Podcast appearances and mentions of Peter G Levine

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

Constraint Induced Therapy: Part I OVERVIEW: Pete: And I asked whoever answered the phone, may I please speak to Dr. Ince. And he goes ‘hello' and I'm in a panic because I'm like this is the guy! It took me three days to find him! And I'm like, ahh, Dr. Ince my name is Pete Levine and I'm doing a book on ah Constraint Induced Therapy and um Dr. Taub said that you were the first human to ever do it on humans and I'm really excited to talk to you... and he goes ‘I can't hear you. There doin' construction outside. Wait, let me close the door.' Boom! Door slams and he comes back and he tells me this fantastic story.  Pete quoting Dr. Ince: In 1967, I'm in a Macy's and I'm standing there next to this guy. I don't know who he is, and ah, we're at a table with toys and our wives are gone doing something, I don't what they were doing. And he was fooling with this toy...' Pete: I always imagine this toy was the monkey with the two cymbals going like shika tik tik. Pete quoting Dr. Ince: ‘And he was foolin' with this toy and we got to talking and I'm a physiatrist and he was doing this stuff and he invited me to his lab in Brooklyn...' Pete: And this is my best NY accent...I'm so sorry...you know I was born in Manhattan, so I have a little bit of right to do this. Pete quoting Dr. Ince: ‘And um, and I asked him: What you're doing with these monkeys... Can I do it with humans? And what I found was that it could be done with people. We did the experiment. We were the first to publish about it and with some people it was successful, with some people not so successful, and some people it was a total failure.' Pete: And that's still where we are today. Constraint Induced Therapy is not for everyone. I think you would agree. Deb: Yes. That's fascinating! What a cool life you have! Pete: I know! Lawrence Ince... he was so cool with me. Once he saw that I wasn't calling him to sell him life insurance or something...you know he was willing to talk. So, he was great. It was just great. It sends shivers up my spine still...   EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is all about Constraint Induced Therapy (CIT). CIT is a big topic and we talked for a long time – enough for two full episodes. In this part 1 section we: Heard about the history of CIT - that it began with Nobel Prize winner, Sir Charles Sherrington  Learned that Sir Charles Sherrington coined the words ‘synapse,' and ‘neuron,' and he talked about ‘neural networks.' That's not all, he drew neurons and synapses! Listen to learn why this is a BIG DEAL... Reviewed dorsal root rhizotomy and went deeper into it, including the procedure and process – according to Pete, it's a really great tool for spasticity treatment Learned about reflexes and movement Talked about the role of Operant Conditioning in CIT Compared differences between research done by Dr. Edward Taub and that performed by Dr. Stephen Page & Pete Levine Tied in the importance of home programs and clinic follow up for client follow through This episode begins with a bit of fascinating neuroscience history to include Nobel Prize winner Sir Charles Sherrington. There's no rabbit hole involved as it ties right into the topic of Constraint-Induced Therapy! Pete takes us along a journey into the research using his artful way of telling a story that keeps everyone captivated.  We transition smoothly from the early days of CIT into Dr. Edward Taub's work, and then onto detailed information around the modified version of CIT with our very own Peter G. Levine's work. As always, we want to hear your top takeaways! LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION: The Brain Science Podcast with Ginger Campbell, MD. Episode 119 with Dr. Edward Taub Episode 120 with Dr. Edward Taub Lee, H. J., Moon, H. I, Kim, J. S., & Yi, T. I. (2019). Is there a dose-dependent effect of modified constraint-induced movement therapy in patients with hemiplegia? NeuroRehabilitation (Reading, Mass.); 45 (1), 57-66. doi: 10.3233/NRE-192721 Eras-Garcia, R., Matuti, G., Carrijo, D, Lea ̃o, A., & Cruz, D. (2019). Effects of modified constraint-Induced movement therapy on post-stroke functional and occupational performance. Archives of Physical Medicine and Rehabilitation (Late Breaking Research Poster). https://doi.org/10.1016/j.apmr.2019.10.043 Scott, S., Shade, H., Crowell, M, Lynch, M., Arpadi, L., Levine, A., Muro, A., et al. (2020). Use it or lose it? The diffusion of Constraint-Induced and Modified Constraint-Induced Therapy into OT practice. DOI: 10.5014/ajot.2020.74S1-PO2716 The EXCITE trial: Large multi-site constraint induced therapy trial Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D; EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104. PubMed PMID: 17077374. Page, S.J., Levine, P., Sisto, S.A., Bond, Q., Johnston, M.V. Patients' and therapists' opinions of constraint-induced therapy. Clin Rehabil 2002; 16 (1): 55-60 Page SJ, Boe S, Levine P. What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restor Neurol Neurosci. 2013 Feb 8. A journal article about the first time constraint induced therapy was tried in humans, by Lawrence Ince, MD. Ince J. Escape and avoidance conditioning of response in the plegic arm of stroke patients; a preliminary study. Psychonom Sci 1969; 16: 49-50. Questions and Comments about the podcast: NogginsAndNeurons@gmail.com DONATE TO NOGGINS & NEURONS: Donate to Noggins And Neurons and get an Allstar Pete Trading Card Using your PayPal app:   RESOURCES: Pete's blog, book, Stronger After Stroke,  and  talks. Blog Book: Stronger After Stroke, 3rd edition Pete's talk for the American College of Rehabilitation Medicine. Deb's OT resources The OT's Guide to Mirror Therapy Tri-Fold Mirror (US address only) Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults REQUEST TO BE A GUEST ON NOGGINS & NEURONS. If you're passionate about stroke recovery and have information or a story you believe will help others, we'd love help you share it on the show. Complete the guest request form below and let's see if we're a good fit!   Guest Request Form MUSIC: “Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com ✨Google Podcasts  ✨iTunes    ✨Spotify

As stroke survivors in rehab reach their plateau they are often discharged. Peter G Levine a clinical researcher says that this is when the real work starts The post 135. Stronger After Stroke – Peter G. Levine appeared first on Recovery After Stroke.

As stroke survivors in rehab reach their plateau they are often discharged. Peter G Levine a clinical researcher says that this is when the real work starts The post 135. Stronger After Stroke – Peter G. Levine appeared first on Recovery After Stroke.

“Stronger After Stroke” is one of the most recommended books for stroke survivors by stroke survivors. It is a roadmap for recovery after leaving the hospital. Peter G. Levine talks about the importance of repetition to neuroplasticity. He dives deeply into Dr. Edward Taub’s Constraint Induced Therapy, and what stroke survivors can learn from musicians and athletes. And Levine joins us in this episode of the Strokecast. Bio (From Pete’s Amazon author page) Peter G. Levine is a researcher, author, clinician, adjunct professor, and science communicator. His career in clinical research has been dedicated to finding and reporting on the best systems for driving post-stroke brain plasticity. For two decades Levine has tested emergent stroke neurorehabilitation options including EMG-based gaming, wearable robotics, mental practice, functional electrical stimulation, transcranial magnetic stimulation, and modified constraint-induced therapy (mCIT). He was the lab co-director at the University of Cincinnati Academic Medical Center, and a Research Associate at Kessler Institute for Rehabilitation. He continued his clinical research with The Ohio State University B.R.A.I.N. lab. Levine communicates what he’s learned in research through his blog, dozens of magazine and journal articles, hundreds of professional talks on stroke recovery and brain injury, as well as his book, Stronger After Stroke. Constraint Induced Therapy Constraint Induced Therapy (CIT) at the most basic level, is about encouraging the survivor to use an affected limb by forcing its use. At one level, we all know we’re supposed to use our affected limbs as much as possible. Of course it’s not always easy. In my case, I try to do something like flip a switch or open a door three times with my left hand. After three tries, I let myself use my unaffected limb. That way I get the practice and I don’t get too frustrated when I can’t do something yet. CIT takes that to the next level. It involves restricting the unaffected limb with a sling or other mechanism to force the use of the affected limb for hours a day of therapy. It should be done under the supervision of a therapist because there is certainly a risk of falling or other injury when the unaffected limbs we rely on more than ever are suddenly restricted. But forcing deliberate use of an affected limb is the best way to bring it back on line. Practice One of the key themes we talked about was the importance of practice and repetition. Musicians and athletes (like Peter G. Levine and Stephen Page)  know the importance of repetitive, deliberate practice. Professionals and amateurs who want to be the best they can, practice. And the enjoy it. Spending hour after hour working on a segment of a song or to shave half a second off a run is how they build the skills they need and want to acquire. Malcom Gladwell in his book “Outliers” popularized the idea that to develop expertise in something takes 10,000 hours of practice. And deliberate practice at that. It’s a theory based on the work described in The Cambridge Handbook of Expertise and Expert Performance. Developing skills and particular motions after stroke is similar. It requires more and more repetitions. As Pete shares, it takes 1200 repetitions to develop a single motion in a single joint. Of course walking requires dozens of joints, muscles, and motions. So multiply all those 1200s against one another, and get to work! Homunculus The homunculus is a representation of the brain and various parts of the body. The more you use a part of the body, the more neurons it takes up in the brain. For example, the hands and tongue take up more space in the than the elbow and pinkie toe. The more time and energy you dedicate to something, the more space in your brain is dedicated to that task. For example, a homunculus of my brain would likely show a much larger segment dedicated to speaking than to throwing a baseball. One way I think about how this applies to survivors (and I may be stretching the homunculus analogy) is that a skill from the prestroke days that a survivor was an expert at may come back before a skill one had limited experience with simply because despite the damage there were simply more nerves dedicated to it. As you continue to work on a skill post stroke, a larger portion of the brain will be dedicated to it. More nerves, dendrites, and synapses will become involved. This is neuroplasticity at work. Four Lessons for Recovery Pete summed up his approach and book in 4 lessons. Recovery takes a lot of repetitive practice. Recovery takes a lot of visualization. Don’t expect miracles. Don’t let the perfect be the enemy of the good. Hack of the Week Pete uses a strap with Velcro as a simple, low-cost AFO. It’s a tool that helps lift the toe to make walking smoother and combat foot-drop. The nice thing about a solution like this is that it also gives you access to a wider assortment of shoes while reducing the risk of tripping. Links Stronger After Stroke Blog https://recoverfromstroke.blogspot.com/ Stronger After Stroke on Amazon https://amzn.to/2U6MBsD Pete on Research Gate https://www.researchgate.net/profile/Peter_Levine2 Stephen Page https://www.medbridgeeducation.com/instructors/stephen-page-ot/ Kessler Institute https://www.kessler-rehab.com/ Taub Therapy Clinic https://www.uabmedicine.org/patient-care/treatments/ci-therapy Dr. Edward Taub https://www.uab.edu/cas/psychology/people/faculty/edward-taub Dr. Jill Whitall https://www.umaryland.edu/commencement/archived-events/commencement-2018/speakers-and-honorees/jill-whitall-phd.php Signe Brunnström on Wikipedia   https://en.wikipedia.org/wiki/Signe_Brunnstr%C3%B6m Brunnstrom Stages of Stroke Recovery https://www.neofect.com/us/blog/understanding-the-brunnstrom-stages-of-stroke-recovery Modified Ashworth Scale https://www.sralab.org/sites/default/files/2017-06/Modified%20Ashworth%20Scale%20Instructions.pdf Homunculus https://en.wikipedia.org/wiki/Cortical_homunculus Brian Harris on Strokecast http://Strokecast.com/MedRythms Where do we go from here? So check out Pete’s book  here and blog here. To get better, continue practicing and doing those exercises your PT and OT recommended. If you think you reached a plateau, try some different exercises, and keep going. Share this episode with someone you know by giving them the link http://Strokecast.com/StrongerAferStroke Don’t get best…get better Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories. *Amazon links are affiliate links. I may receive compensation for purchases made through them.