadn’t anticipated. And in the rehab hospital, her partner Guido proposed something; he told her he’d already decided before the stroke but simply hadn’t gotten around to asking. If this episode raises questions about who is legally positioned to make decisions for you and whether that person actually knows it, it may be worth a conversation with your own family before a crisis forces the issue. For a deeper account of navigating identity, recovery, and unexpected transformation after stroke, Bill’s book The Unexpected Way That A Stroke Became The Best Thing That Happened is available at recoveryafterstroke.com/book. If this show has helped you, you can support it at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Kylie Ralston: Stroke, Bulgaria, and the Friend Who Flew Across the World When Kylie had a stroke abroad, her 19-year-old daughter became her next of kin, and a friend flew in to help her recover. Bill’s Book: The Unexpected Way That A Stroke Became The Best Thing That Happened Support the Recovery After Stroke On Patreon Highlights: 00:00 Introduction – Next of Kin After Stroke03:47 The Day of the Stroke08:55 Rehabilitation Challenges in Bulgaria16:32 Coping with Language Barriers22:08 Reflections on Healthcare Systems32:50 Setting Goals and Achievements38:29 Family Dynamics and Support Systems45:36 Finding Meaning in Recovery54:44 The Impact of Caregiving58:22 Reflections on Recovery and Gratitude Transcript: Introduction – Next of Kin After Stroke Bill Gasiamis (00:00)And one of my first horrible thoughts was, is this a dreadful hoax? Is someone, you know, is this some horrible scam? And it made me feel quite sick actually And then I rang her son who lives in Australia and he’s like, Yeah, I’m so sorry. I haven’t told you. Yes, it’s true, mum’s had a stroke. Bill Gasiamis (00:16)Welcome back to Recovery After Stroke. I’m Bill Gasiamis, and today I’m joined by two guests, Kylie Ralston and her friend Nicole Nott. Kylie was 56 living in Bulgaria when she suffered a left frontoparietal hemorrhagic stroke, a spontaneous brain bleed with none of the usual risk factors. Nicole is an occupational therapist and one of Kylie’s closest friends since they were teenagers. And when she found out what happened, she got on a plane to Bulgaria to help. In this episode, we get into what it means to have a stroke far from home in a country where you don’t speak the language, and public rehabilitation funding barely exists. We talk about who becomes your next of kin when you least expect it, what it’s like to advocate for a friend inside a hospital system that won’t always listen. And what recovery actually looks like 14 months on, before we get into it, if you want a deeper look at identity, recovery, and unexpected transformation after stroke, my book, The Unexpected Way That Stroke Became, the best thing that happened, is available at recoveryafterstroke.com/book. And if this show has helped you And you can support it to keep me on the path of getting to a thousand episodes, you can do so At patreon.com/recoveryafterstroke Bill Gasiamis (01:37)Kylie Ralston and Nicole Nott, welcome to the podcast. lovely to be here, Bill. Thanks for having us, Bill. Kylie, tell me a little bit about what life was like before the stroke. I was very active and I had a full life and I was working full time. and I was living in Sofia in Bulgaria, in my on my own, in my own apartment. I was renting, actually. and I was getting back to fitness. So I was g getting I was running regularly. So two two or three times a week I was hitting the gym and hitting the tr the treadmill. And that had been happening for like a few month like six months or something like that. but before that I was very fit and active. What kind of work were you involved in? I was a HR work. I was a ha HR leader and so I had my own consultancy I had a team of people that I’ve managed. I had thirty five people, so and that they were people in Germany, Poland, Czechia, Portugal, France, so everywhere in in Europe, basically. Yeah. Wow, how how does an Aussie end up in Bulgaria with staff or clients in that many countries? short answer is I came here with my family, so with my ex husband. and shortly after I arrived we separated and and ultimately got divorced. and I stayed on because my daughter is here. So she was only eleven at the time and I could just couldn’t leave her. The Day of the Stroke So you were living at home with your daughter? she was sharing her time between between us both. Yeah. got it. Okay. So both parents are there. So your daughter was going backwards and forwards. On the night of the stroke or on the day of the stroke, can you take us through that? What were you experiencing? Was there anything unusual that happened that made you think something was wrong? How did it go down? I was with my friend Rebecca. And she was running ahead of me as she she was faster than me, so sh and she often often ran ahead of me. and I’d slowed down to a walk and when I started to run again or try to run again, it it was like the message wasn’t getting through from my brain to my legs. And I thought, that’s strange, that’s that’s really odd. ‘Cause I didn’t feel like tired or anything and I didn’t have a headache and well stuff like that. and I just walked through the rest of the park run. And then when Rebecca saw me coming to the finish line, she waved me over and she said, come on, let’s go register your chip. and so I did that. and she said afterwards that there was a little bit of fumbling with with my phone and there’s a there was a little bit of fumbling when I put my jacket on, but other than that, I just seemed exhausted from a run. do you recall after the experience of feeling exhausted from the run where you ended up? Did you need help? Yeah, I do. So so she didn’t notice that I wasn’t talking because I n I’m normally an endless talker, so I she didn’t notice that I wasn’t talking. And she said that that that is one thing that should have alerted her to what was happening. but it it didn’t. And so I’d caught the bus to the park run and her husband was there and so he drove me home. And I j I remember the journey home and when when we when I went to get out, I just couldn’t. And so and Mark came around to my side of the car and help tried to help me out and I just collapsed against him. And so then that so then they said, quick, something’s wrong something’s I don’t remember what they  They they said, you know, they basically took me straight to the hospital. Yeah. And also rang Guido, my now fiance, but my partner at the time. Uh-huh. So you you went from the run, attempted to go home, and then from that attempt to get you out of the car, actually into your home, it was pretty clear that that wasn’t gonna happen and you ended up in hospital. so Did you guys drive to hospital? Do you recall that? Yes. Yes. We do how far is it from your home? it’s pretty close. I don’t know about kilometres or time, but it’s but it’s like ten or fifteen minutes. Yeah, so it’s not too far. But they didn’t know what was going on, of course. They just knew something wasn’t right and then they figured one of the best things to do is just get it to a hospital. You get to the hospital Do you know what happens after that? Do you get admitted? do you get tested for anything? I suppose what I’m asking is when is the first time you realise that that you’ve had a stroke? When do they report that back? When I came out of the coma. So I was put I was put into an an induced coma straight away. so I I obviously don’t remember anything of of that. and but Rebecca’s told me afterwards. so she’s filled in the f filled in the filled in the blanks for me. and by that stage her husband thought it was a stroke. So she’s he said he said to the staff at the hospital, we think she’s having a stroke. And so yeah. So how long were you in the coma, do you know? Has somebody told you how long it was? Yeah, four four days. Four days, okay. And do you know what kind of stroke you had? Yep. I had a left Frontoparietal hemorrhagic stroke. Wow, that’s a good effort. So you had a brain bleed. Yep. Do they know what caused it? No. It was spontaneous and I didn’t have any of the risk factors. So I didn’t have high blood pressure, a history of high blood pressure, but admittedly I’d hadn’t tested my blood pressure immediately before the stroke. but you know That’s un that’s unlikely to be the cause. And I didn’t have a hi a history of high cholesterol. and so they just and I didn’t have an aneurysm and I didn’t have like what’s the other thing? The An AV AVM. AVM, yeah, I didn’t have any of that. And how old were you? Fifty six. Okay. So you had a spontaneous Bleed in the brain. That happens. People do have that happen from time to time. And sometimes they don’t have any symptoms leading up to it or anything like that. and this is the bizarre nature of like there’s an unlimited number of ways, unfortunately, for people to have a stroke. Now, you woke up in hospital four days later. What kind of deficits did you have? I couldn’t move my right side and I couldn’t speak. Okay. Now I’ve got an idea of well, I haven’t got an idea, but my mind immediately kind of says like if you’re in hospital in Bulgaria, that’s not a hospital in Melbourne. That’s not the Royal Melbourne hospital where no shit is unreal, like it’s perfect and it’s got the highest technology and it doesn’t matter how many things we can bitch and moan about the system being here like compared to Bulgaria, my expectation is that we’re world class. Perhaps that’s not the case in Bulgaria. Would you agree with that statement? I would have agreed before and my my my expat friends here would have agreed before, but now we’re all saying maybe Bulgaria is better than we thought. That’s brilliant. Awesome. Okay, so Rehabilitation Challenges in Bulgaria As far as like medical interventions and all that type of stuff, you felt like that was handled like any other world class hospital would have handled it. Yeah. In that in that s it in that stage it was. but there’s no like that was a public hospital and there’s no there’s no public funded rehab after. or or very li very little. So so that’s where that’s where Australia is ahead. So when you knew you had deficits, was there any rehabilitation whatsoever? Did you get any of that while you were still in hospital? Minimal. So the the physio came to see me twice. and so that’s so that’s all and I got no speech therapy and stuff like that. and but when I was discharged from the public hospital here and went and so they they expected me to go home from the public hospital. And so Guido said she just can’t like like what what the fuck? After how many days? After how many days, how long? Fourteen. Wow, your right side was still offline and you still had problem. Yeah. Okay. So we we just paid for paid for private rehab. got it, right. Yeah. And how long were you in private rehab for? another like two months or something like that. Right. Okay, that’s pretty cool. So i even though you couldn’t access it publicly, you were still able to Access a private now. Are you a citizen in Bulgaria? Not a citizen, a permanent resident. Okay. So do you have are you as a result of the fact that you’re a permanent resident and not a citizen, do you have different things that you are able to access because of your status? No. no. I’m it’s I have the same rights as a citizen. The only one the only right I don’t have is I’m I’m not able to vote here and I’m not I’m not able to work in other EU countries. Got it. Okay. So that’s pretty traumatizing, the whole experience, and then to have to deal with overcoming your left side and your speech deficits after the two month mark, roughly where were you at where you where you are now? Because you kinda sound pretty good. Okay. No, yeah. no and and the other thing the other thing that I must say about Bulgaria is I don’t speak Bulgarian. very very little. So that was a problem. Yeah. I can imagine, yeah. so maybe you can come in here, Nicole, and and talk about where I was at when you came to see me, because that was very very very early on in my in in the private rehab hospital. Yeah, Nicole, tell me a little bit about what it’s like to receive a phone call to find out that your friend has had a stroke. I was absolutely hellish. the way I found out is I got a message through social media from someone saying, Hey, I’m a friend of Kylie’s and she’s in hospital in Bulgaria. And one of my first horrible thoughts was, is this a dreadful hoax? Is someone, you know, is this some horrible scam? And it really, you know, it made me feel quite sick actually thinking this is that’s not someone I know. It does look like a name I’ve seen in Kylie’s kind of social media world. And then I rang her son who lives in Australia and he’s like, Yeah, I’m so sorry. I haven’t told you. Yes, it’s true, mum’s had a stroke. and I was kind of beside myself because by training I’m an occupational therapist, but Kylie and I have known each other each other since we were about 16. and it was really hard to get the information that I wanted as a friend, but also as a health professional. I was wanting to understand what kind of stroke is it? Where is it? What’s the rehab? What can we do? How’s it going? And at that stage the information that I had was that you know, it was really seriously affected the speech part of the brain and obviously the hemiplegia, the weakness down the right side and knowing that Kylie was right handed. so, you know, it’s the friendship part that your heart’s breaking and it’s also the therapist part that’s wanting the information to be able to, you know, reconcile it for myself, professionally what that was going to look like as a consequence for Kylie. Yeah, and you’re so far away, so you really can’t do anything and kind of have to like take information second hand, third hand, and be kind of in a position which is really uncomfortable for, I imagine, a friend, but also a therapist, right? So as an occupational therapist, that’s not the information you work on. You work on actual facts, scans, reports, like a whole bunch of things. So are you also playing it out in your mind? Are you kind of Doom thinking it, like are you how does it affect you personally? I think for me I was all I was really very conscious of not stressing other people. So like friends, family, because sometimes when you are a health professional, you know, you have knowledge and information and you know, you sometimes you you’re keeping that to yourself to some extent because you do know what can happen to people and you do know what consequences can be. So I was really trying not to ask too many questions of people as well. but I was seriously desperate for information. And so I remember I’d gone to a party and I didn’t really want to go because I was actually, you know, upset and stressed for Kylie. And I did end up going to a party and during the party I was really kind of outside having a bit of a downer really by a campfire. but I got a phone call or a message to say that I think you’d said some words, Kylie, and were kind of waking up. so you’re still in the acute hospital then and that you’d been able to move your leg a little bit, I think. Yeah. And you know, joy in that moment. And yeah, I felt very, very far away. And then What happens over the next few days? Like do you guys continue to communicate somehow? Do you keep getting information? Are you being updated? Yeah. Yeah. I wasn’t able to get my into my phone or my any of my devices. So I wasn’t able to able to because I couldn’t remember my password, right? And so and and I tried like d different ones and I you know I just got locked out. So and when I was able to get in then that made it it made it easier t because I was able just text short messages. So so Nicole and I kept in touch that way. and before English-speaking Before you came, Nicole, I think I was talking, but not not not as well as I am now. Yeah. So was it, Nicole, in your mind, you were always going to fly over to Bulgaria and beath your friend? Or did you guys have to work that out? Like what happened now? It’s so cool that you get to have a somebody in your corner that is also a Fred, but also a medical professional in the exact field that you’re struggling with now. Right. Like how do you just drop everything and go overseas and be with your friend? Yeah, well, very grateful that I had an up to date passport. So that was that was a good thing. Kylie, it was interesting because the texting, like if I go back and look at that history, it’s like you can see the progress in the texts. So you can see that Kylie was using kind of more single words and having struggles with spelling and putting sentences together. And then over time, you know, they became more fluent. but the thing that happened was that Kylie and I were talking and she was able to you know, she got some speech back and we were talking. And she was just saying about the rehab care that the the the kind of caring staff just seemed to have no rehab expertise. So the physios were amazing. I think they were great. There was no active speech therapy for Kylie. I think we ultimately found an English speaking speech therapist but who still had Bulgarian as a first language. And there’s very few occupational therapists in Bulgaria, seems to be some expats. And Kylie was talking to me a jab about just you know, really basic things like not being taken to the toilet. and that’s probably what broke my heart. It’s like I cannot leave her in bed, not being able to go to the toilet. I just can’t do it. And so I just said to my partner, I think I just need to go to Bulgaria. And luckily I’m self-employed. So I just kind of cleared my schedule, got on a plane and yeah, I was just I suppose I’m incredibly grateful to have the skill. incredibly grateful to have the financial ability to do it. and yeah, and the skills to do it. And you know, you don’t always get an opportunity in life to do the right thing, or sometimes you don’t make that decision and later you think, Why didn’t I do X, Y, and Z? I try not to live my life like that. I try to actually do those things. So, yeah, I got on a plane and basically arrived at the airport, got on a train straight out to see Kylie at the Rehope Hospital. You’re a real superhero. I’m very grateful to Nicole. Yeah. I rec you know, my story is kind of well, it has a similar kind of thread to it. I one of my best friends is a radiographer and he was a radiographer at the Royal Melbourne Hospital where I was a patient for nearly two and a half years because I was in and out with a number of brain hemorrhages. I had three in total in the same spot, but over two and a half years, then I had brain surgery. And I can’t tell you how many scans I had, but being a radiographer, he was the one who was in the room taking the photos through the MRI. Yeah. And then he would come out. And he would tell us what he saw in the RI, which was against the rules. that’s why I won’t name him. But but that meant that we didn’t have to wait a month to get our results and the the meeting for the results was just more of we’ll go through the process and and have the meeting. Yeah. And and and it was like and I regretted my life when at school I used to throw his books on the roof of the canteen just to mess with him going to s to class late to get in trouble. and I’ve apologised profusely for that and thanked him every day for the fact that, you know, he was able to lend his well, you know, he was able to be in the room. He was able to have that conversation with us and he was able to ease our minds. over that two and a half year period and then you won’t believe it. Like his daughter had an AVM at seventeen. And she went through that and and has recovered from that somewhat now in the last few years. and I got to be I mean I hate that I had to be this guy, but I got to be the guy that supported him through that really acute phase and There is just nothing to describe what it’s like to be able to a repay the favor. and then but B, when I was in that situation to have somebody kind of well, you know, like put their arm around me and really walk me through every stage. Me and my wife and my family walk us through every stage of that part of it, other than intervening as a brain surgeon. But he was the one that put us in char in in touch with my brain surgeon. like Everything that happened was just the most amazing experience to be able to be guided like that. And I know it’s a privilege and many people don’t get that opportunity. so I see Chris, I haven’t told him this in person. I see him as like a bit of a superhero, but he doesn’t know that. I’ve told him I love him in the way men tell each other that they love each other by s abusing him and swearing at him and telling him that the team that he follows is terrible and all that kind of stuff. Reflections on Healthcare Systems so you arrived in Bulgaria. take me from the airport to the hospital. Like what happens? How is that? Actually the flight was really good. Customs was pretty easy. There was some annoying folk in front of me who I wanted to punch in the face and tell them to hurry up, but I was just, you know, needed to to get there. Kylie’s daughter met me at the airport. And then we got the train together out to the hospital. So, you know, obviously I’m seeing my first sight of Bulgaria. I’d never been there before. so not really taking a tourist route at this point. so went out to see Kylie. And, you know, when you just eyeball someone and I, you know, just thank God I’m here, I’m in front of her. Her she’d had a shaved head. she had some pretty spectacular surgical scars, a couple of very big scabs still on her head. she looked skinny, she looked pale, she had started doing a little bit of movement and the hospital room was really kind basic and crazy. Her friends had funded a pressure mattress for her that didn’t exist. And some of these things I had been liaising with Kylie’s friends in Bulgaria about what could we do, how you know, what do we want to prevent? So we want to prevent anyone pulling on from. Her weak shoulders and like don’t let anyone pull her by the arm. this is how I want, you know, to help her with posture in bed or in sitting. and you know, like speaking in single kind of actions at a time and just take your time, say something, wait, wait, wait, wait, wait. Just allow Kylie’s brain to, you know, take that information on board. Don’t speak for her. and when I got there, it was really clear that. She had an inattention to the right hand side as an effect from the stroke. So then I was a bit of a ball breaker, rearranging the whole room. No, no, no, no, no. Where, you know, everyone come from the right, everyone sit on the right. no cutler, you’re not allowed to have your phone in your left hand, you’re having your phone in your right hand. I’d taken some things with me from Australia to Bulgaria that I thought she might need. like some built-up cutlery, because I wanted her to use her right hand to feed herself. I took a couple of kind of activities that I thought we could do to look at some retraining for the right arm. what I’ll still bring with me, try to remember now. Benjamin. So yeah, just try kind of going into early stroke rehab principles. Yeah. Did you go there well you went there as a friend. But when you were there, were you able to be a professional and also have a conversation with the local team? Kylie and I laughing. Do you want to tell that story, Kylie? Which one are you thinking about? Where I got told off. No, I don’t remember that. well, Kylie was in act like, you know, there was still quite a lot of weakness, but she was also so determined for her own rehab. And in the system there their carers really don’t have a rehab focus. They have a I’ll provide you a meal focus and I’ll occasionally do some cleaning and I’ll occasionally change the bed linen and but really not a rehab focus. So I’ve personally found it quite easy to help Kylie to like stand move. And so the very first weekend I was there, it was a long weekend and what I didn’t realise later was that they were actually quite understaffed. Which worked in our favour because I was helping Kylie to get onto a shower chair, taking her to have a shower, us taking her to the toilet, because prior to that time they were just, you know, using pads for toileting because Kylie couldn’t stand up or move on her own. And because I’m trained, I found it very easy. She’s a lightweight person and she and I just work together and I could do that. I think it was the Tuesday, person who I refer to as Nurse Ratchet. remembering now kind of intercepted me bringing Kylie back from the bathroom to her room and just like, nope, nope, nope, nope, nope, nope, nope. What are you doing? Stop that, stop that, stop that. and you know, she and I are having a bit of a a discussion. And basically she’s refused and I’m allowed to move Kylie. So Kylie is sitting out in the corridor. I think I’d luckily kind of covered you up for privacy. and she’s like, No, you’re not allowed to move her. I’m gonna go and get the physio. I think at least forty minutes went by and then she comes back, well, okay, and I said, Look, I am a trained person, it’s easy, it’s safe. no, I’ll think about it. And then after I think another fifteen minutes she pushed your chair into the bedroom. And then I think it was probably another fifteen minutes where she just decided to move Kylie herself at that point. even though that was out of policy and the physios had to do it. And then it was all this discussion with me that you can’t do it. And in the end it was you can’t do it because you’re a woman. Not strong enough, you know. so yeah. Then Kylie and I kind of would go on clandestine missions because again, from a rehab point of view, being able to stand transfer, it’s putting all the weight through the leg, it’s giving feedback to the brain. I really wanted to make sure Kylie’s bladder and bowel were gonna work properly. And you know, sitting in bed and that’s just not ideal. So then Kylie’s like, Nicole, I want to go to the toilet. I was like, I’m banned, I’m banned, Mother Nurse Ratchet, I’m not allowed to take you. And I was like, shit. So I would go on a little mission, go look down the corridor, make sure she was nowhere to be seen. And then I quickly stole the shower chair and then I found a bucket. And so Kylie and I were doing secret Wii missions in the bedroom. until w on one of our missions I just hadn’t quite got the bucket in the right place. And so then I it was also then later on a cleaning mission. So it was it was a pretty crazy environment. yeah, just for that lack of t whole team approach to rehab. Whereas, you know, in Australia the nurses would all be rehab trained. They would be transferring someone physios would come in, speech would be coming, OTs would be coming. So I was kind of desperately trying to convince Kylie or to get her rehab to a standard where she’d be able to come back to Australia to get some more rehab. You know what’s good about this conversation other than the hilarious nature of it also is that I as an as a person who hadn’t had a stroke before my hadn’t known anyone who had a stroke before my experience, if I had come across somebody who had had a stroke, I wouldn’t have known what to look out for and what to say to support them in a situation where perhaps something was being neglected. Because I don’t know what I don’t know. I’m not a professional, right? Just like those nurses and therapists that weren’t specifically trained. Yeah. In certain things. I mean, you may as well be not only talking a different language, but you may as well be making it up as you go because as far as they know, now this is what we do for stroke patients. This is how we handle that. is it a lack of understanding of what r stroke rehabilitation requires, or is it a lack of resources, or is it a little bit of both? Do you feel in Bulgaria when you were there? I think I think it’s a lack of of all all of that but it’s the lack of maybe money. So it’s a lack of training. So th there’s there’s not enough there’s not the the nurses or the orderlies or whatever they’re called here, are are aren’t paid very much. So they so And t just like, even though I was in a private rehab hospital, so you would have expected that more. It’s you would have expected more, but I just think that they just don’t have the money to to train those people. Yeah. it wasn’t really a role, was it, Kylie? Like they really were more like housekeepers in a sense. It was more like cleaning a meals. I have to say the physios were excellent. and a lot of the physios had good English as well, which was for your rehab was so important. because again a lot of the carers they would come into the room and you know, again, just from a speech therapy point of view, in Australia, say if someone came into the room who was the person who did the menus or filled up the water bottles or the cleaners, Kyler could have spoken to all of those people and had   incidental communication the whole day in English. But because of all of those p incidental people coming in didn’t speak English, you know, reasonably in Bulgaria. it just for me, I was worried about the lack of just exposure to English language as well. So not even speech therapy, just incidental language through the day. Which is very helpful and people don’t realise how helpful it is to be able to speak to a nurse about how you’re feeling or what’s happening. Yeah. And all the usual stuff. And Kylie’s chatty and friendly and she would have just been having conversations galore, but it just it it it couldn’t be. Yeah. Yeah, it’s another another barrier. so you know when you go overseas, it’s your friend and you’re a professional. How do you handle that? Because you know, like are you emotional? Are you trying to put a lid on it? Are you allowing yourself to Gonna be emotional. How does that work? We had some killer laughs, didn’t we? I mean, I’m a joker anyway. And so, like the first time Kylie got to do a poo on the toilet, I just did a poo dance for her. So I I felt half my job was you know, cheering her up and keeping it light and having fun and chatting about stuff we would just always chat about. as well as doing as much rehab because it was very exhausting because, you know, p after a stroke, it’s very fatiguing. you know, so to Kylie was really tired and needed lots of rest. So and because I had just you know, obviously dropped tools to go over quickly, I was just working sometimes. So I just have my computer and if Kylie was asleep I’d just stay with her and and her partner Guido as well, who was there with her as well. So just, you know, emotional support wise. But Yeah, I do some work. And I stayed in Kylie’s apartment. So I w was I just stayed at her place and I I train out to see her each day at the hospital. W how many hours would you spend in hospital with her? What do you think, Kylie? you would often arrive at like ten in the morning and you wouldn’t go till like five in the evening or six in the evening. Yeah. So technically visiting hours kind of finished at six. So I just try and stay most of the day. A full shift. Yeah. Yeah. Unpaid. Unpaid labour. Slave driver. Yeah. yeah. But nah. That’s what friends are for. I very what I very much wanted to stay the whole day because I did really, really wanna like especially the toileting thing. I just really wanted that. Setting Goals and Achievements I had this bit of a goal for myself for Kylie that she would be able to take herself to the toilet before I left the country. So just from a dignity point of view, from a mobility point of view, transfers, you know, bladder control. So yeah, that was one of my big goals. And she rang me when I was in transit at Dubai Airport on my way back to Australia and said, Nicole, I just took myself to the toilet. Wow, that’s cool. Yeah. Yeah. And and I was having physio two physio sessions a d a wi a day. So I was having other than Nicole. So I was having like about one session about of about an hour in the morning and one session of about an hour in the in the afternoon. Got it. You Kylie seem like pretty mm chill, pretty calm. how are you handling it though, emotionally? How’s the aftermath Treating you because there’s a little bit of you know, there’s all that acute stuff. It’s awesome when your friend is there, but then your friend goes home, right? So how how does that transition kind of happen? Yeah, I might start crying. because I’ve just recently spent seven months in Australia. So I I went to Australia in October last year and I came back in just in May. and I had more rehab there. So I had I had student led rehab at at first and then I got in got accepted into Birch, which is the brain injury rehab community and home in Ad in Adelaide. so that’s that is is a whole team of people. So I had I had physio and I and a occupational therapist and a a e exercise physiologist and a speech therapist and stuff like that so I th that’s really good. now the most frustrating part for me is the aphasia so I I can’t I can’t express myself like I used to. Yeah. You know what I love about interviewing people who have aphasia is when they say I can’t in a sentence to describe something to me it triggers the part of the condition which doesn’t allow the words to come out. It’s so interesting. That happens so so often. And it’s just a for me, I noticed this I’m saying it just from a perspective is maybe I can’t is not the right word. I don’t know. You might remember this, you might not, but maybe I can’t is not the right word. Maybe the right word is Something that helps you get to the word that you need to get to. And okay, now that’s just me, the uneducated stroke survivor on a phasia guy. Like I don’t know about that. But it’s so interesting, it happens every time. but then Nicole goes home, you go home, your partner is kind of now taking over the caregiving role, and you still have some deficits. phage is one of them. what about your right side? How offline was it? I I also moved in with Guido after the after the stroke. So so that was that was a has was ha was and has continues to be a challenge because we’re still getting used to living together because we weren’t living together before. and I was very in very independent before. And I was living in Sofia and he and he and I now live in a in a village. So I live in in a village just outside of Sofia. And I’m not driving yet. but I was medically cleared to drive in Australia before I left. So I’m going through the process here. so anyway, all of all of those things together make it very challenging. don’t get me wrong, I I l I love him, but but you know, and and I d and and I made that decision because my apartment is was was on the fourth floor and th there was no lift. Wow. Yeah. So back to your question. When I was when I was when I came here, when I was discharged, I continued with as an outpatient and and the physio continued to come at home twice a week. So I was having more physio maybe like five times a week. and like it were ha had started to come my right side had was all already back online, but I would I was just working on building strength and and I would get still very tired. Yeah. And did your daughter end up coming to live with you as well? No. but she she at the beginning she she was my next of kin. So at the ripe old age of nineteen, she signed the consent to operate forms. yeah, so that was that was very difficult for her. I didn’t know that at the time, obviously. but yeah. And did that happen, did she become your next of kin because your former partner, her dad, and you had separated and then his that role wasn’t gonna be his anymore. It’s just passed down to the person who was the closest to you. Like how did that happen? Family Dynamics and Support Systems We’re divorced. I I’m divorced from her dad. Yeah. So he’s definitely not my next kin. Right. So that ha changed after the divorce and she was the only person you could nominate because she was over is there an age limit to the next of kin? Eighteen. Yeah. Okay. So she had hit that criteria, you nominated her and then at nineteen she got to make a decision. Which she never and you never would have expected ever for that to be a thing. I didn’t nominate her, it would just happen. So I was I I was unconscious at the time that she signed those forms. So yeah. So my friends actually contacted her. and she she rushed to the hospital. so it was all under duress. It was like this is what happened to your mum, you’re her Next of kin, whether you like it or not, you have to decide. Yeah. Far out. Okay, that’s pretty full on for a 19 year old. Yeah. Yeah, seems like she did a good job. How did she handle this whole mum’s not well situation, this stroke thing? Like how did she deal with it? she was very good. my first memory actually is of her coming into the ICU with with the with the whole, you know, the whole like the the hairnet and the mask and the and the and the what’s it called the scrubs. Scrubs, yeah. and she held my hand and said t that she loved me. so that was pretty special. And incidentally I have an a another memory of Guido coming into the ICU as well and singing singing to me. So he he said that he said that I always wanted him to sing and he refused before. And so did did I want him to sing to me now? And I squeezed his hand or on the on the left he’s was holding my left hand and I squeezed his hand and so he knelt down beside my bed and started singing. Wow. Can he actually hold the tune or is he hard to hear? Yes, see he’s he’s very musical. Okay. Thank God. If my wife had asked me to sing a w if I had asked my wife to sing, it wouldn’t have been a good experience at all for either of us. Yeah, he was he was a busker in i in his younger years. Yeah. and now he decided to come good. Fair enough. Well that that’s important. You know, things like that are important. It lightens the the mood and it makes Yeah. You kind of feel like your family’s around and that you know you know, maybe kind of things might be all right. Like it gives that glimmer of hope. Is that how you received it? Yeah, I did. yeah, but I’m also very, very determined. So I’m a I’m a very normally very strong woman and so everyone said to me that if if well not to me, but w we had a we had a group WhatsApp chat so and I was added to it later and everyone said in that that if anyone can get through this, Kylie can. Yeah. So you know when you’re told you’ve had a stroke, you wake up with all the deficits and everything. Are you like how do you take it? I woke up, couldn’t use my left side. I I did not for one minute. It did not cross my mind like for one minute that this is not a good thing. Like I mean, clearly I wasn’t able to move, etcetera. But it never kinda went a lifesaver, I’m fucked. Like I never had that happen. Me as well. yeah. I I’d I’ve never thought that. I don’t know whether I even thought that It was n like you said, that was not a good thing. I just put one foot in front of the other and or not literally, but the Yeah. Metaphorically. Yeah. Metaphorically. so one foot in front of the other and just got on with it. Yeah. Nicole, like you come across in your work, you come across a lot of different versions of patience, right? Like you get people who might just be by design more negative to a bad experience and then people that are half class full to a bad experience. Just from a professional perspective, what’s the difference like when you’re trying to rehabilitate somebody that has kind of that different mindset? From perhaps what Kylie and I described. Yeah, I mean I’m probably in the last half full camp as well. So as an OT, I suppose we always meet people where they’re at. because everyone is a combination of their past experiences, aren’t they? So and cultural things, like there’s a very significant cultural differences in how people respond to pain or disability and expectations of kind of family and I suppose cultural expectations in Australia are even about you know, what what what should be publicly available. So, you know, from an expectations point of view, I think a lot of it is based on, you know, previous experience. So as a therapist, we’re obviously there to support, you know, emotional well being, physical well being, and try and find the things for people that connect with them. So meaningful, like OTs are our absolute core is meaningful occupation. So how do we find something that’s meaningful to that person that we think is going to get them from kind of, you know, here to there and it’s gonna be very different different motivators, you know. Kylie is probably, you know, very self motivated as described. Sometimes it’s about people really have a d strong desire to get back to work, or people have a really strong family structure that they want to be able to get back to do something with their family. So finding the way or the thing hopefully that’s going to motivate them. But we certainly work with people who you know, have a high level of distress from what’s happened to them and and on an ongoing basis. One of the things I’ve got a little quote on my desk that you can’t see here, but it says, I’m still me, just a different version of me. And it’s what someone one of my clients told me recently who has MS. and often we find need to find the new version of someone. and the new meaning for someone if that, you know, needs to happen. So that’s our great challenge, I suppose. That’s a big job, especially very early on when identity is so tied up into who they were literally days ago. You know, like a week ago. The mobile person, the working person, the money making person, the father, the mother, the whatever. Finding Meaning in Recovery And then, you know, you’re dealing with a physical crisis, the existential crisis, the identity crisis, like you’re dealing with it all in the one moment, and you’re trying to get them to sort of see, well, you know, you’re still you and how we’re gonna move forward with the still you person, like we’re still gonna move forward with that person. And then later does come an adjustment of what that you looks like. did for me like it’s a massive adjustment into what me looks like. But my identity wasn’t so much tied up in a one label specifically, although, you know, I s I was the person who felt like they needed to be the main breadwinner, you know, that you know ran a business that did all these things. I I had a big strong identity. But I think one of the things this is going to sound weird or might even sound logical depending on like w who you are and why you’re listening to this podcast. But for me, the fact that my brain went offline was a really good thing because it and that allowed my emotional side to come to the fore. Like it really enabled me to see things with a different intelligence, you know, and access part of me that my emotional intelligence perhaps that I hadn’t that I perhaps suppressed previously, you know, and just battled through things. And that kind of allowed my identity to come with me, it allowed me to leave some stuff behind and allowed me to bring into my identity this emotional side of me, you know, which who cried, who got excited about new and different opportunities, you know, that my head didn’t convince me out of. You know, so there was a lot of silver linings that I didn’t I wasn’t able to iterate back then. I wouldn’t have been able to tell you that it was a silver lining. But now and a few years later, after it all happened, I was definitely able to talk about those silver linings. Kylie Do you you’re fourteen months or so out, right? So maybe you’re not there yet, I don’t know. But are there some silver and I know a hundred percent Nicole was one of those silver linings, I get it. but do you see some silver linings in this whole saga? Yep. I do. my relationship with my daughter got stronger. Yep. So that was all s that was definitely a silver lining. and you know, I I’m was very grateful before, but it cemented how g how grateful I am for my circle of friends. Yeah. Kylie’s friends were amazing. Yeah. Your friends were amazing. Yeah. Yeah. Yeah. Big family still in Australia is is there a big family in Australia, Kylie? Not not a big one, but my mum and dad are still still alive. So they’re they’re in Melbourne. and my sister is in on the Gold Coast and my brother is in Melbourne as well. Yeah. And my and my son is in Adelaide. Okay. So you still have some family here, but then you were able to create a community in the years before the stroke in Bulgaria. Yeah. you you were doing it a little bit tough after the stroke. Yeah. Correct. Yep. So that’s spot on. Did you Nicole tag team with some of those people as well? Yeah, so Kylie’s friends were beautiful and they were looking after me too. So When I was in Bulgaria, they were looking after me, you know, giving me dinner and what have you, and kind of giving me emotional support as well. And I think they were grateful that I was there from a skills point of view, like they were doing a beautiful job of supporting Kylie emotionally. But and I did kind of train them up a little bit in in some rehab as well, you know, how to help with approaching from the right and how to communicate and also just even doing some activities. Kylie and I had the balloon and we were tapping it back and forward to each other for strengthening up the right arm. And then we’d play some kind of word games as we were doing that for some speech therapy. So I was educating her friends around that kind of stuff. But the other thing, Kylie, that you and I have spoken about is, you know, after the stroke is knowing what’s important and how to let some sh shit go that would have been, you know, annoying or you know. focus on something and now it’s just you you just know it’s just not important. Yeah. Being able to just let crap go. Correct correct. and the other silver lining is that I got engaged. Yes. Did he propose soon after? Yes, in the in the rehab hospital. what a romantic Yeah. But he but he said that he’d already decided before the stroke that he wanted to marry be ma be married to me. So he just hadn’t got around to asking me yet. Yeah, fair enough. That stroke has a way of interrupting people’s plans and the things that they think they’re gonna do. so Nicole you normally treat your patients. They get to a stage. Usually they’re a lot better than they were when they first met you. And part of what you do is you send them off into the big wide world like a kid. I’ve grown you know, I’ve raised them, you know, like they know how to comb their hair now. And you kinda send them off and it’s kind of bittersweet, I imagine, but also a very important part that the people who you’re helping get better actually go off into the world on their own. And stop needing to be supported by you. I know there’s some people who need more support and that continues for longer and some people who don’t get enough and it and it’s never enough. But what’s it like knowing the job is not done, but you still have to leave and go home? that was heartache. I mean, Kylie and I both balled our lies out. it was a long flight home. Yeah. Yeah, it was a long flight home. with lots of reflections. I suppose the good thing at that point was Kylie was easily able to speak on the phone or message each other. So and also, you know, I think at that stage maybe I got to see the brain scan and I was just like, my god, how have you even survived this? ‘Cause I think was it about a seven centimeter bleed, Kylie? Yep. seven and a half. Yeah. To be precise. It truly felt like a a miracle. And again, full kudos to the surgeons in Bulgaria, truly, for that acute care. Because I think Kylie, I feel like you were in surgery in about within about two hours or something after the stroke, which is phenomenal. And, you know, your friends really saved your life. taking you straight to the hospital and prevented like, you know, more serious outcomes from the stroke. So yeah, so for me, I was proud of myself as well. and I, you know, I like to live my life by thinking I can look myself in the mirror. And I felt like I can really I’ve got a tear, really look myself in the mirror. Yeah. Doing the right thing. Yeah. Yeah, yeah. Yeah. You came to the need of somebody who was in need and needed specifically not only your love and support as a friend, but also your skills. Like you had the complete package for them at that time. How long did you end up staying in total? Was I ra away about just under two weeks probably with the flights and everything like that? So yeah. so yeah, leaving was leaving was horrible. But the goal of being able to go to the toilet was met. and also just the skills for, you know, skilled up a few other people and Kylie, you know, had her good networks. I also went out to Kylie’s property out in the village to have a look at any home modifications. So that was another kind of OT type role that that was done. and she’s got an amazing property out there, but it is kind of needs a bit of love and so that was also just reassuring her partner too, like reassuring Guido that no, look, Kylie’s got this. There were a few times where it was like, Nicole, I don’t want her to do this. Like I’m like Guido, she’s safe. She can do it. She’s got sitting balance. She’s okay to sit over the side of the bed. She can wiggle sideways. But he was anxious. And so again, part of my job was to reassure him to make sure that he let her do things. and didn’t step in too quickly. And so as an O T, we’re all used to like sitting on our hands and taking time and letting people struggle a bit. And it was hard for him to let Kylie struggle. So to just encourage him to let her struggle a bit so that she could do it herself and just wait. Just take the time, especially with communication. so yeah, I I kind of obviously knew there was a lot more rehab to be done, but I also had seen Kylie’s determination and that, you know, she kind of knew what to do. and and so that was I I was grateful again for that. Kylie, what was it like when your friend had to leave? I was heartbroken. The Impact of Caregiving I felt like she was a lifeline and I felt like that that had been cut because obviously she speaks English and obviously like Obviously we have a really good relationship. and I felt like I was in a like how do I describe it? In a in a sea of not n of people not understanding. So yeah, not my friends, but the hospital staff, basically. So not the not the physios. Like Nicole said, the physios were exceptional. but, you know, just the hospital staff. Yeah, just generally speaking. So did you feel like she had put you on the right path? Were you more confident with kind of where she left you as opposed to where you guys started and was that enough to kind of give you the foundation for what you needed to take responsibility for when she left? Definitely. yeah, definitely. Yeah. Man, w what a kind of interesting whole situation. You know, if this was fifty years ago, there’s no way anyone’s going anywhere to help anyone with anything. you know, like your hospital s experience in country like Bulgaria after what they’ve been through would have been completely different. You know, your s the chance of surviving telling your story is probably s you know, very much decreased. I know this is gonna sound weird, but like it’s never been a better time to have a stroke in in most of the world. Like let’s face it. the the possibilities are just endless. I’m a miracle from all the medical professionals that put all their time and effort in. I am eternally grateful to my occupational therapists and physios and surgeons and people who invent X ray machines and people who make C T scanners and The plastic bottles where drips go in, like every single thing is just an an absolute miracle of God or medicine or science or I don’t care what, like whatever you want to call it. And it just to me, it you know, here’s a really terrible situation and here and and but look at all the amazing things that came out of it. Somebody from the other side of the planet to be able to come over and intervene in that way, train people up. Like, man, it’s the Perfect like feel good story, you know. Everything’s going okay, things turn shit, and then something good comes out of it and yeah hopefully there’s more good to come, you know. Like, man, it’s just an amazing experience. I just feel really privileged to be able to hear it and share it further. No, not not not me, personally. but now that you say that I will s I will think about it now. the most thing that that Nicole and I reflect on is, you know, like like we’ve already said, how good was that my friends got me to the hospital quickly? How good was the the surgeons the surgeons because it could have all gone wrong. or gone gone a different way. so that’s the stuff we reflect on more. and just just like my amazing recovery. Reflections on Recovery and Gratitude Because I recovered so quickly and so well, like I’ve thrown everyone away here. So so my new my neurologist, my my physios, ever everyone here is like well, back then was like really surprised. So we it’s when I first walked into the n neurologist, she said, like, wow, No one expected you to recover that quickly from such a severe stroke. Yeah. That’s such a good outcome. I like to I like to think that those things wouldn’t have been possible without your most amazing superhero friend Nicole. Nicole, your final thing I’d like to kind of run by you is that your whole career you’re working towards making things better. Yep. Like for people who are going through all really difficult times. have you had you ever dealt with a family member who needed your intervention or family friend or someone like that that needed an intervention with your specific skills before this? man. yes. So when I was quite a young therapist, probably in my early twenties, my dad told me that his One of his like great aunts or cousins elderly relative had had a stroke and she was in hospital and I didn’t really know her. Like she wasn’t someone in the family that I I had knew had known. And I said to Dad, I’ll go and visit her in hospital. And and so I went to the hospital and I found out she was in this room and I walk into the room and there were four people. And I see this gorgeous little old lady who is all crumpled in her chair and squashed and nearly falling out. And I I just walked in and I was horrified. And I just walked straight over to her. And I just said, look, can I help get you more comfortable, get you into a better position? And then I realized it was it was my own relative. and I said to her, I’m Nicole, I’m John’s daughter. you know, dad’s asked me to come and see you. And and she just said the most cutest thing ever. She said, when you walked into the room. You just look so lovely and I hoped you were here to see me, but I I wouldn’t have known what I could have done to deserve that or something something dead cute. anyway, she’d had a very dense stroke and they were basically saying that she wasn’t a candidate for rehab and that she should go straight to a nursing home. And her daughter was a nurse. And she said, Nope, Mum’s not going to a nursing home and she ended up taking her home and I used to go every night after work and do rehab with her. she ended up being able to walk quite with a pretty awkward gait and a and a stick. but she got back to, yeah, walking and living at home and I just again always think that if she didn’t have her daughter, the nurse and myself, she probably would have ended up not not walking. Yeah, being in a nursing home. It’s not that quality of life. So there’s people who definitely go through that. And what I love about you sharing that part of the story is there’s people listening and they’re paying attention and maybe they haven’t been given the amount of therapy that they feel they deserve or need. And maybe that’s going to trigger people to go, you know what, stuff this, I’m gonna find a way to get more therapy, I’m gonna ask. I’m gonna hassle some people, I’m gonna be a pain in the butt to some people, I’m gonna do more. for myself to get me further. I love that you shared that part of the story. That’s kind of the unique experience that a that a a seasoned occupational therapist can kind of impart on us who are early on in the recovery about like how you need to advocate for somebody or yourself for more physical therapy. And and even if you Can’t access that people listening and watching YouTube channels. Go to YouTube. There are a ton of awesome therapists on YouTube showing people how to do exercises at home. Yeah. And I mean, I just took some really basic things. We s I, you know, stole some things out of Kylie’s flat to take in. And Guido’s son gave me some toys and we use those like stacking things to, you know, do rehab with Kylie’s hand. I took some pegs from her house and we made an activity of pegging up the curtains to do shoulder and arm rehab. So you can often do a lot without, yo

Let's cut through the noise....If someone you loved needed pelvic floor therapy tomorrow, where would you send them?

When you look at the intersection of vision and reading in schools, the gaps are impossible to ignore.Consider the data:Two-thirds of American fourth graders cannot read at grade level.One in four school-age children has a vision problem.School vision screenings miss up to 75% of children with vision problems. To make matters worse, standard school vision screenings frequently miss the functional vision deficits—such as convergence, accommodation, and visual perception issues—that directly impact a student's ability to sustain near-work in the classroom.As occupational therapists, understanding how vision impacts functional tasks like reading, writing, and navigating the classroom is central to our holistic approach. We have the foundational textbooks, the clinical frameworks, and the training to address these challenges.So why isn't the full skillset of OTs being utilized to support functional vision in schools?In this course, we sit down with Jaime Spencer, an OT who has been at the forefront of successfully integrating vision into school-based practice. Together, we explore the systemic barriers she has encountered and the practical solutions she has proven to work—from assessment and direct intervention to teacher education.This course is designed for any school-based professional who knows the current system isn't working well enough, and is ready to explore how OTs can deliver deeper, more impactful support for struggling students.See full course details here:https://otpotential.com/continuing-education/course/ot-and-vision-in-schools See all OT CEU courses here:https://otpotential.com/ceu-podcast-coursesCheck our our live webinar schedule here:https://otpotential.com/live-ot-ceu-webinarsSupport the show by using the OTPOTENTIAL Medbridge Code:https://otpotential.com/blog/promo-code-for-medbridgeTry 2 free OT Potential courses here:https://otpotential.com/free-ot-ceusSupport the show

"Access to care" sounds like something everyone should support.So why do we think it's become one of the most misleading phrases in pelvic health?In this episode, we argue that we've been solving the wrong problem.Because the goal isn't access to care.  The goal is access to quality care.We discuss: Why lowering the standard of care isn't the same as increasing access  The difference between access and quality  Why patients are still falling through the cracks despite having "access"  The six biggest opportunities to improve pelvic healthcare  Why raising standards—not lowering them—is how we truly help more people If our profession wants to serve more patients, the answer isn't diluting what makes pelvic health special.It's building more clinicians, better businesses, stronger education, and higher standards. About Nicole & Jesse CozeanPelvic health is hard. We want everyone in this field to have a joyful, impactful career. And for business owners to build something that truly works for them.

Is internal evaluation the gold standard in pelvic health?  We believe the answer is yes.Lately, we've seen more clinicians claiming that internal pelvic floor evaluation isn't necessary—or isn't the gold standard of pelvic rehab. We don't think this is just another social media debate.We think it's one of the most important conversations our profession needs to have.We're going to be diving deep into this topic.  But for Part 1, we discuss: Why this issue matters so much for the future of pelvic health  What the pioneers of our profession fought to establish  The strongest arguments against internal evaluation—and where we think they fall short  Why "access to care" shouldn't mean lowering the standard of care  Why extraordinary claims require extraordinary evidence (Also, the caveat we shouldn't need....Every internal evaluation should be clinically appropriate and performed only with informed patient consent.  Of course.)Instead, this episode asks a bigger question:  What should the gold standard actually be for pelvic rehab?About Nicole & Jesse CozeanPelvic health is hard. We want everyone in this field to have a joyful, impactful career. And for business owners to build something that truly works for them.

What if the thing you've been trying to hide is actually the reason people will choose to work with you? In this episode of OT Yourself to Freedom, Beki Eakins explores why your personal story is one of the most valuable assets you'll ever have when building an online Occupational Therapy business. Many Occupational Therapists believe they need another qualification, a better business idea or years more experience before they're ready to build an online brand. In reality, the people who create the deepest trust and strongest businesses are often those who are willing to share their journey honestly. Whether you've experienced burnout, changed career direction, overcome personal challenges or discovered a new way of practising Occupational Therapy, your lived experience shapes the value you bring to the people you serve. In this episode, Beki explains why your story creates connection, builds credibility and becomes the foundation of a business that nobody else can replicate. In this episode, you'll discover: Why your personal story is your greatest competitive advantage The biggest mistake Occupational Therapists make when creating content How storytelling builds trust faster than qualifications alone Why clients buy connection before they buy expertise How to uncover the experiences that make your business unique Why your lived experience can become your most valuable business asset How to confidently share your story without feeling self-promotional If you're an Occupational Therapist who wants to build an online business, attract the right clients and create content that genuinely connects, this episode will help you see your own journey in a completely different light. Your qualifications may open the door. But your story is what people remember. Subscribe to OT Yourself to Freedom for weekly episodes helping Occupational Therapists build profitable online businesses, create more freedom, and make a bigger impact using the expertise they already have. Connect with Beki Are you ready to leave the whinger mindset behind and embrace your inner go-getter? Beki helps OTs worldwide design, launch, and scale their online business Free Resource: Download Beki's free overnight mindset meditation for free to help you build confidence, overcome money mindset challenges, and develop self-belief. Download here: https://www.bekieakins.com/overnight-subscribe The OT Freedom Formula was a powerful session created to help OTs build more freedom, income and balance - without burnout. Watch it here: https://www.bekieakins.com/Formula-event-Recording-lp Join OT Yourself To Freedom Membership : https://www.bekieakins.com/membership Discover the only membership designed specifically for OTs to create freedom-based businesses by leveraging the skills you already have. Learn to design and sell offers, market effectively, and align your work with your purpose. Follow Beki: Website: https://www.bekieakins.com/ Instagram: https://www.instagram.com/otyourselftofreedom/ Facebook Group: https://www.facebook.com/groups/otyourselftofreedom LinkedIn: https://www.linkedin.com/in/bekieakins/ Book an Inspiration Call : https://otfreedom.bekieakins.com/widget/booking/bqsc3yEhKnzDh3cPz0PZ About the Host Beki Eakins is a business mindset and lifestyle coach for occupational therapists. After leaving traditional OT practice, she has helped hundreds of OTs worldwide design aligned online businesses that support freedom, income, and purpose, without burning out.

"Everyone" seems to be saying the future is online.  Create a course.  Sell a membership.  Telehealth in your pajamas.  Stop trading your time for money.  Retire on a beach.As owners of both a thriving brick-and-mortar practice and a successful online business, we wanted to share a reality check.In this episode, we discuss:✅ Why most pelvic PTs are looking at online business for the wrong reasons✅ Why building an online business is often harder than building a local practice ✅ The biggest mistakes we see clinicians make before they ever get started ✅ Why content creation is a full-time job—not passive income ✅ How AI is changing the future of online education ✅ Why we still believe the greatest opportunity is delivering exceptional in-person careOne of our biggest takeaways:Don't chase what looks exciting online. Build the business you're actually passionate about.Business AcceleratorIf your goal is to build a thriving pelvic rehab business, we'd encourage you to double down on what you already know how to do: provide exceptional patient care.The Business Accelerator helps you build the marketing, systems, pricing, and confidence to grow a profitable brick-and-mortar practice—without chasing every new trend.Learn more about future cohorts:

If you've ever felt like nobody around you understands what it's like to lose your old identity to a diagnosis, this episode names that experience using language borrowed from an unlikely place: sport psychology. The same identity disruption athletes face after a career-ending injury shows up almost exactly the same way after a chronic illness diagnosis.In this episode, you'll hear from Kelsey Ruffing, MA, MS, LCPC, who draws a direct line between an athlete being ignored by a coach and a chronically ill patient being dismissed by a doctor, and explains why both create the same kind of lasting trust injury.Connect with Destiny:  Instagram / Facebook / Website______________________________

In this episode, Jayson Davies sits down with Kelli Fetter, founder of Handwriting Solutions, to explore the world of dysgraphia — from the challenges of diagnosis and assessment to evidence-based, school-based intervention strategies. Kelli shares her personal journey as both an OT and parent of a child with dysgraphia, and explains why she believes school-based OTs are the most well-positioned experts to lead the charge on handwriting support.Kelli and Jayson dig into practical topics including how to assess handwriting across different cognitive load levels, the difference between top-down and bottom-up intervention approaches, and how MTSS frameworks can be used to build tiered handwriting programs in schools. They also discuss the emerging "science of writing" movement and why now is a critical moment for OTs to step into a leadership role in this space.Whether you're new to school-based practice or looking to sharpen your handwriting intervention skills, this episode is packed with actionable strategies you can bring directly to your students. Listen now to learn how to confidently support students with dysgraphia and written expression challenges — and why it's never too late to make a difference.Listen now to learn the following objectives:Explain the OT's role in supporting students with dysgraphia within a tiered MTSS framework, including how to collaborate with teachers, SLPs, and special educators to address written expression as a shared team goal.Apply assessment strategies across varying cognitive load levels — from tracing and near-point copying to dictation and self-generated writing — to identify automaticity gaps and guide intervention planning.Design intensive, frequency-based handwriting intervention models (such as handwriting clubs or camp programs) that leverage motor learning principles to produce faster, more meaningful outcomes than traditional once-weekly sessions.Click here to register & get the best deal on the 2026 Back to School Conference!  Thanks for tuning in! Thanks for tuning into the OT Schoolhouse Podcast brought to you by the OT Schoolhouse Collaborative Community for school-based OTPs. In OTS Collab, we use community-powered professional development to learn together and implement strategies together. Don't forget to subscribe to the show and check out the show notes for every episode at OTSchoolhouse.comSee you in the next episode! 

Endometriosis care is about so much more than surgery.In this episode, Nicole sits down with endometriosis excision surgeon Dr. Mallory Stuparich for a wide-ranging conversation on what it really takes to care for patients living with endometriosis.We discuss: The role of pelvic PT before and after surgery  Setting realistic expectations for recovery  Central sensitization and persistent pain  Imaging, inflammation, and recurrence  Why multidisciplinary care leads to better outcomes But one message stood above everything else:Our first job is to rebuild trust.Many patients with endometriosis have spent years feeling dismissed, misunderstood, or told their symptoms were normal. Before we can guide them toward healing, we have to help them feel seen, heard, and believed.Whether you're part of the surgical team or the rehabilitation team, that trust is where recovery begins. About Dr. Mallory StuparichDr. Mallory Stuparich is a fellowship-trained gynecologic surgeon specializing in advanced endometriosis excision surgery, adenomyosis, and complex pelvic pain. She is passionate about collaborative care and helping patients navigate every stage of their treatment journey with compassion, education, and evidence-based care.Downtraining MasterclassHelping patients with persistent pelvic pain requires more than great hands-on skills.Our Downtraining Masterclass provides practical frameworks for treating high-tension, pain-dominant patients with more confidence.

Why do some Occupational Therapists build successful businesses while others give up before they ever gain momentum? In this episode of OT Yourself to Freedom, Beki Eakins explores one of the biggest misconceptions about building an online Occupational Therapy business. It's not a lack of talent, qualifications or even money that stops most OTs. It's underestimating the energy required to create something completely new. If you've ever wondered why starting a business feels overwhelming, why your confidence disappears the moment you step outside clinical work, or why so many Occupational Therapists quit before seeing results, this episode is for you. Beki shares her own journey of building an online business from scratch, including the creative ways she funded her first coaching investment when she didn't have the money sitting in her bank account. Rather than waiting for the perfect circumstances, she chose resourcefulness over excuses, a decision that completely changed the trajectory of her life and career. This episode is a reminder that every successful entrepreneur started as a beginner. Building an online Occupational Therapy business isn't difficult because you're incapable. It's difficult because you're learning an entirely new profession alongside the one you've already mastered. If you're an Occupational Therapist feeling burnt out by clinical work, dreaming of creating more freedom, or wanting to build a business around your expertise, this conversation will help you reframe the challenges of the start-up phase and understand why discomfort is often a sign that you're growing. Connect with Beki Are you ready to leave the whinger mindset behind and embrace your inner go-getter? Beki helps OTs worldwide design, launch, and scale their online business Free Resource: Download Beki's free overnight mindset meditation for free to help you build confidence, overcome money mindset challenges, and develop self-belief. Download here: https://www.bekieakins.com/overnight-subscribe The OT Freedom Formula was a powerful session created to help OTs build more freedom, income and balance - without burnout. Watch it here: https://www.bekieakins.com/Formula-event-Recording-lp Join OT Yourself To Freedom Membership : https://www.bekieakins.com/membership Discover the only membership designed specifically for OTs to create freedom-based businesses by leveraging the skills you already have. Learn to design and sell offers, market effectively, and align your work with your purpose. Follow Beki: Website: https://www.bekieakins.com/ Instagram: https://www.instagram.com/otyourselftofreedom/ Facebook Group: https://www.facebook.com/groups/otyourselftofreedom LinkedIn: https://www.linkedin.com/in/bekieakins/ Book an Inspiration Call : https://otfreedom.bekieakins.com/widget/booking/bqsc3yEhKnzDh3cPz0PZ About the Host Beki Eakins is a business mindset and lifestyle coach for occupational therapists. After leaving traditional OT practice, she has helped hundreds of OTs worldwide design aligned online businesses that support freedom, income, and purpose, without burning out.

What if the biggest key to business success isn't strategy... but confidence?In this episode, we bring on Joy Noble, founder of Pelvic Pride, to talk about building a business with purpose, creating an incredible team culture, and having the courage to do things differently.A coach in our Rising Mentorship Program, Joy shares the journey from opening her practice just before the pandemic to growing into two locations, expanding her team, and creating one of the most recognizable brands in pelvic health.We discuss:✅ Why community is one of the greatest competitive advantages you can have ✅ The courage it took to rebrand to Pelvic Pride ✅ Building a practice around your values instead of trying to please everyone ✅ Growing from an anxious decision-maker into a confident leader ✅ The importance of mentorship, team culture, and saying "no" ✅ Joy's newest project supporting the mental health of pelvic therapistsOne of our favorite takeaways:Confidence isn't something you're born with. It's something you build by doing hard things.About Joy NobleJoy Noble is the founder of Pelvic Pride, a pelvic health practice dedicated to creating an inclusive, affirming environment where every patient feels seen, heard, and cared for. In addition to leading a rapidly growing multi-clinician practice, Joy is passionate about supporting the wellbeing of pelvic health providers through her newest initiative, The Reset Room.

The highs, the crash, and what overtraining syndrome taught one age-group world champion about ambition, recovery and knowing when to stop. Sue Reynolds was a guest on this podcast three years ago. At that point she had lost over 150 pounds, taken up triathlon in her fifties, and become a world age-group aqua bike and mixed relay champion. Her first book, The Athlete Inside, told that story. But Sue didn't stop there. She wanted to answer a question most age-group athletes never dare ask seriously: what would happen if an ordinary amateur trained with the same expectations, the same daily habits, and the same meticulous standards as an Olympic-level athlete? That question took her to the World Triathlon Championships in Pontevedra in 2023, where she led the swim - alone, three minutes clear, asking an official which way to run because she had never been at the front before. It eventually took her somewhere she hadn't planned to go at all. Her new book, Across The Line, covers all of it. This conversation is one of the most honest I have had on this podcast about ambition, identity, the invisible damage of overtraining, and what it actually means to know your limits. 5 KEY POINTS Meticulous preparation is where races are won before the start gun. Studying the currents, dropping leaves in the water on race morning, switching pontoon position at the last minute. The details are where elite performance actually lives. Overtraining syndrome is not just tiredness. Unlike overreaching, which resolves with rest, OTS means the body can no longer adapt no matter how much recovery you give it. Sue calls it what it really is: under-recovery syndrome. ‘Edited honesty' is one of the most dangerous habits in endurance sport. Sue never asked for recovery. She dropped hints, pointed at data, said she felt like a walrus. But she never said the words and that gap is where things went wrong. An invisible injury is still an injury. OTS left Sue looking completely fine while being unable to function. Nobody could see it. Some days she could barely believe it herself. Periodised commitment beats single-minded obsession. Research shows athletes with interests outside their sport sustain performance better over time. Sue learned this the hard way, at considerable cost.   3 TAKEAWAYS Ask for recovery before you need it. Don't drop hints. Don't hope your coach spots it in the data. Say the words out loud. Saying yes when you should say no is not toughness. It is the thing that ends careers and breaks bodies. Fitness gives you options. Sue's goal is simply to get fit by 2027 and see what becomes possible. Not a specific race. Not a podium. Just options.   KILLER QUOTE "I could have said I need a rest at any point. Why didn't I say that? I took a deep dive into all the cultural messages about sucking it up. We put people who push through on a pedestal. And I had bought into all of it."   CONNECT with Sue Sue Reynolds is a two-time age-group world champion, author and student of high performance. All author proceeds from Across The Line go to the USA Triathlon Foundation to support athletes with disabilities.   Website: suereynolds.net Instagram:  https://instagram.com/sue.reynolds/ Facebook:  https://www.facebook.com/suereynoldstriathlon/ Across The Line - Sue Reynolds - A case study of world-class performance that examines elite coaching, ambition, and the systems that make and break athletes. The Athlete Inside - The inspiring true story of one woman's transformation from 335 pounds to world-class triathlete in just four years.   Sue also recommended the following book by Brad Stulberg: The Way of Excellence: A Guide to Greatness and Deep Satisfaction in a Chaotic World  Mentioned in the episode: Podcast #1 with Sue Reynolds (Oct 2023) - From 150k to World Aquabike Champion in 4 years   If this conversation has made you think differently about your own cardiovascular health, or you're someone juggling a demanding career with serious training and want a structure that looks at your whole picture, not just your swim, bike and run numbers, that's exactly what SWAT is built around. CLICK HERE TO START YOUR MISSION FREE Download

What if defiance is really dysregulation? In this episode I sit down with Alyssa Blask Campbell — New York Times bestselling author of Tiny Humans, Big Emotions, founder of Seed & Sow, and co-creator of the Collaborative Emotion Processing method — to talk about emotional intelligence, unique nervous systems, and why the behavior we find hardest is so often a child asking for support. When we see challenging behavior, we're usually looking at a nervous system that needs support — not a child who needs fixing. Alyssa breaks down the five components of emotional intelligence — self-awareness, self-regulation, empathy, motivation, and social skills — and why every one of us develops them differently. She shares a fresh way to understand empathy, a powerful reframe around the word "autistic" and our own implicit biases, and why so much of supporting a dysregulated child starts with regulating ourselves first. We also get into her flagship free tool, the regulation questionnaire built alongside OTs, and the sensory shift that's helping schools cut behavior support calls by 60 percent — not by adding more tools, but by matching the right tool to the child in front of you. We'll talk about: the five components of emotional intelligence, and why we each develop them differently why regulation is never one-size-fits-all a fresh way to understand empathy: believing a feeling is true for the child the Collaborative Emotion Processing method, and why most of it is about us how implicit bias shapes the way we respond to an autism diagnosis the free regulation questionnaire, and the sensory shift that cut behavior calls by 60% In This Episode, You'll Learn The five components of emotional intelligence: self-awareness, self-regulation, empathy, motivation, and social skills Why "the volcano" is such a powerful way to teach kids self-awareness Why regulation strategies have to match a child's unique nervous system A new definition of empathy — connecting over what a child feels, not why How implicit biases quietly shape what we expect of an autistic child Why supporting kids well starts with regulating ourselves first The difference between sensory-seeking and sensory-sensitive needs, and why the right tool matters How a free regulation questionnaire helps match the right support to the right child Why predictable routines are regulating and build a child's autonomy Key Takeaways Challenging behavior is often a dysregulated nervous system asking for support Every human has a unique nervous system — regulation is not one-size-fits-all We each develop the five components of emotional intelligence differently Empathy means believing a child's feeling is true, no matter the reason behind it The work starts with the adult: our self-awareness, our biases, our self-care The right sensory tool beats more tools — match the tool to the child Meeting sensory needs for everyone can dramatically reduce behavior support calls Predictability regulates the nervous system and supports autonomy Your reactivity isn't failure; it's dysregulation — and there's a path forward Try This Name the "volcano" with a child to build self-awareness before the explosion Ask what truly calms this nervous system instead of defaulting to deep breaths Practice empathy by believing the feeling, without judging the reason for it Notice the story or bias behind your own reaction to a behavior Map your own nervous system: what recharges you, and what drains you Offer a sensory tool to any child who needs it, not just to one labeled child Build in predictable routines and transition objects to ease the day Regulate yourself first, then return to the child with more capacity Related Resources & Links  Seed & Sow — free Regulation Questionnaire Tiny Humans, Big Emotions by Alyssa Blask Campbell Big Kids, Bigger Feelings by Alyssa Blask Campbell Preschool Autism Summit (July 2026) We all have a unique nervous system, and none of us regulate the same way. When we stop trying to manage behavior and start getting curious about the human in front of us — what's dysregulating, what's regulating, what support would actually help — everything softens. Behavior becomes communication, and our job becomes connection. That's good for our autistic learners, and it turns out it's good for every child in the room.

What would it look like if your patients stopped fearing the floor?  In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, discuss with Naomi Casiro, physiotherapist and founder of Neuro Fit Academy, what happened when her falls training sessions at World Parkinson Congress drew over 100 attendees in a room designed for 40. They dig into why patients with Parkinson's are starting to demand falls training themselves, and how that overwhelming response reflects a massive gap in what clinicians are currently being taught. Naomi recently launched her FMF — Functional Movement and Falls Training — Foundations online course through Neuro Fit Academy — a six-hour program built for PTs, OTs, and any neuro rehab clinician who wants practical, immediately applicable falls training skills without needing to wait for an in-person course to come to their city. The course includes PDF clinical guides, problem-solving resources, and twice-yearly office hours with Naomi directly. If you've ever felt unsure about how to actually teach a patient to fall safely, this course was built for you. Learn more about the course here! www.neurofitacademy.org

In this episode, Cathy Love speaks with Rebecca Lockyer, Occupational Therapist and founder of Little Therapies on the Sunshine Coast. Rebecca shares the story of growing her paediatric OT practice from a mobile start-up launched just three weeks before COVID into a clinic-based, multidisciplinary Allied Health team. This conversation explores paediatric OT business growth, clinician-to-business-owner identity, team leadership, supervision, professional development, NDIS revenue diversification and the creation of Paediatric OT Conference Australia, also known as POTCA. Rebecca speaks honestly about the lessons learned through fast growth, business partnership, ethical profit, marketing confidence and building learning experiences that feel practical, playful and deeply connected to the Australian paediatric OT community. Topics covered on paediatric OT business growth, revenue diversification and POTCA: Paediatric OT business growth – Rebecca shares how Little Therapies grew from a COVID-era mobile start-up into a clinic-based team, shaped by stronger systems, values and sustainable decisions. Revenue diversification – Rebecca explores expanding beyond NDIS therapy into supervision, professional development, educator talks and report support, while staying grounded in quality and purpose. The Paediatric Occupational Therapy Conference Australia (POTCA) – Rebecca explains the vision behind Paediatric OT Conference Australia and why she wanted to create a professional development experience that brings Australian paediatric OTs together through practical learning, community, playfulness and meaningful connection. P.S. If this episode is hitting on pain points you're facing, let's chat. We can support you. Book a 20-minute complimentary call with us, and let's talk about how we can help you achieve your vision for your Allied Health business. Midroll Message: Have a great podcast idea or know someone who should be part of the conversation? Email podcast@nacre.com.au Connect with Nacre Consulting: Let's connect on Instagram Follow us on Facebook Let's connect on LinkedIn Join our Facebook Group online community More about The Allied Health Business Brilliance Podcast: The Allied Health Business Brilliance podcast (previously known as Private Practice Made Perfect) powered by Nacre Consulting features authentic conversations that offer real-life stories and expert perspectives for Australian Allied Health Business Owners. Cathy Love, our engaging host, gathers wisdom from Allied Health professionals and industry supporters alike. We dive into the real experiences of running and growing Allied Health businesses in Australia, revealing both the rewards and the inevitable challenges along the way. It's raw, sometimes vulnerable, but always valuable. Join us and stay tuned to keep up with every inspiring story and lesson shared.

What if the very thing making you a brilliant occupational therapist is also stopping your business from growing? In this episode, I explore one of the hardest lessons I've had to learn as an OT entrepreneur: letting go of control. Many occupational therapists build businesses that depend entirely on them. Every client, every decision and every problem sits on their shoulders. The result is more pressure, more clinical hours and, ultimately, another version of burnout. But scaling an occupational therapy business requires a different skill set. It requires trust. It requires systems. And it requires the willingness to stop being the bottleneck. In this episode, I share the mindset shifts that helped me move from doing everything myself to building a business that creates freedom, impact and sustainability. In this episode, you'll learn: Why many OTs accidentally recreate the same pressures they wanted to escape• The hidden cost of perfectionism and control in private practice• How delegation creates space for growth and better client outcomes• The difference between being an excellent clinician and becoming an effective leader• Why stepping back can sometimes be the fastest way to move forwards If you're an occupational therapist feeling overwhelmed by the demands of private practice, online business or leadership, this conversation is for you. Because true freedom isn't built by holding everything together. It's built by creating something that can thrive without you being at the centre of every decision. Listen now and discover what becomes possible when you stop trying to control everything. Connect with Beki Are you ready to leave the whinger mindset behind and embrace your inner go-getter? Beki helps OTs worldwide design, launch, and scale their online business Free Resource: Download Beki's free overnight mindset meditation for free to help you build confidence, overcome money mindset challenges, and develop self-belief. Download here: https://www.bekieakins.com/overnight-subscribe The OT Freedom Formula was a powerful session created to help OTs build more freedom, income and balance - without burnout. Watch it here: https://www.bekieakins.com/Formula-event-Recording-lp Join OT Yourself To Freedom Membership : https://www.bekieakins.com/membership Discover the only membership designed specifically for OTs to create freedom-based businesses by leveraging the skills you already have. Learn to design and sell offers, market effectively, and align your work with your purpose. Follow Beki: Website: https://www.bekieakins.com/ Instagram: https://www.instagram.com/otyourselftofreedom/ Facebook Group: https://www.facebook.com/groups/otyourselftofreedom LinkedIn: https://www.linkedin.com/in/bekieakins/ Book an Inspiration Call : https://otfreedom.bekieakins.com/widget/booking/bqsc3yEhKnzDh3cPz0PZ About the Host Beki Eakins is a business mindset and lifestyle coach for occupational therapists. After leaving traditional OT practice, she has helped hundreds of OTs worldwide design aligned online businesses that support freedom, income, and purpose, without burning out.

What does it really take to grow from a single treatment room into a thriving multi-location practice?In this episode, we sit down with Hannah Strom, founder of Awake Pelvic Health, to talk about the mindset, leadership, and intentional decisions that fueled her incredible growth.Hannah shares how she started in a tiny room at the back of a yoga studio and, just five years later, has built a practice with ten clinicians. But this conversation isn't just about growth—it's about becoming the leader your business needs.We discuss: ✅ Why every stage of growth feels uncomfortable ✅ Building a culture centered on mentorship and curiosity ✅ The transition from clinician to business owner ✅ Balancing high standards with giving your team room to grow ✅ Why workshops have been a cornerstone of her marketing strategy ✅ Creating a business that supports your life—not just your scheduleOne of our favorite takeaways:Your business only grows as much as you're willing to grow.About Hannah StromHannah Strom is the founder of Awake Pelvic Health, a pelvic health practice with three locations built around whole-body care, mentorship, and clinical excellence.Learn more at www.awakepelvichealth.comFollow Hannah on Instagram: @awakepelvichealthBusiness AcceleratorIf you're looking to grow your practice with more confidence, better systems, and support from a community of like-minded pelvic rehab business owners, we'd love to have you in a future Business Accelerator cohort.Learn more at:

If you've ever been told to push through the pain, or worried that going slower means giving up on getting better, this episode will change how you think about movement and healing.You'll hear from Jeannie Di Bon, movement therapist and hypermobility/EDS specialist. She shares why starting with breath and nervous system regulation, not exercise, is often the missing first step that actually makes people stronger.& if you know me (Destiny), you know that I'm very careful with the word nervous system regulation. I think Jeannie uses it accurately and not dismissively here.Connect with Destiny:  Instagram / Facebook / Website______________________________

Walking After Stroke: What Your PT Knows That Your Doctor Doesn’t A doctor walked in, ran a reflex test, and told the patient they would never walk again. That same day, a physical therapist from Dr. Kory Langwell’s team arrived. The patient was in tears. And then they walked 70 feet. “I hope you go back and tell that doctor,” Kory said, “that they missed that.” Dr. Kory Langwell is a Doctor of Physical Therapy with over 15 years of experience. He runs a mobile home therapy practice across Southern California, and now coaches stroke survivors worldwide through his virtual program at Unlimited Potential Physical Therapy. In episode 410 of the Recovery After Stroke podcast, Kory broke down the realities of walking after stroke what’s actually possible, where the system fails survivors, and what a good physical therapist knows that most doctors don’t. The Moment the System Stops For most stroke survivors in the United States, recovery starts with intensity. In the hospital, you might receive three hours of therapy a day. Then you go home. Within weeks, that drops to thirty minutes, once or twice a week. “Insurance doesn’t know when your brain stops recovering,” Kory says. “Therapy ending doesn’t mean progress ends.” The problem is that for many survivors, the message lands the other way around. When the funding stops, the belief follows: that recovery is over, that this is where they plateau, that there’s nothing left to do. That belief, more than the stroke itself, can stall everything that comes next. The Plateau Is Not a Full Stop One of the most damaging phrases in stroke recovery is “you’ve plateaued.” It implies that the brain has reached its ceiling, that whatever function you have now is what you’ll have forever. Kory pushes back hard on this. “I’ve seen progress years, decades, 10 to 20 years after a stroke. Arms, hands, legs, walking ability. People just get fed up and stop looking for resources.” What a plateau usually means is that the current approach has stopped working, not that progress itself is impossible. The clinical response isn’t to discharge the patient. It’s to audit what they’re doing and change something. Different exercises, different load, different feedback. Reassess in six weeks. See what moves. Walking After Stroke: Why More Isn’t Always Better Walking after stroke is where survivors often get their first taste of both independence and confusion. The instinct, and it’s a good one, is to walk more. Further, longer, more often. But Kory draws an important distinction between the acute stage and everything that comes after. In the early weeks post-stroke, more isn’t always better. If someone can walk five steps, pushing them to twenty-five on back-to-back days may overtax the neurological system rather than rebuild it. Fatigue compounds quickly. Quality collapses. And when quality collapses, the brain reinforces the wrong patterns. “I’d rather have somebody walk 50 feet really well than 150 feet terribly,” Kory says. Visual feedback changes this completely. When survivors watch themselves walk in a mirror, or on a phone recording, they often see something very different from what they feel. Bill Gasiamis described exactly this: convinced his running gait was dangerous, he watched the footage and found it was far better than he’d thought. The problem wasn’t the movement. It was the feedback. Once a survivor moves into the chronic stage months or years post-stroke, the calculus shifts. Walking remains one of the best exercises available. Kory also recommends walking backwards in a safe environment like a hallway or near a kitchen sink: it challenges balance, engages the brain differently, and creates new neurological input. Why Falls Happen – And What Actually Prevents Them Falls after stroke aren’t random. They follow a pattern. The clinical term is proprioception: the brain’s sense of where the body’s joints and limbs are in space. After a stroke, this system is often disrupted. Survivors may not feel their foot on the ground, or may not register that a leg isn’t bearing weight the way it needs to. Add a divided attention task carrying a plate, thinking about turning off the television, reaching for something, and the risk multiplies immediately. Bill described this directly: he’d made a sandwich, sat down, finished eating, and went to stand up. His attention was on getting the plate to the sink without dropping it. His left leg wasn’t registered as being on the floor. He fell before he’d taken a step. The countermeasure is simple: stop, feel the floor, confirm the leg is active before moving, then carry the plate. Step by step, not simultaneously. Foot Drop, AFOs, and Electrical Stimulation Foot drop, where the muscles that lift the front of the foot are weakened or uncoordinated, is one of the most common walking challenges after stroke. Many survivors are placed in an AFO (ankle foot orthosis) to manage it. Kory’s view on AFOs is measured: they’re a tool, not a sentence. Whether to wear one, when, and whether to eventually stop using one depends entirely on the individual. “Take it off every once in a while if you’re in a safe environment,” Kory advises. “That gives new input to the brain a chance for things to improve.” Electrical stimulation is another tool worth exploring. Kory recommends starting with an affordable unit available on Amazon for around $40 to test whether the technique produces results before investing in higher-end systems. You can find Kory’s recommended unit at linktr.ee/unlimitedpotentialpt. The “Life Athlete” Mindset Kory calls his stroke survivor clients “life athletes.” Not because they run marathons or lift heavy, but because athlete thinking produces athlete results. Athletes track. They audit their approach. They celebrate small gains. They adjust when progress slows. And they don’t let one bad assessment from one clinician define what they believe is possible. “If somebody told you you’d never walk again, you can take that feedback and use it as motivation,” Kory says. “Or you can let it get you down. That’s up to you.” What to Do With a Limiting Prognosis When a doctor says “you’ll never walk again,” it’s rarely cruelty; it’s usually outdated thinking. General practitioners have limited training in neurological rehabilitation. Some are still working from research that concluded recovery stops at six months or a year. That conclusion was drawn from patients who stopped therapy and stopped trying, not from the brain’s actual ceiling. “I just want to leave the door open,” Kory says. The research on neuroplasticity is clear: the brain continues to adapt when given the right challenge, the right environment, and enough time. A prognosis isn’t a prophecy. It’s a snapshot of what one clinician observed on one day. Walking after stroke real, functional, independent walking is possible far longer and far later than most doctors suggest. And sometimes, it happens the same day they said it never would. If this episode has helped you, Bill’s book The Unexpected Way That A Stroke Became The Best Thing That Happened shares the tools and mindset that made the difference across his own recovery. If the Recovery After Stroke podcast has been valuable to you, you can support it financially at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. She Was Told She’d Never Walk Again – Her PT Proved Them Wrong | Dr. Kory Langwell (Interview) Dr. Kory Langwell on the therapy gap, foot drop, and why the plateau after stroke is a label not a limit. Highlights: 00:00 Introduction – Walking After Stroke 07:24 Insurance and Therapy Limitations 11:22 Supporting Survivors and Caregivers 16:45 Community and Support in Recovery 26:57 The Impact of Electrical Stimulation in Rehabilitation 29:17 Walking: Quality Over Quantity in Recovery 30:25 Understanding the Stages of Recovery 36:39 Navigating the Challenges of Falling Post-Stroke 42:05 Setting Realistic Goals for Recovery 44:46 The Role of Medical Professionals in Rehabilitation Transcript: Introduction – Walking After Stroke Kory Langwell (00:00) So we had a client recently there. Doctor told them they were never gonna walk again. And literally, like they our therapist showed up, the patient was in tears, and then they walked 70 feet with our therapist. And it was all because it was a doctor that didn’t know them. They did like some reflex testing and said, you’re hyporeflexic, you’re never gonna walk again. And then literally that same day walked 70 feet. I was like, I hope you go back and tell them, BIll Gasiamis video 25, image (00:23) Before we get into today’s conversation, I want to extend a genuine thank you to everyone who supports this show. Whether you’ve joined as a YouTube member, contributed through Patreon, left a review, shared an episode, commented, or picked up a copy of my book, You Are the Reason This Podcast Keeps Going. Today’s guest is Dr. Corey Langwell. A doctor of physical therapy with over 15 years of clinical experience. Corey runs a mobile therapy practice across Southern California and now coaches stroke survivors worldwide through unlimited potential physical therapy, a virtual program built for people who can’t access the in-person care they need. In this conversation, we get into the gap that opens up the moment you leave hospital. While the word plateau might be the most dangerous word in stroke recovery, What physical therapists know about walking after stroke that most doctors do not, and what it actually takes to keep making progress, years or even decades post-stroke. If you’ve ever been told there’s a ceiling on your recovery, this episode is going to challenge that. Here’s my conversation with Dr. Corey. BIll Gasiamis (01:39) Kory Langwell, welcome to the podcast. Kory Langwell (01:42) Thanks for having me. BIll Gasiamis (01:43) Tell me a little bit about your background. Kory Langwell (01:47) Yeah, I’ve been a doctor of physical therapy for over 15 years and I’ve had my own mobile therapy practice for a little over five years. So helping people in their homes throughout Southern California with my staff of PTs, OTs, and speech therapists. And now we’re expanding to worldwide really with our virtual coaching program for people that have had strokes. So BIll Gasiamis (02:12) Worldwide. That’s awesome, right? So that’s where I found you on the TikTok app. And it’s a pretty decent channel to follow. Tell me just while we’re here and I remembered to ask, what is the TikTok handle? Kory Langwell (02:14) Yeah. Yeah. Yeah, yeah. It’s Dr. Kory Stroke Recovery PT and I can I can send you the link later on. But yeah, so I started two months ago and it’s been growing ever since. So BIll Gasiamis (02:38) Yeah, it’s really good because I think your information comes from the clinical background, something that I can’t do. I can put a lot of information out about my personal experience with stroke, what other people tell me about their experience, but your specific instructions around how to improve or how to do something differently or how to achieve an outcome with regards to whatever physical deficit people have after stroke. Is really helpful. So for people who are watching and listening, go to TikTok and probably the other social media channels, yeah, Kory? Kory Langwell (03:12) Yeah, yeah, I started a YouTube recently, unlimited potential physical therapy. And yeah, I’m also on Facebook, Unlimited Potential Rehab. So yeah. BIll Gasiamis (03:22) Yeah. You’re one of those people. I often get asked where can I find somebody that’s going to help me with my stroke recovery? I can’t get there or whatever. And I’m I’m often the middleman. People think that I know everything about everyone, especially from Australia to the United States, right? But what’s weird is I do know a lot of people and I can connect people. So it’s great that we connected and I found you. And I think it’s really important that. Kory Langwell (03:39) Yeah. Yeah. BIll Gasiamis (03:50) It’s your perspective and the way you think about recovery that’s different. And that’s why I reckon people A, should follow you and B, listen to this podcast episode. So don’t leave yet. F listen to the episode and then go and follow Kory on TikTok and all the socials. We’ll have all the links in the show notes. My first question is about the gap. Okay. So we’re often Kory Langwell (04:01) I appreciate that. BIll Gasiamis (04:17) Find ourselves as stroke survivors get sent home from hospital. Everyone does amazing things before we leave hospital. The care is amazing. They try and rehabilitate us as much as they can. They keep us alive. They send us home. But then the gap at home is we’re kind of left alone. Nobody to check in with us to make sure that things are kind of on track, that we’ve settled in. And it feels for a lot of people like recovery ends after therapy ends. But Can you give us a bit of a your your thoughts on that? Kory Langwell (04:54) Yeah, usually at least here in the States, people go from getting three hours of therapy a day in the hospital to literally dropping down to thirty minutes once or twice a week. So there is this huge gap where they just feel like they’re not getting enough and then that it really slows down their progress, or so they feel. and that’s where we’ve come in with our in-home care. But what I’ve seen is people just they need that accountability, whether it’s virtually or in person. And so that’s one thing that we really strive to do is just provide that that one-on-one support virtually. And also, you know, what I see with a lot of people is they think that, stroke recovery. Stops at you know, three months, six months, a year. We’ll probably talk about this more later on. But you just got to keep challenging yourself, doing new things. And I find a lot of times people get stuck on just finding random things on the internet, and then they just they don’t reach out or have the support that they need to move forward and make progress. So grant you just don’t want insurance to tell you when therapy ends or when progress ends. So that doesn’t mean your brain just immediately is yeah. Yeah, therapy’s done because insurance says it is and the brain just shuts off. I mean, I’ve seen progress years, decades, you know, 10 to 20 years after a stroke. I’ve seen progress with arms, hands, legs, general walking ability, you know, stuff like that. So it’s a lot of times they just people get fed up, they get frustrated, and then they stop doing or looking for resources. So BIll Gasiamis (06:26) Y the thing that you said is very interesting about insurance telling you when therapy ends. Now what they’re doing, what are they doing? Are they like I know what they’re doing fundamentally, right? They can’t forever pay somebody to have rehabilitation. And maybe they’re encouraged to pay them for as little as possible as well, because it costs money, right? So they they Kory Langwell (06:49) Yeah. Yeah. BIll Gasiamis (06:53) come up with some kind of a conclusion or whatever, and then they say to people, Well, y that’s about it. You’re not going to really improve any more than that. And we need you to we we’re going to stop funding it. So how does that conversation go from what you understand? And can anyone intervene in that moment and continue the therapy? Is there a way to kind of argue your case to get more therapy? Insurance and Therapy Limitations Kory Langwell (07:24) Yeah, it’s a tough one. So having worked in hospitals in acute rehab units, having worked in outpatient clinics, and then now as my own mobile practice in people’s homes, I’ve seen the whole spectrum of therapy and the issues that come along along each step of the way. in the hospital, you know, it used to be therapy they would get six to eight weeks in the hospital a lot of times here in the States. And now it it used it dropped down to like three weeks for a lot of acute rehabs, and now they’re pushing it down to like 10 to 14 days. which is not a lot of time. And, you know, we used to be able to get people to near independence with a lot of their their skills, you know, the activities or ADLs, activities of daily living. But what I see now is a lot of times hospitals when I left the hospital world in November of 2021, at that point, it was like, let’s just get people to like minimum assistance, meaning they need about 25% or less, and let’s we gotta ship them out of here because it’s like it’s like a churn. It cause hospitals, to be honest. They’re big business. They they are, you know, it’s unfortunate. and they have some of the most highly trained therapists, but the therapists are kind of hamstrung from upper management, middle management, you know, being told probably from people above them that they can only do so much. in the states we have private equity buying out a lot of hospitals and stuff like that. So there are things are changing in the length of stay that clients get. Once somebody goes to home health, they usually only get like two to three weeks, once or twice a week, because the goal of home health is usually get them to outpatient, get them to a clinic. and when they go to a clinic, most of the time somebody will reach like a maintenance level where like they’re not really making a ton of progress and the therapists know they’re not gonna be getting reimbursed as well for that. So that gets really challenging and they have to write really good goals to help. you know, progress things or continue with therapy. So if your therapist is telling you in the outpatient clinic, that’s the one area where you can oftentimes have the best chance of extending therapy. They might be able to, you know, wiggle their way around writing new goals, higher level goals that you can work towards and progressing. And then other times they want to stop therapy for one to two months, three months and then reassess, you know, down the road, which is where a lot of times people seek us out for private therapies on the side. So It’s unfortunate, but yeah, the insurance game does have a their hand in it a lot of times, telling people when they can discharge or not. So yeah. BIll Gasiamis (09:50) How hard is it for a therapist to know that the stroke survivor patient is not ready to go home, but you have to wind it up for them. Kory Langwell (09:59) Yeah. Whew, it’s really challenging. And usually, I mean, in out most outpatient clinics, you might get somebody two or three days a week if you’re lucky. Usually 30 minute sessions in in the clinic. Sometimes you have one-on-one places for an hour, which are great, or 45 minutes, but you’re it’s a volume game in the clinics because the reimbursements have shrunk in the outpatient world too. So they’re like, We need more volume here. And it’s unfortunate. It’s not on the therapist. It’s more on the, you know, just the the whole game that they have to do in order to survive, or else they would have to close up shop. But as far as like extending somebody, it it it can be a challenge. It’s it’s really you see it coming as a therapist, you know, and you’re in the outpatient insurance-based game. you’re like, ooh, you know, I I in about two to four weeks I can tell this is gonna be an issue with your insurance or whatnot. And most therapists, if you can get somebody to like 90% better. You know, that’s pretty darn good, especially after a stroke. there’s a lot of factors that go into that, a lot of variables. But yeah, so it’s it’s tough and getting somebody back to a hundred percent is can be challenging with the insurance game. BIll Gasiamis (11:07) Yeah, getting back to a hundred percent is Kory Langwell (11:12) It’s hard. It’s like the new one hundred percent or yeah, it’s another topic for yeah. BIll Gasiamis (11:13) my gosh. Yeah. The new hundred percent I pref yeah, that I love that. That’s a great statement actually, because a hundred percent, I mean Supporting Survivors and Caregivers BIll Gasiamis video 25, image (11:22) If this podcast has helped you in any way, here’s how you can help it reach more people. Share this episode with a survivor, a carer, or anyone who needs to hear that recovery doesn’t have an expiry date. Leave a review. It makes a massive difference. And if you’d like to support the show financially, you can do that through Patreon at patreon.com/recoveryafterstroke or by becoming a YouTube member. Now it’s back to the show. BIll Gasiamis (11:50) I I have that challenge with a lot of stroke survivors who are early on in their recovery. They reach out and they say, you know, how long is this going to take for me to get better? And like, dude, like it might never get better. in that what they want is they want to go back to where they were before the stroke. And there’s n nobody’s going back there. Nobody at all. Kory Langwell (11:59) We don’t know. Yeah. Yeah. BIll Gasiamis (12:11) Not a single person. And if there’s damage in the brain and the damage is permanent, which damage is in some instances, then you cannot reverse that damage. You have to accept that damage and then adjust and recover and overcome the challenges that you’ve been left with. And it’s such a difficult thing. But the new 100%, I love that, Kory, because I kind of am there. And if people ask me how do you feel, which nobody nobody understands to ask how do I feel after my stroke, my left side is completely numb. You know, I get spasticity. It doesn’t look visibly like other people experience spasticity. So I got away with that part of it. I don’t look like I’ve had a stroke, but I have the fatigue, I have the balance issues when I get tired, I have all these challenges that are always there and they’ve been there since two thousand and fourteen. Like it’s not going away. Kory Langwell (13:07) Yeah. There’s There are those silent problems too that like you said, like you’re doing so well in general that a lot of people just can’t see the fatigue or the how tight your arm feels or different things, which is oftentimes really challenging. But if you put it even, you know, towards like an orthopedic injury where somebody has like a shoulder surgery or a knee surgery, typically they also have like that new one hundred percent where it’s you know, it’s never gonna it’s hard to have it feel a hundred percent like it was before. There are certain instances where somebody might make this miraculous recovery. It does happen. Maybe they’ve had a TIA, a mini stroke, or you know, just made this miraculous recovery. Those those people do exist and it does happen. But what I find in the stroke community that happens a lot is there’s this everyone wants to compare themselves to other people, or they’re they’re wanting to get the answers from things, but there is no crystal ball on these recoveries, you know, for for neuro issues. It’s more like let’s see how it progresses in one month, three months, six months, a year, and then just continue to track because it is a lifelong issue that you have. have to manage and and continue to, you know, have things come up over over time. So yeah. BIll Gasiamis (14:14) Yeah, I agree with that. So this next question I thought about how I’m gonna ask it a lot. So I’m gonna ask it just the way my gut’s telling me to ask it, which is how much bullshit is that you’ve reached the plateau? Kory Langwell (14:31) yeah, that’s a that’s a fun one. I I love the I love the the BS part of that. yeah, it’s tough. I mean, you can see a lot of times what you’ll see is like there’s almost, you know, you think of plateau as like a flat line. And a lot of times what we do see is you’re there’s still room for progress. Like maybe somebody’s feeling like they’re 60% back to their normal self. Well, if we can get you to 65%, would you take that? Like most people would say. You know, it’s either sixty or sixty five percent. Like, yeah, let’s do that. But a lot of times what I see is Progress has just slowed down, they get upset, you know, the doctor’s like, whoop, this is as good as it’s gonna get. This is where you’re at. You’ve plateaued and you’ve entered a maintenance stage. And what I often see with that is it’s that’s the time to shift something up, mix something up, do something different. so what we like to do is take into account what kind of audit what somebody’s doing when their exercises, their daily routine and all that, and then shift things in some certain way and reassess in six weeks to see if we can progress that or make any other changes. So just like with any other training, like if somebody was a bodybuilder going for a competition or a professional athlete, we take that kind of same approach to our stroke recovery. We call athletes in general. Like they’re life athletes, you know. So we wanna help people feel as independent and as strong as they can. So yeah. BIll Gasiamis (15:50) That’s a great mindset shift, right? So if you consider yourself somebody who’s injured, somebody who’s never gonna be the same, all that kind of stuff, well, it might be accurate, but it may not be helpful in the way you approach your recovery. But an athlete, that’s very cool. Now I know some people say what an athlete runs on a track and field you know, facility. An athlete does this, an athlete does that. Well, Maybe, maybe they don’t, you know, maybe you can be your own version of an athlete that allows you to think about that constant and never ending pursuit of getting better and improving. And whether you’re getting better and improving your physical side or your mental attitude or your emotional side or your or your nutrition, you know. Community and Support in Recovery Athletes have all these things that they always constantly forever focus on and their gains come from, you know, that really last part, which is almost unattainable, but it’s about going for it. It’s about going for the last one percent. And then reflecting back, like you said, maybe twelve months later and going, Look how far I’ve come, rather than look what I can’t do or look what I haven’t achieved yet. It’s like, look what I have been able to achieve. That’s Kory Langwell (17:03) Yeah. Yeah. Yeah. And that’s where and that’s where tracking comes into it. Are there, you know, your what what are your BIll Gasiamis (17:15) Such a different mindset. Kory Langwell (17:21) you know, your KPIs, your key performance indicators that you’re looking into as far as, hey, I was only lifting one pound with my arm and now I’m do lifting three pounds. Like that’s huge improvement in a, you know, what however long it’s been. So those whatever you’re tracking, it helps to you know, it could be your diet. Am I making good choices eighty percent of the time? Am I so making sure in like all of your life assets assets and that or facets of life, that’s what we try to do as well. And like you said, mindset, movement, muscle, all that. all those things together. we we you know, tie all those things into our our program. And I think everyone needs to do that as far as, you know, their strengthen those the mental muscle, the physical muscle, you know, they’re just as important. And having that support, whether it’s with a coach or whether it’s with family, friends, outsiders, you know, other stroke survivors, it’s really important. So BIll Gasiamis (18:14) Yeah, community is the I think biggest thing for me. because then with the right community, the one that I’ve created for myself, at least I get to talk about the things that bug me about what happened to me with people who one hundred percent understand it. And then that way, even if we’re different in our attitude in the way we go about things, at least we understand. Kory Langwell (18:35) Yeah. BIll Gasiamis (18:45) And you’re totally being heard. Do know what mean? Like it takes one minute to listen to the story of a stroke survivor and to fully understand where they’re coming from because they’ve been through a a similar, a very similar experience to to myself. Kory Langwell (18:52) Yeah. Yeah, yeah, absolutely. for sure. It’s so true. I mean, as a therapist, I I never really I mean, I knew there was a mental toll to it, but having worked with people for, you know, they come on and they’re with us for several years, you really see the mental aspects, like the ups and downs that occur with that. And it’s so huge to you know, important to to focus on that as well. So and not lose sight of it. So those silent symptoms of the stroke, you know, like we were talking about as far as the the emotional aspect or other things of that. So yeah. BIll Gasiamis (19:26) Yeah. Yeah, one of the biggest complaints that I get from stroke survivors, not about their spouse, but about people about people who haven’t had a stroke, right? So often it’s the spouse that gets the raw end of the stick. But it’s that they just don’t understand me. And it’s so true, right? There’s no way that that person can understand you unless they’ve had a stroke, and we do not want that for them. That’s better that they don’t understand you and that you have to learn how to explain yourself in a way Kory Langwell (19:53) Yeah. Yeah. BIll Gasiamis (20:04) that gets the message across even if they don’t get it. Like it’s okay because they’re never gonna get it. We don’t want them to really ever get it. What we wanna do is accept that they can’t understand something that they have never experienced, which we don’t want them to experience. Kory Langwell (20:20) Yeah, that’s so true. I mean, the it a lot of times it comes from a good place. They’re like, just get up and move. Why are you so tired? or you know, things of that nature. And it y you’re right. They just they don’t understand it. It’s it’s tough. There really should be more caregiver support and education. I’ve tr I’ve strived to do that on my page or on my different resources that I’ve included on my bio. But yeah, it’s it’s in sh it’s a challenge for people to to see the whole picture and the recoveries process that’s going on with that. So yeah. BIll Gasiamis (20:51) Yeah. How common is foot drop? Kory Langwell (20:56) yeah. Strokes you you do see it a fair amount. it’s what I see a lot of times with that. You know, when in the hospital, a lot of times I don’t like to immediately put somebody in like an AFO. Everyone knows ankle foot orthosis and stuff like that. but it’s something that I like to see how the body reacts initially to to the the weaker ankle or whatnot, and how is somebody compensating? So you’ll see somebody, you know, try to march their leg up to clear their foot through the gate cycle, or they’ll kick their their leg out to the side so that they don’t drag their foot or their toe. so I like to see. See what’s going on for the first week or so before we start trying to, you know, put a bunch of equipment on somebody. But honestly, it it’s it’s pretty common. it just depends on the nature or severity of the stroke. Most muscle recovery starts proximally, meaning like at the hip and then works its way down, or in the shoulder and then works its way down to the hand. so the ankle and the hand are usually the last to recover. but yeah, so it’s obviously it’s very noticeable on somebody’s walk gate or whatnot if they have it, or you know, as you just see their AFO and you’re like, that guy’s got foot drop, most likely, or whatnot. So yeah, just trying to figure out where’s is there are there other weak links up the chain and the knee, the quad, you know, your your your glutes, your hip, what other areas could use some help to help you get that leg through and help you be more independent? So BIll Gasiamis (22:28) Mm. Kory Langwell (22:29) really treating the whole ankle or the whole walking pattern, not just the ankle or the foot. Cause we a lot of times we get laser focused into one area after a stroke like my hand or my foot, but we gotta look at the whole body. So yeah. BIll Gasiamis (22:41) So there is a conversation that happens again in the community about whether I should be wearing AFO or I shouldn’t. And you often hear people saying, I got rid of my AFO. it was causing me to walk badly or incorrectly and it was decreasing the muscle activity in the correct way. Kory Langwell (22:51) Yeah. Yeah. BIll Gasiamis (23:08) And then you hear the exact opposite. Well, you know, you should definitely have an AFO so you don’t trip over, you don’t do this, you don’t do that. Like, how do you determine that whole should I or should I not have an AFO? And do some people definitely need an AFO? And then also are there some people who can transition out of an AFO? Kory Langwell (23:20) Yeah. Yeah, it it really is with a lot of neurotype issues, it it really does depend. You’ll hear the answer, it depends a lot of times in the neuro world, neurological issue or you know, in the stroke world. But on a case by case basis, it’s really how does somebody look? How independent are they with and without it? How much strength do they have in their the muscles on your shin and on the outside of your leg that help lift your ankle up? is it something that maybe you just wear it when you’re outside? And then when you’re inside the house, you’re getting that input. with your shoes off. I I really liked the shoes off, you know, kind of full input on how your foot’s moving. You can really see it visually, get some feedback there on what’s going on. So it it and it can change over time. Maybe somebody ditches it after a while or maybe they w they know like, hey, I’m gonna be going on this longer walk. I’m gonna use my AFO so I don’t get as tired because it can be more taxing and energy draining to have to, you know, lift your leg up more, kick it out to the side or whatnot. So we’re really trying to figure out what’s the best quality over quantity for for most folks so that they’re not overdoing it, but they still are getting you know, the appropriate amount of feedback and and to help them live their life, be as independent as possible. So I’m not against or for it. It’s just wanna it depends on the person. So yeah. BIll Gasiamis (24:45) Sounds like it’s a tool to be probably continuously assessed and determine its usability and then also for some people determine whether or not it’s short term, long term thing. And then also keep looking at it. What I seem to also see is people get told something, they do it, and then they do it for a long, long time and nobody kind of ever intervenes a year later to say, where are we at with that? Kory Langwell (24:51) Yeah. Yeah. It you know, it it’s it’s good to take it off every once in a while if you’re especially if you’re in safe environment and just reassess things, you know, on your own or with a therapist or whatnot. That again gives new input and sensory, you know, feedback to your brain of like, what’s going on here? And that that’s a chance for that neuroplasticity to occur, which you know, is a is a is a big buzzword in the in the neuro world. But yeah, so we’re just trying to create those environments and those chances for, you know, things to improve and and reassess. assess things as as you’re going along. So yeah. BIll Gasiamis (25:49) Can you explain to me briefly if you can, like what happens with foot drop, why does it occur? and why don’t I hear about the opposite of foot drop, which is the foot changing and going in the other direction? The Impact of Electrical Stimulation in Rehabilitation Kory Langwell (26:06) Yeah. so your your muscles on your shin, you know, like those those are the ones that people get shin splints on from working out or whatnot, your anterior tibialis muscle, those are a prime mover of lifting your foot up. And oftentimes the feedback and the timing, the coordination down to those muscles is just weakened or impaired. So you’ll see a lot of issues with that. You also have muscles on the outside of your shin. They’re called everters. So they evert or turn the foot out. So the combination of those everters and then the dorsiflexors that lift the foot up, those muscles are the two prime movers of that motion. They’re oftentimes affected with different strokes. And then so a lot of times what we end up using is like things. like electrical stimulation. I have a really good video on my YouTube, about eight to ten minutes long on how to set that up. but you can You c I I see a lot of good impact with the with the E stem, whether somebody’s laying down or sitting, or then there’s other things like the bioness for the leg and the arm, but the one for the leg to help with the timing and coordination, all that, all those things that go into it. So it’s just not just weakness, it’s that timing, coordination, balance, all those things combined. So yeah. BIll Gasiamis (27:19) Got it, got it. So you’ve seen some positive, helpful, supportive kind of outcomes from those electrical stimulators at like Bioness and other other types. Kory Langwell (27:33) Yeah, yeah. I’ve even like I’ve I have one that I use with clients that I I bought on Amazon for like forty bucks because the the range is anywhere from thirty to forty bucks up to like hundreds of dollars. Or, you know, the Bioness is you I think they can get that covered with insurance, at least a partial bit of it, but those are a lot more expensive. like thousands of dollars from to my knowledge. But I what I’ve seen is I don’t see a huge difference between some of those cheaper versions and then the larger ones. some of the bigger ones, like the Bioness, you do get a little more feedback or like that since like it will come on at a certain point of your gait cycle. So it’s like, lifts the toes at a certain point. helps you go through whereas versus you know a standard ESTEM unit, you’re usually it’s on for like 10 seconds, it’s off for 10 to 30 seconds depending on the settings. So but as an exercise tool in the general, in general, if somebody’s having issues and they have good sensation to that area. So you don’t want to put it on somebody that like can’t feel their leg or whatever. But it can be very beneficial at like getting that sensory and then the motor or muscle input back to that area. So not saying it’s going to get to that 100%. But it’s gonna help you. it oftentimes does help people, even, you know, if it’s ten to fifty percent better, great. You know, that’s a huge difference with somebody getting around. So yeah. BIll Gasiamis (28:53) Okay. So worth people considering the possibility of getting a forty dollar version just to sort of try it out and see whether or not it might be supportive. And then if it is and they want to get something more expensive, then go f go from there. your homework after this conversation is going to be to send us the links to every single thing you mentioned. So we can put it in the show notes and everyone can have a look at it. Now, with walking, Kory Langwell (29:12) Yeah. Yeah, absolutely. Walking: Quality Over Quantity in Recovery BIll Gasiamis (29:23) I’m of the I’m I I’m I’m in the camp of do more in the from the perspective of if you’re only walking for a minute, try and get to two. If you’re walking for two, try and get to four and so on. And then if you can get to thirty minutes or an hour at some stage, doesn’t matter when, then that’s even better. but when we started that conversation about Kory Langwell (29:39) Yeah. BIll Gasiamis (29:53) you joining me on the podcast and we share ideas about what we’re gonna talk about. You came back with me with regards to something about walking that people miss that could mean that walking further, longer, and more could actually be causing a problem. Tell me about about walking and the things that we can run into that make well, not things worse necessarily, but Not from an exercise perspective, but from a rehabilitation’s pers perspective. Understanding the Stages of Recovery Kory Langwell (30:20) Yeah. Yeah, I think it there’s a little differentiator in there. It’s like where what stage are you at in the recovery? So if somebody’s in that really acute stage, it’s you know, pretty fresh on the stroke, maybe it’s like somebody less than a month post stroke. We don’t want to get to the point where they’re just like you know, nearly exhausting themselves every single walk, you know, so there’s a time and a place for that. So you know, if somebody can only walk like five steps, we don’t want to go try to, you know, you’re gonna walk 25. And like you can do that every now and then, but don’t do it on like back to back days. Don’t do it on like back to back therapy sessions or whatever. So there’s a there’s a combination of like early on we want to make sure things are good quality. And then as we get moving forward, we want to progress in a fashion that’s comfortable and not over Taxing the neurological system, because a lot of times, as you know, fatigue plays a huge role in that. And how is that affecting you? Are you like you went for a super long walk, but now you’re down for the count for two days or you know, at least a day. So you know, walking a hundred feet can feel like a marathon early on. So it’s just making sure that you’re getting the right feedback, that accountability, support, where you’re it’s quality. in not just overdoing it. So I find that a lot where people want to do a ton of reps or like they’re doing an exercise, like they’re trying to lift their arm up, but they’re doing this the whole time, you know, and I’m like, you’re just you’re not lifting your arm, they’re just like tiring out their trap muscle as opposed to like some of the the delt or bicep or different areas. So like you’re just gonna get really bulky but traps up here, but you’re not really necessarily helping yourself versus if you did good quality and like keep that shoulder down. I’m just using that as an example. But for walking, you know, same thing. Like are you using a mirror for feedback? To see, like, I’m actually, I’m every step, I’m kind of falling off to the side. Why is that? I’d rather like have somebody walk 50 feet really well than like 150 feet terribly, you know. So it’s and that that again goes into more of the acute stage. Now, if somebody’s sub-acute, more of a chronic, it’s been 10, 15 years, go for it. Like, if you want, if you feel good about it, you’re not overtact taxing yourself, getting overtired or anything, you know, do what you can. Walking is one of the best exercises for you. I also like I I’m a big fan of walking backwards. So in a safe area like by the kitchen sink or a hallway or something, it just challenges your mind and it’s a really good balance exercise for somebody post stroke or with any neurological issue because it just told you you see somebody try it the first time, they’re like, What do you want me to do? Walk backwards. And then there’s tons of ways you can adjust the the intensity on that as well. So yeah. BIll Gasiamis (33:01) So also I remember being in outpatient rehab and feeling like I actually wasn’t able to walk well. And then the therapist saying, Well, why don’t we just record it and have a look at how you’re walking? And it was also about running because I I wanted to run, but I didn’t want to run marathons. I just wanted to be able to run across the road if a car’s coming or something. And I said, Well, I’m a bit concerned about how that Kory Langwell (33:15) Yeah. BIll Gasiamis (33:30) goes ’cause I don’t want to injure myself running, et cetera. And well he said, Well, why don’t we do a run, I’ll record you and I’ll then we’ll break it down and I’ll show you what you’re doing or what you’re not doing. And it turns out that my running style was fine. What wasn’t fine was the feedback that I was getting because it was completely different to the previous thirty seven years of my life. And I and because it felt different and my brain registered it differently, it It was scary. Like it was like, well, this doesn’t I’m gonna probably injure myself is how I I thought it. But when I saw the video, it was completely different. And sure, there was some instructions still about how to do it correctly, what I might be able to improve, especially with my left leg, but the but the overall picture was more positive than I t made it out to be. And that’s the challenging part. Sometimes we think we’re less capable than we are. Kory Langwell (34:06) Yeah, yeah. Yeah, and that’s why the visual feedback is so important, whether you record it with your cell phone or you know, just getting the real time feedback on with a mirror or something like that. It’s you know, you see that used in therapy a lot because you may not notice that you’re doing something and just having somebody tell you that isn’t gonna help as much as if you’re somebody’s telling you plus they’re showing you what you’re doing. Yeah, that that can be a huge, you know, help of like, you know, that I can feel that now. It’s good biofeedback. I can, you know, move on from there. So yeah. BIll Gasiamis (35:01) Yeah. And so it sounds like there’s two parts to that conversation. Is sometimes we think we’re doing it better than we are, and sometimes we think we’re doing it worse than we are. So it’s really important to have somebody assess you or at least give you feedback and give you the opportunity to check your assumptions about yourself and then also to check via perhaps a recording to check, you know, how you are actually doing things. So you can see it from Kory Langwell (35:10) Yeah. BIll Gasiamis (35:31) their perspective and then you can adjust as you’re going forward. Kory Langwell (35:35) Yeah, absolutely. BIll Gasiamis (35:37) So what about falling? That’s a huge issue after stroke. I fell quite a few times after surgery. The first time I fell, Kory, was about I don’t know, less than twenty-four hours after I woke up after brain surgery. And the nurse said to me, Have you been to the bathroom to movie bowels? And I was like, No, I haven’t been anywhere. And she said, Well, great, get up, I’ll let I’ll help you. get there and now she was a lot smaller than me and a lot thinner framed and she said just put your arm around me and I’ll help you get to the bathroom. Okay, cool. I did that and when I stepped out onto my left leg, from the left side of the bed, as soon as I put weight on it, without her having any idea, I completely fell straight to the ground, in the ward, screaming Kory Langwell (36:32) no. Yeah. Yeah. BIll Gasiamis (36:36) I’ve got a fresh h scar and patch on my head from brain surgery literally twenty-four hours ago. so it became quite a concern after that because it was the first time I realized that my left side doesn’t work. And it was the first time I realized that th falling after a stroke with a cr a fresh craniotomy and all that kind of stuff is also very dangerous, right? So when I came home Navigating the Challenges of Falling Post-Stroke Kory Langwell (36:37) Yeah. BIll Gasiamis (37:04) I was pretty independent and I felt really good about the fact that I was able to walk on my own. but when I got up from the couch one time and many other times when I’ve fallen, when I got up from the couch on time, I forgot to connect my new leg to my my standing up, my getting up from the couch. I had just eaten a sandwich. It was in a plate. I was the one that went and made the sandwich, sat down and started eating it. And then as soon as I finished it, I went to get up to take the plate to the sink. And my left leg wasn’t aware that it was on the ground. And I fell immediately. And I dropped the plate, I broke the plate, I smashed my ribs on the arm of the couch. I thankfully didn’t injure myself terribly, but it was a close call. And I always after that, I always made a point and still do in the morning when I wake up to get out of bed. Kory Langwell (37:41) Yeah. Wow. Yeah. BIll Gasiamis (38:01) make sure my foot is on the ground before I stand up so that I don’t lose balance and fall. So that’s my that’s my story about falling, but also it’s very common in stroke survivors. I hear that a lot. Tell me about why falls happen after stroke. Kory Langwell (38:05) Yeah. Yeah. Yeah. You know, first off it Kinda hurts my therapist heart to hear that what you know, the nurse and you will fall in there. That’s where I’m like, he needed a PT evaluation to see how strong his legs are, where his, you know, sensation is and all that. Usually when we get somebody up, we want to make sure they’re safe at the edge of the bed. And then maybe we’re transferring just to like a a bedside commode in the the first time. And then you’re you you check that box then. We start moving towards walking once we make sure it’s safe. But sometimes the nurses get a little gung ho with things and get a little excited. we try to stay in our lane and, you know, just do the That PTS needed. but as far as like, you know, making sure somebody’s safe, it’s creating the right environment for them that, you know, like I mentioned, making sure they’re strong enough with their legs to, you know, and the most people will know as they started physical therapy what level they’re at, how much help they need, all those things. So, and then not over challenging somebody where we’re doing like very advanced balance exercises or doing very, you know, doing three tasks at once or like you carrying that dish, you know, and that’s a more your brain is like thinking, we’re good and I’m just gonna carry this dish and I’m gonna go turn off the TV while I’m getting up or whatever. And your brain’s like, nope, no you’re not, and you just fall over. So it’s like creating, you know, those too many environmental stimuli probably and then just where it kind of I don’t tricked your brain into to not focusing on where your your leg is at. We call that the proprioception or just realizing where your joints are, your limbs are in space. And sometimes that can be very affected after strokes. So we just wanna, you know, see how that looks, see how you’re moving, and and you know, go from there. So yeah. BIll Gasiamis (40:08) You probably describe that better than anybody, actually. Proprioception is my is a challenge that I have, but nobody ever connected that to what you just said, too many things happening at once. And it was exactly that. I had a plate, I just finished a meal, and my goal was to get the plate back to the sink safely without dropping it. And it was my my attention was Kory Langwell (40:33) Yeah. BIll Gasiamis (40:36) diverted away from making sure my leg was in the right position for me to stand up and was the muscles were activated, which I had been doing every day before that, right? I’d been making sure. But right now I had a plate in my hand and it was get up without dropping the plate. Kory Langwell (40:37) Yeah, Yeah. Yeah, yeah. Yep. Yeah. Pun pun intended, step by step, right? Just looking into like, okay, my feet are on the ground. I am able to push myself up to stand. Now we’re gonna take a step slowly, you know, go through that. So yeah, it’s it’s making sure everything looks appropriate and is, you know, safe for that specific client. So yeah. BIll Gasiamis (41:12) In my case I think now reflecting back on it, it would have been better if I’d gotten up and then reached over to pick up the plate and then moved to towards the the kitchen sink. And I think I was at home alone that day. And again, I screamed because before I knew it all was on the ground. Kory Langwell (41:27) Yeah. It happens. Yeah. Yeah. Setting Realistic Goals for Recovery BIll Gasiamis (41:35) It’s a very interesting thing to reflect back on it. under these sort of conditions where you and I are talking about things that seem they’re very glossed over. They’re not often spoken about in detail and people miss the the point. And sometimes people think I can’t do something properly, therefore I’m not gonna do it at all. But with regards to walking, what’s the best thing to do? about a walk that you haven’t been able to get back to the normal sort of style and and feel uncomfortable about doing. Some people will go, well, I’m opting out, I’m not gonna do that anymore because I can’t do it properly. It’s too difficult or it’s uncomfortable. Kory Langwell (42:21) Yeah. Yeah. I think it’s making goals that are you know, you hear about those specific, measurable, attainable, realistic time frame, the smart goals. So making sure that applies here. So It you gotta be able to walk before you can run, like with anything in life. So and that’s just you know, symbolic quote or whatnot, but you just wanna be able to do stuff that you can be working towards, but it’s also not so far out there that it’s like really hard. And then I see a lot of times people move those goalposts on themselves too much where they’re like, I got here. Now it’s like I wanna, you know, it’s you got to celebrate those small wins and then go from there as like far as you know, moving forward. So we had a client recently there. Doctor told them they were never gonna walk again. And literally, like they our therapist showed up, the patient was in tears, and then they walked 70 feet with our therapist. And it was all because it was a doctor that didn’t know them. They did like some reflex testing and said, you’re hyporeflexic, you’re never gonna walk again. And then literally that same day walked 70 feet. I was like, I hope you go back and tell them, you know, that that you missed that. So it’s BIll Gasiamis (43:15) Mm. Kory Langwell (43:36) really just making sure that you’re creating these sustainable goals that You know, and not letting people like that doctor that may not know you, a family member, you know, get in your ear and and cause these things that are detrimental to your your progress and take it in the right way. So yeah. BIll Gasiamis (43:55) You can’t actually answer this and I’m putting you on the spot, but I’m gonna ask it anyway. Like I assume that doctors, therapists, everybody is about rehabilitating, supporting, helping people and all that kind of stuff. I I not assume they definitely are, right? But what do you think is behind a questi a statement like you’re never going to X again? Like I hear that so, so much and I thought that by the time we get to twenty twenty six that that won’t be a thing that I hear about so often. Like, but I I don’t think it comes from being nasty or trying to give people setbacks or whatever. But do you have a sense of what that might be? Is it training? Is it a lack of training? Kory Langwell (44:30) Yeah. The Role of Medical Professionals in Rehabilitation I think yeah, you see a lot of like GPs, general practitioners, they don’t really have great training in like neurological rehab. So if it’s a PM and R doc, like a physical medicine and rehab doc, I find usually they’re a little more open-minded or or willing to s you know see the the progress or or whatnot over time. If you go into a doctor’s appointment, you show up in a wheelchair and it’s been, you know, six months, the doctor’s probably your general practitioner is probably gonna be like, well, this is what it is. It’s been six months. And I think some of that is from old research that came out that you can’t make progress after six months to a year, which was more because they just stopped therapy, they stopped doing things and you know, didn’t see progress because of that. So it’s, you know, yeah, if you don’t do anything and you just sit on your butt, all day you’re you’re not gonna see progress or you’re not gonna change. So but yeah as far as from a doctor’s standpoint it it can also be case by case with the doctors as far as their own experience and whatnot. And I don’t think necessarily they ever mean like harm or anything. Maybe they are trying to be realistic with clients as far as like this is what I’m seeing. I don’t think you know, the chances of this are slim, but they they it’s probably just a way of wording it better versus saying you’re never gonna do something again because there’s so many different things that are coming out, like research wise, treatment, you know, like things change drastically now. so it’s I I just like to to leave a at least leave the door open for people to see that improvement. So yeah. BIll Gasiamis (46:16) And walking doesn’t have to be the way you walked before. It could be a different version. It looked differently, feel differently, but it can still be walking. also I think it’s from ignorance, right? And again, ignorance, I don’t throw that out as a way to attack somebody, but it’s like literally that person hasn’t been in the space where Kory might work. They haven’t been in a space where they have seen people overcome some difficult challenges. Kory Langwell (46:23) Yeah. BIll Gasiamis (46:41) So they just make a assumption based on old thinking or something they heard in the past or old research that just stuck. And they’re just telling you, your job, your responsibility is to find new research to overcome that challenge because that research, it’s so bad if there was some and if they disseminated it to all the population in the medical community, and that has been continued to be passed on. I mean, that is so crazy that it persists and now. I just want to encourage people, do not believe anyone that tells you, A, you’ve hit hit a plateau, B, that you’re never going to do something again. And even though that might be true, just don’t believe it because there might be a technology around the corner that happens to solve that problem for you. You just don’t know about it yet. And always work towards the solution rather than focusing on the problem is kind of how I see it. And that’s generally what you guys tend to do. You guys tend to help people focus on. Kory Langwell (47:27) Yeah. Yeah. BIll Gasiamis (47:41) How do we overcome a problem? What’s the solution to this? Kory Langwell (47:46) Yeah, I think using it as motivation is is huge. So like you can take anything somebody tells you, you can take it one of two ways. And if you let it get you down, that’s up to you. Or if you’re like, Okay, I take that feedback, I appreciate it, but I’m not gonna accept it and use it as motivation to to strive to do better and move better. Like that that’s up to you. and who somebody is in their own, you know, life. So I always tell people it’s like, Well, what do you want to work on? You know, if some people are like, I don’t wanna do this anymore, I don’t wanna exercise, it’s like that’s up to you. So And other people they’re like, I want to push as hard as I can, I want to do what I can do. And so it’s really, you know, up to the what that somebody wants to do with their life and their progress, their recovery. BIll Gasiamis (48:28) Kory, it’s been an awesome conversation. Thanks so much for joining me on the podcast and saying yes when I reached out to have you on here and share your wisdom. Can you tell me where can people go and find th information about you? Kory Langwell (48:44) Yeah, so our our main website is unlimitedpotential.biz and you we have a health coaching page on there where people could message me on there if they want. I’ve had some people reach out. I’m pretty active in TikTok on on like DMs if people in my private messages of people reach out there as well. Dr. Kory, K-O-R-Y, stroke recovery PT. and then I’ll we’ll try to get you the handle there, the links on all that stuff. Those are probably the two best ways to reach me. I will say it’s really hard to give specific advice over a text or an email or whatnot. So I and there obviously I understand like there’s a lot of people that have financial issues or they they want the free advice or whatnot, but it’s just it’s really hard as a therapist to give a lot of that. I try my best and I can’t reach everyone doing that, but we really are able to to make a difference when we do work with people one on one. So yeah. BIll Gasiamis (49:36) Yeah. There might be programs that people can look into that you are offering either in house or somewhere else. That’s probably why I would encourage people to reach out to get an answer about your specific issue. Dr. Corey’s not going to do that. just like many people can’t answer a specific question about a problem that you may or may not have un unless they have information about your data or you know, they’re your physician or they have your scans and all that kind of stuff, that’s not gonna happen. But that’s okay. people can still follow you because your tips on TikTok are really cool. They’re on the mark and that’s where I love listening and learning from you. Kory Langwell (50:16) Thank you, I appreciate it. I’ll keep coming. BIll Gasiamis (50:19) Yeah, definitely keep them coming, man. it’s been a great thing, this social media thing because it brings information to people that otherwise wouldn’t be able to access it. Some people might be stuck with the doctor who said, You’re never gonna do this again. And that would be the most terrible place to be stuck and have nobody else to kind of throw a spanner in the works in that type of thinking and then suggest something more, more hopeful, more positive. Kory Langwell (50:34) Yeah. Yep. Yeah, absolutely. And it’s always good. I mean, I learn from stroke survivors all the time on what they’re going through. And it’s just, you know, it’s everyone working together around the world now. So I’m in I’m in California and we have, you know, like we’re talking you’re in Australia. I’ve talked to people all over the world now and it’s it’s just been great to to open those doors to a lot of people and you know, at least have conversations with them. So BIll Gasiamis (51:09) Doctor Kory, thank you so much for joining me on the podcast. Kory Langwell (51:11) Yeah. Thanks. Thanks for having me. BIll Gasiamis video 25, image (51:13) Well, that was Dr. Corey Langwell, Doctor of Physi

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In this special roundtable episode, I am joined by fellow members of the AOTA Innovative Entrepreneur Ad Hoc Committee for an honest and inspiring conversation about innovation, entrepreneurship, emerging practice, and the future of occupational therapy. Together, we explore how occupational therapists and occupational therapy assistants are creating impact in spaces far beyond traditional healthcare settings while remaining deeply rooted in the core values of our profession. From home organization and functional medicine to marketing, ergonomics, community-based practice, leadership, and advocacy, this episode highlights the many ways OT practitioners are applying their unique lens to solve problems, create opportunities, and improve lives. Whether you're a student, clinician, educator, entrepreneur, or someone simply curious about where OT can go next, this conversation offers encouragement, practical advice, and a reminder that there is no single path to being an occupational therapy practitioner.In This Episode:• The vision behind the AOTA Innovative Entrepreneur Ad Hoc Committee• Why innovation and entrepreneurship matter now more than ever• How OT practitioners are creating careers beyond traditional settings• The unique strengths OTs and OTAs bring into emerging practice areas• Overcoming fear, imposter syndrome, and professional isolation• Finding community, mentorship, and support in non-traditional roles• Advice for students, new graduates, and practitioners considering a career pivotFeatured Guests:Dr. Arameh Anvarizadeh, OTD, OTR/L, FAOTA -President, American Occupational Therapy Association (AOTA)LinkedIn: https://www.linkedin.com/in/arameh-anvarizadehInstagram: https://www.instagram.com/drarameh/?hl=enShould I Be an AOTA Member? Arameh Anvarizadeh's 2-Minute Pitch -OT Potential with Sarah Lyon - Breakdown of 4 C'shttps://www.youtube.com/watch?v=2h7FyFBnebc&t=26sSarah Larsen, OTR/L - Home Organization Occupational TherapistWebsite: https://balancedhomeorganization.com/Instagram: https://www.instagram.com/balancedhomeorganization_pdx/Facebook: https://www.facebook.com/BalancedHomeOrganization/LinkedIn: https://www.linkedin.com/in/sarah-larsen-292390181/Anne-Marie Dundas, OTR/L - Occupational Therapist, Functional Medicine & Wellness PractitionerLinkedIn: https://www.linkedin.com/in/ann-marie-dundas-2963378b/Instagram: https://www.instagram.com/whole_life_healthy_/Krista Frahm, OTR/L – Occupationa Therapist, Marketing Strategist & Copywriter for Healthcare ProfessionalsWebsite: https://www.kristafrahm.comLinkedIn: https://www.linkedin.com/in/kristafrahmagency/Instagram: https://www.instagram.com/kristafrahmagency/Aja Black, COTA/L, CAE - Certified Occupational Therapy Assistant & Ergonomics ProfessionalLinkedIn: https://www.linkedin.com/in/aja-black-b676b4125/Instagram: https://www.instagram.com/ajaeblack/?hl=enPatricia Motus, OTR/L, CTIS, RYT - Community-Based Occupational Therapist, Educator, Mentor, Speaker, and Host of The Uncommon OT SeriesWebsite: https://www.wholistic-transitions.com/LinkedIn: https://www.linkedin.com/in/patricia-motus/Instagram: @transitionsOTAdditional Ad Hoc Committee Members:Tomeico Faison, OTD, OTR/L, FAOTA - EntrepreneurWebsite: https://tomeicofaison.com/LinkedIn: https://www.linkedin.com/in/tomeicofaison/Gretchen Kingma, OTR/L, CAPS, ECHM - RealtorWebsite: https://empoweredhomes.com/author/gretchen/LinkedIn: https://www.linkedin.com/in/gretchen-kingma-21930387/Instagram: https://www.instagram.com/gretchenkingma_/?hl=enAOTA Education Ad Hoc CommitteeRyan Lavalley, PhD, OTR/L, FAOTA https://www.linkedin.com/in/ryanlavalley/Innovative Practice OT Interest & Connection Formhttps://docs.google.com/forms/d/e/1FAIpQLSf4L_DkBlWZmrwn3o-OglNyzsTqjClaYKSJvx4X0GOwUapIbA/viewformAs always, I welcome any feedback & ideas from all of you, or if you are interested in being a guest on future episodes, please do not hesitate to contact Patricia Motus at transitionsot@gmail.com or DM via Instagram @transitionsotTHANK YOU for LISTENING, FOLLOWING, DOWNLOADING, RATING, REVIEWING & SHARING “The Uncommon OT Series” Podcast with all your OTP friends and colleagues!Full Episodes and Q & A only available at:https://www.wholistic-transitions.com/the-uncommon-ot-seriesSign Up NOW for the Transitions OT Email List to Receive the FREEUpdated List of Uncommon OT Practice Settingshttps://www.wholistic-transitions.com/transitionsotTo Add Your Profile to The Uncommon OT Directory:https://www.wholistic-transitions.com/requestFor Non-Traditional OT Practice Mentorship w/ Patricia:https://docs.google.com/forms/d/e/1FAIpQLSeC3vI5OnK3mLrCXACEex-5ReO8uUVPo1EUXIi8FKO-FCfoEg/viewformHappy Listening Friends! Big OT Love!All views are mine and guests own.

Leaving a job is one of the trickiest moments in your career.Whether you're the employee or the employer, emotions run high, plans change quickly, and patients are caught in the middle.In this episode, we discuss a question that came up in the Pelvic PT Huddle and use it to explore what it really means to leave a position professionally and gracefully.We cover:✅ Why giving notice is so emotionally complex for both sides✅ The difference between a poor business decision and an unethical one✅ Why it's not your job to create the transition plan✅ How to advocate for your patients without taking on responsibility that isn't yours✅ Why pelvic rehab is incredibly important... but it isn't life-or-death careOne of our biggest takeaways:You can care deeply about your patients without carrying the weight of the entire system on your shoulders.About Nicole & Jesse CozeanPelvic health is hard. We want everyone in this field to have a joyful, impactful career. And for business owners to build something that truly works for them.

For the first time in the seven years I've been a part of OTS, I had some major tech issues with a scheduled upload, but thankfully after a little rearranging of my schedule and while that is being dealt with on the back end we can sit back and enjoy learning about Marian Yee's incredible new book, set to hit shelves near you this Tuesday!!We had a fantastic conversation and I can't think of a better way to end off the month!Follow MarianFollow OTSOTS SubstackMap of Indie BookstoresGet 4 Janes (out 6/30!)Brookline BooksmithTrident Bookstore

It's hard to overstate how important it is for OTs and PTs to understand the new value-based care models.But, let's be honest—they are an overwhelming and confusing alphabet soup (TEAM, LEAD, GUIDE, ACO REACH), and that's just the acronyms.For OTs and PTs, understanding these models will be the difference between being embedded in the healthcare team of the future—where we deliver highly valued care—and falling into obscurity while our patients receive sub-par care.Luckily, we have a master at demystifying the complex, Dana Strauss, back on the podcast. You'll learn:-How to analyze new models-How to understand your potential role in them-How to move your career and your organization forwardI know therapists are so busy on the ground, but we can't afford to miss this one.See full course details here:https://otpotential.com/continuing-education/course/therapy-and-value-based-care-modelsSee all OT CEU courses here:https://otpotential.com/ceu-podcast-coursesCheck our our live webinar schedule here:https://otpotential.com/live-ot-ceu-webinarsSupport the show by using the OTPOTENTIAL Medbridge Code:https://otpotential.com/blog/promo-code-for-medbridgeTry 2 free OT Potential courses here:https://otpotential.com/free-ot-ceusSupport the show

You have money mindset issues.We do too.  Every business owner does.The question isn't whether you have them...It's how much they're quietly holding your business back.In this episode, we unpack how money mindset shows up in pricing, hiring, investing, patient care, and even the recommendations you make in the treatment room.We discuss: Why money mindset affects far more than your finances  The subtle ways it shows up in your business every day  How it impacts pricing, confidence, and patient care  Why awareness alone isn't enough  The ABCs of changing your money mindset: Awareness, Behavior, and Coaching & Community One of the biggest takeaways:Your money mindset doesn't just affect your income. It affects your decisions.And better decisions build better businesses. Business Accelerator Program

Are you an occupational therapist whose diary is packed, yet you still feel overwhelmed, exhausted, and financially stuck? In this episode of OT Yourself to Freedom, Beki Eakins explores one of the most common patterns she sees among occupational therapists, particularly OT business owners and private practice clinicians. Many OTs believe their biggest challenge is time management, marketing, or finding more clients. But what if the real issue is something deeper? Beki unpacks the hidden cycle that keeps occupational therapists trapped in endless clinical hours, overdelivering, undercharging, and constantly saying yes to work that no longer aligns with their goals. You'll discover why boundaries, self-worth, scarcity thinking and people-pleasing often sit at the heart of burnout, and how these patterns prevent OTs from creating the freedom, income and impact they truly want. Connect with Beki Are you ready to leave the whinger mindset behind and embrace your inner go-getter? Beki helps OTs worldwide design, launch, and scale their online business Free Resource: Download Beki's free overnight mindset meditation for free to help you build confidence, overcome money mindset challenges, and develop self-belief. Download here: https://www.bekieakins.com/overnight-subscribe The OT Freedom Formula was a powerful session created to help OTs build more freedom, income and balance - without burnout. Watch it here: https://www.bekieakins.com/Formula-event-Recording-lp Join OT Yourself To Freedom Membership : https://www.bekieakins.com/membership Discover the only membership designed specifically for OTs to create freedom-based businesses by leveraging the skills you already have. Learn to design and sell offers, market effectively, and align your work with your purpose. Follow Beki: Website: https://www.bekieakins.com/ Instagram: https://www.instagram.com/otyourselftofreedom/ Facebook Group: https://www.facebook.com/groups/otyourselftofreedom LinkedIn: https://www.linkedin.com/in/bekieakins/ Book an Inspiration Call : https://otfreedom.bekieakins.com/widget/booking/bqsc3yEhKnzDh3cPz0PZ Website: www.bekieakins.com Instagram: OT Yourself to Freedom Facebook Group: OT Freedom Community LinkedIn: Beki Eakins Book an Inspiration Call: Click here About the Host Beki Eakins is a business mindset and lifestyle coach for occupational therapists. After leaving traditional OT practice, she has helped hundreds of OTs worldwide design aligned online businesses that support freedom, income, and purpose, without burning out.

Wait...you don't have a gym?  It's a question we get all the time.Especially because when we redesigned our clinic from the ground up, we could have built anything we wanted.A dedicated gym space.  Fancy equipment.  Treadmills.  Squat racks. All the toys.Instead?We made our treatment rooms bigger.In this episode, we discuss how to think strategically about clinic space, equipment, and designing a practice around your actual patients—not what your last employer had, what you see on social media, or what everyone else seems to be doing.We cover: ✅ Why your treatment philosophy (Ethos) should drive your decisions ✅ How to think critically about expensive equipment purchases ✅ Why you don't need everything right away ✅ Creative alternatives to dedicated gym spaces ✅ Matching your environment to your patient population ✅ When investing in equipment absolutely makes senseOne of the biggest takeaways:Every square foot in your practice should serve a purpose.Build the clinic that supports your patients and your style of care—not someone else's.Business Accelerator Program

After working with more than 900 pelvic rehab business owners, we've noticed something:The people who have long-term success aren't necessarily the most talented, charismatic, or the best clinicians.They're the most consistent.In this episode, we break down the five biggest principles we've seen separate thriving business owners from everyone else.We discuss:✅ Why you're a different business every six months✅ Why consistency beats talent every time✅ The surprising power of community and support✅ How to embrace the seasons of business and life✅ Why financial confidence matters more than financial successOne of the biggest takeaways:Business growth is personal growth.The businesses that last aren't built by people who avoid challenges.They're built by people who learn, adapt, stay connected, and keep showing up.If you're playing the long game, this episode is for you. Registration for Accelerator Cohort #7 is now open.This episode is essentially a summary of what we've learned from coaching more than 900 pelvic rehab business owners over the last decade.Inside the Accelerator, we help you build the three pillars of a successful business:

Send us Fan MailNo crew. No guardrails. Just Aaron on a members-only mic doing what he does best—thinking out loud and lighting fires. This episode is an end-of-year wrap that turns into a manifesto: why fitness is a moral obligation, why “peaceful” without capability is a lie, and how attribute-based selection actually works when the slogans stop. Aaron breaks down why OTS waited, why it's scaling fast, and why 2026 is about to get wild—including international moves. Then he unloads on the Venezuela boat story, media hysteria, political hypocrisy, and why precedent matters more than pearl-clutching. If you're looking for polished takes, you're lost. If you want clarity without comfort, press play.⏱️ Timestamps:00:00 Aaron Solo, Members Only02:15 Fitness, Violence, and Real Virtue05:00 Attribute-Based Selection Explained08:30 Why OTS Exists and Why It Waited12:45 Going International & Ego Management16:00 Zulu Course Reality Check20:00 Venezuela Boat Story and Media Panic27:30 Precedent, Power, and Hard Truths30:00 2026 Direction & Final Shots

Send us Fan MailNot all rotator cuff tears are the same, and understanding why can completely change how you set expectations and build a plan with your patients. In this episode, we break down tendon anatomy and physiology, the different ways rotator cuff tears develop (degenerative vs. traumatic), the difference between partial- and full-thickness tears, and the factors that influence healing and prognosis for both conservative and surgical patients.In this episode you'll learn:What a tendon actually is and why its structure (and blood supply) matters for healingThe difference between degenerative and traumatic rotator cuff tearsRisk factors that make someone more likely to develop a tearArticular-side vs. bursal-side partial thickness tears — and why bursal tears tend to hurt moreWhat "massive" and "irreparable" tears mean, and how outcomes differPredictors of good outcomes with conservative care (hint: baseline ROM and strength matter)A quick look at steroid injections vs. PRP for rotator cuff tearsTest yourself:What is a tendon's main job, and what structures help it do that job?What are the main categories of rotator cuff tears?What are the two types of partial thickness tears, and how do they differ?What factors affect healing after a rotator cuff tear — for both conservative and surgical patients?

Do you run late with your patients?  Most clinicians do. And almost all of them think it's either helping or 'not that big a deal'.It's not.In this episode, we break down why running late is one of the most damaging habits in clinical practice—for you, your patients, and your business.We discuss: Why running late doesn't earn gratitude or loyalty  How it quietly poisons patient expectations  The biggest reasons clinicians fall behind schedule  Why insecurity often shows up as "doing too much"  How poor session planning creates chaos  The importance of ending sessions confidently and professionally  Simple logistical fixes that can immediately improve your schedule One of the biggest takeaways:Running late isn't a victimless problem.It affects your energy, your stress levels, the patient experience, your clinic and ultimately your ability to provide great care.If you're constantly behind, this episode will help you identify why—and what to do about it.Business Accelerator ProgramRegistration for Accelerator Cohort #7 is open now.One of the biggest things we help business owners do is create a business that doesn't depend on chaos, stress, and constantly feeling behind.If you're ready for better systems, better boundaries, and a business that actually supports your life:

It feels like in every practice area, the importance of the vagus nerve is being talked about.But nowhere is it being researched as much as vagal nerve stimulation post-stroke. And the initial results are promising — as long as it is paired with rehabilitation. The stimulation sets the body up for new motor learning, but then the rehab actually creates the change.In this beginner's course, I'm excited to talk to Sarah Blair, OTR/L  from Vivistim about what she has learned about this relatively new intervention and what generalist OTs need to know about this option.See full course details here:https://otpotential.com/ceu-podcast-courses/the-vagus-nerve-and-stroke See all OT CEU courses here:https://otpotential.com/ceu-podcast-coursesCheck our our live webinar schedule here:https://otpotential.com/live-ot-ceu-webinarsSupport the show by using the OTPOTENTIAL Medbridge Code:https://otpotential.com/blog/promo-code-for-medbridgeTry 2 free OT Potential courses here:https://otpotential.com/free-ot-ceusSupport the show

Getting leads is only the first step.  The next part is turning those leads into paying patients.  And this is where many of us struggle. In this episode, we break down the conversion system that takes someone from "I'm interested" to actually showing up for an evaluation.We cover: Why scripts are only a small part of conversion  The biggest follow-up mistakes practice owners make  Why texting isn't enough  The power of getting people on the phone  How systems reduce mental load and improve consistency  Why most people aren't losing patients to competitors—they're losing them to inaction If your schedule isn't full, your conversion system may be leaking more patients than you realize.Business Accelerator ProgramRegistration for Accelerator Cohort #7 is opening soon! Inside our 6-month coaching program, we give you: ✅ The exact phone scripts we used at PelvicSanity ✅ The conversion systems that have helped thousands of patients get scheduled ✅ Marketing, business systems, and clinical excellence training ✅ Coaching, accountability, and support from our teamIf you're ready to make your business look different by the end of 2026, we'd love to help.

This episode of PT Breakfast Club is a practical conversation about value, access, content, and revenue in physical therapy. Jimmy McKay, Tony Maritato, and Dave Kittle start with a wild sports pricing example, then bring the conversation back to the clinic: why do PTs struggle to charge for expertise when other industries clearly understand premium access?The group digs into insurance reimbursement, cash-pay models, YouTube memberships, creator burnout, and why patient education content may become a serious business asset for PTs and clinic owners.Key Insights• People pay for access, status, trust, and simplicity. PTs need to understand which of those they are actually offering.• Billing codes can train clinicians to think in units instead of outcomes, expertise, and value.• Premium PT care and broad access are not opposites. A clinician can charge more for high-touch care while also creating lower-cost education through content, memberships, and video libraries.• YouTube memberships may be a practical way for PTs to build education-based revenue without building a custom app.• The biggest content barrier for many PTs is not editing, gear, or planning. It is confidence, consistency, and fear of being judged.• A shared rehab creator network or launchpad could help PTs, OTs, and SLPs build audiences faster than working alone.• Corporate content often fails when it feels like an ad too early. Trust has to come before the close.Why This Matters For PTs And Clinic OwnersClinic owners are under pressure from reimbursement, staffing, burnout, and rising patient expectations. This episode pushes the profession to think beyond the visit-based model and ask: what else can expert clinicians build with their knowledge?For individual PTs, the message is simple: your expertise can create value outside the treatment room, but only if you are willing to publish, test, learn, and keep going.Hosts / GuestsJimmy McKayPT PintcastTony MaritatoTotal Therapy Solution - Physical Therapyhttps://www.youtube.com/c/TotalTherapySolutionDave KittleThe Dave Kittle Showhttps://www.youtube.com/@thedavekittleshowSponsorsSaRA Healthhttps://sarahealth.comEMPOWER EMRhttps://empoweremr.comU.S. Physical Therapyhttps://usph.comSubscribe & FollowApple Podcastshttps://podcasts.apple.com/us/podcast/pt-pintcast-physical-therapy/id1000443325Spotifyhttps://open.spotify.com/show/3LmMUT64yrUc2iGo9EmafcYouTubehttps://www.youtube.com/@PTPintcastLinkedInhttps://www.linkedin.com/in/jimmy-mckay-pt-dpt-a4207659/Instagramhttps://www.instagram.com/ptpintcastX / Twitterhttps://x.com/PTPintcastWebsitehttps://www.ptpintcast.com/

What if the answer for your most complex patient...was actually simpler than you think?In this episode, we share a favorite clinical principle and one that we train on at PelvicSanity...The more complex the patient, the simpler the intervention.Because when someone has seen multiple providers, tried countless treatments, and feels completely overwhelmed by their symptoms...The last thing they usually need is a more complicated plan.We discuss:✅ Why newer clinicians shouldn't be shielded from complex patients✅ The foundational interventions most clinicians overlook✅ How to choose treatment priorities with your patient ✅ Metaphors that help patients understand why you're starting simple ✅ Why patience is required—for both clinician and patient ✅ Why no patient is too complex to helpIf you've ever felt intimidated by a long history, a thick intake packet, or a patient who's "tried everything"...This episode is for you. Downtraining MasterclassMany complex patients don't need more exercises.They need a nervous system that can actually accept change.If you'd like a deeper dive into downtraining and nervous system-focused treatment, check out the Downtraining Masterclass.

Why isn't your schedule full?The first place to look is whether we are getting enough leads.We break down the 10 biggest marketing and sales mistakes pelvic rehab business owners make—and how to fix them.From not tracking your numbers to relying too heavily on social media, these mistakes quietly sabotage growth and leave owners feeling frustrated, overwhelmed, and stuck.You'll learn: ✅ Why most owners don't actually know how many leads they need ✅ The hidden cost of inconsistent marketing ✅ Why relying on one marketing strategy is dangerous ✅ How poor follow-up kills referrals and leads ✅ Why social media isn't the answer most people think it is ✅ The biggest conversion mistakes happening on the phone ✅ How to identify whether your problem is marketing, sales, systems, or clinical excellenceIf you want a different result in your business by the end of the year, you'll need to take different action.This episode shows you where to start. Business Accelerator ProgramRegistration for Cohort #7 is now open!The Business Accelerator is our signature 6-month coaching program designed specifically for pelvic rehab business owners.Inside the program we help you master the three pillars of practice growth:

Are you still relying on the Peabody or BOT as your go-to assessment? You're not alone, but you might be missing something critical. In this episode, we dive deep into occupation-based assessment with Dr. Alysha Skuthan and Dr. Erin Gaby, who recently published groundbreaking research on the occupational profile in school-based practice.This conversation is for every school-based OT who has ever wondered: What actually makes an assessment occupation-based? Why does the occupational profile matter? And how can I fit it into my already overwhelming workload?The research reveals surprising findings from their research showing that 35% of school-based OTs don't complete occupational profiles, despite it being a formal requirement in the Occupational Therapy Practice Framework.You'll hear practical strategies for collecting occupational profiles, honest talk about barriers like time constraints and parent communication, and compelling reasons why using occupational language in your reports matters for advocacy. Plus, they discuss occupation-based alternatives to common standardized tests and share their favorite tools like the School Function Assessment.Listen to learn how shifting to occupation-based practice can transform not just your assessments, but your entire intervention approach.Learning Objectives— Learners will identify the key characteristics that distinguish occupation-based assessments from skill-based assessments— Learners will recognize why the occupational profile is an important component of every SBOT evaluation— Learners will identify the importance of using occupational language in evaluation reports for professional advocacyClick here to register & get the best deal on the 2026 Back to School Conference!  Thanks for tuning in! Thanks for tuning into the OT Schoolhouse Podcast brought to you by the OT Schoolhouse Collaborative Community for school-based OTPs. In OTS Collab, we use community-powered professional development to learn together and implement strategies together. Don't forget to subscribe to the show and check out the show notes for every episode at OTSchoolhouse.comSee you in the next episode! 

Should we be anti-Kegel?  Has the pendulum swung too far?We brought on the one and only Michelle Lyons to continue the conversation.  It deserved a Part 3, and there's no one else we'd rather deep dive into the topic with than Michelle.  We cover:Why Kegels and pelvic floor muscle training are NOT the same thing  The history of Dr. Kegel (and why we may have misunderstood him)  Why pelvic floor rehab is far more sophisticated than "squeeze and lift"  The role of strength, timing, coordination, endurance, and movement  Why social media has made this debate more confusing  How to become a more evidence-informed clinician If you've followed Parts 1 and 2 of the Great Kegel Debate, this episode brings everything together with one of the sharpest minds in pelvic health.Michelle LyonsMichelle Lyons is an internationally recognized pelvic health physiotherapist, educator, author, and speaker. She has taught clinicians around the world on pelvic health, hormones, oncology, GI dysfunction, and women's health rehabilitation.Learn more: 

Many of us have the feeling there's more potential in the business…we just don't know how to unlock it. What got us to this level of success isn't enough to take us to the next.We start to feel stuck, or wonder 'is this it?'Working harder than ever.  Stressing about the business.  Trying to do 'all the right things'.And yet: You're not hitting your financial goals  You don't feel the freedom you expected  And you know your business could be doing moreThat's what we tackle in this episode.Free Training - How to Unlock The Hidden PotentialIf you're a pelvic PT/OT business owner, make sure you've signed up for our free training on June 3rd (replay available for a limited time).www.pelvicptrising.com/potentialAnd our newest cohort of the Accelerator Program starts in just a few weeks - check it out at www.pelvicptrising.com/acceleratorAbout Nicole & Jesse CozeanPelvic health is hard. We want everyone in this field to have a joyful, impactful career. And for business owners to build something that truly works for them.

In this episode, I'm joined by Mental Health Endorsed Occupational Therapist, Yoga Teacher, Circle of Security Parenting Facilitator and Motherhood Studies practitioner Hollie Swanton to explore matrescence, regulation, identity, and the transition into motherhood through the lens of occupational therapy. Hollie supports women both perinatally and across the lifespan using body-based and mind-body approaches to healing, regulation, and reconnection. Together we explore the often invisible work of adapting to motherhood - the shifts in identity, routines, relationships, nervous system responses, and daily occupations that can emerge during the transition into becoming a mother. We discuss what occupational therapy actually is, how OTs can support mothers, and why motherhood can feel so physically and emotionally dysregulating, particularly within systems and cultures that often leave women unsupported, overstimulated, and disconnected from themselves. CONNECT WITH HOLLIE: Free meditations and somatic practices for mothers: https://www.hollieswanton.com.au/free-meditations-for-mothers Instagram: https://www.instagram.com/hollieswanton_ot/ Website: https://www.hollieswanton.com.au Resources: https://www.hollieswanton.com.au/hearth-womens-health

Are we trying to do too much as pelvic rehab providers?That might be an uncomfortable question.Because when it comes to birth prep, many of us genuinely want to help our patients have the best experience possible.But where does our expertise end?And where does someone else's begin?In this episode, Nicole sits down with Gina Conley of MamasteFit—perinatal fitness provider, birth doula, educator, and someone who has attended hundreds of births—to talk about the role pelvic PTs actually play in pregnancy and birth preparation. This conversation challenges a lot of assumptions and asks us to reflect on how we're showing up for our pregnant patients.We dive into:

One of the biggest reasons people start a business…is freedom.  Freedom to: Work the hours you want  Pick your kids up from school  Travel  Control your schedule But somewhere along the way…the dream turns into a nightmare.You started the business for freedom, but... 

Dolphins start OTS's, How Mario Christobal and Kirby Smart stack up, Movie Reviews of Obsession and Lifehack, Why many neophytes don't understand the InterMiamiCF mess, 3A Graphix Sports Calender, Music History, Bisthdays, How JSN gets screwed, Home for future Superbowls and more.

Dolphins start OTS's, How Mario Christobal and Kirby Smart stack up, Movie Reviews of Obsession and Lifehack, Why many neophytes don't understand the InterMiamiCF mess, 3A Graphix Sports Calender, Music History, Bisthdays, How JSN gets screwed, Home for future Superbowls and more.

Dolphins start OTS's, How Mario Christobal and Kirby Smart stack up, Movie Reviews of Obsession and Lifehack, Why many neophytes don't understand the InterMiamiCF mess, 3A Graphix Sports Calender, Music History, Bisthdays, How JSN gets screwed, Home for future Superbowls and more.

When a student refuses to eat at school, it affects everything—academic performance, regulation, social interactions, and the afternoon meltdown that follows.In this episode, @Jayson Davies sits down with Alisha Grogan, MOT, OTR/L, founder of Your Kid's Table, to talk about feeding challenges in school-based OT. Alisha brings over 20 years of experience working with extreme picky eaters and shares what school-based practitioners need to know about supporting students who struggle with lunch and snacks.You'll learn how to identify when picky eating crosses into extreme territory, why the cafeteria environment can be so overwhelming for sensory-sensitive students, and what accommodations actually help. Alisha also clarifies the often-confusing scope question: what can school-based OTs reasonably address versus what requires outside support?Whether you're freezing up when feeding comes up in an IEP or wondering how to support a student who won't eat at school, this conversation offers practical, realistic guidance grounded in both clinical expertise and respect for the school setting.Listen now to learn how to make lunchtime less stressful and more successful for the students on your caseload.Learning ObjectivesBy the end of this episode, learners will be able to:Learners will identify the clinical indicators that distinguish extreme picky eating from typical developmental selectivity, including the 20-food threshold and sensory-behavioral red flags (Remember/Understand)Learners will identify and address environmental barriers in the cafeteria that prevent students from eating at school—including sensory overwhelm from noise, lighting, smells, and peer interactions—and implement appropriate accommodations such as quiet eating spaces, noise-canceling headphones, weighted lap pads, and regulation strategiesLearners will identify scope of practice for feeding intervention in schools by understanding what is appropriate for school-based OT (supporting participation in lunch/snack routines, environmental modifications, family education) versus what requires outside clinic-based or medical feeding therapy (expanding food repertoire, intensive feeding protocols, home mealtime culture changes)Click here to register & get the best deal on the 2026 Back to School Conference!  Thanks for tuning in! Thanks for tuning into the OT Schoolhouse Podcast brought to you by the OT Schoolhouse Collaborative Community for school-based OTPs. In OTS Collab, we use community-powered professional development to learn together and implement strategies together. Don't forget to subscribe to the show and check out the show notes for every episode at OTSchoolhouse.comSee you in the next episode! 

Send us Fan MailPeaches is solo in the team room—and this one turns into a full-on reality check.It starts simple: pre-recording for Nashville, OTS updates, life logistics. Then he rolls into a Pentagon clip that asks one of the dumbest questions imaginable—what does it feel like to order violence? That's where it flips.Peaches breaks down the truth most people will never understand: war isn't emotional, it isn't personal, and it sure as hell isn't about “feeling powerful.” It's about finishing the job and bringing your people home.Then he goes deeper—mindset, awareness, and why most people are walking around completely blind to the world around them. Cooper's Colors, escalation of force, and the uncomfortable reality that sometimes the only winning move… is going all the way to 100.And yeah—he addresses the “dealer of death” crowd too. If you think Americans celebrate killing, you're missing the entire point.Ends strong with the A-10 staying alive—and why that matters more than people think.Bottom line: this isn't a feel-good episode. It's a wake-up call.⏱️ Timestamps: 00:00 Solo Episode—No Safety Net 02:00 Nashville & OTS Updates 05:00 Finding the Right Training Environment 08:00 Pentagon Clip—What Are We Asking? 11:00 “What Does Violence Feel Like?” 14:00 War Isn't Personal 17:00 Cooper's Colors Explained 21:00 Most People Are in White (Clueless) 25:00 Yellow to Orange—Stay Ready 29:00 Red—When It's Go Time 32:00 Why Escalation Gets You Killed 36:00 Going Straight to 100 40:00 The Reality of Violence 44:00 “Dealer of Death” Misunderstood 48:00 Stop Misreading the Military 52:00 A-10 Saved—Now Comes the Hard Part 56:00 Final Thought—Wake Up

Send us Fan MailPeaches and Trent are coming to you live from Nashville, Tennessee—halfway through day one of Operator Training Summit, and yeah… the chaos is exactly what you'd expect.43 candidates. Full cadre. Heated pool. Turf gym. Zero excuses. And somehow Aaron's already in full “don't talk to me” mode before lunch. Business as usual. The guys break down why Nashville might be the best OTS location yet, what actually happens behind the scenes, and why this isn't a smoke session—it's mentorship, diagnostics, and teaching candidates how to stop training like idiots.From Chris Thomas' legendary stories, to Taylor Starch casually fixing people's garbage run mechanics, to the brutal reality of a surprise IFT after a full day of work… this is what “Train With Intent” actually looks like.Bottom line: you can watch reels all day… or you can show up and find out where you really stack up.⏱️ Timestamps: 00:00 We Forgot to Plan This Episode 01:00 Live from Nashville OTS 02:00 Why This Facility Is Unreal 04:00 Aaron's Already Grumpy 06:00 What Happens Between Training Days 08:00 Chris Thomas—Stories That Hit Different 10:00 “You Want to Be a PJ? Start Running.” 12:00 Why Community Changes Everything 14:00 Stop Training Alone 16:00 Light Bulbs on the Track 18:00 Running 6:45s Without Realizing It 20:00 Training Smarter, Not Harder 22:00 Taylor Starch Is Breaking Hips Again 24:00 Standards Matter—Pushups, Pullups, and Pain 26:00 The “Optional” IFT… Sure 29:00 10+ Hours in the Pool Tomorrow 31:00 Hoist, Hydration, and Who's About to Cramp 33:00 Pennsylvania OTS Is Live 35:00 Final Thought—Show Up or Stay Average