June 26, 2024 • 57 mins
Feeling lost after a neurological diagnosis? You're not alone. But what if we told you there's hope for reclaiming your strength and independence?
This episode with Dr. Ann Phillips is your roadmap to neurological rehab revolution.
You'll discover the power of early intervention and explore common neurological conditions, all with the goal of empowering you and your loved ones.
5 Tips to Enhance Neurological Rehabilitation:
- Build a Rock-Solid Foundation: It all starts with stability and balance. Think of it as building a strong base for your brain's comeback story.
- Tech to the Rescue: Supercharge your rehab with cutting-edge tools like brain-computer interfaces. Imagine the possibilities! Think e-STEM.
- Motivation Magic: Small wins are BIG motivators! We'll show you how to track progress (hint: think videos) and celebrate every step on your recovery journey.
- Sleep, Stress Less, Conquer More: Optimize your brainpower with the power of quality sleep and stress management techniques.
- Fuel Your Body & Mind: Brain food isn't just a myth! We'll explore how nutrition and exercise can supercharge your recovery.
By implementing these tips and embracing a positive mindset, you're not just recovering – you're rebooting your brain and reclaiming your life. The road might have detours, but the destination is a future filled with hope, strength, and endless potential.
We encourage you to visit our website now at www.connect-empower.com to explore more information on our guest and to access our resources.
To ask us your questions or to share your story, email us at podcast@connect-empower.com.
Be sure to rate, review and follow the podcast so you don’t miss an episode.
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Don't forget to share with your family and friends what inspired you or the tips you've learned!
John & Erin
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ann (00:00):
it's just our ability to handle different kinds of loads.
(00:03):
There's like stress load.
There's physical load.
There's chemical loads.
There's different kinds ofloads.
but the more taxing, it is forus to overcome things, the
harder it is to bounce back.
So with the older population,some of the barriers I've
encountered is just willingnessto change.
John (00:32):
Hi, I'm John,
Erin (00:34):
and I'm Erin.
You're listening to connect andpower.
The podcast that proves age isno barrier to growth and
enlightenment
John (00:41):
tune in each week as we break down complex subjects into
bite sized enjoyable episodesthat will leave you feeling
informed, entertained, and readyto conquer the world
Erin (00:54):
a season physical therapist and the co-founder of
grit mobility, a mobile practicespecializing in neurological
care.
Our guest Ann Phillips earnedher master's degree in physical
therapy from the university ofOklahoma in 2004 and later a
doctorate from the university ofMontana in 2020.
(01:15):
Throughout her career.
Ann has worked in diversesettings, including brain injury
programs and outpatient neurorehabilitation.
Gain over 10 years ofspecialized experience.
Her deep understanding ofhealthcare, shortcoming inspired
her to launch grit, mobility tosupport those often overlooked
by the system.
(01:37):
Besides her professional work.
Ann a clinical instructor,actively mentor students runs a
local support group forindividuals with spinal cord
injuries and other physicaldisabilities.
Also known as Molly rollers oftreasure valley.
And collaborates with strokesurvivors can to educate and
(01:59):
connect with the community.
Alongside her husband.
She co-founded the nonprofitfueled by fire To assist both
local and internationalcommunities.
Let's give a warm welcome to ourguests.
Dr.
Anne Phillips, the.
Thank you so much for being
Ann (02:16):
Thanks so much for having me.
I'm excited.
Erin (02:20):
We were talking a little bit ago and I'm probably going
to mess this up a few times,but.
I'm going to ask you to shareyour story, but also correct me
along the way, because it'sneurological is what I say, but
it can be neurologicrehabilitation.
Correct?
Ann (02:36):
Yeah, it's it means the same
Erin (02:38):
Ah, perfect.
if you wouldn't mind going intoyour story and sharing really
how you found this field or ifthe field found you and really
explain more about what it is,
Ann (02:49):
Yeah, I guess it depends on how far back you want to go.
my mom's a nurse.
And, I always had.
This fascination with the humanbody, the more you learn about
it, the more you recognize andyou can't deny divine design,
for sure, it's just fascinating.
And then, I would say the brainis, or the central nervous
(03:09):
system is the most fascinatingpart because that's the
operating system.
my mom's a nurse and, she waspushing me towards the medical
field and, medicine.
And I actually was initiallywanting to go pre med, but then
I learned that physicians Don'thave a life for the first one,
15 years.
Um, I really also had thisfascination with, like I said,
(03:34):
the human body.
So I was really big into likefitness and how the body
responds to, to differentthings.
So, physical therapy is like theperfect combination.
it's technically physicalmedicine is what some
departments will call it.
that's kind of where.
where my path went, I used to bea personal trainer and aerobic
instructor and stuff like that.
(03:55):
and, just kept digging in deeperand, it led me to physical
therapy.
So I've been doing it for about20 years now.
Erin (04:03):
sounds like the two of us, like we're always looking for
knowledge somewhere.
And then the more books and themore research and John's been in
it a little bit heavier than Ihave.
Right.
You've been saying a lot more.
I followed Jim quick and he hadthat book limitless.
And so John had it before mecause I was trying to finish
another book.
He's like, Oh my gosh, thisstuff is blah, blah.
And I'm like, man, I can't waitto read it, but it is
(04:25):
fascinating.
Ann (04:27):
You just released a new version of it.
Erin (04:29):
that's the one I got.
John (04:31):
Yeah, that's the one I just read.
It was an amazing book.
There's so many, so much greatinformation.
So shout out to Jim Quick andLimitless.
great book.
Erin (04:41):
Yeah, and I,
Ann (04:42):
to read it.
Erin (04:43):
and the older I get, the more I want to learn.
I was like, why wasn't I thisway when I was younger?
it's just interesting.
John (04:49):
so Dr.
Phillips, can you please explainwhat neurologic rehabilitation
is and why it is important,especially when we age?
Ann (04:59):
So neurologic rehab is a different branch of rehab.
So there's different branches inphysical therapy, just like
there's different branches inmedicine.
So if you think about it, likein medicine, there's oncology,
which is like cancer.
there's pediatrics.
Which is kids.
there's geriatrics, which isolder adults.
So there's different branches.
(05:20):
in physical therapy in someways, there's also other
branches and there's differentcertifications that you can get
for it.
Now, there's not certificationsfor everything, but, there's
like wound care and.
And geriatrics and things likethat.
So neurologic is the area ofrehab where we really hone in on
kind of the nervous system andhow the nervous, system affects
(05:43):
the body and how we move.
So in simplest terms, that'sneurologic rehab.
now in reference to older adultsor aging, the aging population,
we, as we get older, We're notas, resilient where you don't
bounce like what you used to.
it takes a little bit longer tomake sense of things.
(06:06):
And, when you add an insult likea neurologic injury, like a
stroke or a disease process,like Parkinson's or MS or
something like that, itinfluences the body functions
and ultimately how the bodymoves.
Does that make sense?
Erin (06:23):
Yeah.
And that was going to be my nextquestion what are some of the
common neurological, conditionsthat you see?
Ann (06:29):
some of the common diagnoses that fall under that
umbrella, that neurologicumbrella would be like traumatic
brain injury, spinal cordinjury, Parkinson's, MS, stroke.
now there's different kinds ofbrain injuries too, if you think
about it.
Cause there could be like abrain tumor, right?
Or something like that.
So there's, that kind of fallsunder acquired brain injury.
(06:53):
And then there's traumatic braininjury.
So that's when there's some kindof trauma associated with it, a
car accident or, someone hitsyou on the head or something
like that.
So that's, that mechanism ofinjuries is different than like
an acquired brain injury, like apathology.
Erin (07:08):
this has been fun on the journey of podcasting because
going into it, I didn't realize.
Any PT or OT or any, I'm like, Ijust clumped it all kind of
together and everybody knowseverything and to learn that
there are different specialtiesthat people can go to see for
certain conditions.
Like I didn't know, right?
I didn't know that this is
Ann (07:31):
Yeah.
Erin (07:31):
right?
Ann (07:32):
There's a lot of people that don't know and that's
that's the problem with it.
I'm so glad you guys are doingwhat you're doing to help
educate the community.
And that's, that's a big passionof mine too.
because people don't know whatthey don't know.
And, When you don't know, thenyou, I don't want to say you
sabotage yourself, but you leaveit to other professionals to
(07:54):
make decisions for you insteadof you being empowered to play a
role in your own health.
So that's a big piece of what mypractice and my heart is to
capture those people who arefalling through the cracks of
healthcare and to educate themand empower them and advocate
for them.
(08:15):
Like I said, there's so manypeople that don't know what they
don't know.
Erin (08:19):
And that's what we're all about.
That's, you know, we want tomake sure people know and
understand there are people outthere to help you and we want to
bring the resources for sure.
Now, when we're younger versuswhen we're older, is when you're
rehabilitating somebody, is itdifferent?
Are there different approachesyou take?
Is it take longer, shorter, themethods you use?
(08:40):
How does that work?
Ann (08:42):
Yeah.
I think, gosh, so with the olderpopulation, I would say, yes, it
does take longer and a big pieceof that is because, For one, as
we get older, we're less likelyto feel comfortable with change
changes really hard and adaptingto change.
(09:04):
So I feel like that's a bigpiece.
and also, like I said, we'rejust not as resilient as we get
older, but, This is a side note,something I've been super
fascinated with lately is, thedifference between biological
aging and chronological right?
There's a difference betweenlifespan and healthspan, and we
(09:25):
could actually equip ourselvesto where we can handle those
hits, those health hits againstus if we are healthy to begin
with.
and it all comes down todifferent kinds of load, in the
literature, you'll, heardifferent kinds of loaded, like
viral load when cobit was outright and big, they talked about
(09:45):
why some people respond.
Better than others.
And it's just our ability tohandle different kinds of loads.
There's like stress load.
There's physical load.
There's chemical loads.
There's different kinds ofloads.
but the more taxing, it is forus to overcome things, the
harder it is to bounce back.
(10:05):
does that kind of make sense?
So with the older population,some of the barriers I've
encountered is just willingnessto change.
I know you've been doing thisfor 50 years, but the game has
changed.
We have to think about adifferent strategy to, or to
stand or whatever it might be.
Erin (10:26):
you find that people, because maybe they don't have a
purpose, it's like, well, whydid I do this?
Where am I walking?
Who am I going to go see?
Where am I hanging out?
So why really?
They're almost like they want togive up a little bit
Ann (10:37):
Motivation.
Yeah.
So motivation's huge.
fear and anxiety is huge.
those are big barriers.
willingness to change, I've donethis forever.
Why would I change now?
I hear I'm too old to change.
but then I, you know, it's, youhave to be careful not to judge
(10:58):
people before you actually workwith them because sometimes
we'll get these referrals andwe'll kind of read through their
history and stuff.
And they have a list this long.
And you think, and you createthis picture in your mind of how
they're going to look whenyou're face to face with them.
That happened one time when Iused to work in inpatient rehab
I was reading through this chartabout this lady and she just had
(11:20):
a huge medical history.
And so I, I had this picture andI walk in to, the dining room
to, to see her and she's likesitting with her knee up to her
chest, like reading a book orstuff like that.
And I'm like, don't know a lotof people that have that
flexibility, you know, and thatit's, it all comes back to the
(11:41):
lifestyle that you assume.
and that, influences like theunderlying conditions.
before a neurologic injuryhappens.
John (11:52):
So how important is early intervention in the success of
rehabilitation?
Ann (11:59):
in the context of let's say stroke, so like stroke rehab,
the literature is saying is themost change happens within the
first three to six months.
However, Neuroplasticity isstill viable up to five years is
what we've shown, possiblylonger.
(12:19):
within the first, I would saythree months, is the most
critical because once peoplestart adopting nasty patterns,
it's really hard to break it.
Even if they have the capacityto do it, just getting someone
to change their movementbehavior is so difficult once
it's already established.
(12:41):
And if, if they already find itto be successful and pretty
efficient for them, it's hard toconvince them otherwise.
even capacity.
Erin (12:51):
what are some of the techniques that you give them to
help them overcome?
Ann (12:56):
Yeah.
one of the biggest ones is, andthat the literature supports to
is task oriented.
So if essentially I could helpit make sense to their brain,
and it has meaning to them,they're more likely to be
engaged.
and they can make theconnection.
As far as the why we're doingit.
(13:18):
So if they have meaning to it.
And it's a task that makes senseto them.
They're more likely toparticipate and, and engage
their brain and their bodyconnection.
(13:40):
Yes.
multiple strategies as far aswhatever the task is.
I may have to tweak the task towhere, they're more engaged.
Or I may have to tweak how Icommunicate the task.
sometimes if they don'tunderstand what I'm asking of
them.
Then they're going to go acompletely different direction.
(14:01):
Yeah.
And that's what makes the neurospecialty a little bit, quite a
bit different than standard.
John (14:08):
we all know that, things can become harder and harder as
we get older.
Maybe our muscles and our bodyjust doesn't operate the way it
normally does.
And sometimes we have fall riskswhere people fall.
And so how can you specialize inyour support system after a
fall?
Instead of just calling somebodyto have them do physical
(14:30):
therapy, is it more important tocall you as well so you can
analyze whether they've had amajor head injury or something
that could alter their course oflife?
Erin (14:40):
Good question.
Thank you.
Ann (14:42):
Yeah, so falls are huge and in the older population and
after someone's experienced thefall, they're more likely to
have another one.
because it's going to influencehow they move right they're
going to be more anxious, a lotof times they actually limit
their movement, which puts themmore at risk because then you're
(15:03):
not as efficient in movie.
Right.
So the less I move, the more wecan, that connection between the
brain and the body to move.
So we're designed to move.
It is what I tell a lot of mypatients.
And when we don't move, thingsget grumpy, your joints get
stiff.
(15:23):
It's harder to move.
and if you think about like inthe context of like arthritis,
for example.
So if I have a bad me, so tospeak.
I'm going to not move it somuch.
So the less I move it, thestiffer it gets, the stiffer it
gets, the harder it is to move.
So what I teach them is safeways to move.
(15:45):
and when you move, it actuallyoils the joints, which makes it
easier to move.
So if we can help, the patientsestablish those safe parameters.
To move, it lowers the anxietyand the fear of moving and the
quality of how they move aswell.
So the more confident someone isin moving, the more likely they
(16:09):
are to move.
Erin (16:10):
I'm not an older adult yet by any means.
I'm still in my twenties, but, Ifind that I have an ankle injury
and I baby it.
It's almost like a self.
It's Oh, I baby it.
I don't want to do this becauseI know if I do this, it'll hurt.
But then I'm limiting mymovement, right?
It's if I do a lunge or I walkup a hill this way, this is
going to be the repercussions ofwhat I just did.
(16:32):
So I'd rather not do it.
So I can see where they're like,if I do this is going to hurt.
And then I'm going to be outlonger versus if I just did
this, right?
Your mind starts playing thosegames versus, maybe you take the
time, slow down, still do thatstuff.
but maybe do not as many reps ornot as long of a walk, and just
make that slow movement and letyour body heal and not overwork
(16:53):
it.
That, that's where my mind is.
Ann (16:55):
more deliberate, right?
Being more deliberate with whatyou do.
um, I tell people, you know,it's, it's not about, what you
do as much as it is how you doit.
So I try not to tell peopleabsolutely no, I try not to give
them hard no's when there'ssomething that they really want
to do.
We just might have to explorehow we do it, what are safe and
(17:20):
efficient ways to do it.
that's where you have to becreative.
Erin (17:25):
so now I have a neurological disorder, right?
I mean, I'm coming to see youfor rehab.
Do I come to you because I findyou on my own?
Is that from a doctor doing areferral or both?
Ann (17:36):
I would say both.
I do have a relationship withSeveral neurologists and, a
stroke program and stuff likethat, but, conversations like
this, are very valuable, but I'mtrying to get out there more to
where I feel like the waybusinesses and clinics have
moved, it's just been, like yousaid, there's just one big
(17:59):
physical therapy.
It's just in one big box, right?
so the typical procedure is,someone comes into their
position and they might say,Hey, my shoulders bothered me
and the physician may or may notsend them the physical therapy.
They may just prescribe the painmedication, pain time,
inflammatory, something likethat.
(18:19):
But let's say they do sometherapy.
Most likely it's going to be aclinic that clinic is associated
with.
it enters this pool oftherapists and it's just
whoever's schedule's open mostof the time.
So you have no say in who thetherapist is that you see and
(18:41):
what kind of experience theyhave unless you initiate the
conversation as far as, Is, arethey going to be a good match
for me, you know, do theyspecialize in, so going back to
that conversation with theposition, shoulder injury, maybe
the physician overlooked thatthey had a stroke five years
ago.
(19:01):
And it's on that hemipareticsite.
That can influence why theshoulder hurts, because it may
be the shoulder of theunaffected side because they
overuse it.
I see that a lot.
John (19:13):
While I can see how it would be such a struggle, right?
Because we live in such a fastpaced world.
And I think that, if we slowedthings down a little bit or we
advocated for our loved ones,say Say they have had some falls
or whatever, maybe talk tosomebody and say, okay, yes, we
know that physical therapy isbeing recommended for my mom or
(19:34):
my dad, my grandma or whoever.
But since she has had some fallsor she has had a past stroke, we
would really like to know if youhave.
A neurologic, you'llrehabilitation program or a
therapist that specializes inthat we really have to advocate
for ourselves because it is sofast based.
And like you said, when thereferral goes out, it gets sent
(19:56):
to whoever has, room on theircaseload to be able to take
that.
But, We out here that arereceiving that type of therapy
might not benefit as much unlesswe have the correct referral to
the correct therapist that maybespecializes such as yourself.
So,
Erin (20:13):
well, and that's why we should do our homework, right?
Whether it's like, okay, I needto go see PT, make sure who's
going to be the best fit for me.
Tell my doctor, Hey, this is whoI want to be referred to.
And as long as they're in yournetwork, there shouldn't be an
issue with them referring.
John (20:28):
Yeah.
Ann (20:29):
The problem with, going to provider is, A lot of times I
don't have the bandwidth to lookand see, okay, well, who is this
you're talking about?
What's their fax number?
How do I get a hold of them?
so the good thing about Idaho iswe're a direct access state, so
we don't have to have aphysician referral.
So you could actually call ourclinic directly and we'll do the
(20:50):
legwork for you as far as,following up the position and
everything.
Yeah.
Erin (20:55):
that's awesome.
As a family member or caretaker,how can I support someone that's
going through physical therapy,the neurological therapy?
Ann (21:06):
Yeah.
So in order to make changes inthe brain or the nervous system,
we have to have lots and lots ofrepetitions.
And if we, if I can recruitcaregivers or family members to
reinforce what I've alreadyestablished and implemented.
And I've shown to be successfullike they're responding really
(21:28):
well to these cues, or thissetting, or this setup, if you
do it.
This way, they do really well towhere you don't have to pull on
them.
You don't have to yank on them.
You know, please don't do that.
they can do it themselves.
So we, what they might may haveto do is just know how to help.
So a lot of caregivers, strugglewith that piece.
(21:51):
Like, I hate seeing my mom'sstruggle to stand up or so
they'll just yank on them,right?
They'll manhandle them orwhatever it might be.
a big mistake I see a lot isthey'll like pull on their arms.
things like that.
so there's some pretty, prettyhorrific things I've seen, as
far as caregiver strategies.
(22:12):
in response to your question, ifthey could reinforce what I've
already implemented, and I'vealready shown the patient that
they could do successfully, andit actually makes them feel
good.
It gives them some autonomy,right?
It gives them some self efficacyto where they have, you They
have some control over thatprocess.
Nobody likes.
(22:33):
to be manhandled.
Erin (22:35):
Right.
Ann (22:35):
if I can give them some of that power as far as how they
initiate the transition, howthey can actually participate in
it, active participation ishuge.
no one can rehab passively.
They need to activelyparticipate in it.
whether it, it is, the patient.
Coaching the caregiver throughhow to help them.
(22:59):
That's still activelyparticipating.
So if they had a spinal cordinjury or something like that,
for example, and they, they needhelp with certain things.
Nothing wrong with their brain.
They could still direct thecaregiver.
As far as how to help them.
and that was a long response toyour question,
Erin (23:18):
no.
I think it's important.
It's allow them to do what theyneed to do without frustrating
them.
So be patient, but also show upto the physical therapy and
learn, be proactive with yourloved one that you're caring
for, or, you know, a friend,family member, whoever it may
be, go to these therapy sessionsand learn.
So you know how to assist themwhen they need not be scared
(23:42):
yourself.
Ann (23:42):
Yeah, and not to do too much, right?
You want to offer them theopportunity to engage, and
that's how we make changes.
John (23:52):
so when it comes to physical therapy, when it comes
to the neural neurologic side ofit, is it a combination between
of drugs and physical therapy oris it, still mainly just,
Getting them to think ofdifferent ways to rehab.
Is there a combination there or
Ann (24:13):
So are you referring to more like orthopedic, like
muscle bone and joint type stuff
John (24:19):
no, I'm more of talking like, for instance, if somebody
has had a stroke or they've hadsomething happen and they need
some.
Deep rehabilitation, with aemphasis on the neurological
side of it.
So is there medications thathelp support your practices of
therapy or is it mainly juststill just the physical therapy
(24:43):
side of it?
Ann (24:45):
So, if you think about physical therapy as we are
movement specialists that's ourjam.
That's what we're going to focuson.
So whether it's been mobility,whether it's helping them be
able to transfer moreindependently, walking more
safely and efficiently, thingslike that is going to be a big
(25:05):
direction of what we focus on,because if it doesn't translate
to function, why are we doingit?
that's how the patient's goingto look at it too.
Yep.
If this isn't going to help youdo a, B and C better, why are we
doing it?
you're never going to see me dolike bicep curls with a patient
or, you know, just straight upexercise, unless it's somehow
(25:29):
translate to, function, becauseI find that I get better
outcomes that way, if it makessense to their brain and their
nervous system, and I can get.
the brain and the body to talkto each other better, they're
going to move better.
So they're going to be moreefficient.
They're going to be moreindependent.
They're going to be more safe.
And they're actually kind oflearning those parameters on
(25:52):
their own as far as, Oh, well,I'm in a different chair now.
I have to do this kind ofadjustment to be able to stand
successfully.
in reference to the medications,there's some conditions where
medications are necessary, likeParkinson's, for example.
there's some MS medications,they're always changing.
(26:13):
And there's new ones out.
I'm not a huge, a huge fan ofpharmacology.
so a lot of conditions like MS,for example, it is linked to
inflammation.
So what we're learning is thatthere's a lot of.
There's a lot of benefits inreally controlling our
(26:36):
lifestyle, which encompasseswhat we eat as well, and how we
move, and how much we move.
Erin (26:43):
So no eating in and out burgers and fries every day or
John (26:48):
Especially right before a therapy session, you probably
don't want to do that
Ann (26:53):
I mean not
Erin (26:54):
Probably not a good idea.
Ann (26:56):
Yeah.
Erin (26:57):
As our technology is changing in the world.
How do you see it being used inyour department, like with VR,
robotic assistance and anything?
I'm just kind of curious to seewhere you might see some of that
coming for you and helping yourpatients.
Ann (27:14):
Well, I would say we're seeing more and more as far as
brain computer interface.
That's kind of you've heard ofElon Musk, like Neuralink and
things like that.
This is a technology that's beenin the works for, I want to say
like 20 plus years.
But we're seeing more and morelike they're getting closer and
(27:34):
closer to it actually used.
and it's basically a real timeinteraction between the brain
and some kind of output, whetherit's a device or whatever it is.
it's pretty cool.
Some of the technologies isn'tnecessarily new, they're more
refining it.
So like functional e STEM forlike, muscles that aren't
(28:00):
working the way they should, butif we can get them to fire at
the right time during a certaintask, like for walking, for
example.
or for hand movement for gripand stuff like that.
that is still a pretty strongtechnology that that we're using
quite a bit in neuro rehab.
you're seeing a lot of roboticstype stuff for like people who
(28:24):
have paralysis.
We're seeing more and more ofthat.
However, making it easy for thepublic to access is that's a
different story.
Unless you're Iron Man.
So,
Erin (28:36):
we'll
Ann (28:36):
um.
John (28:37):
to get some robotics for Aaron, so I can take her
snowboarding and she can't say,Oh, my ankles hurt and get her
some robotics so that she canstill do it.
Erin (28:47):
Well, you know, as we age, our cognitive.
our cognitive functionssometimes change.
And so can that present achallenge when you're trying to
rehab somebody?
Ann (28:58):
absolutely.
so in order to learn, you haveto be able to attend to a task,
right?
And if I can't get you to focuslong enough to learn something
and have the memory to retainit, it's hard.
It's hard not to, just defaultback to old patterns.
So that's where caregivers comein a lot, as far as they have to
(29:22):
be.
So if we can't internalizesomething, like if I can hold on
to a piece of informationmyself, then I have to use some
kind of external strategy,whether it's a sign or notes or
someone reminding me or using myphone or whatever it might be.
Erin (29:39):
Well, that's the other thing I was gonna ask you too.
If I don't have a caregiver, Idon't have somebody helping me
and I come and I need this.
What are strategies you give meto take home to remember if I'm
already having a hard time?
Ann (29:51):
Yeah.
So something I found prettysuccessful is, I will use like a
patient's phone or their iPad ortablet, something like that,
because I dump a lot ofinformation on them in one, one
session.
And as I understand it, it'shard to remember all the details
of everything.
So what I'll do is I'll ask thempermission to record them with
(30:14):
their device, and I will coachthem through.
A movement and they'll hear mynagging voice in the background.
They'll see themselves.
And it also gives them areference as far as, okay, Mr.
Smith, this is where you were onday one.
We're going to be able tocompare this to six weeks from
(30:35):
now, and I guarantee you'regoing to be doing a lot better.
So it's nice to be able to lookback at that too.
Erin (30:41):
I like that.
John (30:42):
Yeah, I like that.
So can you, just walk us throughlike the most successful
strategies?
Like you show up at the home,maybe you do an eval and treat,
and I'm not quite sure how thisgoes, but if you could just walk
us through the best casescenario with helping somebody
get through the steps of,neurologic rehabilitation and
(31:05):
how it might be different fromnormal therapy.
Ann (31:08):
Yeah.
So I always tell people thefirst step is to establish a
good foundation because if yourfoundation stinks, we have
nothing to build on.
So people's goals are alwayspretty high and you go in and
someone can't even stand in itand their goal is.
What?
(31:29):
I want to walk, right?
So, before you walk, you've gotto be able to do A, B, and C,
right?
We've got to start somewhere.
first, we work on foundations.
So if you can't stabilize whenyou're sitting, I can't expect
you to stabilize while we werestanding.
And I definitely can't expectyou to stabilize when you're
walking.
Right?
(31:49):
So we start with the basics.
We start with, I consider it asfar as general stability.
There's three levels.
So level one is, can youstabilize when you're still,
when you're just sitting there,can you find where you belong?
and that gives me a goodpicture.
As far as, is there a mismatchbetween where they think they
are and where they actually are?
(32:10):
So for example, I might say,Hey, Mr.
Smith, what do you think asyou're sitting in that chair, if
that chair was a parking space,are you sitting pretty straight
in that parking And they couldbe looking at me like this and
be like, Yeah, I'm prettystraight.
So they're, they're butts aboutto slide out of the seat.
They're leaning way over.
(32:33):
There's a mismatch, right?
Between where they think theyare and where they actually are.
And, to simplify it, I'll sayit's kind of like your GPS is
wacky.
You're, you're telling your GPSto take you home, but it takes
you a block down.
It's close, but you're notthere.
So when there's that mismatch,Mistakes happen, right?
(32:55):
I thought I was close enough tothe seat.
I thought I was safe.
So that's, level one is can youfigure out where you belong?
Right?
Can you stabilize when you'rejust still?
When you're just sitting there.
Level two is can you stay stableas you're moving?
So I'll have them do somethinglike just turn their head.
Or I might have them leanforward.
(33:16):
Can they stay stable?
Or do they totally deviate oneway or the other?
Do they fall apart?
And level three is can you applyit to function?
Can you apply it to real life?
So I apply that when they'resitting, when they're standing,
when they're walking.
those are the foundations,
Erin (33:33):
What are some techniques you teach them to stay
motivated?
Because I know sometimes for meit can get frustrating, you're
here and there's no progressbecause with my ankle, I go
backwards a little bit.
I frustrate PT people.
It's fun.
But what are things you can doto help or techniques to teach
that, Hey, this is how you staymotivated because it can be a
long process sometimes and don'tfeel frustrated, you know?
Ann (33:56):
right?
Well, we talked about the video,right?
So when I video them, that is,that's a tag, a timeline tag,
right?
I know you don't feel likeyou're doing any better, but
let's review where you were dayone.
you're doing things now that youweren't able to do that day.
so that's one strategy.
(34:18):
Another strategy is what we calloutcome measures.
So I do certain tests on dayone.
And then after a few weeks, Irevisit those tests.
So we actually have objectivemeasures to where I can show
them, it took you this long todo this.
day one, you did it in half thetime today, right?
(34:40):
And you did it safer and youdidn't have to use your hands
or, there's different.
Variables that I'll add to makea task more difficult.
And once they nail it, it helpsthem recognize, Oh, I guess I
am.
I'm also tracking quality ofmovement and I'm also tracking
like falls, for example, when wefirst met, you were saying that
(35:04):
you were falling four times amonth.
When was the last time you fell?
I can't remember last time Ifelt, so does that make sense?
sense?
Erin (35:14):
yeah.
Thank you.
And that, I guess that goesback.
I should have asked thisquestion first is when someone
comes to you, what do you, whatare the first steps, the
assessing them and the questionasking and all of that.
So it's great that's part of it.
Ann (35:27):
Yeah.
Yeah.
So we try to establish a solidbaseline.
So during the initial eval, weget a good picture of where they
are, where they were and wherethey want to be.
and we gauge like how big isthat gap between where they are
and where they want to be.
Right.
Is it reasonable.
I never, like I said, I nevertell them no.
(35:47):
but we do start with baby steps,those small victories.
Erin (35:51):
And then you throw a big party afterwards.
Ann (35:54):
Yes.
John (35:55):
so my question, I'm sure a lot of listeners are thinking
about this.
I know rehab can take a longtime depending on an injury or a
stroke or your cognitiveabilities or your support
system, all these differentvariables, right?
But on average, how long does ittake for patients to see the
(36:16):
biggest changes?
is it like a month?
Is it like six months?
how long can they expect to seechanges?
Ann (36:26):
sometimes, honestly, sometimes I go in, Because we by
nature are fixers.
sometimes I go in day one andtechnically during an
evaluation, I'm not supposed tointervene yet.
I'm supposed to get a truebaseline of where they are
before we start.
But I have a big problem keepingmy mouth shut.
(36:47):
If I see a problem, I'm going tofix it.
But, I always within myevaluation towards the end, I'll
do treatment too.
And sometimes it's so simple.
Hey, have you thought abouttrying this strategy?
have you thought about maybemoving your foot here or using
this?
and that could be a game changerfor them.
So a lot of times day one, theycan notice a difference to
(37:11):
where, wow, I didn't know Icould do that.
so they, they won a lot of thetime that they'll see some kind
of change and that motivatesthem for the next treatment.
but as far as consistent change,that's what gets hard, right?
(37:31):
without me barking at you, canyou do it right?
If you could do it in thecontext of your home, but can
you do in the context of yourfavorite restaurant?
so that's ultimately what we'reworking towards.
I want them to be equipped to dowhatever they need to do in the
environments that they need tofunction
Erin (37:51):
other things we can do now that will help prep us as we
age.
And I know there's all differentstages, but if it's like, Hey,
you know, your nutrition canreally set up you up or your
hydration can really set you upfor when you do come across
having, you know, aneurological,
John (38:10):
Well, when you have any sorts of challenges, right?
because as we do get older, youknow, our muscles start to
atrophy, we start gettingweaker.
We can have falls happen.
And so I think what you'retrying to ask, and sorry if I'm
wrong, but, how diet nutritionplay into in hydration, play
into your ability to recuperateand yeah, gain.
(38:32):
More successful motivation asyou're healing from say a fall
or a
Ann (38:36):
Yeah.
I'm so glad you asked that.
so big pillars, more and moreresearch is coming out talking
about the benefits of.
nutrition.
so much so that now Stanford andHarvard are both recognizing
nutritional benefits onbehavior.
So Stanford has launched amedical branch called
(38:59):
nutritional metabolic nutritionand Harvard nutritional
psychiatry.
So where it used to be, as faras what we eat, we used to kind
of, you know, dismiss people andbe like, Oh, you're just Hippie
or whatever it is, right?
That's just foo foo stuff, andnow we're actually recognizing
(39:23):
more and more.
I, I have a whole new respectfor functional medicine because
that is one, area where I, Ireally do feel like they're
getting down to the root causeYou know, if you have a
headache, there's a hundreddifferent reasons why you could
Well, let's figure out why,Whereas traditional medicine,
(39:44):
they may just give youpharmaceuticals, and it's not,
you know, I'm not bashingallopathic medicine or
traditional medicine.
It's just.
The way the system is set up,they're forced to, you know, see
a huge volume of people in ashort period of time, and they
just don't have the bandwidth toreally dig.
(40:06):
So it's not their fault.
It's just the way it's set up.
so pillars of health.
Sleep is huge.
recommendations are seven tonine hours a night of
restorative sleep.
And, your body likes routine.
Your body is always fighting fora state of balance homeostasis.
So your body likes routine andthere are certain rhythms or
(40:27):
you've heard of circadianrhythm, right?
There's certain rhythms are ourbody assumes, and it likes that.
So if you go to bed about thesame time every night.
And you kind of establish a goodsleep hygiene routine.
So, you know, don't have an In NOut burger right before bed.
So sleep is huge stressmanagement, huge.
(40:52):
So I feel like one of the goodthings about COVID is a.
Brought to surface a lot of likemental health issues where we
used to shove it under thetable.
We don't talk about things likedepression and anxiety, but now
it's been more in the forefrontand we're linking it a lot with
stress.
So we live in a constant stateof stress and environment is a
(41:16):
huge contributor to stress.
what we feed ourselves is a hugecontributor to stress.
there's all kinds of stress,right?
There's environmental, chemical,emotional, physical stress.
the more your body is having torally to overcome those things,
the less resources you have tofocus on something that you
(41:37):
enjoy.
So sleep, stress management,movement, exercise.
So lots and lots of literatureon benefits of exercise on
general wellbeing.
So we know, just cardiovascularhealth, lung health, but now
we're learning that it alsoaffects, your brain.
So when we exercise just like a20, 30 minute good walk to where
(42:02):
you get your heart rate goingactually impacts two areas of
your brain.
the prefrontal cortex, which is,that's the adult in the room,
right?
That's the one that, that doesthe planning, the higher level
thinking, the, considersconsequences, things like that.
And your hippocampus, which isthe memory center.
(42:24):
So the hippocampus also is a bigplayer in stress management,
stress and anxiety management.
So that's why when you've beensitting at your desk for hours
and You hit a roadblock andyou're like, I can't even look
at the screen anymore.
You go for a walk, you come backand things start flowing again.
That's what, okay.
So sleep, stress management,exercise, and what we feed
(42:48):
ourselves and nutrition.
We're learning more and more.
And it, it makes sense.
Our body operates onbiochemistry.
If you think about it, hormones,neurotransmitters, electrolytes,
right?
You've heard all those terms.
Those are all biochemicals.
and what we eat influences that.
(43:08):
we've learned like a big pieceof chronic diseases,
inflammation.
So a lot of the crappy foods,fried foods, high sugar foods,
highly processed foods aretoxins in it and your body
responds by inflammation.
And what we're learning is whenyou have inflammation like in
(43:29):
your joints.
we hurt, we know it, werecognize that, but when you
have inflammation in yournervous system, you don't feel
pain, but what you do experienceis like brain fog and your
tolerance for things is less,you know, you're moody.
you can't sleep, you can't calmdown, you're stressed, you're
(43:51):
anxious, things like that.
So that's how that shows up.
And they've actually linked itto things like Parkinson's and
autism and MS and things likethat.
So when we eat, those highlyprocessed and high sugar foods,
it weakens your body's abilityto protect itself.
It weakens the gut lining, andit actually weakens the brain,
(44:12):
the blood brain barrier to ourjunk.
Can get to your brain.
that's something else that theresearch is showing that things
we didn't think would cross theblood brain barrier is and, it's
crazy.
John (44:26):
Is
Ann (44:26):
that was a long response to
Erin (44:28):
No.
Can I say this one comment?
I'd say, is that why when we getolder, people get grumpier is
because they're so inflamed.
It messes with our moods andwe're hurting.
Ann (44:40):
It could be.
Yeah.
Yeah, it could be because there.
John (44:44):
to me.
Ann (44:44):
Well, I, find that the older population too, they're
less invested in taking the timeto eat well.
It's just whatever's easiest.
Right.
John (44:53):
I,
Ann (44:53):
in general populations like
Erin (44:55):
right.
John (44:56):
yeah, I love that.
We're talking about this becauseit's something I've been
passionate about for years.
And, we talked about Jim quick'sbook, limitless in there.
It talks about the correlationof gut health.
Versus our brain and how, thevagus nerve is transferring
nutrition up to your brain andhow it operates.
And so now I'm a huge advocateof eating, brain healthy foods
(45:18):
like avocados, walnuts, youknow, dark leafy greens,
berries, a lot of thosedifferent things.
And you're right.
I think a lot of people don'trealize the importance of what
you're putting in your body asfar as the quality of the
nutrition and how it's going toaffect us as we get older and
our abilities to function,whether it's, our cognitive
(45:41):
abilities of thinking andprocessing, focusing, and, your
memory, but also things likemovement, Being able to walk and
do all the things physicallythat we've been able to do for
years.
So.
Ann (45:54):
Well, I, I like how there's some crossover too.
So we talked about how I said, Imentioned, it's not always what
you do.
It's how you do Right.
Same thing with what you eat.
Even though you're eating somehealthy stuff, if you're eating
it in a stressful environment orif you're eating it really
quickly, and you're drinking asoda with it, it influences how
(46:17):
your body responds to it, whichis fascinating.
Combinations of different foods,will influence the
bioavailability of it it'sfascinating.
Erin (46:26):
Have you noticed how the brain reacts with a glucose
spike?
Like if you're eating somethingin the order, like you mentioned
the order that you're eatingsomething in the how that messes
with your brain.
Ann (46:38):
Yeah.
something you'll see like in theliterature is glycemic index.
So something like the higher,it's my understanding, the
higher the number, the faster itturns to sugar, basically.
now your brain is, is a bigsugar hog.
It consumes quite a bit becauseit's the operating system, but
(46:59):
when it gets too much, then itjust Circulates and, and it can
cause insulin resistance andthings like that.
So we've got to be careful withthe sugar intake, but, it's
interesting.
you mentioned like the gut brainconnection and that, that is
huge.
And we're seeing more and more.
I mean, I would say even in justNetflix and, things like that,
(47:22):
you're seeing more and moreabout the gut brain connection,
like 95 percent of serotonin isproduced in your gut.
So serotonin is one of thoseneurotransmitters that that
affect mood, right?
the problem with that is itdoesn't cross the blood brain
barrier unless it's combinedwith certain foods.
(47:43):
So like tryptophan is aprecursor to serotonin.
So if you eat it, so chickpeashas tryptophan.
So if you eat like chickpeaswith like a carb, then it
crosses the blood brain barriereasier.
So protein with tryptophan and acarb and it'll cross the blood
(48:04):
brain barrier, make you feelbetter.
John (48:06):
I like to tell people that, when we're young, we can
process things so much faster,it's like a brand new engine in
a car.
but if you abuse yourself overtime, there's an accumulative
effect and then you have issueslater on in life.
So the sooner you take care ofyourself, you keep moving.
You put in the proper nutrition,you're getting sleep and
(48:27):
hydration and all of thesethings, the better off you're
going to be as you age.
And I think that's the messagethat we're trying to get out
there with our company,connecting power, connecting
people with the resources, theinformation to make better
decisions so that we're morecomfortable and we can continue
to live the life that we choose.
Right?
Erin (48:45):
so no, I agree.
Are there things that maybe wemight've missed that we didn't
ask you that you feel is veryvital that our listeners here,
like you guys need to know this.
This is, or these are ways maybeto prep and be ready when you
come and see someone like me.
Ann (49:02):
You guys were pretty thorough.
You had some great questions.
yeah, you, I think you did agreat job.
no, I don't think so.
Yeah.
I think you,
Erin (49:12):
any advice or anything to give out?
Ann (49:15):
don't be afraid to do your own research and don't be afraid
to ask questions to yourphysician.
So if their solution is just toadd another medication, then
it's okay to ask.
Hey doc, is there anything elsewe could take off my medication
list if you're going to addthis?
is there any other alternative?
(49:36):
Because what we're finding toois like 80, I think I already
mentioned it, like 80 percent ofchronic diseases can be managed
with lifestyle changes.
So, people have been able to getoff like their diabetes
medication and their heartmedication and their anxiety
medication by altering theirlifestyle.
(49:57):
And I'm not saying do that, but,there, there are options like,
under the direction of aqualified professional, you can
do that and people have beenable to make noticeable changes
in 2 weeks.
Erin (50:11):
Wow.
Ann (50:12):
yeah.
John (50:12):
I love that.
And I think that what peopleneed to understand too, because
sometimes I can get almost alittle too intense on the
changes that I'm trying to maketo better my life.
And it doesn't take a lot.
You can do small changes, startwith small, small changes to
improve your life.
And then be consistent withthose small changes and see what
(50:34):
happens, right?
and I love what you just said,About, not necessarily just
taking doctor's advice andtaking another pharmaceutical
because sometimes we can alterour nutrition.
We can get a little bit moresleep.
We can hydrate more and that alot of that stuff is free.
We don't have to pay for anexpensive prescription, right?
(50:55):
So, yeah, this has been fun.
I love this topic.
brain health to me is one of themost important things as we age.
ever.
it's, our bodies are going toatrophy, but our minds will too,
unless we take care of them.
Erin (51:09):
Yeah.
Ann (51:10):
So it doesn't have to be that way is I think the message.
Yeah.
Erin (51:14):
Would you like to ask the last
John (51:16):
Oh gosh.
All right.
Erin and I are passionate abouttravel and adventure.
So we'd like to know, if there'sa place that you've gone or that
you want to go, that you're,You're excited about, or you
look forward to, or someplaceyou recommend that our
listeners, consider.
Ann (51:34):
Just one place.
John (51:35):
Oh, you can name a couple if you'd like.
Yeah, no, we're totallyinterested.
Ann (51:40):
so you guys already know this response, but Vietnam is a
place I've always wanted to go.
That's where I was born and Iturned 50 this year.
So I think would be cool to kindof circle back there and, and
experience the culture and learnmore about it.
that's at the top of my list.
we sponsor several kids throughcompassion in different
(52:02):
countries.
So Thailand, Guatemala,Dominican Republic, things like
that.
I would love to visit kids.
I would actually, I would allthe kids that we've sponsored
through the years.
Yeah.
And, I've never been to Europe.
I think that would be cool.
different countries in Europe.
And, I don't know, I would love,I haven't even been to all 50
(52:26):
states.
So that's a goal too.
Where my husband and I are bigfoodies.
So we think it's fun to findthose local dives and what is a
good reflection of the localculture.
And the story behind it.
We love hearing the storiesbehind food.
John (52:42):
I love that.
I love that you're speaking ourlanguage because we're both.
if we could just travel andlearn about different cultures
and try the different cuisines,and the people and hear the
Erin (52:54):
their culture, that's, that's
John (52:56):
living for us.
Ann (52:57):
Yeah.
John (52:58):
thanks for sharing that.
Erin (52:59):
and thank you for being on today.
I think this was valuable forour listeners to know, ask those
questions, the servicesprovided, talk to your doctor,
research who you want to visit,
John (53:11):
Yeah.
And I'm excited because I didn'tknow there was a such thing as a
neurologic, rehabilitationtherapy that you can, get or you
can ask for.
So I think that our listenersthat maybe are having some
declining with their cognitivehealth that's affecting their
abilities to move and do thethings that they're passionate
(53:32):
about, to know that.
You and other providers havethat skillset, I think is just
awesome.
so
Ann (53:39):
Yeah.
Yeah.
Oh, two more things one, don'tbe afraid to fail.
Try new things.
Don't be afraid to fail.
and two is, learn something new.
Give yourself an opportunity tolearn something new.
that's a great way to.
To keep that process viable,keep your brain sharp is more
(54:00):
doing something different thatyou are afraid to do.
John (54:04):
Jim Yeah, I know I keep referring to Jim quick and I
think it's because the book wasjust such an amazing book, but
it talks about as we get olderto keep reading, to keep trying
to learn new things.
And one thing that I thought wasa need that I didn't even think
about was.
Brush your teeth with theopposite hand, maybe eat with
(54:25):
the opposite hand, startpracticing doing things with the
opposite side of your body thatyou normally don't do because it
can help sharpen you.
It gives your body thatstimulation, that's needed for
growth and sharpness.
I love all this.
I just eat
Erin (54:41):
eat it up.
so thank you.
He's getting ready to geek outnow.
for sure.
Oh, but again.
Ann (54:48):
thanks for having me.
Erin (54:49):
Oh, it was a pleasure.
John (54:52):
Thank you for tuning in to another episode of Connect
Empower.
We want to express our gratitudeto you for being part of our
community, and we hope today'sepisode has provided you with
valuable insights andinspiration to enhance your life
and that of a loved one.
Erin (55:06):
We are more than just a podcast.
We are a community dedicated toenhancing the lives of our aging
adults and their support system.
We encourage you to visit ourwebsite now at www.
connect empower.
com.
Explore more information aboutour guests from today's episode
and to access our freeresources.
John (55:28):
resources.
Our mission doesn't end at theconclusion of this episode.
We invite you to take action nowby sharing the knowledge you've
gained today with someone whomay benefit from it.
Whether it's a family member,friend, or colleague, your
influence can spark positivechange.
Erin (55:42):
Remember, Subscribing to our podcast ensures you never
miss an episode and we have moreincredible guests and resources
in store for you.
So hit that subscribe button andstay connected with us.
Your commitment is the drivingforce behind our mission and
together we can create amovement for a brighter future
as we age.
John (56:03):
I'm John.
Erin (56:04):
I'm Erin.
Until next Wednesday.
it's just our ability to handle different kinds of loads.
(00:03):
There's like stress load.
There's physical load.
There's chemical loads.
There's different kinds ofloads.
but the more taxing, it is forus to overcome things, the
harder it is to bounce back.
So with the older population,some of the barriers I've
encountered is just willingnessto change.
John (00:32):
Hi, I'm John,
Erin (00:34):
and I'm Erin.
You're listening to connect andpower.
The podcast that proves age isno barrier to growth and
enlightenment
John (00:41):
tune in each week as we break down complex subjects into
bite sized enjoyable episodesthat will leave you feeling
informed, entertained, and readyto conquer the world
Erin (00:54):
a season physical therapist and the co-founder of
grit mobility, a mobile practicespecializing in neurological
care.
Our guest Ann Phillips earnedher master's degree in physical
therapy from the university ofOklahoma in 2004 and later a
doctorate from the university ofMontana in 2020.
(01:15):
Throughout her career.
Ann has worked in diversesettings, including brain injury
programs and outpatient neurorehabilitation.
Gain over 10 years ofspecialized experience.
Her deep understanding ofhealthcare, shortcoming inspired
her to launch grit, mobility tosupport those often overlooked
by the system.
(01:37):
Besides her professional work.
Ann a clinical instructor,actively mentor students runs a
local support group forindividuals with spinal cord
injuries and other physicaldisabilities.
Also known as Molly rollers oftreasure valley.
And collaborates with strokesurvivors can to educate and
(01:59):
connect with the community.
Alongside her husband.
She co-founded the nonprofitfueled by fire To assist both
local and internationalcommunities.
Let's give a warm welcome to ourguests.
Dr.
Anne Phillips, the.
Thank you so much for being
Ann (02:16):
Thanks so much for having me.
I'm excited.
Erin (02:20):
We were talking a little bit ago and I'm probably going
to mess this up a few times,but.
I'm going to ask you to shareyour story, but also correct me
along the way, because it'sneurological is what I say, but
it can be neurologicrehabilitation.
Correct?
Ann (02:36):
Yeah, it's it means the same
Erin (02:38):
Ah, perfect.
if you wouldn't mind going intoyour story and sharing really
how you found this field or ifthe field found you and really
explain more about what it is,
Ann (02:49):
Yeah, I guess it depends on how far back you want to go.
my mom's a nurse.
And, I always had.
This fascination with the humanbody, the more you learn about
it, the more you recognize andyou can't deny divine design,
for sure, it's just fascinating.
And then, I would say the brainis, or the central nervous
(03:09):
system is the most fascinatingpart because that's the
operating system.
my mom's a nurse and, she waspushing me towards the medical
field and, medicine.
And I actually was initiallywanting to go pre med, but then
I learned that physicians Don'thave a life for the first one,
15 years.
Um, I really also had thisfascination with, like I said,
(03:34):
the human body.
So I was really big into likefitness and how the body
responds to, to differentthings.
So, physical therapy is like theperfect combination.
it's technically physicalmedicine is what some
departments will call it.
that's kind of where.
where my path went, I used to bea personal trainer and aerobic
instructor and stuff like that.
(03:55):
and, just kept digging in deeperand, it led me to physical
therapy.
So I've been doing it for about20 years now.
Erin (04:03):
sounds like the two of us, like we're always looking for
knowledge somewhere.
And then the more books and themore research and John's been in
it a little bit heavier than Ihave.
Right.
You've been saying a lot more.
I followed Jim quick and he hadthat book limitless.
And so John had it before mecause I was trying to finish
another book.
He's like, Oh my gosh, thisstuff is blah, blah.
And I'm like, man, I can't waitto read it, but it is
(04:25):
fascinating.
Ann (04:27):
You just released a new version of it.
Erin (04:29):
that's the one I got.
John (04:31):
Yeah, that's the one I just read.
It was an amazing book.
There's so many, so much greatinformation.
So shout out to Jim Quick andLimitless.
great book.
Erin (04:41):
Yeah, and I,
Ann (04:42):
to read it.
Erin (04:43):
and the older I get, the more I want to learn.
I was like, why wasn't I thisway when I was younger?
it's just interesting.
John (04:49):
so Dr.
Phillips, can you please explainwhat neurologic rehabilitation
is and why it is important,especially when we age?
Ann (04:59):
So neurologic rehab is a different branch of rehab.
So there's different branches inphysical therapy, just like
there's different branches inmedicine.
So if you think about it, likein medicine, there's oncology,
which is like cancer.
there's pediatrics.
Which is kids.
there's geriatrics, which isolder adults.
So there's different branches.
(05:20):
in physical therapy in someways, there's also other
branches and there's differentcertifications that you can get
for it.
Now, there's not certificationsfor everything, but, there's
like wound care and.
And geriatrics and things likethat.
So neurologic is the area ofrehab where we really hone in on
kind of the nervous system andhow the nervous, system affects
(05:43):
the body and how we move.
So in simplest terms, that'sneurologic rehab.
now in reference to older adultsor aging, the aging population,
we, as we get older, We're notas, resilient where you don't
bounce like what you used to.
it takes a little bit longer tomake sense of things.
(06:06):
And, when you add an insult likea neurologic injury, like a
stroke or a disease process,like Parkinson's or MS or
something like that, itinfluences the body functions
and ultimately how the bodymoves.
Does that make sense?
Erin (06:23):
Yeah.
And that was going to be my nextquestion what are some of the
common neurological, conditionsthat you see?
Ann (06:29):
some of the common diagnoses that fall under that
umbrella, that neurologicumbrella would be like traumatic
brain injury, spinal cordinjury, Parkinson's, MS, stroke.
now there's different kinds ofbrain injuries too, if you think
about it.
Cause there could be like abrain tumor, right?
Or something like that.
So there's, that kind of fallsunder acquired brain injury.
(06:53):
And then there's traumatic braininjury.
So that's when there's some kindof trauma associated with it, a
car accident or, someone hitsyou on the head or something
like that.
So that's, that mechanism ofinjuries is different than like
an acquired brain injury, like apathology.
Erin (07:08):
this has been fun on the journey of podcasting because
going into it, I didn't realize.
Any PT or OT or any, I'm like, Ijust clumped it all kind of
together and everybody knowseverything and to learn that
there are different specialtiesthat people can go to see for
certain conditions.
Like I didn't know, right?
I didn't know that this is
Ann (07:31):
Yeah.
Erin (07:31):
right?
Ann (07:32):
There's a lot of people that don't know and that's
that's the problem with it.
I'm so glad you guys are doingwhat you're doing to help
educate the community.
And that's, that's a big passionof mine too.
because people don't know whatthey don't know.
And, When you don't know, thenyou, I don't want to say you
sabotage yourself, but you leaveit to other professionals to
(07:54):
make decisions for you insteadof you being empowered to play a
role in your own health.
So that's a big piece of what mypractice and my heart is to
capture those people who arefalling through the cracks of
healthcare and to educate themand empower them and advocate
for them.
(08:15):
Like I said, there's so manypeople that don't know what they
don't know.
Erin (08:19):
And that's what we're all about.
That's, you know, we want tomake sure people know and
understand there are people outthere to help you and we want to
bring the resources for sure.
Now, when we're younger versuswhen we're older, is when you're
rehabilitating somebody, is itdifferent?
Are there different approachesyou take?
Is it take longer, shorter, themethods you use?
(08:40):
How does that work?
Ann (08:42):
Yeah.
I think, gosh, so with the olderpopulation, I would say, yes, it
does take longer and a big pieceof that is because, For one, as
we get older, we're less likelyto feel comfortable with change
changes really hard and adaptingto change.
(09:04):
So I feel like that's a bigpiece.
and also, like I said, we'rejust not as resilient as we get
older, but, This is a side note,something I've been super
fascinated with lately is, thedifference between biological
aging and chronological right?
There's a difference betweenlifespan and healthspan, and we
(09:25):
could actually equip ourselvesto where we can handle those
hits, those health hits againstus if we are healthy to begin
with.
and it all comes down todifferent kinds of load, in the
literature, you'll, heardifferent kinds of loaded, like
viral load when cobit was outright and big, they talked about
(09:45):
why some people respond.
Better than others.
And it's just our ability tohandle different kinds of loads.
There's like stress load.
There's physical load.
There's chemical loads.
There's different kinds ofloads.
but the more taxing, it is forus to overcome things, the
harder it is to bounce back.
(10:05):
does that kind of make sense?
So with the older population,some of the barriers I've
encountered is just willingnessto change.
I know you've been doing thisfor 50 years, but the game has
changed.
We have to think about adifferent strategy to, or to
stand or whatever it might be.
Erin (10:26):
you find that people, because maybe they don't have a
purpose, it's like, well, whydid I do this?
Where am I walking?
Who am I going to go see?
Where am I hanging out?
So why really?
They're almost like they want togive up a little bit
Ann (10:37):
Motivation.
Yeah.
So motivation's huge.
fear and anxiety is huge.
those are big barriers.
willingness to change, I've donethis forever.
Why would I change now?
I hear I'm too old to change.
but then I, you know, it's, youhave to be careful not to judge
(10:58):
people before you actually workwith them because sometimes
we'll get these referrals andwe'll kind of read through their
history and stuff.
And they have a list this long.
And you think, and you createthis picture in your mind of how
they're going to look whenyou're face to face with them.
That happened one time when Iused to work in inpatient rehab
I was reading through this chartabout this lady and she just had
(11:20):
a huge medical history.
And so I, I had this picture andI walk in to, the dining room
to, to see her and she's likesitting with her knee up to her
chest, like reading a book orstuff like that.
And I'm like, don't know a lotof people that have that
flexibility, you know, and thatit's, it all comes back to the
(11:41):
lifestyle that you assume.
and that, influences like theunderlying conditions.
before a neurologic injuryhappens.
John (11:52):
So how important is early intervention in the success of
rehabilitation?
Ann (11:59):
in the context of let's say stroke, so like stroke rehab,
the literature is saying is themost change happens within the
first three to six months.
However, Neuroplasticity isstill viable up to five years is
what we've shown, possiblylonger.
(12:19):
within the first, I would saythree months, is the most
critical because once peoplestart adopting nasty patterns,
it's really hard to break it.
Even if they have the capacityto do it, just getting someone
to change their movementbehavior is so difficult once
it's already established.
(12:41):
And if, if they already find itto be successful and pretty
efficient for them, it's hard toconvince them otherwise.
even capacity.
Erin (12:51):
what are some of the techniques that you give them to
help them overcome?
Ann (12:56):
Yeah.
one of the biggest ones is, andthat the literature supports to
is task oriented.
So if essentially I could helpit make sense to their brain,
and it has meaning to them,they're more likely to be
engaged.
and they can make theconnection.
As far as the why we're doingit.
(13:18):
So if they have meaning to it.
And it's a task that makes senseto them.
They're more likely toparticipate and, and engage
their brain and their bodyconnection.
(13:40):
Yes.
multiple strategies as far aswhatever the task is.
I may have to tweak the task towhere, they're more engaged.
Or I may have to tweak how Icommunicate the task.
sometimes if they don'tunderstand what I'm asking of
them.
Then they're going to go acompletely different direction.
(14:01):
Yeah.
And that's what makes the neurospecialty a little bit, quite a
bit different than standard.
John (14:08):
we all know that, things can become harder and harder as
we get older.
Maybe our muscles and our bodyjust doesn't operate the way it
normally does.
And sometimes we have fall riskswhere people fall.
And so how can you specialize inyour support system after a
fall?
Instead of just calling somebodyto have them do physical
(14:30):
therapy, is it more important tocall you as well so you can
analyze whether they've had amajor head injury or something
that could alter their course oflife?
Erin (14:40):
Good question.
Thank you.
Ann (14:42):
Yeah, so falls are huge and in the older population and
after someone's experienced thefall, they're more likely to
have another one.
because it's going to influencehow they move right they're
going to be more anxious, a lotof times they actually limit
their movement, which puts themmore at risk because then you're
(15:03):
not as efficient in movie.
Right.
So the less I move, the more wecan, that connection between the
brain and the body to move.
So we're designed to move.
It is what I tell a lot of mypatients.
And when we don't move, thingsget grumpy, your joints get
stiff.
(15:23):
It's harder to move.
and if you think about like inthe context of like arthritis,
for example.
So if I have a bad me, so tospeak.
I'm going to not move it somuch.
So the less I move it, thestiffer it gets, the stiffer it
gets, the harder it is to move.
So what I teach them is safeways to move.
(15:45):
and when you move, it actuallyoils the joints, which makes it
easier to move.
So if we can help, the patientsestablish those safe parameters.
To move, it lowers the anxietyand the fear of moving and the
quality of how they move aswell.
So the more confident someone isin moving, the more likely they
(16:09):
are to move.
Erin (16:10):
I'm not an older adult yet by any means.
I'm still in my twenties, but, Ifind that I have an ankle injury
and I baby it.
It's almost like a self.
It's Oh, I baby it.
I don't want to do this becauseI know if I do this, it'll hurt.
But then I'm limiting mymovement, right?
It's if I do a lunge or I walkup a hill this way, this is
going to be the repercussions ofwhat I just did.
(16:32):
So I'd rather not do it.
So I can see where they're like,if I do this is going to hurt.
And then I'm going to be outlonger versus if I just did
this, right?
Your mind starts playing thosegames versus, maybe you take the
time, slow down, still do thatstuff.
but maybe do not as many reps ornot as long of a walk, and just
make that slow movement and letyour body heal and not overwork
(16:53):
it.
That, that's where my mind is.
Ann (16:55):
more deliberate, right?
Being more deliberate with whatyou do.
um, I tell people, you know,it's, it's not about, what you
do as much as it is how you doit.
So I try not to tell peopleabsolutely no, I try not to give
them hard no's when there'ssomething that they really want
to do.
We just might have to explorehow we do it, what are safe and
(17:20):
efficient ways to do it.
that's where you have to becreative.
Erin (17:25):
so now I have a neurological disorder, right?
I mean, I'm coming to see youfor rehab.
Do I come to you because I findyou on my own?
Is that from a doctor doing areferral or both?
Ann (17:36):
I would say both.
I do have a relationship withSeveral neurologists and, a
stroke program and stuff likethat, but, conversations like
this, are very valuable, but I'mtrying to get out there more to
where I feel like the waybusinesses and clinics have
moved, it's just been, like yousaid, there's just one big
(17:59):
physical therapy.
It's just in one big box, right?
so the typical procedure is,someone comes into their
position and they might say,Hey, my shoulders bothered me
and the physician may or may notsend them the physical therapy.
They may just prescribe the painmedication, pain time,
inflammatory, something likethat.
(18:19):
But let's say they do sometherapy.
Most likely it's going to be aclinic that clinic is associated
with.
it enters this pool oftherapists and it's just
whoever's schedule's open mostof the time.
So you have no say in who thetherapist is that you see and
(18:41):
what kind of experience theyhave unless you initiate the
conversation as far as, Is, arethey going to be a good match
for me, you know, do theyspecialize in, so going back to
that conversation with theposition, shoulder injury, maybe
the physician overlooked thatthey had a stroke five years
ago.
(19:01):
And it's on that hemipareticsite.
That can influence why theshoulder hurts, because it may
be the shoulder of theunaffected side because they
overuse it.
I see that a lot.
John (19:13):
While I can see how it would be such a struggle, right?
Because we live in such a fastpaced world.
And I think that, if we slowedthings down a little bit or we
advocated for our loved ones,say Say they have had some falls
or whatever, maybe talk tosomebody and say, okay, yes, we
know that physical therapy isbeing recommended for my mom or
(19:34):
my dad, my grandma or whoever.
But since she has had some fallsor she has had a past stroke, we
would really like to know if youhave.
A neurologic, you'llrehabilitation program or a
therapist that specializes inthat we really have to advocate
for ourselves because it is sofast based.
And like you said, when thereferral goes out, it gets sent
(19:56):
to whoever has, room on theircaseload to be able to take
that.
But, We out here that arereceiving that type of therapy
might not benefit as much unlesswe have the correct referral to
the correct therapist that maybespecializes such as yourself.
So,
Erin (20:13):
well, and that's why we should do our homework, right?
Whether it's like, okay, I needto go see PT, make sure who's
going to be the best fit for me.
Tell my doctor, Hey, this is whoI want to be referred to.
And as long as they're in yournetwork, there shouldn't be an
issue with them referring.
John (20:28):
Yeah.
Ann (20:29):
The problem with, going to provider is, A lot of times I
don't have the bandwidth to lookand see, okay, well, who is this
you're talking about?
What's their fax number?
How do I get a hold of them?
so the good thing about Idaho iswe're a direct access state, so
we don't have to have aphysician referral.
So you could actually call ourclinic directly and we'll do the
(20:50):
legwork for you as far as,following up the position and
everything.
Yeah.
Erin (20:55):
that's awesome.
As a family member or caretaker,how can I support someone that's
going through physical therapy,the neurological therapy?
Ann (21:06):
Yeah.
So in order to make changes inthe brain or the nervous system,
we have to have lots and lots ofrepetitions.
And if we, if I can recruitcaregivers or family members to
reinforce what I've alreadyestablished and implemented.
And I've shown to be successfullike they're responding really
(21:28):
well to these cues, or thissetting, or this setup, if you
do it.
This way, they do really well towhere you don't have to pull on
them.
You don't have to yank on them.
You know, please don't do that.
they can do it themselves.
So we, what they might may haveto do is just know how to help.
So a lot of caregivers, strugglewith that piece.
(21:51):
Like, I hate seeing my mom'sstruggle to stand up or so
they'll just yank on them,right?
They'll manhandle them orwhatever it might be.
a big mistake I see a lot isthey'll like pull on their arms.
things like that.
so there's some pretty, prettyhorrific things I've seen, as
far as caregiver strategies.
(22:12):
in response to your question, ifthey could reinforce what I've
already implemented, and I'vealready shown the patient that
they could do successfully, andit actually makes them feel
good.
It gives them some autonomy,right?
It gives them some self efficacyto where they have, you They
have some control over thatprocess.
Nobody likes.
(22:33):
to be manhandled.
Erin (22:35):
Right.
Ann (22:35):
if I can give them some of that power as far as how they
initiate the transition, howthey can actually participate in
it, active participation ishuge.
no one can rehab passively.
They need to activelyparticipate in it.
whether it, it is, the patient.
Coaching the caregiver throughhow to help them.
(22:59):
That's still activelyparticipating.
So if they had a spinal cordinjury or something like that,
for example, and they, they needhelp with certain things.
Nothing wrong with their brain.
They could still direct thecaregiver.
As far as how to help them.
and that was a long response toyour question,
Erin (23:18):
no.
I think it's important.
It's allow them to do what theyneed to do without frustrating
them.
So be patient, but also show upto the physical therapy and
learn, be proactive with yourloved one that you're caring
for, or, you know, a friend,family member, whoever it may
be, go to these therapy sessionsand learn.
So you know how to assist themwhen they need not be scared
(23:42):
yourself.
Ann (23:42):
Yeah, and not to do too much, right?
You want to offer them theopportunity to engage, and
that's how we make changes.
John (23:52):
so when it comes to physical therapy, when it comes
to the neural neurologic side ofit, is it a combination between
of drugs and physical therapy oris it, still mainly just,
Getting them to think ofdifferent ways to rehab.
Is there a combination there or
Ann (24:13):
So are you referring to more like orthopedic, like
muscle bone and joint type stuff
John (24:19):
no, I'm more of talking like, for instance, if somebody
has had a stroke or they've hadsomething happen and they need
some.
Deep rehabilitation, with aemphasis on the neurological
side of it.
So is there medications thathelp support your practices of
therapy or is it mainly juststill just the physical therapy
(24:43):
side of it?
Ann (24:45):
So, if you think about physical therapy as we are
movement specialists that's ourjam.
That's what we're going to focuson.
So whether it's been mobility,whether it's helping them be
able to transfer moreindependently, walking more
safely and efficiently, thingslike that is going to be a big
(25:05):
direction of what we focus on,because if it doesn't translate
to function, why are we doingit?
that's how the patient's goingto look at it too.
Yep.
If this isn't going to help youdo a, B and C better, why are we
doing it?
you're never going to see me dolike bicep curls with a patient
or, you know, just straight upexercise, unless it's somehow
(25:29):
translate to, function, becauseI find that I get better
outcomes that way, if it makessense to their brain and their
nervous system, and I can get.
the brain and the body to talkto each other better, they're
going to move better.
So they're going to be moreefficient.
They're going to be moreindependent.
They're going to be more safe.
And they're actually kind oflearning those parameters on
(25:52):
their own as far as, Oh, well,I'm in a different chair now.
I have to do this kind ofadjustment to be able to stand
successfully.
in reference to the medications,there's some conditions where
medications are necessary, likeParkinson's, for example.
there's some MS medications,they're always changing.
(26:13):
And there's new ones out.
I'm not a huge, a huge fan ofpharmacology.
so a lot of conditions like MS,for example, it is linked to
inflammation.
So what we're learning is thatthere's a lot of.
There's a lot of benefits inreally controlling our
(26:36):
lifestyle, which encompasseswhat we eat as well, and how we
move, and how much we move.
Erin (26:43):
So no eating in and out burgers and fries every day or
John (26:48):
Especially right before a therapy session, you probably
don't want to do that
Ann (26:53):
I mean not
Erin (26:54):
Probably not a good idea.
Ann (26:56):
Yeah.
Erin (26:57):
As our technology is changing in the world.
How do you see it being used inyour department, like with VR,
robotic assistance and anything?
I'm just kind of curious to seewhere you might see some of that
coming for you and helping yourpatients.
Ann (27:14):
Well, I would say we're seeing more and more as far as
brain computer interface.
That's kind of you've heard ofElon Musk, like Neuralink and
things like that.
This is a technology that's beenin the works for, I want to say
like 20 plus years.
But we're seeing more and morelike they're getting closer and
(27:34):
closer to it actually used.
and it's basically a real timeinteraction between the brain
and some kind of output, whetherit's a device or whatever it is.
it's pretty cool.
Some of the technologies isn'tnecessarily new, they're more
refining it.
So like functional e STEM forlike, muscles that aren't
(28:00):
working the way they should, butif we can get them to fire at
the right time during a certaintask, like for walking, for
example.
or for hand movement for gripand stuff like that.
that is still a pretty strongtechnology that that we're using
quite a bit in neuro rehab.
you're seeing a lot of roboticstype stuff for like people who
(28:24):
have paralysis.
We're seeing more and more ofthat.
However, making it easy for thepublic to access is that's a
different story.
Unless you're Iron Man.
So,
Erin (28:36):
we'll
Ann (28:36):
um.
John (28:37):
to get some robotics for Aaron, so I can take her
snowboarding and she can't say,Oh, my ankles hurt and get her
some robotics so that she canstill do it.
Erin (28:47):
Well, you know, as we age, our cognitive.
our cognitive functionssometimes change.
And so can that present achallenge when you're trying to
rehab somebody?
Ann (28:58):
absolutely.
so in order to learn, you haveto be able to attend to a task,
right?
And if I can't get you to focuslong enough to learn something
and have the memory to retainit, it's hard.
It's hard not to, just defaultback to old patterns.
So that's where caregivers comein a lot, as far as they have to
(29:22):
be.
So if we can't internalizesomething, like if I can hold on
to a piece of informationmyself, then I have to use some
kind of external strategy,whether it's a sign or notes or
someone reminding me or using myphone or whatever it might be.
Erin (29:39):
Well, that's the other thing I was gonna ask you too.
If I don't have a caregiver, Idon't have somebody helping me
and I come and I need this.
What are strategies you give meto take home to remember if I'm
already having a hard time?
Ann (29:51):
Yeah.
So something I found prettysuccessful is, I will use like a
patient's phone or their iPad ortablet, something like that,
because I dump a lot ofinformation on them in one, one
session.
And as I understand it, it'shard to remember all the details
of everything.
So what I'll do is I'll ask thempermission to record them with
(30:14):
their device, and I will coachthem through.
A movement and they'll hear mynagging voice in the background.
They'll see themselves.
And it also gives them areference as far as, okay, Mr.
Smith, this is where you were onday one.
We're going to be able tocompare this to six weeks from
(30:35):
now, and I guarantee you'regoing to be doing a lot better.
So it's nice to be able to lookback at that too.
Erin (30:41):
I like that.
John (30:42):
Yeah, I like that.
So can you, just walk us throughlike the most successful
strategies?
Like you show up at the home,maybe you do an eval and treat,
and I'm not quite sure how thisgoes, but if you could just walk
us through the best casescenario with helping somebody
get through the steps of,neurologic rehabilitation and
(31:05):
how it might be different fromnormal therapy.
Ann (31:08):
Yeah.
So I always tell people thefirst step is to establish a
good foundation because if yourfoundation stinks, we have
nothing to build on.
So people's goals are alwayspretty high and you go in and
someone can't even stand in itand their goal is.
What?
(31:29):
I want to walk, right?
So, before you walk, you've gotto be able to do A, B, and C,
right?
We've got to start somewhere.
first, we work on foundations.
So if you can't stabilize whenyou're sitting, I can't expect
you to stabilize while we werestanding.
And I definitely can't expectyou to stabilize when you're
walking.
Right?
(31:49):
So we start with the basics.
We start with, I consider it asfar as general stability.
There's three levels.
So level one is, can youstabilize when you're still,
when you're just sitting there,can you find where you belong?
and that gives me a goodpicture.
As far as, is there a mismatchbetween where they think they
are and where they actually are?
(32:10):
So for example, I might say,Hey, Mr.
Smith, what do you think asyou're sitting in that chair, if
that chair was a parking space,are you sitting pretty straight
in that parking And they couldbe looking at me like this and
be like, Yeah, I'm prettystraight.
So they're, they're butts aboutto slide out of the seat.
They're leaning way over.
(32:33):
There's a mismatch, right?
Between where they think theyare and where they actually are.
And, to simplify it, I'll sayit's kind of like your GPS is
wacky.
You're, you're telling your GPSto take you home, but it takes
you a block down.
It's close, but you're notthere.
So when there's that mismatch,Mistakes happen, right?
(32:55):
I thought I was close enough tothe seat.
I thought I was safe.
So that's, level one is can youfigure out where you belong?
Right?
Can you stabilize when you'rejust still?
When you're just sitting there.
Level two is can you stay stableas you're moving?
So I'll have them do somethinglike just turn their head.
Or I might have them leanforward.
(33:16):
Can they stay stable?
Or do they totally deviate oneway or the other?
Do they fall apart?
And level three is can you applyit to function?
Can you apply it to real life?
So I apply that when they'resitting, when they're standing,
when they're walking.
those are the foundations,
Erin (33:33):
What are some techniques you teach them to stay
motivated?
Because I know sometimes for meit can get frustrating, you're
here and there's no progressbecause with my ankle, I go
backwards a little bit.
I frustrate PT people.
It's fun.
But what are things you can doto help or techniques to teach
that, Hey, this is how you staymotivated because it can be a
long process sometimes and don'tfeel frustrated, you know?
Ann (33:56):
right?
Well, we talked about the video,right?
So when I video them, that is,that's a tag, a timeline tag,
right?
I know you don't feel likeyou're doing any better, but
let's review where you were dayone.
you're doing things now that youweren't able to do that day.
so that's one strategy.
(34:18):
Another strategy is what we calloutcome measures.
So I do certain tests on dayone.
And then after a few weeks, Irevisit those tests.
So we actually have objectivemeasures to where I can show
them, it took you this long todo this.
day one, you did it in half thetime today, right?
(34:40):
And you did it safer and youdidn't have to use your hands
or, there's different.
Variables that I'll add to makea task more difficult.
And once they nail it, it helpsthem recognize, Oh, I guess I
am.
I'm also tracking quality ofmovement and I'm also tracking
like falls, for example, when wefirst met, you were saying that
(35:04):
you were falling four times amonth.
When was the last time you fell?
I can't remember last time Ifelt, so does that make sense?
sense?
Erin (35:14):
yeah.
Thank you.
And that, I guess that goesback.
I should have asked thisquestion first is when someone
comes to you, what do you, whatare the first steps, the
assessing them and the questionasking and all of that.
So it's great that's part of it.
Ann (35:27):
Yeah.
Yeah.
So we try to establish a solidbaseline.
So during the initial eval, weget a good picture of where they
are, where they were and wherethey want to be.
and we gauge like how big isthat gap between where they are
and where they want to be.
Right.
Is it reasonable.
I never, like I said, I nevertell them no.
(35:47):
but we do start with baby steps,those small victories.
Erin (35:51):
And then you throw a big party afterwards.
Ann (35:54):
Yes.
John (35:55):
so my question, I'm sure a lot of listeners are thinking
about this.
I know rehab can take a longtime depending on an injury or a
stroke or your cognitiveabilities or your support
system, all these differentvariables, right?
But on average, how long does ittake for patients to see the
(36:16):
biggest changes?
is it like a month?
Is it like six months?
how long can they expect to seechanges?
Ann (36:26):
sometimes, honestly, sometimes I go in, Because we by
nature are fixers.
sometimes I go in day one andtechnically during an
evaluation, I'm not supposed tointervene yet.
I'm supposed to get a truebaseline of where they are
before we start.
But I have a big problem keepingmy mouth shut.
(36:47):
If I see a problem, I'm going tofix it.
But, I always within myevaluation towards the end, I'll
do treatment too.
And sometimes it's so simple.
Hey, have you thought abouttrying this strategy?
have you thought about maybemoving your foot here or using
this?
and that could be a game changerfor them.
So a lot of times day one, theycan notice a difference to
(37:11):
where, wow, I didn't know Icould do that.
so they, they won a lot of thetime that they'll see some kind
of change and that motivatesthem for the next treatment.
but as far as consistent change,that's what gets hard, right?
(37:31):
without me barking at you, canyou do it right?
If you could do it in thecontext of your home, but can
you do in the context of yourfavorite restaurant?
so that's ultimately what we'reworking towards.
I want them to be equipped to dowhatever they need to do in the
environments that they need tofunction
Erin (37:51):
other things we can do now that will help prep us as we
age.
And I know there's all differentstages, but if it's like, Hey,
you know, your nutrition canreally set up you up or your
hydration can really set you upfor when you do come across
having, you know, aneurological,
John (38:10):
Well, when you have any sorts of challenges, right?
because as we do get older, youknow, our muscles start to
atrophy, we start gettingweaker.
We can have falls happen.
And so I think what you'retrying to ask, and sorry if I'm
wrong, but, how diet nutritionplay into in hydration, play
into your ability to recuperateand yeah, gain.
(38:32):
More successful motivation asyou're healing from say a fall
or a
Ann (38:36):
Yeah.
I'm so glad you asked that.
so big pillars, more and moreresearch is coming out talking
about the benefits of.
nutrition.
so much so that now Stanford andHarvard are both recognizing
nutritional benefits onbehavior.
So Stanford has launched amedical branch called
(38:59):
nutritional metabolic nutritionand Harvard nutritional
psychiatry.
So where it used to be, as faras what we eat, we used to kind
of, you know, dismiss people andbe like, Oh, you're just Hippie
or whatever it is, right?
That's just foo foo stuff, andnow we're actually recognizing
(39:23):
more and more.
I, I have a whole new respectfor functional medicine because
that is one, area where I, Ireally do feel like they're
getting down to the root causeYou know, if you have a
headache, there's a hundreddifferent reasons why you could
Well, let's figure out why,Whereas traditional medicine,
(39:44):
they may just give youpharmaceuticals, and it's not,
you know, I'm not bashingallopathic medicine or
traditional medicine.
It's just.
The way the system is set up,they're forced to, you know, see
a huge volume of people in ashort period of time, and they
just don't have the bandwidth toreally dig.
(40:06):
So it's not their fault.
It's just the way it's set up.
so pillars of health.
Sleep is huge.
recommendations are seven tonine hours a night of
restorative sleep.
And, your body likes routine.
Your body is always fighting fora state of balance homeostasis.
So your body likes routine andthere are certain rhythms or
(40:27):
you've heard of circadianrhythm, right?
There's certain rhythms are ourbody assumes, and it likes that.
So if you go to bed about thesame time every night.
And you kind of establish a goodsleep hygiene routine.
So, you know, don't have an In NOut burger right before bed.
So sleep is huge stressmanagement, huge.
(40:52):
So I feel like one of the goodthings about COVID is a.
Brought to surface a lot of likemental health issues where we
used to shove it under thetable.
We don't talk about things likedepression and anxiety, but now
it's been more in the forefrontand we're linking it a lot with
stress.
So we live in a constant stateof stress and environment is a
(41:16):
huge contributor to stress.
what we feed ourselves is a hugecontributor to stress.
there's all kinds of stress,right?
There's environmental, chemical,emotional, physical stress.
the more your body is having torally to overcome those things,
the less resources you have tofocus on something that you
(41:37):
enjoy.
So sleep, stress management,movement, exercise.
So lots and lots of literatureon benefits of exercise on
general wellbeing.
So we know, just cardiovascularhealth, lung health, but now
we're learning that it alsoaffects, your brain.
So when we exercise just like a20, 30 minute good walk to where
(42:02):
you get your heart rate goingactually impacts two areas of
your brain.
the prefrontal cortex, which is,that's the adult in the room,
right?
That's the one that, that doesthe planning, the higher level
thinking, the, considersconsequences, things like that.
And your hippocampus, which isthe memory center.
(42:24):
So the hippocampus also is a bigplayer in stress management,
stress and anxiety management.
So that's why when you've beensitting at your desk for hours
and You hit a roadblock andyou're like, I can't even look
at the screen anymore.
You go for a walk, you come backand things start flowing again.
That's what, okay.
So sleep, stress management,exercise, and what we feed
(42:48):
ourselves and nutrition.
We're learning more and more.
And it, it makes sense.
Our body operates onbiochemistry.
If you think about it, hormones,neurotransmitters, electrolytes,
right?
You've heard all those terms.
Those are all biochemicals.
and what we eat influences that.
(43:08):
we've learned like a big pieceof chronic diseases,
inflammation.
So a lot of the crappy foods,fried foods, high sugar foods,
highly processed foods aretoxins in it and your body
responds by inflammation.
And what we're learning is whenyou have inflammation like in
(43:29):
your joints.
we hurt, we know it, werecognize that, but when you
have inflammation in yournervous system, you don't feel
pain, but what you do experienceis like brain fog and your
tolerance for things is less,you know, you're moody.
you can't sleep, you can't calmdown, you're stressed, you're
(43:51):
anxious, things like that.
So that's how that shows up.
And they've actually linked itto things like Parkinson's and
autism and MS and things likethat.
So when we eat, those highlyprocessed and high sugar foods,
it weakens your body's abilityto protect itself.
It weakens the gut lining, andit actually weakens the brain,
(44:12):
the blood brain barrier to ourjunk.
Can get to your brain.
that's something else that theresearch is showing that things
we didn't think would cross theblood brain barrier is and, it's
crazy.
John (44:26):
Is
Ann (44:26):
that was a long response to
Erin (44:28):
No.
Can I say this one comment?
I'd say, is that why when we getolder, people get grumpier is
because they're so inflamed.
It messes with our moods andwe're hurting.
Ann (44:40):
It could be.
Yeah.
Yeah, it could be because there.
John (44:44):
to me.
Ann (44:44):
Well, I, find that the older population too, they're
less invested in taking the timeto eat well.
It's just whatever's easiest.
Right.
John (44:53):
I,
Ann (44:53):
in general populations like
Erin (44:55):
right.
John (44:56):
yeah, I love that.
We're talking about this becauseit's something I've been
passionate about for years.
And, we talked about Jim quick'sbook, limitless in there.
It talks about the correlationof gut health.
Versus our brain and how, thevagus nerve is transferring
nutrition up to your brain andhow it operates.
And so now I'm a huge advocateof eating, brain healthy foods
(45:18):
like avocados, walnuts, youknow, dark leafy greens,
berries, a lot of thosedifferent things.
And you're right.
I think a lot of people don'trealize the importance of what
you're putting in your body asfar as the quality of the
nutrition and how it's going toaffect us as we get older and
our abilities to function,whether it's, our cognitive
(45:41):
abilities of thinking andprocessing, focusing, and, your
memory, but also things likemovement, Being able to walk and
do all the things physicallythat we've been able to do for
years.
So.
Ann (45:54):
Well, I, I like how there's some crossover too.
So we talked about how I said, Imentioned, it's not always what
you do.
It's how you do Right.
Same thing with what you eat.
Even though you're eating somehealthy stuff, if you're eating
it in a stressful environment orif you're eating it really
quickly, and you're drinking asoda with it, it influences how
(46:17):
your body responds to it, whichis fascinating.
Combinations of different foods,will influence the
bioavailability of it it'sfascinating.
Erin (46:26):
Have you noticed how the brain reacts with a glucose
spike?
Like if you're eating somethingin the order, like you mentioned
the order that you're eatingsomething in the how that messes
with your brain.
Ann (46:38):
Yeah.
something you'll see like in theliterature is glycemic index.
So something like the higher,it's my understanding, the
higher the number, the faster itturns to sugar, basically.
now your brain is, is a bigsugar hog.
It consumes quite a bit becauseit's the operating system, but
(46:59):
when it gets too much, then itjust Circulates and, and it can
cause insulin resistance andthings like that.
So we've got to be careful withthe sugar intake, but, it's
interesting.
you mentioned like the gut brainconnection and that, that is
huge.
And we're seeing more and more.
I mean, I would say even in justNetflix and, things like that,
(47:22):
you're seeing more and moreabout the gut brain connection,
like 95 percent of serotonin isproduced in your gut.
So serotonin is one of thoseneurotransmitters that that
affect mood, right?
the problem with that is itdoesn't cross the blood brain
barrier unless it's combinedwith certain foods.
(47:43):
So like tryptophan is aprecursor to serotonin.
So if you eat it, so chickpeashas tryptophan.
So if you eat like chickpeaswith like a carb, then it
crosses the blood brain barriereasier.
So protein with tryptophan and acarb and it'll cross the blood
(48:04):
brain barrier, make you feelbetter.
John (48:06):
I like to tell people that, when we're young, we can
process things so much faster,it's like a brand new engine in
a car.
but if you abuse yourself overtime, there's an accumulative
effect and then you have issueslater on in life.
So the sooner you take care ofyourself, you keep moving.
You put in the proper nutrition,you're getting sleep and
(48:27):
hydration and all of thesethings, the better off you're
going to be as you age.
And I think that's the messagethat we're trying to get out
there with our company,connecting power, connecting
people with the resources, theinformation to make better
decisions so that we're morecomfortable and we can continue
to live the life that we choose.
Right?
Erin (48:45):
so no, I agree.
Are there things that maybe wemight've missed that we didn't
ask you that you feel is veryvital that our listeners here,
like you guys need to know this.
This is, or these are ways maybeto prep and be ready when you
come and see someone like me.
Ann (49:02):
You guys were pretty thorough.
You had some great questions.
yeah, you, I think you did agreat job.
no, I don't think so.
Yeah.
I think you,
Erin (49:12):
any advice or anything to give out?
Ann (49:15):
don't be afraid to do your own research and don't be afraid
to ask questions to yourphysician.
So if their solution is just toadd another medication, then
it's okay to ask.
Hey doc, is there anything elsewe could take off my medication
list if you're going to addthis?
is there any other alternative?
(49:36):
Because what we're finding toois like 80, I think I already
mentioned it, like 80 percent ofchronic diseases can be managed
with lifestyle changes.
So, people have been able to getoff like their diabetes
medication and their heartmedication and their anxiety
medication by altering theirlifestyle.
(49:57):
And I'm not saying do that, but,there, there are options like,
under the direction of aqualified professional, you can
do that and people have beenable to make noticeable changes
in 2 weeks.
Erin (50:11):
Wow.
Ann (50:12):
yeah.
John (50:12):
I love that.
And I think that what peopleneed to understand too, because
sometimes I can get almost alittle too intense on the
changes that I'm trying to maketo better my life.
And it doesn't take a lot.
You can do small changes, startwith small, small changes to
improve your life.
And then be consistent withthose small changes and see what
(50:34):
happens, right?
and I love what you just said,About, not necessarily just
taking doctor's advice andtaking another pharmaceutical
because sometimes we can alterour nutrition.
We can get a little bit moresleep.
We can hydrate more and that alot of that stuff is free.
We don't have to pay for anexpensive prescription, right?
(50:55):
So, yeah, this has been fun.
I love this topic.
brain health to me is one of themost important things as we age.
ever.
it's, our bodies are going toatrophy, but our minds will too,
unless we take care of them.
Erin (51:09):
Yeah.
Ann (51:10):
So it doesn't have to be that way is I think the message.
Yeah.
Erin (51:14):
Would you like to ask the last
John (51:16):
Oh gosh.
All right.
Erin and I are passionate abouttravel and adventure.
So we'd like to know, if there'sa place that you've gone or that
you want to go, that you're,You're excited about, or you
look forward to, or someplaceyou recommend that our
listeners, consider.
Ann (51:34):
Just one place.
John (51:35):
Oh, you can name a couple if you'd like.
Yeah, no, we're totallyinterested.
Ann (51:40):
so you guys already know this response, but Vietnam is a
place I've always wanted to go.
That's where I was born and Iturned 50 this year.
So I think would be cool to kindof circle back there and, and
experience the culture and learnmore about it.
that's at the top of my list.
we sponsor several kids throughcompassion in different
(52:02):
countries.
So Thailand, Guatemala,Dominican Republic, things like
that.
I would love to visit kids.
I would actually, I would allthe kids that we've sponsored
through the years.
Yeah.
And, I've never been to Europe.
I think that would be cool.
different countries in Europe.
And, I don't know, I would love,I haven't even been to all 50
(52:26):
states.
So that's a goal too.
Where my husband and I are bigfoodies.
So we think it's fun to findthose local dives and what is a
good reflection of the localculture.
And the story behind it.
We love hearing the storiesbehind food.
John (52:42):
I love that.
I love that you're speaking ourlanguage because we're both.
if we could just travel andlearn about different cultures
and try the different cuisines,and the people and hear the
Erin (52:54):
their culture, that's, that's
John (52:56):
living for us.
Ann (52:57):
Yeah.
John (52:58):
thanks for sharing that.
Erin (52:59):
and thank you for being on today.
I think this was valuable forour listeners to know, ask those
questions, the servicesprovided, talk to your doctor,
research who you want to visit,
John (53:11):
Yeah.
And I'm excited because I didn'tknow there was a such thing as a
neurologic, rehabilitationtherapy that you can, get or you
can ask for.
So I think that our listenersthat maybe are having some
declining with their cognitivehealth that's affecting their
abilities to move and do thethings that they're passionate
(53:32):
about, to know that.
You and other providers havethat skillset, I think is just
awesome.
so
Ann (53:39):
Yeah.
Yeah.
Oh, two more things one, don'tbe afraid to fail.
Try new things.
Don't be afraid to fail.
and two is, learn something new.
Give yourself an opportunity tolearn something new.
that's a great way to.
To keep that process viable,keep your brain sharp is more
(54:00):
doing something different thatyou are afraid to do.
John (54:04):
Jim Yeah, I know I keep referring to Jim quick and I
think it's because the book wasjust such an amazing book, but
it talks about as we get olderto keep reading, to keep trying
to learn new things.
And one thing that I thought wasa need that I didn't even think
about was.
Brush your teeth with theopposite hand, maybe eat with
(54:25):
the opposite hand, startpracticing doing things with the
opposite side of your body thatyou normally don't do because it
can help sharpen you.
It gives your body thatstimulation, that's needed for
growth and sharpness.
I love all this.
I just eat
Erin (54:41):
eat it up.
so thank you.
He's getting ready to geek outnow.
for sure.
Oh, but again.
Ann (54:48):
thanks for having me.
Erin (54:49):
Oh, it was a pleasure.
John (54:52):
Thank you for tuning in to another episode of Connect
Empower.
We want to express our gratitudeto you for being part of our
community, and we hope today'sepisode has provided you with
valuable insights andinspiration to enhance your life
and that of a loved one.
Erin (55:06):
We are more than just a podcast.
We are a community dedicated toenhancing the lives of our aging
adults and their support system.
We encourage you to visit ourwebsite now at www.
connect empower.
com.
Explore more information aboutour guests from today's episode
and to access our freeresources.
John (55:28):
resources.
Our mission doesn't end at theconclusion of this episode.
We invite you to take action nowby sharing the knowledge you've
gained today with someone whomay benefit from it.
Whether it's a family member,friend, or colleague, your
influence can spark positivechange.
Erin (55:42):
Remember, Subscribing to our podcast ensures you never
miss an episode and we have moreincredible guests and resources
in store for you.
So hit that subscribe button andstay connected with us.
Your commitment is the drivingforce behind our mission and
together we can create amovement for a brighter future
as we age.
John (56:03):
I'm John.
Erin (56:04):
I'm Erin.
Until next Wednesday.
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