In this episode of the No Plateau Podcast, Henry Hoffman sits down with Amber Walter, Clinical Science Director, and Caitlin Wright, Occupational Therapy Advisor at Sheltering Arms Institute, to dig into one of the biggest debates in stroke rehab: should therapy focus on restoring movement, or teaching patients to adapt with compensatory strategies? But on the other hand, if therapy leans too much on compensation, are we robbing the brain of its chance to truly recover?

Amber and Caitlin share how Sheltering Arms has taken a bold stance by committing to a neuro-restorative model of care, one built on intensity, technology, and outcome-driven practice. They talk about the science of neuroplasticity, the dangers of defaulting to one-handed strategies, and why therapists need to start planting seeds of recovery early, even for patients with the most severe deficits.

Throughout the conversation, you’ll hear why high-repetition, evidence-based therapy matters, how technology extends what therapists can do, and why the future of stroke rehab depends on longer, more intensive sessions that focus on restoration, not just adaptation.

In This Episode

Introduction to Caitlin Wright and Amber Walter (00:00)

The Importance of Neuroplasticity in Stroke Recovery (05:23)

Challenges in Current Stroke Rehabilitation Practices (07:25)

Sheltering Arms Institute: A New Approach (12:46)

Implementing Restorative Therapy at Sheltering Arms (15:05)

Technology and Evidence-Based Practices in Therapy (20:30)

Evaluating and Treating Stroke Patients (24:13)

Therapist Fatigue and Technology in Patient Recovery (31:44)

Critical Components for Severe Impairment Recovery (32:34)

Balancing ADLs and Intensive Therapy (35:31)

Historical Perspective on Rehabilitation (37:25)

Innovative Approaches in Modern Rehabilitation (38:35)

Case Study: Remarkable Patient Recovery (44:18)

Implementing Evidence-Based Practices (55:38)

Closing Thoughts and Recommendations (56:04)

Our Guests

Amber Walter, PT, DPT, NCS, is the Clinical Science Director at Sheltering Arms Institute in Richmond, VA. She oversees multiple therapy disciplines and specializes in translating research into everyday practice to improve outcomes for stroke and brain injury survivors.

Caitlin Wright, MOT, OTR/L, is an Occupational Therapy Advisor at Sheltering Arms Institute. She is board-certified in physical rehabilitation and a certified brain injury specialist, with expertise in implementing neuro-restorative strategies to maximize recovery potential.

Resources & Links

Sheltering Arms Institute Website

Amber Walter on LinkedIn

Caitlin Wright on LinkedIn

Henry Hoffman on LinkedIn

Saebo

On YouTube

On Instagram

On LinkedIn

Saebo’s Stroke Caregiver Support Group

Saebo’s Stroke Survivor Support Group

Stroke Guidelines 2023

In this episode of the No Plateau Podcast, host Henry Hoffman is joined by Amanda Saylor, an occupational therapist specializing in neurological rehabilitation, to discuss Vivistim Therapy, a groundbreaking treatment for chronic stroke survivors with upper limb deficits. Vivistim combines vagus nerve stimulation (VNS) with intensive therapy to enhance neuroplasticity and improve arm and hand function. Amanda shares her experience implementing Vivistim in her clinic, the science behind the treatment, and how it can be integrated into stroke rehabilitation.

"Vivistim is basically vagus nerve stimulation paired with therapy. It has to be—it cannot be one without the other."– Amanda Saylor

This episode highlights the importance of combining innovative technology like Vivistim with evidence-based practices to push the boundaries of stroke recovery. For therapists and patients alike, Vivistim offers a new avenue for hope and progress in the journey toward recovery.

"The success of Vivistim is only as good as the therapist that's going to be doing it. It’s the tool, but it’s the person behind the tool that makes the difference."

– Henry Hoffman

As Amanda and Henry discuss, the future of stroke rehabilitation lies in longer, more intensive therapy sessions and the integration of neurotechnology to enhance neuroplasticity.

"Patients need more time in therapy. We know they need more repetitions, and they can't always get those on their own."

– Amanda Saylor

In This Episode

Our Guest

Amanda Saylor, MOT, OTR/L, is an occupational therapist with over eight years of experience specializing in neurological and orthopedic rehabilitation. She works at AdventHealth in Orlando, Florida, and is a consultant for MicroTransponder, the company behind Vivistim. Amanda is passionate about stroke rehabilitation and shares treatment ideas and tips on her Instagram page, @neuro_ots, with her colleague Becca Carr.

Resources & Links

• Saebo’s Stroke Caregiver Support Group

• Saebo’s Stroke Survivor Support Group

• Stroke Guidelines 2023

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

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

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

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

In This Episode

Our Guest

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

Resources & Links

• Saebo’s Stroke Caregiver Support Group

• Saebo’s Stroke Survivor Support Group

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

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

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

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

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

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

In This Episode

Our Guest

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

Resources & Links

• Henry Hoffman on LinkedIn

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

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

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

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

In This Episode 

Our Guest

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

Resources & Links

• Henry Hoffman on LinkedIn

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

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

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

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

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

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

In This Episode 

Our Guest

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

Resources & Links

• Henry Hoffman on LinkedIn



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

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

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

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

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

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

In This Episode 

Our Guest

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

Resources & Links

• Henry Hoffman on LinkedIn

What does aphasia treatment look like?

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

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

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

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

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

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

In This Episode

Our Guest

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

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

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

Resources & Links

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

• Henry Hoffman on LinkedIn

Jessica Miller, neuro-based occupational therapist and founder of Pathways Neuro Rehabilitation & Education, is back for another No Plateau Podcast episode! 

If you’re an avid listener, you’ll remember Jessica from the first season when she came to discuss the importance of comprehensive education for caregivers and patients. With her experience as an OT, she’s walked through the transition back to home life with countless families, so she knows which tools are the most effective and helpful for patients settling back into their homes. 

“The hospital in in-patient rehab will help them get a wheelchair, and maybe if they need a hospital bed or something like that, but all these other things that we’re talking about today, they might get touched in a discharge recommendation list on the day they leave… But they don’t really have enough time, so I’m glad that we’re doing this.” – Jessica (3:27)

In this episode, we break down various durable medical equipment (DME) available on RehabMart to help caregivers and survivors transition back home after a hospital stay and the five major steps patients must work through upon arrival. 

“I have seen so many loved ones purchase so many items because they just want to help in any way they can… I know it comes from a place of love, and I want you to have support in that. If you aren't sure if something could be helpful, I would say take it to your friendly OT…” – Jessica (40:49)

In This Episode

Our Guest

Jessica Miller is an OT and certified brain injury specialist with 19 years of experience working with stroke survivors. She is also the founder of Pathways Neuro Rehabilitation and Education, which helps treat stroke patients in their own homes and helps therapists grow their skills.

Resources & Links

• Henry Hoffman on LinkedIn

After a stroke at 38, Keith Taylor struggled to rebuild some of his life and move through recovery. As he worked to process his identity and the entire experience, a dark season of depression followed. In this episode, he’s joining me to discuss surviving his stroke, picking up the pieces after the fact, and how he came to found Strength After Stroke, a mental health resource and program for fellow survivors. 

“It was right in that time period that I thought, ‘Wait a minute. I’m here for a reason. There’s something that’s happened here that’s caused this for me, and I’m not going to allow it to take over. I think it’s a message that tells me that it’s time to get some things put in place for others.’ And that’s what I went to work on.” (9:51)

When Keith was in recovery, he discovered an obvious need for mental health care for survivors. While physical care and rehabilitation were top of mind, psychological health was less of a priority. He touches on how this realization came to him, how it helped him create various resources for survivors, caregivers, and families, and where he hopes to take these programs in the future.

“The mental health aspect, I feel like there is still a huge hole… That gap is huge, and we have to fill that gap.” – (18:47)  

In This Episode

Our Guest

After surviving a stroke and struggling with his mental health and suicidal thoughts, Keith Taylor made his way to the other side of that depression and decided to use his experience to help others. He founded a mental health resource and program called Strength After Stroke to help others through that season of depression after a stroke. 

Resources & Links

• Henry Hoffman on LinkedIn