I Love Neuro

On today’s episode Claire McLean and Erin Gallardo offer an update to a previous episode on setting up overhead harness systems for your neuro rehab gym the way Claire has it set up at Rogue. Rogue has a DIY, relatively inexpensive setup using things like anchors, rope ratchets, and construction-style harnesses.

The big update to share was finding some new products that have really improved the comfort and usability of their system. The addition of "quick links,” which are essentially two carabiners connected by a nylon spacer helps keep the bulky pulleys and hardware away from people's heads.

They also talked about using a spreader bar, which helps position the support points even further away when doing single-point balance training. Claire was really excited about these little upgrades, saying they were "game changers" that made a big difference in how comfortable and safe the system is for their clients.

Additionally they also discussed other helpful aspects of the treadmill set up like Swiss balls and chalk lines on the treadmills, to help people with conditions like Parkinson's take bigger steps. Lots of little tricks to make the training environment as supportive as possible.

The updates in this episode will help you create an even better set up and system! Please reach out with any questions or shares at [email protected] 

Episode 139: How To Create Your Own Harness Set Up Like Rogue’s 

Claire’s equipment mentioned (not affiliate links)

Anchor

Rope Ratchet

QuickLinks

Harness

Mass Rehab Inc

In this episode, hosts Erin Gallardo and Claire McLean interviewed Dr. Amy Ashmore, an expert in resistance training programming. Dr. Ashmore shared her extensive experience and passion for resistance training. Some of the key points she shares are that timing is critical. Dr. Ashmore emphasized the importance of precisely controlling the timing of concentric and eccentric contractions to target specific training adaptations, such as muscle power, strength, or hypertrophy.

She also notes the importance of adjusting volume for aging muscle citing that recent research suggests older adults may require higher training volumes, up to 36 repetitions per set, to stimulate muscle growth and maintain lean mass as they age. There is also a need to prioritize motor skill development for older or neurologically impaired clients new to resistance training and what the focus should be. Learn these insights and more by listening to the episode so you can get stronger clients starting today!

Learn more about Dr. Ashmore’s courses here:

https://physicaltherapy.education 

https://amyashmore.com/

https://www.linkedin.com/in/amyashmorephd/

In this episode of the I Love Neuro podcast, hosts Erin Gallardo and Claire McLean discuss important updates and research related to Parkinson's disease. They used neurologist Dr. Michael Okun’s Instagram account as inspiration for the recent research to discuss. 

The first article discussed is titled End-of-life Health Care Service Use and Cost Among Medicare Decendents With Neurodegerative Diseases. The discussion highlights the high healthcare costs and lack of planning for end-of-life care in neurodegenerative diseases like Parkinson's. The article emphasizes the importance of involving neurologists and having a comprehensive care plan to improve outcomes, and we discuss what that might look like.

The second article discussed is titled Pain Fluctuation in Parkinson’s Disease and their Association with Motor and Non-Motor Fluctuations with an interesting finding about the type of pain people with PD typically experience, when they experience and our theories about why. Pain management is an expensive and often frustrating industry, so this is an important topic!

Find the article here: End-of-life Health Care Service Use and Cost Among Medicare Decendents With Neurodegerative Diseases

Find the article here: Pain Fluctuation in Parkinson’s Disease and their Association with Motor and Non-Motor Fluctuations

Follow Dr. Michael Okun here for PD research updates!

Does your energy get sucked when you do certain administrative tasks in your business? Do you love some tasks and dread others? What if it could be fun? Do you believe it could? Well, after listening to this episode you just might! And what would you gain? You’ll feel more energized, you’ll be more creative, and you’ll end up being more productive while also attracting more ideal people to your business. In this episode of the I Love Neuro podcast, hosts Erin Gallardo and Claire McLean chat with business coach Emily Duval Ledger about the transformative power of infusing fun into your business operations.

The discussion begins with Emily sharing how a simple suggestion from Erin - to make administrative tasks more fun - completely changed her perspective. Erin explains how she learned the importance of fun in business, even though it wasn't a priority growing up. The trio then dive into specific examples of how they've incorporated fun into their own businesses.

Emily shares how she revamped her book writing process by recording audio notes while exercising, rather than the tedious typing that drained her creativity. The group also explores the potential of AI to automate mundane tasks in an engaging way, like using chatbots customized to a company's unique voice.

Claire and Erin emphasize that they built NeuroCollaborative and Claire built Rogue around the principle of fun from the start, whether that's through themed events, spontaneous dance parties, or flexible scheduling. They explain how aligning your business model with your personal interests and passions is key to maintaining that sense of enjoyment.

The conversation touches on the physiological benefits of incorporating play and fun and ideas for how clinicians can encourage patients to make mobility transitions more fun. By making work more enjoyable, you can reduce stress, boost productivity, and find greater fulfillment in your entrepreneurial journey, so why not try it yourself?.

In today’s episode Erin Gallardo, PT, DPT, NCS and Claire McLean, PT, DPT, NCS had the pleasure of interviewing APTA President Roger Herr and asking all of the burning questions about what it’s like to run a neuro practice with Medicare as it is and where we’re going. Roger shared his journey into physical therapy and his extensive experience in key roles that gave him a wide angle perspective of the profession he advocates for now.

Alternative Payment Models for PT Practices - Herr emphasized the importance of finding local, regional payment models that best fit each practice's needs, whether that's working with employers, payers, or patient groups. - He discussed strategies like opting out of Medicare, negotiating contracts, and exploring cash-based services to create sustainable business models.

Challenges for Micro Practices - Smaller PT practices often struggle with billing, communicating with payers, and navigating the complexities of Medicare coverage. - Could clearer guidelines around medical necessity and skilled care be a helpful short-term goal?

Advocacy Efforts for the PT Profession - Herr highlighted the need to shift from volume-based to value-based care, and to advocate for recognizing the downstream costs and impact on patients. - He discussed opportunities in Medicaid, annual wellness visits, and partnering with patient advocacy groups to drive change.

Modernizing Medicare Access - Herr explained efforts to update Medicare legislation and allow beneficiaries to directly contract with physical therapists. - This could provide more flexibility and options for patients, though the details around rules and limitations are still being worked out.

Leveraging Technology and AI - Herr shared insights on how technology and AI can support population health management, documentation, and reducing administrative burdens for PT practices.

APTA Infographic of Prior Authorization

ChoosePT How Medicare Determines Payment HH and SNF

Download the APTA Advocacy App

ChoosePT Directory - Sign up by logging into APTA account, then go to Online Profile, then Find a PT

Instagram  rogeraherr  

X @RAHPT 

Facebook Roger Herr

Feel confused about how to assess and treat someone with Functional Neurological Disorder (FND)? We got your back! In this episode host Erin Gallardo interviews FND experts Heather Salon, PT, DPT, NCS and Julie Maggio, PT, DPT, NCS on this range of neurological symptoms that includes functional movement disorders, seizures, and speech/communication issues. FND is characterized by abnormal brain connectivity and network dysfunction, often presenting with mixed symptoms. A key shift in recent years has been the recognition of FND as a "rule-in" diagnosis, rather than a diagnosis of exclusion. Learn what to expect during the subjective evaluation and how to approach it with best practice.

Heather and Julie highlight the importance of identifying specific "rule-in" signs, such as Hoover sign, give-way weakness, and symptom variability, to confidently diagnose FND. They also emphasize the need for a comprehensive assessment, including evaluations of the motor, sensory, and autonomic systems. Also discussed are differential diagnoses like dystonia.  

The conversation underscored the multidisciplinary nature of FND care, with physical therapists, occupational therapists, psychologists, and neurologists working collaboratively to provide optimal treatment. Sensory-based interventions, such as the use of Kinesio tape, abdominal binders, and visual feedback, were discussed as valuable tools in the PT's toolbox.

Importantly, Heather and Julie stress the need to manage patient expectations and set realistic goals, focusing on improving function and reducing symptoms rather than aiming for complete symptom resolution. They also highlighted the importance of ongoing education and resources for clinicians interested in advancing their knowledge and skills in the FND field.

Check out these resources mentioned in the episode:

https://www.fndsociety.org/fnd-education FND society education resources

26.08.2023-Information-guideance-sheet-for-medical-professionals.pdf (fndaction.org.uk) Inform the doctor fact sheet

Diagnosis and Management of FND

A framework for understanding the pathophysiology of functional neurological disorders

A practical review of FN for the general physician 

Have you heard some things about working with people with MS that make you question how to approach their care? Are they old school thoughts or based on science? Who can tell?! You’ll know after listening to this episode! Hosts Erin Gallardo and Claire McLean had the privilege of speaking with Herb Karpatkin, PT, DSc, NCS, MSCS, a leading expert in physical therapy for individuals with multiple sclerosis (MS). Herb shared invaluable insights from his decades of clinical experience and research, providing guidance for physical therapists on how to actually  support patients with this complex neurological condition so they improve.

A key focus of Herb's research has been exploring ways to help MS patients overcome debilitating fatigue, which often limits their ability to participate in rehabilitation. He has found great success with intermittent training protocols, where patients alternate short bursts of activity with rest periods. Herb shares specific parameters from the research so you can use it now.

Next you must recognize that a significant portion of disability in MS patients may be due to deconditioning, rather than the neurological disease process itself. By implementing targeted reconditioning programs, physical therapists can make a substantial impact on improving functional mobility, even in those with advanced disease.

Herb's research has also demonstrated the benefits of high-intensity interval training for individuals with MS. Contrary to outdated beliefs, many MS patients are able to tolerate and thrive with aggressive exercise programs when implemented thoughtfully. Herb emphasizes the importance of gradually progressing patients to higher intensities, while closely monitoring for signs of fatigue.

To further support the MS community, Herb is actively involved with the Degenerative Disease Special Interest Group of the American Physical Therapy Association. This group has created a Clinician Locator Map to help patients find physical therapists with expertise in treating degenerative conditions like MS.

For your patients and clients with MS: MS Cooling Products Application 

Sign up for the clinician locator map:

https://www.neuropt.org/special-interest-groups/degenerative-diseases/ddsig-clinician-locator-map

Register for the free webinar on MS interventions you can apply immediately here! https://www.neurocollaborative.com/ms-webinar

In the ever-evolving world of neurorehabilitation, Dr. Ryan Lovell, PT, DPT, NCS, ATP has carved out a unique path that blends his clinical expertise with a passion for research and storytelling simply through curiosity and exploration. As a physical therapist, doctoral student, and podcast host, Ryan's multifaceted career serves as an inspiring example of the diverse opportunities available within the neuro field.

Ryan's journey began with a strong foundation in the medical field, influenced by his mother's work as a registered nurse. Drawn to the intersection of sports medicine and neurology, Ryan found his calling in physical therapy, particularly after a fortuitous opportunity to intern at Casa Colina Hospital. This experience ignited his interest in neurorehabilitation and set him on a course to pursue a neuro residency, specialized certifications, and eventually, PhD candidacy in Rehabilitation and Movement Science.

As a researcher, Ryan has tackled intriguing questions, from exploring the use of transcranial stimulation devices for stroke and spinal cord injury rehabilitation to investigating clinical biomarkers in post-concussion syndrome. His work has highlighted the importance of bridging the gap between clinicians and product companies, ensuring that new technologies are not only safe but also truly beneficial for patients.

Ryan's passion for storytelling has also found expression through his podcast, The Parallax Effect. Recognizing the power of narrative in making complex scientific concepts accessible, Ryan has used this platform to share diverse perspectives and foster meaningful dialogue within the neuro community. His ability to seamlessly blend his scientific expertise with creative flair serves as a testament to the value of interdisciplinary thinking.

As Ryan continues to navigate the realms of research, teaching, and podcasting, his story serves as a reminder of the boundless opportunities that await those willing to embrace the intersection of science, technology, and storytelling. By bridging the gap between clinicians, researchers, and the broader community, Ryan Lovell's work exemplifies the transformative power of a multidimensional approach to neurorehabilitation.

Episode 189 of the I Love Neuro Podcast with Lynne Becker

YouTube: The Parallax Effect Podcast

Instagram: @parallaxeffectmedia

X: @parallaxeffects

TikTok: RyloKen27

Facebook: The Parallax Effect Podcast

Did you know there are some unique differences when working with aging adults who experience concussions? In fact, patients may come to your clinic after a fall and not have the diagnosis of concussion but they may actually have one. How would you know? What would you do to screen for it? What would you treat first? Tune in to answer all of these questions and more!

- Concussions in the elderly population often result from falls at standing height, rather than high-velocity impacts. - Symptoms like imbalance and dizziness may be overlooked or attributed to other conditions, making diagnosis difficult.

Comprehensive Assessment and Treatment - Evaluating neck pain, vestibular function, balance, and autonomic dysfunction is crucial for managing geriatric concussion. - Strengthening neck muscles, improving cervical proprioception, and incorporating vestibular rehabilitation exercises can aid recovery. - Screening for BPPV and addressing visual motion sensitivity are also important treatment considerations.

Monitoring Exertion and Symptom Management - Graded exercise testing, such as the Buffalo Concussion Treadmill Test, can help determine safe activity levels. - Educating patients on pacing activities and using the "gas tank" method can prevent overexertion and prolonged symptoms. - Incorporating breathing exercises can help regulate the autonomic system and promote calming.

Interdisciplinary Collaboration and Ongoing Support - Referring patients to the appropriate specialists, such as neurologists or physiatrists, is key for comprehensive care. - Participating in mentorship opportunities, like the NeuroSpark office hours, can provide valuable guidance for clinicians. - Continuous monitoring and adjustments to the treatment plan are essential for successful geriatric concussion management.

Check out this episode for more information!

182: Assessing and treating dysautonomia in neuro clients with Jennifer Lazaro, PT, DPT, NCS

Learn more about NeuroSpark here!

In this episode, hosts Erin Gallardo and Claire McLean are joined by guest Dr. JJ Mowder-Tinney, PT, PhD, NCS, a highly experienced physical therapist specializing in neurological conditions. Are you afraid to get your patients on the floor? Are you nervous it will be too painful for them (or you)? Join us for this engaging discussion on the importance of getting patients down on the floor and practicing floor transfers, as well as strategies to overcome the common fear and hesitation clinicians may have around this.

Some of the key takeaways include:

- The significance of building patients' self-efficacy and confidence in getting up from the floor, as fear of falling is closely linked to increased fall risk.

- The value of strong movement analysis skills that allow therapists to tailor floor activities to each patient's unique presentation and abilities.

- Practical tips for breaking down the task into smaller, more manageable parts and adjusting the environment (e.g. using padded mats) to facilitate success.

- The collaborative approach of problem-solving with patients to find the best methods for them, rather than prescribing a one-size-fits-all technique.

- The importance of regularly assessing floor skills and incorporating floor exercises into treatment, even for higher-functioning patients.

- Encouragement for clinicians to reflect on their own comfort level with floor transfers, seek support from colleagues, and continuously expand their skills in this area.

We are also excited to announce a free webinar on September 24th titled "Gettin’ Down and Dirty: Mastering Floor Transfers and Exercises in Neuro Without the Fear," which will give you the opportunity to brainstorm live with hundreds of neuro colleagues from around the world, see some helpful videos, and give you specific takeaways you can use the next day.  

Here is the floor mat Claire uses at her clinic (not an affiliate link) 

https://www.neurocollaborative.com/floor-transfers

Follow @jjmowderpt