I Love Neuro Erin Gallardo and Claire McLean

Do you see a gap in the care of individuals that you work with? Sometimes the work isn’t done after discharge, am I right? The desire to fill a gap for individuals with spinal cord injury (SCI) is what led 2 PTs and an OT to establish Empower SCI in 2012. Empower SCI is a non-profit dedicated to providing intensive rehabilitation experiences for people with SCI by creating immersive, residential experiences with clinical experts, peer mentors, recreational opportunities, and around the clock support. Empower SCI has a unique and innovative model that is volunteer driven and loved by all who encounter it.  
In this episode we interviewed the co-founders, Carrie Callahan, PT, DPT, ATP, Jessica Goodine, PT, DPT, NCS, and Elizabeth Lima Remillard, MS, OTR/L about everything from how it all started to where it’s all going. They shared the motivation for starting Empower, what “residential program” means, where and how they operate without a brick and mortar, who qualifies and who doesn’t qualify for an intensive, their biggest challenges to running intensives, why they decided to create a nonprofit, their tips for a successful partnership of 3, their new teen program and how you can get involved. Join us for an amazing dive into a life changing program that will inspire you!
Please share this episode and information with anyone you know who might be interested in either volunteering or attending!
To sign up to be a volunteer or participant use this link: empowersci.org/applications 
Participants for the upcoming teen program have until June 15, 2024 to apply!
IG @empowerspinalcordinjury
FB Empower SCI
 

Have you ever felt like there was a disconnect between what the researchers are thinking and what you, as a clinician, are thinking? You’re not the only one! The desire to bridge the gap between research and what really goes on in the clinic has been a topic of discussion for decades. We interviewed Dr. Carolee Winstein, PhD, PT, FAPTA about this very topic and what the possible solutions may be. Dr. Winstein, a pivotal figure in redirecting professional focus towards motor control, motor learning and neuroplasticity, shares her transformational journey. When working with individuals with neurologic conditions in the 1990s (“before neuro rehab was a thing,” as she laughs) she wondered, why do some people get better and some don’t? Her intellectual curiosity propelled her into the sphere of motor learning and control under the tutelage of the esteemed Richard (Dick) Schmidt, PhD, an intellectual leader in motor learning and control and founder and founding editor of the Journal of Motor Behavior. 
Accumulating over 34,000 citations, Dr. Winstein stands as a luminary in the realm of neuro rehabilitation, boasting an unparalleled expertise in motivation, motor control, and neuroplasticity. She shares why the practice of neuro rehabilitation must be accompanied by an understanding of the behavioral literature. She provides advice and guidance for the clinician struggling to incorporate the research into practice, a warning about Clinical Practice Guidelines (CPGs), and what types of studies you should actually pay attention to in order to implement emerging evidence. Have you ever felt like your patient population doesn’t really match those studied in the research? She addresses that too and provides advice and encouragement about how to shift this disconnect.   
Articles mentioned in the interview can be found and downloaded here:
Boyne, et al Optimal Intensity and Duration of Walking Rehabilitation in Patients with Chronic Stroke
Dawson, et al Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischemic stroke (VNS-REHAB)
Hornby, et al Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury
Tsay, et al Five Features to Look for in Early-Phase Clinical Intervention Studies

How much are you challenging the older adults you work with What biases do you have about someone when you see their age or comorbidities? Are they limiting how much you push them?  Have you ever thought about the consequences of not pushing someone enough?? On today’s show we interviewed Dr. Dustin Jones, PT, DPT, GCS about his approach to working with aging adults and how it challenges the norm. He was working in skilled nursing facilities and seeing nearly everyone with the same exercises and plans of care despite varying abilities. This led to a desire to change the approach to care to be about determining what is really possible for aging adults and questioning why we only reserve more challenging work for those who are younger.  
In the episode Dustin explores how many therapists make assumptions (often ageist) about what someone is able or not able to do that isn’t backed up by research. He discusses the fear that something could go wrong when you challenge an older adult and challenges you to consider what could go right. If you approach it the right way, honoring their system and giving time to adapt, older adults have so much to gain by doing heavy lifting and strength training. The bigger risk for this population is actually to underdose them. People who are stronger and more fit have an ability to overcome more illnesses and stay independent longer. We discuss how to have conversations and set expectations for hard work outs that could lead to soreness or even orthopedic flare ups and how this is actually less risky as a consequence of pushing someone than the alternative outcomes that can happen is they aren’t as strong as possible, such as illnesses and chronic conditions from being sedentary.  
Keys to success with a fitness forward approach include ensuring the exercises are aligned with the patient’s primary goal. If they have pain, address that first but still have the conversation about where you’re going. Keep tying the exercise approach back to their independence and functional goals, and help them see the connection. Make sure they know the worst thing they can do is stop. Assure them to keep coming back so you can help them through it. 
Dustin runs StrongerLife, a gym for people over 55 and teaches Modern Management of the Older Adult as part of the Institute of Clinical Excellence, or PT on ICE.
Learn more about Dustin and StrongerLIfe at www.StrongerLifeHQ.com 
Modern Management of the Older Adult - PTonICE.com
@mmoa.icephysio
@strongerlifehq 
 

Everyone is on their own timeline. For some the notion to start a business doesn’t happen until well into their career. For others it happens almost immediately. For some, the slow growth method is right. For others it’s full speed ahead. Dr. Han Nguyen, PT, DPT, NCS is a PT who’s constantly seeking growth and opportunity. She asks, “what’s next?” and continues to strive for more and better. In today’s show we had the opportunity to learn about how she set up a multidisciplinary neuro rehab clinic in Saint Petersburg, FL focused on high intensity sessions, creative treatment strategies and team work. Han mentions some very key ways she was able to grow so quickly including being involved in her community. She also discusses the transitions she did from starting out mobile to renting shared space to recently signing a lease of her own. She’s learned lessons with hiring, negotiating, and growing her team. She also discusses her model of care and why she decided to be participating with Medicare. She also highlights the importance of understanding who you’re here to serve (hint: it’s not a diagnosis), getting clear on your messaging and one invaluable investment that has made all the difference. If you’re looking for inspiration to start your own thing or you’re already doing it, you’re sure to take away helpful insights in today’s show!  
@neubilityrehab 
If you’re interested in coaching for your neuro biz, schedule a discovery call with Emily Duval Ledger today! https://www.neurocollaborative.com/request-a-discovery-call-neurobiz-1
For an invitation to our NeuroBiz Besties free slack group fill out THIS FORM

Busy-ness and fluctuations are pretty normal when running a business but do you have trouble turning your business brain off? Can you go on vacation without working? Do you know the signs in your body when you’ve hit your edge? In the world of hustle culture how do you show up differently so you can love what you do and make it sustainable without wanting to burn it all to the ground? If you’re finding it difficult to step away from your business, this episode is for you. If you’re feeling frustrated because you think you’re doing everything right and it’s just not working, this episode is for you. If you’re snapping at people and cranky and you think it’s everyone else’s fault, this episode is for you. We’ve been there too and will provide you with strategies that work for us when we need grounding and a break. Emily Duval Ledger, NeuroBiz coach is here to coach Erin and Claire and anyone listening. You’re sure to come away with permission, insight and tactics.

Who wants to talk about a fun topic?! What if learning about Medicare Maintenance Therapy actually was fun and didn’t make you fall asleep? Well, that’s what you’re going to get on today’s episode! We sat down with our favorite Medicare Utilization Reviewer, Dr. Robbie Leonard, PT, DPT, CHC to discuss the hot and sticky points about Medicare skilled therapy. We know a LOT of US-based therapists have questions and we’re here to help! In today’s show we discuss some common misconceptions about using Medicare for therapy so we can help you pass an audit and stay out of trouble! 
Some of the topics covered today include:
Medicare’s definition of medical necessity and when it does and does not cover services
The only 2 standards under which you can treat - restorative and maintenance and what they each mean
When do to restorative and when to do maintenance and why you should NOT mix the two
The questions you should ask yourself every time you see a patient: Could what I’m doing be provided by a caregiver or technical person that I train? If yes, it should not be billed at all. Unfortunately it doesn’t matter whether there is a qualified caregiver available or not.
How you get audited: You can be flagged to be audited because your data profile looks different. If you always use or never use KX you can be audited for being an outlier. You should never stop seeing people just because they’ve reached the threshold. This can be a red flag!
What you should NEVER say to a patient about their Medicare dollar usage
When it is and is not appropriate to stop providing skilled therapy (hint: it doesn’t have to do with where the patient is in their threshold spend!)
How to know if you can provide more therapy to a person who’s reached their threshold for the year: evaluations will always be covered! 
Why you should not be concerned (or turn away) a patient who has used up to their Medicare threshold or beyond Initial threshold
What about Medicare and cash? If you’re providing a covered service you cannot opt out of Medicare as a therapist. You are legally obligated to file a claim.
What does wellness look like then?
What does a reasonable time frame actually look like?
Jimmo settlement CMS
Medicare regulations all US therapists should read: Medicare Benefit Policy Manual Chapter 15, Section 220.2 D
NeuroSpark members find the Parkinson Focus Track call recording with Robbie HERE with additional information covered
Find Robbie at: robbie@8150advisors.com
**Please note, the contents in this episode are for educational purposes and should not be considered legal advice