The NOGGINS AND NEURONS Podcast
 

The NOGGINS AND NEURONS Podcast

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Stroke and Brain Injury

Episodes

Super Survivor Kathy Spencer On Successful Recovery

Thursday May 13, 2021

Thursday May 13, 2021

Super Survivor Kathy Spencer On Successful Recovery

OVERVIEW: Kathy - Well, when I got in the arm study, I was like ten or eleven months out and my I could barely— I couldn't move my wrist, my hand, or my fingers. All I could do is clench but that was it. And I thought, if I just believe that I would have given up and I wouldn't be recovered today. So, I always tell people— and Pete's book is outstanding on the plasticity of the brain— but doctors don't tend to tell us that. I went around talking to certain groups around here a while back and people were crying, they said, "You know I believed the doctor" and they gave up on their therapy.

I said: You are never done unless you quit.

Deb - Something that you said caught my attention...what your OT said to you when you were being discharged. Remind me what she said and I want to know how that made you feel because a lot of what we do in occupational therapy has to do with that rapport that we build with people and I’m just curious to know how that made you feel. It sounds like you knew more about yourself than the therapy team.

Kathy:  I loved, loved, loved my OT. We laughed every day...because I would laugh at myself.

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is an ear-gripping conversation with Super Survivor Kathy Spencer. She graciously shares her story of having and recovering from an ischemic stroke. We hope you enjoy listening as much we loved being a part of this time with her. Join in the learning as Kathy:

  • Reminds us that recovery never ends
  • Shares strategies that work to improve hand function
  • Describes how to harness the power of the mind for optimal recovery
  • Explains the importance of self-advocacy and what that looks like

Kathy shares her lived experience from when the stroke occurred, her rehab journey and beyond. Strategies that worked for her include evidence-based interventions such as repetitive practice, mental imagery/visualization and journaling for self motivation. Kathy learned how perseverance plus patience equals peace, and tells inside details about this puzzling equation. Lastly, she reminds us that while repetition might be boring, recovery is not! This is a must listen for anyone who works with stroke survivors, knows a survivor or is a survivor.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

  1. Kathy’s blog article: Bouncing Back From Stroke by Katie D. Neal on February 24, 2011
  2. Kathy’s Youtube Video:
  3. Bioness Website

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“Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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Measuring Recovery

Wednesday Apr 28, 2021

Wednesday Apr 28, 2021

OVERVIEW: “This episode was largely geared towards the survivors at home...once they’re at home doing this and some very simple strategies for how to do it and I LOVE the video recording piece. I know some people are shy and afraid to look at themselves on camera but you don’t have to show it to anybody...You know...And the people that love you won’t care any way. They will be happy to see your progress...”

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is all about ways to measure change along the recovery journey. There are different reasons for measuring from insurance reimbursement to deciding how long a person remains on a skilled therapy program to just wanting to know if what’s being done is working. Pete does most of the talking in this episode (and Deb is fine with that – she’s an introvert at heart and sometimes, when she’s learning, thinking makes her happy).  Keep listening for more great information as we:

  • Explain reasons for taking measurements
  • Discuss the difference between validity and reliability
  • Explain aphasia and dysarthria and ways to measure changes in the motor aspects of speech
  • Talk about the importance of standardizing measurements
  • Review simple ways for survivors to measure change at home, starting with a baseline and maintaining consistency over time.
  • Learn what it means when there’s no change in measurements and what to do when that happens. Hint: It’s not time to quit!
  • Delve into some interesting history about  Signe Brunnström, and Axl Fugl-Meyer

Join us as we start the conversation with reasons for taking measurements. The conversation takes a quick turn as we talk about a simple strategy – using time to establish baseline measurements and progress for walking, while also being mindful of safety. Pete introduces “self selected walking speed” and use of assistive devices and tells us how to be consistent over time. Other activities that can be measured with time include buttoning, zipping and putting a jacket on/taking it off. Quality of movement, fatigue and other factors also need to be taken into consideration when tracking change. It is important to note that it’s not time to quit when it looks like there’s a plateau as Pete reminds us to think like an athlete or musician when this occurs.

We learn about the vast respect Pete has for  Signe Brunnström as he digs deep into history and explains the genius scoring she developed (that was later credited by name to Axl Fugl-Meyer) which has become the gold standard in outcome measures for people who’ve had stroke.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

  1. Is gait speed or walking distance a better predictor for community walking after stroke?
  2. Testing Spasticity: The Modified Ashworth Scale
  3. The Arm Motor Ability Test

CONNECT WITH US:

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

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RESOURCES:

MUSIC

“Soft Inspiration” by Scott Holmes/ Scott Holmes Music scottholmesmusic.com

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Bilateral Training for the Arm, and Leg

Monday Apr 26, 2021

Monday Apr 26, 2021

OVERVIEW: "Antiphase would be right hand forward right hand back, left hand forward left hand back...you get the idea. So, there’s a million things that you can do within the...This could be fun! It should be fun! Yeah....Put the “fun” back in function! Exactly! The lower extremity’s super easy to do...Here’s the thing about the lower extremity – one of the things that messes up in people that have gait problems after a brain injury is the rhythmicity of walking....put in ear plugs one time and walk. It’s almost like a shuffle beat (Pete adds sound effects). It has all that beat going on. in. it. And so if you can re-establish the rhythmicity of gait you start to re-establish stride length, kinematics, hip rotation, the amount of knee flexion...it’s just something that’s not used by clinicians very often and I’m flummoxed as to why. Get a metronome...get it on your phone...use it and see if you can’t get people to re-establish their rhythmicity of gait."

EPISODE SUMMARY: This third episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is all about bilateral training. We jump right into the massive benefits of this intervention and learn immediately that bilateral training isn’t one of the top rehab go-to interventions by PT’s and OT’s! There’s good news for you if you’re someone who hasn’t used this intervention – you aren’t ALONE! Keep listening for more great information as we:

  • Describe bilateral training in depth – including important Google search information that can leave you confused and wondering if you’re just getting started with this technique
  • Experience the power of bilateral training with a fun activity
  • Observe what it’s like for Deb when she’s put on the spot! We’re pretty sure it will make some of you feel more at home in your own skin
  • Learn about Bilateral Arm Training with Rhythmic Auditory Cues (BATRAC) and Jill Whithall’s research
  • Talk about the Tailwind and how to get one – maybe – FYI...the price is higher than Pete thought
  • Discover good research and rationale supporting the justification of bilateral training (OT’s and anyone involved in UE rehab – pay attention – this might be just what you need to enhance your documentation skills)
  • Talk about a common clinical strategy that is NOT appropriate for use in Bilateral Training interventions and why

Join us in this engaging and insightful conversation about bilateral training. We encourage listeners to set aside preconditioned notions and beliefs about stroke rehab – this includes letting go of judgment and beliefs about how rehab should be done.  We look at the research around bilateral training and experience first-hand what it feels like – a must for any rehab professional to try. We share important information around Jill Whitall’s research with this topic and Pete gives us some real life strategies to try. We’re wondering why this intervention isn’t used more often in rehab settings. Knowing that it’s never too late to change, Deb openly admits lack of clinic use may begin with classroom instruction. She plans to up her intervention instruction game for the fall ’21 semester.

If you are using bilateral training in the clinic or as a home program, PLEASE share that with us! If you aren’t using it and think you might start, we want to hear about that too! Let’s start a conversation that improves the rehab and stroke recovery experience.

We always want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

  1. Article Referenced: McCombe Waller, S., & Whitall, J. (2008). Bilateral arm training: why and who benefits?.  
  2. Additional Tailwind Information:
  1. Pete’s Book-Bilateral Training: pp. 118-125
  2. Choosing Wisely Campaign
  3. American Occupational Therapy Association & Choosing Wisely  
  4. Metronome Apps:

CONNECT WITH US:

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:

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RESOURCES:

MUSIC

“Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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THE CLARIFICATION

Friday Apr 23, 2021

Friday Apr 23, 2021

OVERVIEW: There’s another important component to us as humans and that is our level of motivation and building habits for recovery...And I think that’s an important role that therapists play in the rehab phase for a person...and really talking with them about it, the survivor if they understand. If they’re struggling to understand it’s time to bring in the caregivers...where is this person going when they leave our level of care...and talking about the importance of establishing whatever this habit, routine is towards recovery and explaining clearly the benefits of getting in the groove now.

 

EPISODE SUMMARY: This second episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, emerged as Pete and Deb realized additional clarifications were warranted. Not surprisingly, more insights come about as the conversation unfolded! In this episode we:

Share Pete’s clarification’s which take us on a deeper dive into differences between diseases affecting the brain & acquired brain injury; differences between hemorrhagic & ischemic strokes.

  • Learn of Pete’s discovery that not all published research is necessarily the most recent!
  • Uncover the truth about neuroplasticity in subacute and chronic phases.
  • Are reminded that no 2 brain injuries are alike. Ever. This is because all brains are unique!
  • Consider the importance of motivation & habit and how they are underutilized at the subacute level. Let’s remember to include the survivor’s loved ones at this early stage for max benefit.
  • Answer the first listener question!

Join us as we continue to unpack stroke, brain injury and learned non-use. Pete reminds us there is a difference between acquired brain injuries and other diagnoses such as Alzheimer’s and Parkinson’s Diseases. He dives into further detail about hemorrhagic strokes and the ways they differ from ischemic strokes, referring to a well-known survivor, Jill Bolte-Taylor’s experience. Deb’s brain went into overdrive a couple times, bringing the conversation a bit deeper into real life recovery and the importance of building good recovery habits at the subacute stage, including how practitioners are uniquely positioned to help move survivors and caregivers in that direction. Pete also discovered that other researchers attempted to stage recovery phases after he did, bringing to light that researchers can miss really important information (Pete’s did the work first, in this case!). Perhaps this is a reminder to always do our best to be thorough while also realizing that with the vastness of the world, not all work is original or copied. Even though no 2 brains are alike multiple people can think similarly!

We also answered our first listener question from Ingrid Kanics, OTR/L, FAOTA, President of  ­­­­­Kanics Inclusive Design Services. Ingrid asked for more information about what goes on inside the brain regarding dendritic pruning, the penumbra and neuroplasticity. Thanks for asking, Ingrid!

Please share your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

  1. Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, Cramer SC. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017 Jul;12(5):444-450. doi: 10.1177/1747493017711816. PMID: 28697708.
  1. My Stroke of Insight by Jill Bolte Taylor
  1. Stronger After Stroke: Your Roadmap to Recovery 3rd Edition by Peter G. Levine

CONNECT WITH US:

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:

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RESOURCES:

MUSIC

“Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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Learned Non-use

Sunday Apr 11, 2021

Sunday Apr 11, 2021

OVERVIEW: ...So hyper-acute, acute, subacute and chronic, those are the 4 phases...The way that you tell it’s time to start is look for subacute, spontaneous recovery and then, once they plateau, after that you’re not waiting for this easy ride of the brain coming back online...It’s all neuroplastic change after that. You’ve got to borrow from some other part of the brain that’s still intact and so then it becomes real learning....

EPISODE SUMMARY: In this first, full episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb discuss the perplexing phenomenon of Learned Non-Use. This engaging conversation will help you understand:

  • How, when and why learned non-use it occurs
  • Common deficits and rehab approaches that contribute to learned non-use
  • An introduction to interventions and strategies to help thwart and reverse it

Join us as we start to unpack this fascinating topic. As you’ll soon discover, learned non-use and other concepts that occur in and around stroke or acquired brain injury are inter-relational. As Pete eludes to in the podcast, no 2 strokes or brain injuries are the same. Our engaging conversation is a great foundational episode as we define stroke and brain injury, discuss the 4 phases of stroke, the concept of too much too soon and the sweet spot of the subacute phase. There are some interesting implications for everyone – from those who provide care at any level for survivors, occupational and physical therapy practitioners, to the survivor’s and more. Please share your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

  1. 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 one, 15(8), e0221668. https://doi.org/10.1371/journal.pone.0221668
  1. V S Ramachandran and his work with mirror therapy: http://cbc.ucsd.edu/ramabio.html  
  1. The Brain That Changes Itself by Normal Doidge, MD https://www.penguinrandomhouse.com/books/291041/the-brain-that-changes-itself-by-norman-doidge-md/
  2. Documentary – The Brain That Changes Itself https://www.youtube.com/watch?v=VIdWFuuZaxw
  3. The Mind and the Brain: Neuroplasticity and the Power of Mental Force by Jeffrey Schwartz https://jeffreymschwartz.com/
  4. The Brain Science Podcast - https://brainsciencepodcast.com/

CONNECT WITH US:

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:

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RESOURCES:

MUSIC

“Soft Inspiration“ by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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Intro Episode: Stroke and TBI Recovery Simplified

Sunday Apr 11, 2021

Sunday Apr 11, 2021

NOGGINS & NEURONS: Stroke and TBI Recovery Simplified: Intro Episode

Peter G. Levine and Debra Battistella discuss the heart and soul of this endeavor and you will learn how quickly they go down a rabbit hole! We discuss our passion for filling in gaps and the single, most important goal of this podcast...To simplify everything around stroke and brain injury so that survivors, caregivers and loved ones, therapists, the medical team and students understand the recovery process better. Better understanding can make for a better recovery experience. We look to the future and share our thoughts on next topics to include such as core concepts around optimal recovery and why applying them is sometimes tough. Debra summed it up when she said, “If we can be the agents of change for simplifying things to enable people to have a good rehab experience, to have good continued recovery, then I think we’re doing what we set out to do.”

CONNECT WITH US:

DONATE TO NOGGINS & NEURONS:

Donate to Noggins And Neurons and get an Allstar Pete Trading Card

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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

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“Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com

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