Intensity matters! In the fourth and final of a multi-part series on stroke, Dr. Michael Powers explores best current evidence in stroke interventions including task-oriented training, clinical practice guidelines to improve locomotor function, and clinical practice guidelines on the use of ankle foot orthoses and functional electrical stimulation. He highlights the importance of keeping intensity, salience, and repetitions high during stroke rehabilitation to drive neuroplasticity. He discusses the importance of emphasizing interventions at the participation and activity level, and how treatments which overly emphasize body function and structure are not consistent with the best current evidence nor the recommended approach to examination which was discussed last episode. He hopes that by the end of this episode you will start thinking of your patients as athletes who benefit from high intensity practice!

Key Takeaways

• Neuroplasticity mechanisms
• Adaptive vs maladaptive neuroplasticity
• Lifestyle facts impacting neuroplasticity
• Experience-dependent neuroplasticity
• Factors impacting neuroplasticity
• The importance of exercise and intensity
• Aerobic exercise and brain-derived neurotrophic factor
• Non-locomotor outcomes improved with high intensity gait training

References

• The Neuroplastic Brain: Current Breakthroughs and Emerging Frontiers
• The Combined Influences of Exercise, Diet and Sleep on Neuroplasticity
• Neuroplasticity After Stroke: Adaptive and Maladaptive Mechanisms in Evidence-Based Rehabilitation
• Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotrophic Factor
• Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage
• Moving Forward
• Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis
• Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury
• Clinician Resources for Locomotor CPG
• Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: [email protected]
• LinkedIn

Intensity matters! In the fourth and final of a multi-part series on stroke, Dr. Michael Powers explores best current evidence in stroke interventions including task-oriented training, clinical practice guidelines to improve locomotor function, and clinical practice guidelines on the use of ankle foot orthoses and functional electrical stimulation. He highlights the importance of keeping intensity, salience, and repetitions high during stroke rehabilitation to drive neuroplasticity. He discusses the importance of emphasizing interventions at the participation and activity level, and how treatments which overly emphasize body function and structure are not consistent with the best current evidence nor the recommended approach to examination which was discussed last episode. He hopes that by the end of this episode you will start thinking of your patients as athletes who benefit from high intensity practice!

Key Takeaways

• Task-Oriented Training and Neuroplasticity
• Movement is at the intersection of the individual, the task, and the environment
• Key features to consider at the levels of the individual, the task, and the environment
• Improving Locomotor Function Clinical Practice Guideline
• Importance of high intensity in improving walking function
• Intensity, repetitions, and salience more important than normalizing gait kinematics
• Clinical Practice Guideline for Use of AFOs and FES Post Stroke
• AFOs and FES with multiple benefits across ICF domains

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• Shumway-Cook and Woollacott Motor Control, 6th ed.
• Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury
• Clinician Resources for Locomotor CPG
• A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke
• Clinician Resources for AFO and FES CPG

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: [email protected]
• LinkedIn

Begin with the end in mind! In the third of a multi-part series on stroke, Dr. Michael Powers advocates for starting the examination with collaborative goal setting focused on participation. He outlines how working backward from participation to activity and then body function and structure optimizes therapeutic alliance and helps drive neuroplasticity by emphasizing what is salient to the patient. He then discusses the importance of the review of systems and systems review (and how to distinguish these potentially confusing terms!), before concluding with an evidence-based framework for movement and task analysis. 

Key Takeaways

• Importance of collaborative goal setting with emphasis on participation
• Biopsychosocial model and impact on salience and neuroplasticity
• Stroke Impact Scale
• Key factors impacting Quality of Life after stroke
• Prevalence and impact of depression after stroke
• Evidence-based screening for depression
• Review of systems and systems review
• Using the Movement Continuum to analyze tasks
• Standardizing terminology - glossary of terms for movement analysis

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• ICF Health-Based Rehabilitation Program Promotes Activity and Participation
• Goal Setting with ICF and Multidisciplinary Team Approach in Stroke Rehabilitation
• Therapeutic Alliance in Physical Rehabilitation
• Stroke Part II: Examination and Evaluation
• Stroke Impact Scale
• Diagnostic and Clinical Utility of the PHQ-2
• Prevalence and Natural History of Depression After Stroke
• Impact of Depression on Stroke Outcomes Among Stroke Survivors
• A Framework for Movement Analysis of Tasks: Recommendations from the Academy of Neurologic Physical Therapy's Movement System Task Force

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: [email protected]
• LinkedIn

Not everything is weakness! In the second of a multi-part series on stroke, Dr. Michael Powers highlights the role of abnormal synergies and spasticity on movement and functional difficulties after stroke. Along the way, you'll learn about stereotypical synergy and spasticity patterns, motor recovery expectations, tools to examine synergies and spasticity, and how to consider synergies and spasticity within an evidence-based plan of care for stroke rehabilitation.

Key Takeaways

• Acute stroke response and flaccidity
• Abnormal synergies and impact on movement
• Stages of motor recovery following stroke
• Outcome measures for synergies: STREAM and Fugl-Myer
• Spasticity as part of the upper motor neuron (UMN) syndrome
• Strongest spasticity components for the upper and lower extremity
• Examining spasticity: Modified Ashworth Scale and Tardieu Scale
• Moving Forward: contextualizing synergies and spasticity within best current evidence

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• Stroke Rehabilitation Assessment of Movement
• Fugl-Meyer Assessment of Motor Recovery after Stroke
• Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity
• Moving Forward: State of Evidence in Neurologic Physical Therapy

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: [email protected]
• LinkedIn

Time to talk stroke! In the first episode of a multi-part series on stroke, Dr. Michael Powers discusses stroke risk factors, the importance of early detection including the value of BEFAST and HINTS, and presentations of common vascular syndromes. Along the way, you'll learn about the differences between ischemic and hemorrhagic strokes, and how despite these differences the functional outcomes between these types of strokes is fairly similar. As 1 in 4 adults over the age of 25 will sustain a stroke in their lifetime, this is a vital topic for all physical therapists regardless of practice area!

Key Takeaways

• Prevalence/incidence of stroke
• Stroke risk factors
• PT role in educating patients on modifiable risk factors
• Time is brain
• Early detection: FAST, BEFAST, and HINTS
• Ischemic vs hemorrhagic stroke - differences in medical management, similarities in functional outcomes
• Vascular syndromes: ACA, MCA, PCA, which is most common?
• Hemispheric differences

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• WHO Global Stroke Fact Sheet 2025
• Stroke Symptoms
• Systematic Review Comparing FAST and BEFAST
• HINTS Exam More Sensitive Than Early MRI
• TPA vs TNK in Acute Ischemic Stroke Within 4.5 Hours
• Hemorrhagic Stroke Overview
• Hemorrhagic Transformation of Ischemic Stroke
• Ischemic vs Hemorrhagic Stroke Functional Outcomes

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: [email protected]
• LinkedIn

Time to talk about good ol' carpal tunnel syndrome! In this episode, Dr. Michael Powers discusses key considerations of managing carpal tunnel syndrome, including the importance of patient history and the use of evidence-based practice in clinical-decision making. He also highlights the importance of knowing your anatomy, including knowing the unforgiving structure of the carpal tunnel (how many flexor tendons are squeezed in there?) and recalling peripheral nerves are complex structures composed of multiple neurons functionally grouped together in fascicles. This episode is a must-listen if you're wanting to improve your confidence in applying the evidence toward the diagnosis, prognosis, and management of carpal tunnel syndrome!

References

• Global and Regional Prevalence of Carpal Tunnel Syndrome
• Carpal Tunnel Syndrome
• Teach Me Anatomy: The Carpal Tunnel
• A Self-administered Hand Diagram for the Diagnosis of Carpal Tunnel Syndrome
• A Handy Review of Carpal Tunnel Syndrome
• Median Nerve Injury
• CPR for Carpal Tunnel Syndrome
• Carpal Tunnel Syndrome: A Summary of Clinical Practice Guideline Recommendations - Using the Evidence of Guide Physical Therapy Practice
• Electrodiagnostic Evaluation of Carpal Tunnel Syndrome
• Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome
• Surgical vs. Non-surgical Treatment for Carpal Tunnel Syndrome

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• Email: [email protected]
• LinkedIn

Let's learn about the brain! In this episode, Dr. Michael Powers introduces the cerebral cortex including the four main lobes (and wait, is there maybe a 5th lobe?), differences between the left and right hemispheres, and the importance of the limbic system. If you've ever wondered where in the brain language is processed, memories are stored, commands for movement are generated, where incoming sensation is interpreted, or the role of emotions in memory consolidation then this episode is for you!

References

• Clinical Neuroanatomy, 30th Edition
• Brain Anatomy and How the Brain Works
• Neuronatomy, Cerebral Cortex
• Insular Cortex
• Neuroanatomy, Limbic System
• Amygdala Activity
• My Stroke of Insight: A Brain Scientist's Personal Journey

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

In this episode, Dr. Michael Powers outlines key considerations for assessing and treating balance. He discusses the importance of considering contributions to balance from the individual, the environment, and the balance task including differences between various dimensions of balance. He differentiates normal age-related changes from balance dysfunction, and encourages clinicians to NOT accept balance dysfunction as part of the normal aging process. Your ability to effectively assess and treat balance will be enhanced after listening to this episode!

Show References

• Motor Control, 6th edition
• Changes in Sensory Organization Test Scores with Age
• Motor Unit Number Estimates in Masters Runners: Use it or Lose it?
• Muscle Changes in Aging
• Heavy Strength Training in Older Adults
• Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

In this episode, Dr. Michael Powers highlights the importance of extending our thinking beyond biological and anatomical processes. Outcomes for patients with neurological conditions are NOT dependent solely upon medical diagnosis, rather, human elements such as psychology and social connections have an outsized impact on patient recovery and quality of life. Expand your neuro toolkit by learning how to optimize your therapeutic alliance in this episode!

References

• Biopsychosocial Model 25 Year Later
• A Revitalized Biopsychosocial Model
• Healthy People 2030
• Role of Biopsychosocial Factors In Stroke Rehab
• Status Syndrome: A Challenge to Medicine
• Social Determinants of Health: If You Aren't Measuring Them, You Aren't Seeing the Big Picture
• Social Determinants of Health and Delivery of Rehab to Older Adults During ICU Hospitalization
• Fatigue And Fatigability In Neurologic Illnesses
• Post-Stroke QoL, Stroke Severity, and Function
• Post-Stroke QoL
• QoL Changes Post-Stroke by Clinical and Sociodemographic Factors
• QoL In Patients with Spinal Cord Injury
• QoL In People with Spinal Cord Injury Response Shifts 1 to 5 Years Postinjury
• QoL In Patients with Multiple Sclerosis
• QoL In Parkinson's Disease
• Disability In the Labor Market: Employment and Participation
• The Economic Argument For Hiring People With Disabilities

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Contact: [email protected]

Dr. Kirsten Potter joins the podcast to talk about outcome measures! She discusses her experiences with outcome measures, from witnessing initial clinician resistance toward leading the charge as a change agent through her work in developing the core set of outcome measures and her role as MS Edge Chair. Dr. Potter and Dr. Powers highlight the evolution of evidence-based practice and data within neurologic physical therapy, including how the use of the core set measures leads to improved clinical decision-making and patient outcomes. After this episode, you will have added the core set measures into your toolkit while also appreciating the tremendous work (past and present!) being done to supply clinicians with the best available evidence in neurologic physical therapy!

References and Took Kit

• ANPT Core Set of Outcome Measures: https://www.neuropt.org/practice-resources/anpt-clinical-practice-guidelines/core-outcome-measure-cpg
• Core Set of Outcome Measures Clinical Practice Guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC6023606/
• Self-Report Measures of Fatigue for People with Multiple Sclerosis - A Systematic Review: https://journals.lww.com/jnpt/fulltext/2024/01000/self_report_measures_of_fatigue_for_people_with.2.aspx
• Modified Fatigue Impact Scale: https://www.sralab.org/rehabilitation-measures/modified-fatigue-impact-scale
• Fatigue Severity Scale: https://www.sralab.org/rehabilitation-measures/fatigue-severity-scale

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Contact Dr. Powers

• Email: [email protected]
• LinkedIn: https://www.linkedin.com/in/michael-powers-pt-dpt-edd/

Contact Dr. Potter: 

• Email: [email protected] 
• LinkedIn:  https://www.linkedin.com/in/kirstenpotter/