The NOGGINS AND NEURONS Podcast
Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann PART 2

Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann PART 2

October 12, 2021

Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann PART 2

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Obex Technologies are a UK software team working with Dr Dawn Neumann and her colleagues to develop a mobile version of the original Facial Affect Recognition intervention, which will be named FACES in the App stores.  FACES is scheduled for public release in App stores late 2021, where it will be free to download for clinical and academic use.

Facial Affect Recognition Task

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

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Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann

Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann

October 10, 2021

Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann

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  1. NEUMANN: And every time something was brought up, you know, we would show them this picture, his face would be as flat as can be but his physiological responses, his arousal of responses were really strong every time he saw one of these emotion stimuli. And it was amazing because just looking at his face there was nothing there. And he doesn’t think anything is there. You know I had asked him, “What would you do if your wife divorced you?” And he said as flat as he, you know, just straight faced as he could possibly be, “Well she’s got to do what she has to do.” Yet, this massive spike so you could tell he had this emotional response. And so it made me think that like these people who have this blunted affect, I think that it’s just unlocking something. There’s something there that we have to get through. We have, it’s a barrier that we have to get through and help them learn there’s a threshold. And it’s, this threshold has become so high in some of these individuals that we’ve got to lower this threshold and their ability to tackle when something’s going on. And kind of unlock some of these physiological responses and so that’s what led me to kind of develop the intervention that we have for teaching people with brain injury to gain insight into their emotions, detect these physiological responses, connect physiological responses with an emotional label and what they’re feeling and then being able to communicate and express those things. And then, so, if this neural plasticity, I believe that it’s there. I believe that as long as these, you know, these connections aren’t fully and completely destructed. You know, you can revive some of these and strengthen some of these connections.
  2. ZUPAN: What happens is when people first have a brain injury, there’s often so many things that they need help with, right? And so you’re focusing on let’s get them back to eating, let’s get them back to walking, let’s get them the skills they need to go back to work or to their life. And so this whole emotion, empathy, social cognition side of things kind of gets forgotten about or, in some cases, isn’t recognized as a problem, because when you’re in a hospital or rehab situation, everything’s structured and everything’s happening with a specific purpose or reason so sometimes those interactional problems don’t show up but also people are, um, too busy being focused on other things. So then these people go home and they no longer have this regular therapy and everyone thinks they’re ready to go…you know they’ve the skills they need to be fairly successful and it all falls to pieces…And that’s because, if you’re not responding or interacting emotionally and using social communication the way people expect, then that creates huge problems…

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, we chat at length with Dr. Barbara Zupan and Dr. Dawn Neumann about emotion perception following traumatic brain injury/stroke. Topics covered include:

  • Alexithymia (the inability to recognize emotions from vocal, facial and body movement cues) and the problems experienced by the survivor and those they interact with as a result.
  • Pete’s sleuthing skills, how Dawn and Barbara started working together and other important members of their research team
  • Alexithymia, no words for emotions, neuroplasticity and treating the problem in brain injury survivors
  • Role of neuro imaging in emotion recovery
  • Interoception is key for detecting physiological responses and identifying emotions
  • Interventions to improve communication for partners and survivors and who can and should facilitate them…from SLP’s, Neuropsychologists and OT’s to trained support workers
  • Social cognition treatment, apps, training and intervention delivery. The intervention Dawn and Barbara developed will be available via app later this year! Stay tuned…
  • The value of explicit communication and managing emotional responses on the part of caregivers and loved ones

As always, we want to hear your top takeaways! Email us!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Facial Affect Recognition Task

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

  • Music by scottholmesmusic.com

 

Brain Injury Vision Recovery Recap

Brain Injury Vision Recovery Recap

October 4, 2021

Brain Injury Vision Recovery Recap

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OVERVIEW - Conversation: Pete and Deb joke about Pete’s microphone being on the floor and his pre-podcast snacking. We also talk a bit about equipment design and fabrication because Deb’s friend and OT colleague designed a new piece of adaptive equipment. Pete shared his experience around production based on the arm skate he designed. It’s a fun and interesting conversation!  

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified recaps our thoughts and perspectives on the conversation we had with vision expert, Dr. Mary Warren. In this episode Pete and Deb talk about:

  • The OTA students’ love for Pete and the PTA students quick grasp of neuro concepts
  • Deb’s AOTA proposal acceptance for the national conference in spring ’22 and Pete’s talk withdrawal from ACRM
  • Noggins And Neurons podcast and Facebook stats
  • Pete’s reminder that practitioners have an inside track to what the research shows works and practice-based intervention
  • Stupid questions, feeling stupid and professional relationships
  • The negative impact of missing vision deficits, how to pick them up sooner and appropriate intervention strategies
  • Quick screen to determine if a visual field cut is present
  • Optometrist vs Ophthalmologist clarification
  • biVABA vision assessment, how to locate it, YouTube video demo and more
  • Vision interventions to implement now
  • Pete explains ABAB experiment design
  • Dr. Mary Warren conversation snippets followed by Deb and Pete thoughts

We love talking about what we learned in the Vision episodes with Dr. Warren. Review certainly helps us grow in our roles as clinicians and educators; Pete and I hope you find benefit too!

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Brain Injury Visual Assessment Battery for Adults (Demo)

Brain Injury Visual Assessment Battery for Adults (biVABA)

visABILITIES REHAB SERVICES, INC. Continuing Education

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 2

 

Low Vision Rehabilitation Graduate Certificate program at University of Alabama at Birmingham

Chapter 24: Evaluation and Treatment of Visual Deficits After Brain Injury. (2018). In Pedretti’s Occupational Therapy Practice Skills for Physical Dysfunction (pp. 594–630). Elsevier.

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

  • Music by scottholmesmusic.com
Mary Warren: Vision and Brain Injury. Part II

Mary Warren: Vision and Brain Injury. Part II

September 27, 2021

Mary Warren: Vision and Brain Injury. Part II

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DEB: So sometimes when we’re working with someone who needs extra time, we might think it’s because of a motor problem, we might think it’s because of fatigue and maybe even memory, but it could be because they’re not visually taking in their environment properly.

 

  1. WARREN: Yeah. That’s exactly it. That’s why it’s important to screen right? Because if I have that client and I’m first seeing them and I screen for their acuity and I screen for their contrast and I look at whether they can move their eyes together and I look at their visual attention...If I do that basic screening and get a sense of what are their strengths in using their visual system and what are their weaknesses, then I can further assess their performance in an ADL or something else and I can help start to distinguish, you know, is this vision or is it something else? If it’s vision one of the ways I can test it is just by making whatever they’re doing more visible to them. I can add task lamp to spotlight it, I can simplify it, I can get rid of all the pattern that’s around it, whatever I need to do, if I can create it and make it more visible and then watch how their behavior changes.

 

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is Part II of our conversation with vision expert, Dr. Mary Warren. In this episode we learn about:

 

  • Three common environmental barriers that add visual stress in home environments are too much pattern, incorrect lighting and not enough contrast
  • Warren’s belief that people improve following brain injury when they can successfully engage in their occupations again (The premise of occupational therapy practice), stimulating neuroplasticity and avoiding depression
  • Behaviors that mask vision deficits - looking at the feet and head positions when walking as signs of vision deficits
  • How cognition and vision are intertwined. Signs that look like frontal lobe injury (decreased initiation, increased time to complete a task and indecisiveness) could indicate a vision problem
  • The Brain Injury Visual Assessment Battery for Adults (biVABA) for assessing vision following stroke and brain injury. It aligns with the visual perceptual hierarchy, determines strengths and weaknesses of vision and guides intervention using the strengths to compensate for weaknesses
  • Warren’s continuing education course on vision
  • Warren’s perspective on how OT services are judged by the clients we serve
  • Low Vision Rehabilitation Graduate Certificate program was started by Dr. Mary Warren with Beth Barstow, PhD, OTR/L, SCLV, FAOTA
  • Vision declines but visual attention doesn’t have to! Engaging in activities that require reactivity can help improve visual attention, memory and driving in older adults
  • Visual deficits associated with vestibular system impairments and where to look for help
  • The question that helped Dr. Warren establish the most important professional relationship of her career

We hope you feel as inspired as we do after listening to this episode on vision.

As always, we want to hear your top takeaways!

 

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Brain Injury Visual Assessment Battery for Adults (biVABA)

visABILITIES REHAB SERVICES, INC. Continuing Education

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 2

visAbilities

Low Vision Rehabilitation Graduate Certificate program at University of Alabama at Birmingham

Chapter 24: Evaluation and Treatment of Visual Deficits After Brain Injury. (2018). In Pedretti’s Occupational Therapy Practice Skills for Physical Dysfunction (pp. 594–630). Elsevier.

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

  • Music by scottholmesmusic.com

 

Mary Warren: Vision and Brain Injury. Part I

Mary Warren: Vision and Brain Injury. Part I

September 26, 2021

Mary Warren: Vision and Brain Injury. Part I 

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  1. WARREN: They are very concerned about falling and running into something. If you have a hemianopia you’re going to have some collusions right off the bat. And they walk very slowly or they do a thing where they stare straight ahead and just walk towards a target and hope they make it. These are dangerous types of things and you can’t get away with them when you’re in dynamic environments; they don’t keep you safe. So the person tends to avoid dynamic environments and won’t go outside the house then, because of the way they’re moving. So we...the big culprit for that....I gues that takes me off in a different direction that’s a very interesting thing that the brain does is that when we’re scanning our environment, when we’re finding things, we don’t go from object to object to build a visual scene. Instead what our frontal lobes do is they sample the visual scene and then they perceptually complete it based on past experience with this environment and expectations of what you should see and by doing that the frontal lobes allow us to process information very rapidly and move through environments that are very dynamic, like driving environments. What was discovered about hemianopia and the first research was published in the 1960’s, is that person’s with hemianopia where fifty percent of their vision is missing, actually exercise perceptual completion. So when you first experience a hemianopia, even though you’re missing fifty percent of your vision, you feel like you see everything. You have a completed visual field in front of you, you don’t have a border that tells you exactly where you have vision and where you don’t have vision. There’s no black curtain there, there’s nothing to tell you when you are getting into your blind field or how far you should go into the blind field.

 

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is Part I of our conversation with vision expert, Dr. Mary Warren. In this episode we learn about:

 

  • Warren’s professional path into vision - vision and driving rehab, brain injury recovery, her development of the Visual Perceptual Hierarchy
  • Statistical information about vision deficits following stroke or brain injury:
    • 50-90% experience ocular motor problems
    • 50-70% experience difficulty using the eyes together
    • Visual field changes – about 50%
    • Acuity – 25%
    • Visual attention (neglect) – 70% (immediately following right middle cerebral artery stroke
  • Vision impairment and hidden disability
  • Vision impairment may cause changes in motor and cognitive behavior, masking vision as the underlying problem
  • The difference between neglect and hemianopia and gaze preference as an early sign of neglect
  • Vision deficits that respond to rehab, perspectives of ophthalmology and optometry and evidence for interventions
  • The difference between restorative and compensatory measures in vision recovery following stroke and brain injury
  • Client who has hemianopia can have recovery success (driving, reading, overall quality of life) IF they get the right therapeutic interventions (and it doesn’t require a lot)
  • Common problems experienced by people with hemianopia include reading and mobility challenges due to decreased field of view. Therapy can help. Without therapeutic intervention people often:
    • Quit reading due to difficulty finding the words, slowness and fatigue
    • Stop leaving the house because dynamic environments become frightening
  • Dynavision and other light boards to help improve vision and cognition deficits
  • Free vision training programs for people with hemianopia

We hope you feel as inspired as we do after listening to this episode on vision.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

DREX Durham Reading & Exploration Training

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1

A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 2

visAbilities

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

  • Music by scottholmesmusic.com

 

Listener Q‘s & Decoding Teasell

Listener Q‘s & Decoding Teasell

September 22, 2021

Listener Q's & Decoding Teasell

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DEB: An easy question for you to answer from JE. She is wondering, ‘Is there ever a time when spasticity turns itself off?’

 

PETE: Yes, there is a time when it turns off and that’s when they’re sleeping. Then that had implications for things like a splint that you can’t get on when they’re awake, you might be able to get it on when they’re asleep. So, my wife...this was another joke I used to tell in my talks. So my wife would say ‘yeah, I know about the splinting (Pete whispering) and sometimes I would sneak into their room and I’d be very quiet and I wouldn’t want to wake ‘em and then I would put the splint...’ and she’s a PT so it was probably something on the lower extremity...um...a boot or something. ‘And then I would sneak out.’ (Normal voice) But that’s not ethical right? So I’m like maybe I should report you to the state board, Ila! But no, I think as long as you ask permission first and every clinician that I told that joke to they’d go just ask first and you’re good. So you can do it if they’re sleeping, and truly, if you want to get a real perspective on the amount of spasticity that  they have, then it’s good to do something like the Modified Ashworth, which is a test of spasticity, while they’re sleeping because that’ll give you a true baseline. The other thing is if you’re confused about whether something is contracture or spasticity then, if it’s contracture, when they’re sleeping, it’ll still be evident as much as it ever was, whereas if you let them fall asleep and you can move it, then you know it’s just a whole lot of spasticity. Because sometimes it’s hard to tell the difference between a 4 on the Ashworth, which is, you know, can’t move it, and true contracture but that is a way of sort of the differential diagnosis of that.

 

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete & Deb share more thoughts about our conversation with Dr. Robert Teasell and Marcus Saikaley as well as listener questions. In this episode we talk about:

  • Rehab light for stroke survivors in the US
  • Client transitions throughout the rehab process, continuity of care through and a warm hand off
  • Best assessment tools to objectively measure upper extremity coordination
    • Box and Blocks test - grasp/release
    • Fugl-Meyer - finger to nose/dysmetria – liked by Dr. Teasell and done the most by Pete
    • Nine Hole Peg Test - manual dexterity
    • Action Research Arm Test – assesses specific changes in limb function
    • Jebsen Hand Function Test (JHFT) – functional hand motor skills
    • Wolf Motor Function Test (WMFT) -
    • Arm Motor Ability Test – Pete dislikes but Doro seems to know about it
  • Repetitive Transcranial Magnetic Stimulation is a primer. It’s nonpainful and very expensive. Direct Electrical Stimulation to the brain is a primer and requires surgery.
  • Less expensive brain primers cost little and are easy to use.
  • Times when spasticity turns itself off, the Modified Ashworth Scale and telling the difference between spasticity (Modified Ashworth score of 4) and contracture.
  • Brain Primers and focus on function – challenges for OT practitioners related to occupation-based interventions and making a plan for using primers to facilitate success.
  • Primer interventions appropriate for survivor home use. They might be boring but they work!
    • Bilateral Arm & Leg Training – intact limb helps improve affected limb movement
    • Mental Practice – use ready-made recordings and create client-centered recordings. Good to do just prior to engaging in mirror therapy.
    • Action Observation – at home upper extremity examples include watching another person obtain items for setting the table. Make videos of the person and watch repeatedly
    • Electromyography/biofeedback – using surface electrodes an EMG machine will show a muscle moving when it can’t be felt – even when it’s thought about. Can do repetitive practice before you’re able to move. Moves into a more expensive direction. Mental practice/mental imagery can be used instead – more trust is required but the same effect occurs.
  • Teasell suggests using 1 primer and 1 facilitator – for example, follow a primer with something such as strength training, trunk training or constraint-induced therapy.
  • Adding cognition may increase fatigue and rest is necessary.
  • Terms used in the EBRSR and what they mean. If an intervention beats standard of care:
    • 66% of the time or more they use the word may or can
    • 50-66% of the time they consider the evidence to be conflicting or mixed
    • Less than 50% of the time the term may not is used

As always, we want to hear your top takeaways...Please email us or post in the Noggins And Neurons Facebook group!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Pete & Deb Review Teasell‘s Insights

Pete & Deb Review Teasell‘s Insights

September 19, 2021

Pete & Deb Review Teasell's Insights

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DEB: Dr. Teasell said that the reasons that therapists have for not doing these things...so they include not having enough time, being busy...and I understand all of this. I do, because I’ve been in those shoes...all of those reasons...he said that they’re legit. And I think that whatever our reasons are, whoever we are, I think they’re legit to a degree. I think that we need to start empowering ourselves to take some steps and try new things. I just think it’s important to have a culture of listening and kindness. Be compassionate with each other and then that way you’re going to advance your clinical outcomes, you’ll advance your practice setting. In trying to implement something new and doing new things, it’s become very apparent to me that we really are limited by our own weaknesses.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete & Deb share thoughts about our conversation with Dr. Robert Teasell and Marcus Saikaley of the Evidence-Based Review of Stroke Rehabilitation (EBRSR). In this episode we talk about:

  • Our general feelings about the interview – Deb enjoyed being a part of the conversation and learning about opportunities. Pete was excited about the brain primers and moving beyond old school interventions.
  • Our thoughts on disability, the government, listening to patients, trust and advocacy.
  • Research, policy change, the brain and passion in practice.
  • The vast amount of stroke research and the three big messages:
    • Earlier is better (too much too soon can make infarct worse)
    • Intensity matters
    • Task specificity
  • Bobath strategies take longer to work.
  • Distrust among healthcare workers towards patients, being more trusting as a provider and collaborating.
  • Listener question: why therapists are afraid to try new things and push patients harder.
  • Opportunities to improve outcomes beyond standardized care using adjunct therapies are critical to the future-moving beyond cultural beliefs and sideways glances.
  • Pete’s tips for navigating change and stepping into leadership.
  • Therapist belief systems don’t belong in the clinic when they conflict with research.
  • Growth mindset, kindness and compassion belong in the clinic.
  • Certifications, creativity and translating the research in clinical practice.
  • Pete’s thoughts about why there is so much focus on the upper extremity.

As always, we want to hear your top takeaways...Please email us or post in the Noggins And Neurons Facebook group!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part II

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part II

September 18, 2021

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part II

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  1. TEASELL: ...second of all, try and develop ways in which we can move things forward. You know? Not necessarily get to the you know, I say research is always about trying to get to the truth, and we’re far from it and our piece, hopefully, will get us a little closer to it, but it clearly isn’t going to be it. But I do think, you know, I think we all agree that we’re kind of at a point where we’re stuck, you know, and stroke rehab, there doesn’t seem to be a lot of movement forward clinically, you know, we’ve gotten really good at standardized care and even that’s starting to be eroded, you know what I mean, in some jurisdictions? And I think it’s time for us to really think about what do we pivot to next? Right? What do we add onto that to make it better, get people excited about stroke rehab again and sort of end that erosion of funding that is occurring in some centers and encourage more funding in other centers?

 

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is Part II of our conversation with Dr. Robert Teasell and Marcus Saikaley of the Evidence-Based Review of Stroke Rehabilitation (EBRSR). In this episode we learn about:

  • Brain primers – what they are and the best ways to use them

    1. The vast number of randomized controlled trials on brain priming interventions that work: mirror therapy (75), bilateral arm training (66), virtual reality (99), EMG biofeedback (66)
  • What the words can, may and may not mean when interpreting research and how these terms are used in the EBRSR
  • Academic training, certifications, trainings and guidelines for implementing adjunct therapies in practice
  • The EBRSR spinoff projects:
    1. Spinal Cord Injury Evidence (SCIRE) – there are two components:
  • The spinal cord professional aspect for rehab professionals (similar to the EBRSR)
  • Spinal cord community – video information for patients
  1. Evidence-Based Review of Acquired Brain Injury (ERABI) – focus on cognition, mental health and community re-integration challenges following brain injury

    • Less evidence available compared to stroke
    • Research challenges due to the cognitive deficits experienced by brain injured people
  • Interventions that work for stroke recovery are not always translatable to Traumatic Brain Injury – the injuries are not the same stroke lesions tend to be more focal compared with TBI
  • The CORE Program consists of many research projects
  • The future, network meta-analysis as a tool for the future. Compares multiple treatments against each other with:
    1. direct evidence and can
    2. estimate indirect evidence (can make estimates for comparative effectiveness of two interventions which might not be compared in the literature)
  • The best interventions according to the Network Meta-Analysis are....
    1. Modified Constraint Induced Movement Therapy. Developed by yours truly, Pete Levine, and his colleague Dr. Steven Page
    2. Functional e-stim
    3. Theta burst stimulation
    4. Motor imagery
    5. Bilateral Arm Therapy
  • Research shows that primers work better than facilitators, but therapists seem to like facilitators more. Now it’s time to start using the treatments that work.
  • Adjunct treatments, standardized treatments, the future and improved care
  • Wondering how to help therapists use the research on interventions that work to maximize recovery
  • 85% of interventions that work are adjunct treatments we don’t use very often – we need to take advantage of them, especially the cheap ones.

We hope you feel as inspired as we do after listening to this episode on interventions that work and other resources.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Evidence-Based Review of Stroke Rehabilitation

Evidence-Based Review of Moderate-to-Severe Acquired Brain Injury

Spinal Cord Injury Research Evidence

Collaboration of Rehabilitation Research Evidence

Collaboration of Rehabilitation Research Evidence twitter

Dr. Teasell’s Google Scholar Page 

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

ACRM.jpg

Debra's Website:

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

September 14, 2021

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

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PETE:  When I first got involved in clinical research, I remember there was this statistic that the lag time between bench and bedside and rehabilitation was 15-20 years and the idea was you know that in oncology you couldn’t have that much lag time because people die of cancer whereas typically nobody dies of bad therapy. Do you think that the translation is still that long? What would you estimate is the, or is it impossible to estimate, it depends on the therapist kind of deal?

 

TEASELL: It depends on the treatment and it depends on the kind of support that the treatments got. A lot of it’s cultural as well but I would say that 15-20 years...you know from moving into the research into regular clinical practice would be considered to be a very early adoption. That would be considered to be rapid. It’s more than 15-20 years. In some cases, I think it’s a couple generations. You know, when we sit down with our therapists and ask them, you know, ‘do you use the adjunct therapies?’ the answer is usually not a lot and why? Well there’s a number of reasons-timing, but it’s just like it’s not part of the culture. Like it’s just not part of the culture. You know...And you ask them, ‘would you like to do it?’ ‘Of course, we would, I mean, why wouldn’t we? Right. I wouldn’t mind trying something new or trying this new technology or this new treatment but I don’t know where to start; it’s not what we’ve traditionally done; it’s not what we tend to do; I’m busy enough as it is’ and so these treatments don’t get incorporated or added. So, you know, the reasons are legit, they’re fine, but I mean, if we’re looking at ways that we might be able to further improve recovery and the next big step...cuz you know, one of the things that you get a feeling in stroke rehab is people just not sure where we’re gonna go next. It strikes me that this is a lost opportunity that we could take advantage of.

 

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is Part 1 of a captivating interview with Dr. Robert Teasell and Marcus Saikaley of the Evidence-Based Review of Stroke Rehabilitation (EBRSR). Join us as we learn about:

  • The history of EBRSR, including Teasell’s original work:

    • To demonstrate that chronic pain can be debilitating, the evidence supporting facts around chronic pain, patient advocacy and policy change.
    • With the Ontario government to create and implement best practice guidelines for stroke recovery, therapists inability to agree on recommendations and Dr. Teasell’s idea to duplicate his work in chronic pain research.
    • With the Ontario government funded project of stroke evidence as the birth of the EBRSR.
    • The growth of research and importance of using the research in practice.
    • Evolution of additional research reviews for Traumatic Brain Injury and Spinal Cord Injury.
  • Stroke rehab has more evidence than any other area of neuro rehabilitation.
  • Behind the scenes look at how systematic reviews are completed, including PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines.
  • Knowledge Translation and clinical practice change.
  • Reasons why research tends to focus on the Upper Extremity
  • Changes in stroke rehab over the years, Canadian and American processes and standardization of care and outcomes. Best practice includes:
    • The right amount of intensity
    • Task-Specific interventions
    • Early intervention
  • Adjunct therapies, brain primers and missed opportunities. Examples include mirror therapy, Repetitive Transcranial Magnetic Stimulation (rTMS), Robotics, Action Observation and Functional Electrical Stimulation (e-stim). NOTE: Despite the fact that adjunct therapies account for 85% of the research they are rarely used.
  • Home programs, early supported discharge and best “patient handoff” to promote continued recovery and optimal results.

We hope you find value in part 1 of our conversation to the extent you feel empowered to look at your current practice and discover possibilities to improve client and clinic outcomes.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Evidence-Based Review of Stroke Rehabilitation

Evidence-Based Review of Moderate-to-Severe Acquired Brain Injury

Spinal Cord Injury Research Evidence

Collaboration of Rehabilitation Research Evidence

Collaboration of Rehabilitation Research Evidence twitter

Dr. Teasell’s Google Scholar Page 

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

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Debra's Website:

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More Listener Q‘s & More StrokEngine

More Listener Q‘s & More StrokEngine

September 10, 2021

More Listener Q's & More StrokEngine

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PETE: And having other kinds of problems like diabetes flares up or whatever it is...and so they cycle back through to the therapist and what the therapist sees is not the people getting better because they’re gone. They’re Kathy Spencer...they’re people that are living their life and going to work and doing stuff that’s important to them. The therapists keep seeing the sick people, who are often sick because they don’t exercise, and the therapists don’t interface with the successful survivors. And that’s the other thing, like, some of the people that I’ve met through some of the survivor Facebook groups, they’ve come to my talks. And you know, I’ve got to meet them, and they’re still working and they’re pressing and they’re exercising and those people I think it would be good if you knew who those people were. And that you kept in touch with them. We trashed Facebook in the last episode so now let’s say something nice. There’s some groups on Facebook that you can get engaged in that are really good to help you know the full rainbow of the kinds of survivors that exist.

DEB: Yeah...

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb got into more N & N FB group member questions and another Stroke Engine intervention. We discussed:

  • Goal setting strategies to instill motivation for recovery:

    • Benefits of involving athletic trainers for stroke recovery success
    • Hard (honest) conversations about interventions that work and what’s required
    • Habits, routines and home programs during inpatient rehab
    • Thinking about the dreaded plateau before it happens
    • Patient and practitioner viewpoints about pushing harder on the recovery journey
    • Improving service delivery with tele rehab, consultations, part B and the “low-level athlete” mindset
    • Survivor Facebook groups are opportunities to interact with successful survivors
    • Moving away from practice are territorialism and into professional collaboration to optimize survivor recovery
    • Using therapy opportunities wisely to educate and empower clients to be involved in their recovery journey
    • Tiny changes lead to big improvements
  • The dance of cognitive rehab: no pencil & paper tasks! Only the “doing” works
    • Understanding the fatigue factor and the just right challenge
  • Stroke Engine A-Z:
    • Aerobic exercise following stroke to improve cardiovascular health, quality of life, leg and body function, spasticity, cognition, dexterity and more!
    • Task specificity, brain re-wiring, task focus (bring in meaning), repetition and follow through
    • Mental imagery, wandering thoughts and guided mental practice to reduce boredom
    • Use brain primers first: mental imagery & mirror therapy prepare for task specific training
    • High and low intensity related to task specific training and efficacy for the upper and lower extremities

 As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

Deb‘s Trip & Listener Questions

Deb‘s Trip & Listener Questions

September 6, 2021

EPISODE TITLE: Deb's Trip & Listener Questions

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DEB: I think too, that if we do a case study and we talk about it and we kinda say what our process is and the way that we think about things and link it to the research, maybe it will help clinicians to know that they’re probably thinking about things the right way. I think sometimes there’s just insecurities around trying something new. Or, even doing what you think you should do. Especially if you don’t have a mentor available to you...which I always recommend anybody have a mentor of some type or even work in a clinic where there are seasoned therapists there or at least people who have some more experience than you do because it’s hard. Especially when you’re a new grad. It’s hard to put all those pieces together in a meaningful way. And then...yeah!

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talked about Florida travels and listener questions. We talked about:

  • Deb’s Florida travels-rural towns and ALF visiting leniency, catching up with cousins, dolphins and beauty.
  • Florida driving challenges were worth it to see Doro, Lynette and the Neuro Hub in person.
  • While at the Neuro Hub, Deb got to see the RecoveriX in action and experience the Neofect Smart Glove.
  • Upcoming podcast guests, including Dr. Teasell and Marcus Saikaly from the EBRSR, Mary Warren, PhD, OTR/L, vision, tennis and learned non-use; Jennica Colvin and Suzanne McCrum from Trio Rehab in Texas, and Drs. Dawn Neumann and Barbra Zupan who will talk about their work in recovery of emotional behavior in folks with brain injury.
  • Diaschisis, neural pruning, what happens in the brain when a person no longer does an activity and brain area interdependence.
  • Pete’s next book and publishing decisions, his mom and New Jersey weather
  • The Noggins And Neurons Facebook group is growing
  • A listener question about the difference between ischemic and hemorrhagic strokes, survivor stories and recovery stats.

We hope you enjoy this fun conversation as much as we did!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Improvement of functional was greater in hemorrhagic than ischemic stroke

Cognitive Rehabilitation Training Course (ACRM)

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

Brain ‘Splain Pete Style

Brain ‘Splain Pete Style

August 25, 2021

Brain 'Splain Pete Style

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EPISODE TITLE: Brain ‘Splain Pete Style

DEB: What?

PETE: So, I’ve got a funny story for you...So, my college had a career development day. And they wanted people to do an hour, hour and a half on whatever they wanted to do and people were doing it on how to run a good zoom meeting and how to grab a great power point and a lot of other interesting things and of course I pitched my crazy, ‘how does the brain really learn? and ‘how can we engage students if we look at it from a neuroscience perspective?’ And they said ok, we’ll give you an hour and a half to do that, so I show up at the college today and I go to the room that I’m supposed....it’s in this big convention center....and I go to the room I supposed to be in and, ah, the door’s locked. So I called the lady that runs the whole thing and she says, “well, um” I said ‘when will the door be unlocked?’ And she said, “well, um, at 9:00 they’ll be coming in,” this is by the way at 1:00 in the afternoon or 12:00 in the afternoon. “At 9:00 they’ll be coming in and they’ll set up everything so you have it ready” And I’m getting this weird vibe from her and I realize I’m there a day early.

DEB: Awesome!

PETE: And then I said to her, ‘I got a funny story, I’m out in front of the door waiting for somebody to unlock it like an idiot. So, ah, that was fun. But here’s the favor I have to ask you...So what I would like to do is, I know we had an agenda tonight but I would like to do my entire talk for tomorrow for an audience of one and that way I get to practice it.

DEB: That’s a great idea!

PETE: You like that idea?

DEB: I do...

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete presents valuable information on “The Brain and How it Learns Simplified: Driving Cortical Plasticity.” We talked about:

  • Deb’s upcoming road trip and her fast car.
  • The number of CEU talks Pete has done from 2010 to 2020 (700 of them) and this teacher presentation being the first live presentation since March of 2020.
  • Review of Pete’s work in research-do you love hearing this stuff as much as I do?
  • Learning defined, the circulatory system defined, the difference between the two and
  • Motor learning, college and motor cognition. It’s the original template for all learning.
  • Brain Derived Neurotrophic Factor, exercise, sleep and protein synthesis are essential for learning.
  • The homunculus man, the motor cortex and why hands-on learning is key for learning.
  • Using eating, mating and patterns to keep an audience engaged.
  • The Davinci man, arm span and murmurations of starlings to understand how the brain works
  • Repetition, challenge and meaning are necessary for learning. Celebrate small wins to stay motivated and feel life satisfaction.
  • Hemispherectomy and the ability to be independent-no excuses, action observation, tossing balls in class, repetitive practice and measuring change.

Pete practices his presentation and Deb enjoyed being the audience. We hope you find the information valuable too.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, MD with Eric Hagerman

'I only have half a brain'

The homunculus in 3D

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

StrokEngine: A-Z Treatment Options

StrokEngine: A-Z Treatment Options

August 19, 2021

StrokEngine: A-Z Treatment Options 

 

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DEB: Acupuncture has to do with stimulating certain trigger points along the body’s meridian lines to help regulate the flow of energy or chi. They looked at this in the different phases of stroke and they found that it’s not more helpful in general. So they looked at in terms of balance, cognitive function, depression, dexterity, independence a lot of other things, that it’s not really effective for. But you know what it’s effective for? Swallowing problems. It’s effective for dysphagia.

PETE: What? Get out!

DEB: I’m not kidding you....

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk start a conversation on stroke treatments listed on the Stroke Engine website. We started the episode with a listener question about the number of repetitions needed for the brain to change and motor recovery to occur. Pete shared more research and we talked about what it means for real life recovery. We also discussed:

  • Growth mindset, learning and recovery
  • Hints about our upcoming conversation with Robert Teasell and Marcus Saikaley of the Evidence Based Review of Stroke Rehabilitation (EBRSR)
  • Virtual Reality for the upper extremity, the View Master and the Ramachandran Rule
  • Acupuncture and dysphagia, cognitive function and insomnia
  • Virtual Reality for the lower extremity, measuring real-time data, gait rhythmicity, the Nu Step and the Kinetron

Pete and Deb took a deep dive into these topics, looking at pros and cons of each along with next steps for clients and clinicians, including measuring change.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

How many repetitions does it take to drive brain changes and movement changes in folks with brain injury/ stroke?

This study showed that there were similar outcomes under three dosages of repetitive practice...

There were four groups:

  • Group A (the control) received 3 hours of traditional therapy consisting of passive movement, therapeutic positioning, and weight bearing on the affected limb. Throughout study the score increased ~3 points for the Fugl-Meyer.
  • Group B: Modified constraint induced therapy consisting of 3 hours of shaping practice per day, and a constraint on 90% of all waking hours. Throughout study the score increased ~17 points for the Fugl-Meyer.
  • Group C: 300: repetitions per day, 5 days per week, increases across all outcomes (FM, MAL, WMFT, etc.) started at 2 weeks and the trajectory continued throughout the study. Throughout study the score increased ~17 points for the Fugl-Meyer.
  • Group D: Same as Group C, but double the number of repetitions. Throughout study the score increased ~19 points for the Fugl-Meyer.

The Brain Boosting Power of the Mighty N -Back

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

What Makes a Great Therapist?

What Makes a Great Therapist?

August 13, 2021

What Makes a Great Therapist?

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“I want to do what I did with the smaller group earlier this week and read you my favorite letter. Because, I think the thing that pushes me and everything...My why...My purpose...are embedded in the idea of service in care to others. Meaning all of those to self, to family, to community, the society. And, if you’re not clearly in touch with just how unbelievable it feels to care for others, my favorite letter of several hundred thousand will hint.”

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk about qualities that make someone a good clinician. Here’s what we came up with:

  • Understanding qualities of excellence can aid in selecting the right therapist
  • Striving for excellence is a lifelong quest
  • Proper training may lay a foundation for clinicians developing necessary skills for clinical success
  • Asking significant questions is as important as knowing what to do with the answers
  • Be a good listener to provide excellent patient care
  • Advocacy and listening often go hand in hand
  • Lifelong learning includes topics beyond diagnoses and deficits
  • “The Diving Bell and the Butterfly” book or movie can help with understanding brain injury
  • Develop observational skills and don’t be afraid to speak up about what you learn so you can help your patients
  • Traumatic brain injury survivors can re-learn empathy

Pete and Deb talk about these topics and more. We share stories and thoughts from personal experiences and hope this helps you in your clinical practice or recovery.

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

Sleep: Vital for Everyone, Essential for Survivors

Sleep: Vital for Everyone, Essential for Survivors

August 8, 2021

Sleep: Vital for Everyone, Essential for Survivors

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DEB: Did you know that rest and sleep are considered occupations? The Occupational Therapy Practice Framework is a document that we use is occupational therapy to guide the process of what we do in OT and it also explains what occupations are and what they mean. And sleep preparation is a thing in the OTPF and it talks about routines. Bedtime routines to prepare yourself, to prepare the body, to prepare the mind that it’s time to wind it down and get ready to fall asleep. They talk about how routines that prepare the self for comfortable rest are important and then they have some examples; grooming, get your clothes out for the next day, reading and listening to music, saying goodnight to others and engaging in meditation or prayers before bed, determining the time of day and length of time that somebody desires to sleep. And then how much time somebody needs to be awake...so being mindful of that and planning for that. And establishing healthy sleep patterns. When you start with these habits you can build them into a routine and then your body just kind of gets used to looking for that.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk about all things sleep. In this conversation we cover:

  • Sleep disorder statistics in stroke survivors
  • The effects of insomnia on behavior and emotions
  • How lack of sleep can lead to Alzheimer’s Disease
  • Sleep stages and what occurs in the body, including dendrite formation and learning consolidation
  • The effects of sedatives and prescription medications on sleep
  • Sleep hygiene strategies for people who have difficulty sleeping

Pete and Deb also talk about avoiding caffeine and sugar before bed time to improve sleep quality; the value of routine for sleep preparation and establishing healthy sleep patterns and natural ways to set the internal clock for improved sleep quality.

We hope you enjoy our thoughts and find them mentally stimulating and thought provoking!

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Neurobiology of Sleep and Circadian Rhythms

Sleep and Stroke

Male seahorse "birthing" baby seahorses!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

Dr. Jones, TexMex, and Synaptic Connections

Dr. Jones, TexMex, and Synaptic Connections

August 5, 2021

Dr. Jones, TexMex, and Synaptic Connections

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PETE: Hey everybody, this is Pete. I just wanted to jump in real quick and tell you about a mistake I made. I forgot to put the bio for our interview with Dr. Theresa Jones ahead of the actual interview. So, I’m gonna put the bio at the beginning of this episode, which kinda works because it is a review of the episode and what we learned, when we did interview Dr. Jones. Thanks!

DEB: New clinicians working in the world of stroke recovery need to understand what is too much too soon. And I think she made some good points about it. That early mobility doesn’t mean early intensity. So, you know, early mobility really is to get the person up so that other systems in the body don’t start to fail them. And...which would impact negatively, negatively impact their recovery. So we keep them healthy while they’re still in that acute stage so that when they enter that more subacute phase they can participate.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb have a stimulating conversation about our interview with the Great, Dr. Theresa A. Jones, a behavioral neuroscientist from University of Texas at Austin. Some things we reflect on include:

  • How repetition rules in learning. In fact, intensity and learned non-use came up again. It’s nice to hear Dr. Jones’ perspective and how to think and talk about these topics in practice and recovery.
  • Getting beyond feelings of intimidation and putting people on different levels based on education and ego for improved communication and care.
  • Real time look into the brain through windows in rat skulls.
  • Being a woman in a male dominated field, making it work and resilience.
  • Humility, communication and translating animal research to humans.
  • Sorting through compensation and recovery and Dr. Jones’ research perspectives
  • Moving into gray areas, thinking and clinical reasoning. Ask questions from the understanding that even science doesn’t have all the answers. Don’t be afraid to hear that you’re thinking is off track and be open to where it will take you in future thinking.
  • Neuroplasticity in action and what it looks like in real time.
  • Monkeys in research, COVID, travel and more questions to ask Dr. Jones.

We hope you enjoy our thoughts and find them mentally stimulating and thought provoking!

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:1

Repost of articles posted on the Dr. Jones interview:

Theresa A. Jones, PhD Articles:

Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nature Reviews Neuroscience. 18:267-280.

Clark TA, Sullender C, Jacob D, Zuo Y, Dunn AK & Jones TA (2019) Rehabilitative training interacts with ischemia instigated spine dynamics to promote a lasting population of new synapses in peri-infarct motor cortex.  Journal of Neuroscience, 39: 8471-848

Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E & Jones TA (2021) Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behavioural Brain Research, 396:

Dorothy A. Kozlowski, PhD and Theresa A. Jones, PhD Articles:

Use-Dependent Structural Events in Recovery of Function

Use Dependent Exaggeration of Neuronal Injury After Unilateral Sensorimotor Cortex Lesions

Use Dependent Exacerbation of Brain Damage Occurs During an Early Post-Lesion Vulnerable Period

Neural Plasticity and Neural Rehabilitation Following Traumatic Brain Injury

Combinatorial Motor Training Results in Functional Reorganization of Remaining Motor Cortex After Controlled Cortical Impact in Rats

Combining Multiple Types of Motor Rehabilitation Enhances Skilled Forelimb Use Following Experimental Traumatic Brain Injury in Rats

Learned Non-Use Article:

Barth, J., Geed, S., Mitchell, A., Lum, P. S., Edwards, D. F., & Dromerick, A. W. (2020). Characterizing upper extremity motor behavior in the first week after stroke. PloS one15(8), e0221668. 

VECTORS trial

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Debra's Website:

Music by scottholmesmusic.com

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

August 2, 2021

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

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Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

PETE: So one of the things I find interesting about fMRI’s...it doesn’t directly measure neuroplastic change and I always thought you would have to get really lucky drilling a hole through the skull, through the meninges and somehow get a very big microscope and see actual synaptogenesis and you’d have to get very lucky that those neurons just happen to get connected at that point. But you’re saying in this model they glow green and you can see that process happening in individual neurons?

 

DR. JONES: I feel so lucky to have lived long enough for these techniques in neuroscience that I had nothing to do with to be dropped into my lap. Yeah these, they’re transgenic mice that seem to be normal except they have been manipulated to have fluorescent proteins expressed in a subset of their cortical neurons, so that you can see the dendritic barbers of the cortical neurons either through thin skull or through implanted windows. And so you can watch the same parts of a neuron over time and see how they change and because you have the windows are big, you look at a whole big dendritic field and at least with cortical changes in response to learning new ways of moving, those changes seem not just to be in one neuron. I mean there’s crazy activity that gets instigated and, after a stroke, there’s crazy activity...by activity I don’t mean activity...I mean structural changes in neurons. A structural neural plasticity um is just explosive in response to strokes because that’s the remodeling process.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb engage in stimulating conversation with Dr. Theresa A. Jones, a behavioral neuroscientist from University of Texas at Austin. We talk about:

  • Translating research from bench side to bedside and what that means in terms of informing clinical practice and brain injury recovery
  • The importance of communication when translating research from animals to humans and questions are key, especially in terms of parameters and boundaries. Conditions matter!
  • Background details in Dr. Jones’ research such as age and health status of animals as it relates and applies to humans.
  • Some advantages of studying animal models include studying topic area one at a time, generalizing information, aging animals
  • The behavioral changes that follow stroke are major players in stroke outcome!
  • Intensity, timing and potential for harm; the VECTORS trial and mobilizing clients following stroke.
  • Repair and remodeling processes depend on neural activity patterns which are determined by behavioral experiences
  • Behavioral compensation is one of the most obvious ways behavioral adaptation (change) occurs following stroke and can be a major driver in brain remodeling after stroke
  • Compensation coupled with disuse impedes recovery of more normal movement
  • Bimanual training in animal models to learn about influence on unimanual function
  • Patterns of synaptic changes across both hemispheres that occur with learning new ways of using the good limb on its own vs. together with the affected limb
  • Dr. Jones’ thoughts on:
    • writing, which is a skill
    • rabbit holes and tangents-they’re fun
    • ways to improve communication, which might include putting the ego aside

We hope you enjoy our conversation with Dr. Jones. She is a true delight and makes information about brain research and stroke recovery understandable.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Theresa A. Jones, PhD Articles:

Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nature Reviews Neuroscience. 18:267-280.

Clark TA, Sullender C, Jacob D, Zuo Y, Dunn AK & Jones TA (2019) Rehabilitative training interacts with ischemia instigated spine dynamics to promote a lasting population of new synapses in peri-infarct motor cortex.  Journal of Neuroscience, 39: 8471-848

Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E & Jones TA (2021) Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behavioural Brain Research, 396:

Dorothy A. Kozlowski, PhD and Theresa A. Jones, PhD Articles:

Use-Dependent Structural Events in Recovery of Function

Use Dependent Exaggeration of Neuronal Injury After Unilateral Sensorimotor Cortex Lesions

Use Dependent Exacerbation of Brain Damage Occurs During an Early Post-Lesion Vulnerable Period

Neural Plasticity and Neural Rehabilitation Following Traumatic Brain Injury

Combinatorial Motor Training Results in Functional Reorganization of Remaining Motor Cortex After Controlled Cortical Impact in Rats

Combining Multiple Types of Motor Rehabilitation Enhances Skilled Forelimb Use Following Experimental Traumatic Brain Injury in Rats

Learned Non-Use Article

Barth, J., Geed, S., Mitchell, A., Lum, P. S., Edwards, D. F., & Dromerick, A. W. (2020). Characterizing upper extremity motor behavior in the first week after stroke. PloS one15(8), e0221668. 

VECTORS trial

 

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Pete’s blog, book, Stronger After Stroke, and talks.

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The N&N Review: What We’ve Learned and Where We’re Going

The N&N Review: What We’ve Learned and Where We’re Going

July 29, 2021

The N&N Review:

What We’ve Learned and Where We’re Going

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Pete and Deb started off with a little silliness before moving on to talk about Noggins And Neurons podcast stats...

DEB: ...So I did look up downloads before we reconvened here tonight and we’re over 5,500...so, it’s saying something, I’m just not sure exactly what it’s saying and some day I hope to know

PETE: It’s like reading tea leaves. So, what is today’s episode about?

DEB: Today’s episode is...I love the name that you called it....it’s sort of a State of the Union episode because we have over 5,000 downloads, we’ve...how many episodes did we make so far? We’ve got 22 or 23 out there?

PETE: I think it’s 22. I could be wrong...

DEB: You’re probably right...We’re gonna talk about whatever the state of this union is.

PETE: I think you’re right, it’s 23....

DEB: And we have 122 followers. I think those are the people that have taken the time to follow us through Podbean.

PETE: So maybe that’s a good place to start. We have no idea what any of these numbers mean. We don’t even know if the download is only through Podbean’s site or through all sites. Isn’t that correct? We don’t know that, right?

DEB: Yeah, I don’t understand the back end of this thing.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about the podcast data and speculate on what it means. We highlight information from previous episodes and:

  • Try to determine what the topic download numbers mean. We speculate that therapists want to learn more about specific interventions, are curious about what other OT’s are doing and likely aren’t interested in common clinical concerns such as fall prevention.
  • Wonder why there were fewer listens to the episode with Super Survivor Kathy Spencer. Pete suggests that we can all learn from Kathy and other survivors who are doing well.
  • Share our viewpoints about reasons for intervention episodes having high interest.
  • Talked about our favorite episodes and why.
  • Enjoyed re-visiting important points already made while adding new thoughts.

We hope you enjoy this review and would love to hear from you! You can share information about who you are, your interest in stroke and brain injury and whatever else you think is relevant!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Music by scottholmesmusic.com

Measuring Spasticity

Measuring Spasticity

July 25, 2021

Measuring Spasticity

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PETE: So, are we sorta kinda ready?

DEB: Yeah, ready or not...here I come

PETE: We’re never gonna outgrow this, are we?

DEB: No

PETE: It’s just gonna be like this forever...OK...so, hey, Deb Battistella, how you doin’?

DEB: Pete Levine, I’m great, how are you?

PETE: Oh, by the way, American College of Rehabilitation Medicine...I’m doing a talk for them in September. So, if you’re a member of ACRM or you’re planning to go, you should go to my talk! Thanks! That was a public service announcement from one of the co-hosts who was self-promoting his own stupid talk even though he doesn’t make any money off it. So, don’t worry about that, just come to his talk. Thank you very much.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about measuring spasticity. We start with a rabbit hole of sorts where we discuss the problem of home care OT’s not addressing client and caregiver needs when cognition is involved and overall therapist abuse by rehab companies. Here’s more detail about our conversation:

  • We talked about a problematic, current, real-life scenario where OT discharged a patient who would still benefit from skilled OT
  • Pete mentioned professional association advocacy that doesn’t seem to be working
  • We learned there is a time of day when spasticity isn’t present
  • Pete mentioned reasons why it’s important to use spasticity measurement scales rather than observation
  • Deb sought further clarification on spasticity, ROM and contractures - and yes, I’ve been an OT for over 20 years
  • We talked about spasticity measurement scales and how to perform them

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Music by scottholmesmusic.com

 

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

July 21, 2021

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

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EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk with Doro & Lynette from The Neuro Hub, Orlando, Florida, about leading edge OT services they provide. In part 2 we:

  • Learned about the Neuro Hub locations, staff and more
  • Talked about the roles sleep, gut health and heart rate variability for recovery and health
  • Discussed how nature, exercise and community are important for achieving optimal health
  • Learned how Doro and Lynette educate on and incorporate mindfulness strategies to promote the mind-body connection and facilitate improvement in their clients
  • Talked about non-OT books that inform OT practice
  • Found out how the Neuro Hub uses brain computer interface technology in stroke and brain injury recovery.

You will hear fun facts and behind the scenes details and thoughts about these topics, including how the brain computer interface program incorporates evidence into practice on many levels. Doro & Lynette bring their dynamic personalities and passion for OT to this conversation. We’re certain that everyone who listens will find meaning and inspiration... Clinicians perhaps you’ll break out of tradition and create new opportunities in practice...Survivors and caregivers maybe you’ll seek high quality care for the recovery journey – it’s out there!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

Pete’s blog, book, Stronger After Stroke, and talks.

Music by scottholmesmusic.com

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