No Plateau Podcast Henry Hoffman

Are you or someone you know working towards recovery and looking for effective ways to break through barriers? In the world of rehabilitation, evidence-based practices are making a significant impact, especially within the field of occupational therapy.

"We really have to take the time as educators to be willing to modify our courses, stay up to date on evidence, and make sure that we're using the best resources that are the most up to date." (17:45) - Jessica

In today’s episode of the No Plateau Podcast, we delve into the integration of evidence-based practice in occupational therapy education and clinical settings from our own perspectives. We tackle the challenges of translating research into practice, including the delay between discovery and implementation and the hurdles we clinicians encounter in keeping abreast of new information. We cover the initiatives we're taking at Concordia University to improve evidence translation, the significance of clinical practice guidelines, and the role we play as fieldwork educators. We also engage in the debate over whether to focus on ADLs or neuroplasticity post-stroke and discuss the use of assessments like the Fugl-Meyer. We recommend the ViaTherapy app as a tool for evidence-based stroke rehabilitation, sharing our insights and experiences with it.

"You can't get your arm and hand back if it's seven months, nine months, two years later; you missed a window. So focus on what matters the most, which is neuroplasticity." (24:25) - Henry

In This Episode

The need for evidence-based learning (00:00:32)

Challenges in implementing evidence-based practice (00:05:27)

Strategies for speeding up evidence translation in education (00:11:11)

Dealing with outdated practices (00:22:20)

Adaptive techniques and neuroplasticity (00:24:21)

Barriers in implementing evidence-based strategies (00:31:22)

Accessing clinical practice guidelines (00:37:58)

Impairment-based outcome measures (00:45:12)

ViaTherapy App and free resources (00:49:32)


Our Guest

Jessica Schmidt, OTR/L is an assistant professor of occupational therapy at Concordia University of Wisconsin. She earned her master's from the University of Wisconsin-Milwaukee, and her post-professional doctorate in occupational therapy from Rocky Mountain University School of Health Professions. She is a member of ACRM, AOTA, and WOTA. In clinical practice, Jessica specialized in treating adult neurological patients in acute care and inpatient rehabilitation settings. She is passionate about evidence-based practice, helping translate research into the clinic, and preventing healthcare worker burnout.

Resources & Links


Henry Hoffman on LinkedIn

Jessica Schmidt on LinkedIn



Saebo

On YouTube

On Instagram

On LinkedIn


Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

What steps are necessary to establish a program for managing shoulder subluxations in a healthcare facility?

In today’s episode, we dive into the topic of creating a stroke shoulder subluxation program in acute and subacute settings. This is a topic of interest for many therapists, yet it's often overlooked in most facilities. To shed more light on this topic, we are joined by Jenna Barber, who has successfully created a subluxation program at her facility.

“Most facilities are not preemptively addressing this issue. Why pass the buck to outpatient when you have the opportunity to attack it now?"

During our discussion with Jenna, we debunk the effectiveness of slings and taping in reducing or preventing subluxation. Instead, we emphasize that strengthening exercises, particularly for patients with volitional movement, are the most effective approach. We also highlight the importance of proper electrode placement during electrical stimulation (e-stim) therapy, focusing on the posterior deltoid rather than the supra. We stress the importance of evidence-based practice and the need for therapists to be trained and competent in using e-stim therapy.

"I don't know if I would change the program to maybe like shoulder e-stim program. I'm still debating on this one, but I really stressed in the beginning that it's not just shoulder subluxation, it's for those who don't have one yet to prevent one from happening."

Jenna explains the implementation process of the subluxation program for stroke survivors at Froedtert. Patients are evaluated on day one or two after a stroke to determine if they would benefit from the program. Regardless of whether the patient currently has shoulder subluxation or not, they start them on the program to prevent it from happening. 

In This Episode


Introduction to Jenna and her subluxation program (02:08)

Subluxation and its effects (07:00)

Strengthening and electrical stimulation for subluxation mitigation (11:25)

Questioning the use of supra for shoulder subluxation treatment (12:19)

Jenna’s motivation to start the program (14:58)

The developmental process and challenges of starting a therapy program (17:00)

The synergy between nursing and therapist training in healthcare (20:45)

Contraindications for the subluxation program (24:29)

Managing the subluxation program at a large neuro hospital (30:20)

The waitlist issue (30:59)

Transition to subacute facilities (33:36)

Communication with subacute therapists (36:34) 

How billing for unattended electrical stimulation contributes to therapist productivity (44:41)

Plans to expand the shoulder subluxation program (47:27) 

The potential benefits of using tools like mirror boxes and mental practice (50:40)


Our Guest

Jenna Barber, MOT OTR/L, is an accomplished occupational therapist with a Bachelor's in Kinesiology from UW-Eau Claire and a Master's in Occupational Therapy from Concordia University Wisconsin. She excels at Froedtert & MCW, specializing in neuro and orthopedic conditions. Jenna is also an adjunct faculty member, recognized for exceptional patient care, and enjoys family time with her husband and two daughters. 

Resources & Links


Jenna Barber on LinkedIn

Stroke Guidelines 2023


Henry Hoffman on LinkedIn


Saebo

On YouTube

On Instagram

On LinkedIn



Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

This week, we are talking about activity-based training, what it is, what the benefits are, and how this practice's guidelines and progress compares against stroke therapy and patients. Darci Pernoud is an OT going on 18 years and has immense experience working with spinal cord injury patients in her very own gym. This week on the No Plateau Podcast, she speaks with Henry about ABT, patient recovery, and current state of spinal injury treatment and technology.

“A great deal has changed from where we are today than where we were 20, 30, 40 years ago. There is much more incomplete injuries, more people walking. I think it has a lot to do with continued research, continued thought process, how to push people hard. It's a very hot topic. I feel like right now in the rehab world is higher intensity pushing people harder to help create that change and drive home that neuroplasticity.”

Darci wastes no time in emphasizing the importance of activity based training also known as ABT. The benefits of this therapy are numerous and the impact on patient recovery and healing is immense.

“And so, by applying activity based therapy principles, that includes our health and wellness exercise measures, it's getting our bone density where it needs to be. It's getting our cardiovascular training where it is, it's getting our muscles stronger for resistance training, which is going to help with posture. So, it's going to help people look better. The benefits of exercise, getting circulation, getting all the right hormones, the growth factors, everything on a cellular level is going to be improved. So people are going to feel better, Their mental health is going to be better. That's going to affect their quality of life.”

In This Episode 

Darci Pernoud talks about her medical background (01:31)

What is spinal cord injury and what are some of the common impairments? (04:17)

Darci describing Activity Based Training in detail (10:56)

The five main pillars of Activity Based Training (13:26)

Was ABT in practice when she graduated in 2005? (16:17)

The current guidelines and care expectations in terms of standpoint of frequency, duration and time (19:13)

Comparing the treatment and care between spinal cord and stroke patients (22.55)

The average length of stay for a spinal cord patient (24:49)

What happens when patients are discharged from the hospital? (26:48)

The average onset post recovery for Independence Rehab clients (28:42)

Darci talks about ABT benefits and the recommended cardiovascular and resistance training (31:45)

How popular and accessible are ABT gyms? (38:39)

Discussing OT and PT equipment and technology (40:43)

The current state of progress for spinal cord patients potentially walking again (44:55)

Darci discusses the progress of one of her clients (46:04)

Thoughts of patients doing Activity Based Training virtually or remotely from home (48:20)

How people can reach Darci or learn more about ABT therapy (50:59)


Our Guest

Darci Pernoud has been an OT for over 18 years. She started out as a dual diagnosis therapist working in-patient rehab, and eventually went through a day program, an out-patient program, post-op work and upper extremity limb data collection work. She started networking with an activity based therapy gym which closed during Covid, prompting her to become a gym owner, trying to help the community’s experience of neurodiagnosis, assisting them in their recovery journey.

Resources & Links


Darci Pernoud on Linkedin

Back to Independence Rehab


Henry Hoffman on LinkedIn


Saebo

On YouTube

On Instagram

On LinkedIn



Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

In this episode, we delve into the critical nature of the first few weeks following a stroke and how the type of care and approach can greatly impact the outcome of a patient's recovery. Our guest, occupational therapist Cortney Jessee, provides a detailed overview of the inpatient rehab process, offering useful insights and tips for therapists, caregivers, and patients alike.

“The problem is that I think the whole purpose for this podcast being the no plateau podcast is again if we don’t start at those basics, we can’t get to our task specific training so how much are we being true proponents of the plateau. I think that’s the true plateau, not the myth of your first three months is where you are going to get the most outcome.”

Cortney stresses the importance of specific care within the first 72 hours post-stroke and the severity of subluxation in inpatient rehab. Drawing on her experience, Cortney elaborates on the need for proper positioning and understanding of anatomy to ensure optimal success for patients. 

“If we know our anatomy and if we can show our caregivers and our patients what we are looking for in positioning and help them feel like they are not going to mess it up in what to look for; the outcomes are significantly more impactful. It also makes our jobs a lot more fun.”

Courtney highlights the impact of small things and offers practical tips for therapists to empower patients and caregivers. She also offers passionate words of encouragement for occupational therapists to embrace their impact on patients' lives and stresses the importance of consistency in a patient's recovery process.

“I just want to encourage any OT’s out there who are either starting their time in neuro or been doing it for a while that your jobs are impactful, no matter what part of recovery you are in someone’s stroke. And the little things matter. Going back to that 60-to-90-day mark, that’s wonderful. But how great would it be from days 0 to 30, to be a part of your patient’s foundation for optimal success. And I want therapists to feel empowered to do those small things for consistency in a patient's life and to give our caregivers and patients hope.”

In This Episode 


Cortney Jessee's medical background and qualifications (01:25) 

The patient's transition from acute stage to inpatient rehabilitation (09:26) 

The critical 72-hour window after a stroke: common mistakes and best practices in hospitals (16:04) 

An in-depth look at the Brunnstrom stages of recovery (20:15) 

Separating fact from fiction: tackling the myths surrounding subluxation (24:50) 

Activities for patients and caregivers to do in their rooms to aid in recovery (31:22) 

Reviewing the studies conducted by Dr. Teazel (33:45) 

Patient handoff and the role of transformative learning in transitioning to outpatient care (42:05) 

Examining the 60-90-120-day timeline in stroke recovery (44:20) 

Cortney's words of encouragement for occupational therapists (46:48)


Our Guest

Cortney Jessee is an experienced occupational therapist with over 6 years of specialized practice in inpatient rehab at Novant Health in North Carolina. Although she recently transitioned to outpatient neuro-rehab, she maintains a deep attachment to inpatient care and values the unique challenges and rewards it offers.

Resources & Links


Novant Health

Cortney Jessee on Novant Health


Henry Hoffman on LinkedIn


Saebo

On YouTube

On Instagram

On LinkedIn



Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

The topic of today's discussion is spasticity treatment after stroke, a condition affecting up to 40% of first-time stroke patients. Our guest, Dr. Samuel Milton, specializes in this treatment and offers invaluable tips to patients and therapists. According to him, spasticity treatment after stroke requires clear objectives, cautious consideration of treatment options, and proper aftercare techniques to achieve the best possible outcomes. 

“What’s really important when you are looking at a treatment plan is that you want to have a goal in mind. What are you, the therapist, the patient, and caregiver, what are you trying to accomplish?”

While some patients may be eager to rush into Botox treatment, Dr. Milton advises caution and consideration of visual markers to assess the rate of return before and after the treatment.

“In this business many times you find that when patients or loved ones go through a scenario like this, they want the opposite. So if their hand is starting to close all of a sudden they say well I need Botox. But at the same time their hand is just starting to close so I may not want to jump in there and necessarily do Botox especially if their range of motion is full. Now they are starting to get some rate of return. Let’s see where that return takes us. If there is a problem, we’ll address it. I generally don’t jump on that right away.”

After a treatment is done, proper aftercare is essential to ensure the highest rate of success. Dr. Milton stresses that the type of treatment is just as important as the technique used to apply it.

“My injection technique usually after I inject, I will pretty aggressively stretch the muscle because Botox diffuses pretty readily in the muscle and I do that to help with the spread of the muscle. Really spread the muscle out as much as I can after I do an injection.”

In This Episode 


Dr. Milton talks about his educational background, medical expertise, and work practice (01:36)

How to best describe the medical condition of spasticity to patients (03:50)

Dr. Milton elaborating on why the flexors are typically the spastic muscles (05:18) 

What types of spasticity treatments are currently available? (07:37) 

Medication or Botox? How to determine who gets what? (09:00)

What are the side effects for taking medication for spasticity (09:53)

Explaining what intrathecal back pumps are (11:17)

Discussing Chemo denervation techniques and botulism (13:04)

What other local injections should one consider (14:39)

What every new stroke patient should know (13:04)

What treatments do Dr. Milton’s patients prefer? (16:39)

Using electric stimulation to speed up the reaction (19:51)

Different types of injections and Botox techniques (20:58)

Funding Botox for stroke patients (27:07)

Can we achieve the breakthrough to no spasticity? (31:56) 


Our Guest

Dr. Samuel Milton is a highly experienced physiatrist with over 30 years of medical practice. He received his medical degree from Harvard University College of Medicine and has been working at Emory Healthcare in Atlanta, GA for over 20 years. During his career, he has been involved in teaching academic practice with inpatient and outpatient settings, but mostly running stroke rehab units. Currently, Dr. Milton manages the inpatient stroke unit at Emory and has an outpatient practice for patients with chronic stroke deficits. 

Resources & Links


Samuel Milton on LinkedIn

Emory Healthcare


Henry Hoffman on LinkedIn


Saebo

On YouTube

On Instagram

On LinkedIn



Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

What does aphasia treatment look like?

In this episode, we talk with speech-language pathologist Abbe Simon M.A., CCC-SLP, whose professional work has been focused on helping to treat communication disorders, specializing in evaluating and treating aphasia.

“One of the most important things I must stress and hope that the listeners take away from this: Aphasia does not affect intellect, one’s intelligence, or the knowledge that’s stored in their brain before the stroke or other reason that happened to cause it occurred.”

With over 24 years of experience working with aphasia patients, Abbe shares with us common misconceptions about aphasia and communication disorders, as well as how aphasia is evaluated and treated.

“The last thing the brain wants is a compensatory strategy, but we need to acknowledge that some people’s brains or some brains actually want that - dare I say it - the easy way out, right? When we approach speech therapy to improve language, as you mentioned, occupational therapists can do or we, as professionals, can introduce compensatory strategies, or we can introduce restorative strategies - how can we restore something or regain its function….there’s nothing wrong with compensating…but it’s not maximizing neuroplasticity.”

Abbe also shares her perspective on various treatment methods for aphasia, her opinion on specific evidence-based approaches to treating and evaluating aphasia, and all the amazing work she does with iCommunicare.

“People do make huge strides…There ain’t no such thing as a plateau…There’s no plateau. I can work with someone who is 6 days, 6 weeks, 6 months, or 6 years post-stroke and who has aphasia, and they will make improvements if they want to.”

In This Episode


Abbe shares her background and career journey to starting iCommunicare (02:08)

The types of communication disorders Abbe helps treat as a Speech Language Pathologist (04:17)

How speech therapists evaluate and treat aphasia traditionally and currently (06:00)

Where is the cutoff to shift from traditional treatment to modern technological treatments with aphasia patients? (14:10)

Constraint-Induced Language Therapy (CILT) with aphasia patients: does it work? (20:02)

Why is CILT not as popular as Constraint-Induced Movement Therapy (CIMT)? (24:20)

What are the expectations of patients and outcomes experienced with aphasia? (27:10)

Can we bridge the gap between Occupational Therapists and Speech-Language Therapists with cross-therapeutic interventions? (31:01)

Abbe’s top recommended technology tools for treating aphasia (37:25)

Abbe’s company iCommunicare, and her integrative health coaching work (39:49)


Our Guest
Abbe Simon is a speech-language pathologist and integrative health coach with over 20 years of experience helping adults with aphasia and communication disorders take back control of their life and overcome the barriers of these disorders.

Abbe believes everybody can improve their aphasia if they are motivated and willing to try. She also believes that small wins build momentum and encourages patients to keep pushing to improve. Abbe’s focus is client-centered and emphasizes creating outcomes that go beyond just the treatment room. 

Abbe lives in North Carolina, where she runs iCommunicare, an aphasia rehabilitation private practice combining evidence-based programs and integrative health coaching principles to improve aphasia.

Resources & Links


iCommunicare

Abbe Simon on LinkedIn

Abbe Simon on Facebook

Abbe Simon on Instagram


Kleim and Jones article (2008): Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage


Henry Hoffman on LinkedIn


Saebo

On YouTube

On Instagram

On LinkedIn



Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group