Brain Rehab Revolution: Rewrite Your Recovery Story

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:

1. 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. 
2. Tech to the Rescue: Supercharge your rehab with cutting-edge tools like brain-computer interfaces. Imagine the possibilities!  Think e-STEM.
3. 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. 
4. Sleep, Stress Less, Conquer More: Optimize your brainpower with the power of quality sleep and stress management techniques. 
5. 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. 

Transcript

Ann: 0:00

it's just our ability to handle different kinds of loads. There's like stress load. There's physical load. There's chemical loads. There's different kinds of loads. but the more taxing, it is for us to overcome things, the harder it is to bounce back. So with the older population, some of the barriers I've encountered is just willingness to change.

John: 0:32

Hi, I'm John,

Erin: 0:34

and I'm Erin. You're listening to connect and power. The podcast that proves age is no barrier to growth and enlightenment

John: 0:41

tune in each week as we break down complex subjects into bite sized enjoyable episodes that will leave you feeling informed, entertained, and ready to conquer the world

Erin: 0:54

a season physical therapist and the co-founder of grit mobility, a mobile practice specializing in neurological care. Our guest Ann Phillips earned her master's degree in physical therapy from the university of Oklahoma in 2004 and later a doctorate from the university of Montana in 2020. Throughout her career. Ann has worked in diverse settings, including brain injury programs and outpatient neuro rehabilitation. Gain over 10 years of specialized experience. Her deep understanding of healthcare, shortcoming inspired her to launch grit, mobility to support those often overlooked by the system. Besides her professional work. Ann a clinical instructor, actively mentor students runs a local support group for individuals with spinal cord injuries and other physical disabilities. Also known as Molly rollers of treasure valley. And collaborates with stroke survivors can to educate and connect with the community. Alongside her husband. She co-founded the nonprofit fueled by fire To assist both local and international communities. Let's give a warm welcome to our guests. Dr. Anne Phillips, the. Thank you so much for being

Ann: 2:16

Thanks so much for having me. I'm excited.

Erin: 2:20

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 share your story, but also correct me along the way, because it's neurological is what I say, but it can be neurologic rehabilitation. Correct?

Ann: 2:36

Yeah, it's it means the same

Erin: 2:38

Ah, perfect. if you wouldn't mind going into your story and sharing really how you found this field or if the field found you and really explain more about what it is,

Ann: 2:49

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 human body, the more you learn about it, the more you recognize and you can't deny divine design, for sure, it's just fascinating. And then, I would say the brain is, or the central nervous system is the most fascinating part because that's the operating system. my mom's a nurse and, she was pushing me towards the medical field and, medicine. And I actually was initially wanting to go pre med, but then I learned that physicians Don't have a life for the first one, 15 years. Um, I really also had this fascination with, like I said, the human body. So I was really big into like fitness and how the body responds to, to different things. So, physical therapy is like the perfect combination. it's technically physical medicine is what some departments will call it. that's kind of where. where my path went, I used to be a personal trainer and aerobic instructor and stuff like that. and, just kept digging in deeper and, it led me to physical therapy. So I've been doing it for about 20 years now.

Erin: 4:03

sounds like the two of us, like we're always looking for knowledge somewhere. And then the more books and the more research and John's been in it a little bit heavier than I have. Right. You've been saying a lot more. I followed Jim quick and he had that book limitless. And so John had it before me cause I was trying to finish another book. He's like, Oh my gosh, this stuff is blah, blah. And I'm like, man, I can't wait to read it, but it is fascinating.

Ann: 4:27

You just released a new version of it.

Erin: 4:29

that's the one I got.

John: 4:31

Yeah, that's the one I just read. It was an amazing book. There's so many, so much great information. So shout out to Jim Quick and Limitless. great book.

Erin: 4:41

Yeah, and I,

Ann: 4:42

to read it.

Erin: 4:43

and the older I get, the more I want to learn. I was like, why wasn't I this way when I was younger? it's just interesting.

John: 4:49

so Dr. Phillips, can you please explain what neurologic rehabilitation is and why it is important, especially when we age?

Ann: 4:59

So neurologic rehab is a different branch of rehab. So there's different branches in physical therapy, just like there's different branches in medicine. So if you think about it, like in medicine, there's oncology, which is like cancer. there's pediatrics. Which is kids. there's geriatrics, which is older adults. So there's different branches. in physical therapy in some ways, there's also other branches and there's different certifications that you can get for it. Now, there's not certifications for everything, but, there's like wound care and. And geriatrics and things like that. So neurologic is the area of rehab where we really hone in on kind of the nervous system and how the nervous, system affects the body and how we move. So in simplest terms, that's neurologic rehab. now in reference to older adults or aging, the aging population, we, as we get older, We're not as, resilient where you don't bounce like what you used to. it takes a little bit longer to make sense of things. And, when you add an insult like a neurologic injury, like a stroke or a disease process, like Parkinson's or MS or something like that, it influences the body functions and ultimately how the body moves. Does that make sense?

Erin: 6:23

Yeah. And that was going to be my next question what are some of the common neurological, conditions that you see?

Ann: 6:29

some of the common diagnoses that fall under that umbrella, that neurologic umbrella would be like traumatic brain injury, spinal cord injury, Parkinson's, MS, stroke. now there's different kinds of brain injuries too, if you think about it. Cause there could be like a brain tumor, right? Or something like that. So there's, that kind of falls under acquired brain injury. And then there's traumatic brain injury. So that's when there's some kind of trauma associated with it, a car accident or, someone hits you on the head or something like that. So that's, that mechanism of injuries is different than like an acquired brain injury, like a pathology.

Erin: 7:08

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, I just clumped it all kind of together and everybody knows everything and to learn that there are different specialties that people can go to see for certain conditions. Like I didn't know, right? I didn't know that this is

Ann: 7:31

Yeah.

Erin: 7:31

right?

Ann: 7:32

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 doing what you're doing to help educate the community. And that's, that's a big passion of mine too. because people don't know what they don't know. And, When you don't know, then you, I don't want to say you sabotage yourself, but you leave it to other professionals to make decisions for you instead of you being empowered to play a role in your own health. So that's a big piece of what my practice and my heart is to capture those people who are falling through the cracks of healthcare and to educate them and empower them and advocate for them. Like I said, there's so many people that don't know what they don't know.

Erin: 8:19

And that's what we're all about. That's, you know, we want to make sure people know and understand there are people out there to help you and we want to bring the resources for sure. Now, when we're younger versus when we're older, is when you're rehabilitating somebody, is it different? Are there different approaches you take? Is it take longer, shorter, the methods you use? How does that work?

Ann: 8:42

Yeah. I think, gosh, so with the older population, I would say, yes, it does take longer and a big piece of that is because, For one, as we get older, we're less likely to feel comfortable with change changes really hard and adapting to change. So I feel like that's a big piece. and also, like I said, we're just not as resilient as we get older, but, This is a side note, something I've been super fascinated with lately is, the difference between biological aging and chronological right? There's a difference between lifespan and healthspan, and we could actually equip ourselves to where we can handle those hits, those health hits against us if we are healthy to begin with. and it all comes down to different kinds of load, in the literature, you'll, hear different kinds of loaded, like viral load when cobit was out right and big, they talked about why some people respond. Better than others. And it's just our ability to handle different kinds of loads. There's like stress load. There's physical load. There's chemical loads. There's different kinds of loads. but the more taxing, it is for us to overcome things, the harder it is to bounce back. does that kind of make sense? So with the older population, some of the barriers I've encountered is just willingness to change. I know you've been doing this for 50 years, but the game has changed. We have to think about a different 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, why did 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 to give 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 done this forever. Why would I change now? I hear I'm too old to change. but then I, you know, it's, you have to be careful not to judge people before you actually work with them because sometimes we'll get these referrals and we'll kind of read through their history and stuff. And they have a list this long. And you think, and you create this picture in your mind of how they're going to look when you're face to face with them. That happened one time when I used to work in inpatient rehab I was reading through this chart about this lady and she just had a huge medical history. And so I, I had this picture and I walk in to, the dining room to, to see her and she's like sitting with her knee up to her chest, like reading a book or stuff like that. And I'm like, don't know a lot of people that have that flexibility, you know, and that it's, it all comes back to the lifestyle that you assume. and that, influences like the underlying conditions. before a neurologic injury happens.

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 the most change happens within the first three to six months. However, Neuroplasticity is still viable up to five years is what we've shown, possibly longer. within the first, I would say three months, is the most critical because once people start adopting nasty patterns, it's really hard to break it. Even if they have the capacity to do it, just getting someone to change their movement behavior is so difficult once it's already established. And if, if they already find it to be successful and pretty efficient for them, it's hard to convince 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, and that the literature supports to is task oriented. So if essentially I could help it make sense to their brain, and it has meaning to them, they're more likely to be engaged. and they can make the connection. As far as the why we're doing it. So if they have meaning to it. And it's a task that makes sense to them. They're more likely to participate and, and engage their brain and their body connection. Yes. multiple strategies as far as whatever the task is. I may have to tweak the task to where, they're more engaged. Or I may have to tweak how I communicate the task. sometimes if they don't understand what I'm asking of them. Then they're going to go a completely different direction. Yeah. And that's what makes the neuro specialty a little bit, quite a bit different than standard.

John: 14:55

we all know that, things can become harder and harder as we get older. Maybe our muscles and our body just doesn't operate the way it normally does. And sometimes we have fall risks where people fall. And so how can you specialize in your support system after a fall? Instead of just calling somebody to have them do physical therapy, is it more important to call you as well so you can analyze whether they've had a major head injury or something that could alter their course of life?

Erin: 15:27

Good question. Thank you.

Ann: 15:29

Yeah, so falls are huge and in the older population and after someone's experienced the fall, they're more likely to have another one. because it's going to influence how they move right they're going to be more anxious, a lot of times they actually limit their movement, which puts them more at risk because then you're not as efficient in movie. Right. So the less I move, the more we can, that connection between the brain and the body to move. So we're designed to move. It is what I tell a lot of my patients. And when we don't move, things get grumpy, your joints get stiff. It's harder to move. and if you think about like in the context of like arthritis, for example. So if I have a bad me, so to speak. I'm going to not move it so much. So the less I move it, the stiffer it gets, the stiffer it gets, the harder it is to move. So what I teach them is safe ways to move. and when you move, it actually oils the joints, which makes it easier to move. So if we can help, the patients establish those safe parameters. To move, it lowers the anxiety and the fear of moving and the quality of how they move as well. So the more confident someone is in moving, the more likely they are to move.

Erin: 16:58

I'm not an older adult yet by any means. I'm still in my twenties, but, I find 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 because I know if I do this, it'll hurt. But then I'm limiting my movement, right? It's if I do a lunge or I walk up a hill this way, this is going to be the repercussions of what I just did. 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 out longer versus if I just did this, right? Your mind starts playing those games versus, maybe you take the time, slow down, still do that stuff. but maybe do not as many reps or not as long of a walk, and just make that slow movement and let your body heal and not overwork it. That, that's where my mind is.

Ann: 17:43

more deliberate, right? Being more deliberate with what you do. um, I tell people, you know, it's, it's not about, what you do as much as it is how you do it. So I try not to tell people absolutely no, I try not to give them hard no's when there's something that they really want to do. We just might have to explore how we do it, what are safe and efficient ways to do it. that's where you have to be creative.

Erin: 18:12

so now I have a neurological disorder, right? I mean, I'm coming to see you for rehab. Do I come to you because I find you on my own? Is that from a doctor doing a referral or both?

Ann: 18:24

I would say both. I do have a relationship with Several neurologists and, a stroke program and stuff like that, but, conversations like this, are very valuable, but I'm trying to get out there more to where I feel like the way businesses and clinics have moved, it's just been, like you said, there's just one big 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 not send them the physical therapy. They may just prescribe the pain medication, pain time, inflammatory, something like that. But let's say they do some therapy. Most likely it's going to be a clinic that clinic is associated with. it enters this pool of therapists and it's just whoever's schedule's open most of the time. So you have no say in who the therapist is that you see and what kind of experience they have unless you initiate the conversation as far as, Is, are they going to be a good match for me, you know, do they specialize in, so going back to that conversation with the position, shoulder injury, maybe the physician overlooked that they had a stroke five years ago. And it's on that hemiparetic site. That can influence why the shoulder hurts, because it may be the shoulder of the unaffected side because they overuse it. I see that a lot.

John: 20:00

While I can see how it would be such a struggle, right? Because we live in such a fast paced world. And I think that, if we slowed things down a little bit or we advocated for our loved ones, say Say they have had some falls or whatever, maybe talk to somebody and say, okay, yes, we know that physical therapy is being recommended for my mom or my dad, my grandma or whoever. But since she has had some falls or she has had a past stroke, we would really like to know if you have. A neurologic, you'll rehabilitation program or a therapist that specializes in that we really have to advocate for ourselves because it is so fast based. And like you said, when the referral goes out, it gets sent to whoever has, room on their caseload to be able to take that. But, We out here that are receiving that type of therapy might not benefit as much unless we have the correct referral to the correct therapist that maybe specializes such as yourself. So,

Erin: 21:01

well, and that's why we should do our homework, right? Whether it's like, okay, I need to go see PT, make sure who's going to be the best fit for me. Tell my doctor, Hey, this is who I want to be referred to. And as long as they're in your network, there shouldn't be an issue with them referring.

John: 21:16

Yeah.

Ann: 21:17

The problem with, going to provider is, A lot of times I don't have the bandwidth to look and 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 is we're a direct access state, so we don't have to have a physician referral. So you could actually call our clinic directly and we'll do the legwork for you as far as, following up the position and everything. Yeah.

Erin: 21:43

that's awesome. As a family member or caretaker, how can I support someone that's going through physical therapy, the neurological therapy?

Ann: 21:53

Yeah. So in order to make changes in the brain or the nervous system, we have to have lots and lots of repetitions. And if we, if I can recruit caregivers or family members to reinforce what I've already established and implemented. And I've shown to be successful like they're responding really well to these cues, or this setting, or this setup, if you do it. This way, they do really well to where 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 have to do is just know how to help. So a lot of caregivers, struggle with that piece. Like, I hate seeing my mom's struggle to stand up or so they'll just yank on them, right? They'll manhandle them or whatever it might be. a big mistake I see a lot is they'll like pull on their arms. things like that. so there's some pretty, pretty horrific things I've seen, as far as caregiver strategies. in response to your question, if they could reinforce what I've already implemented, and I've already shown the patient that they could do successfully, and it actually makes them feel good. It gives them some autonomy, right? It gives them some self efficacy to where they have, you They have some control over that process. Nobody likes. to be manhandled.

Erin: 23:23

Right.

Ann: 23:23

if I can give them some of that power as far as how they initiate the transition, how they can actually participate in it, active participation is huge. no one can rehab passively. They need to actively participate in it. whether it, it is, the patient. Coaching the caregiver through how to help them. That's still actively participating. So if they had a spinal cord injury or something like that, for example, and they, they need help with certain things. Nothing wrong with their brain. They could still direct the caregiver. As far as how to help them. and that was a long response to your question,

Erin: 24:06

no. I think it's important. It's allow them to do what they need to do without frustrating them. So be patient, but also show up to the physical therapy and learn, be proactive with your loved one that you're caring for, or, you know, a friend, family member, whoever it may be, go to these therapy sessions and learn. So you know how to assist them when they need not be scared yourself.

Ann: 24:30

Yeah, and not to do too much, right? You want to offer them the opportunity to engage, and that's how we make changes.

John: 24:39

so when it comes to physical therapy, when it comes to the neural neurologic side of it, is it a combination between of drugs and physical therapy or is it, still mainly just, Getting them to think of different ways to rehab. Is there a combination there or

Ann: 25:01

So are you referring to more like orthopedic, like muscle bone and joint type stuff

John: 25:07

no, I'm more of talking like, for instance, if somebody has had a stroke or they've had something happen and they need some. Deep rehabilitation, with a emphasis on the neurological side of it. So is there medications that help support your practices of therapy or is it mainly just still just the physical therapy side of it?

Ann: 25:32

So, if you think about physical therapy as we are movement specialists that's our jam. That's what we're going to focus on. So whether it's been mobility, whether it's helping them be able to transfer more independently, walking more safely and efficiently, things like that is going to be a big direction of what we focus on, because if it doesn't translate to function, why are we doing it? that's how the patient's going to look at it too. Yep. If this isn't going to help you do a, B and C better, why are we doing it? you're never going to see me do like bicep curls with a patient or, you know, just straight up exercise, unless it's somehow translate to, function, because I find that I get better outcomes that way, if it makes sense to their brain and their nervous system, and I can get. the brain and the body to talk to each other better, they're going to move better. So they're going to be more efficient. They're going to be more independent. They're going to be more safe. And they're actually kind of learning those parameters on their own as far as, Oh, well, I'm in a different chair now. I have to do this kind of adjustment to be able to stand successfully. in reference to the medications, there's some conditions where medications are necessary, like Parkinson's, for example. there's some MS medications, they're always changing. And there's new ones out. I'm not a huge, a huge fan of pharmacology. so a lot of conditions like MS, for example, it is linked to inflammation. So what we're learning is that there's a lot of. There's a lot of benefits in really controlling our lifestyle, which encompasses what we eat as well, and how we move, and how much we move.

Erin: 27:31

So no eating in and out burgers and fries every day or

John: 27:36

Especially right before a therapy session, you probably don't want to do that

Ann: 27:41

I mean not

Erin: 27:42

Probably not a good idea.

Ann: 27:44

Yeah.

Erin: 27:44

As our technology is changing in the world. How do you see it being used in your department, like with VR, robotic assistance and anything? I'm just kind of curious to see where you might see some of that coming for you and helping your patients.

Ann: 28:02

Well, I would say we're seeing more and more as far as brain computer interface. That's kind of you've heard of Elon Musk, like Neuralink and things like that. This is a technology that's been in the works for, I want to say like 20 plus years. But we're seeing more and more like they're getting closer and closer to it actually used. and it's basically a real time interaction between the brain and some kind of output, whether it's a device or whatever it is. it's pretty cool. Some of the technologies isn't necessarily new, they're more refining it. So like functional e STEM for like, muscles that aren't working the way they should, but if we can get them to fire at the right time during a certain task, like for walking, for example. or for hand movement for grip and stuff like that. that is still a pretty strong technology that that we're using quite a bit in neuro rehab. you're seeing a lot of robotics type stuff for like people who have paralysis. We're seeing more and more of that. However, making it easy for the public to access is that's a different story. Unless you're Iron Man. So,

Erin: 29:24

we'll

Ann: 29:24

um.

John: 29:25

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 can still do it.

Erin: 29:34

Well, you know, as we age, our cognitive. our cognitive functions sometimes change. And so can that present a challenge when you're trying to rehab somebody?

Ann: 29:46

absolutely. so in order to learn, you have to be able to attend to a task, right? And if I can't get you to focus long enough to learn something and have the memory to retain it, it's hard. It's hard not to, just default back to old patterns. So that's where caregivers come in a lot, as far as they have to be. So if we can't internalize something, like if I can hold on to a piece of information myself, then I have to use some kind of external strategy, whether it's a sign or notes or someone reminding me or using my phone or whatever it might be.

Erin: 30:26

Well, that's the other thing I was gonna ask you too. If I don't have a caregiver, I don't have somebody helping me and I come and I need this. What are strategies you give me to take home to remember if I'm already having a hard time?

Ann: 30:39

Yeah. So something I found pretty successful is, I will use like a patient's phone or their iPad or tablet, something like that, because I dump a lot of information on them in one, one session. And as I understand it, it's hard to remember all the details of everything. So what I'll do is I'll ask them permission to record them with their device, and I will coach them through. A movement and they'll hear my nagging voice in the background. They'll see themselves. And it also gives them a reference as far as, okay, Mr. Smith, this is where you were on day one. We're going to be able to compare this to six weeks from now, and I guarantee you're going to be doing a lot better. So it's nice to be able to look back at that too.

Erin: 31:29

I like that.

John: 31:29

Yeah, I like that. So can you, just walk us through like 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 this goes, but if you could just walk us through the best case scenario with helping somebody get through the steps of, neurologic rehabilitation and how it might be different from normal therapy.

Ann: 31:56

Yeah. So I always tell people the first step is to establish a good foundation because if your foundation stinks, we have nothing to build on. So people's goals are always pretty high and you go in and someone can't even stand in it and their goal is. What? I want to walk, right? So, before you walk, you've got to 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 when you're sitting, I can't expect you to stabilize while we were standing. And I definitely can't expect you to stabilize when you're walking. Right? So we start with the basics. We start with, I consider it as far as general stability. There's three levels. So level one is, can you stabilize when you're still, when you're just sitting there, can you find where you belong? and that gives me a good picture. As far as, is there a mismatch between where they think they are and where they actually are? So for example, I might say, Hey, Mr. Smith, what do you think as you're sitting in that chair, if that chair was a parking space, are you sitting pretty straight in that parking And they could be looking at me like this and be like, Yeah, I'm pretty straight. So they're, they're butts about to slide out of the seat. They're leaning way over. There's a mismatch, right? Between where they think they are and where they actually are. And, to simplify it, I'll say it's kind of like your GPS is wacky. You're, you're telling your GPS to take you home, but it takes you a block down. It's close, but you're not there. So when there's that mismatch, Mistakes happen, right? I thought I was close enough to the seat. I thought I was safe. So that's, level one is can you figure out where you belong? Right? Can you stabilize when you're just still? When you're just sitting there. Level two is can you stay stable as you're moving? So I'll have them do something like just turn their head. Or I might have them lean forward. Can they stay stable? Or do they totally deviate one way or the other? Do they fall apart? And level three is can you apply it to function? Can you apply it to real life? So I apply that when they're sitting, when they're standing, when they're walking. those are the foundations,

Erin: 34:20

What are some techniques you teach them to stay motivated? Because I know sometimes for me it can get frustrating, you're here and there's no progress because with my ankle, I go backwards a little bit. I frustrate PT people. It's fun. But what are things you can do to help or techniques to teach that, Hey, this is how you stay motivated because it can be a long process sometimes and don't feel frustrated, you know?

Ann: 34:43

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 like you're doing any better, but let's review where you were day one. you're doing things now that you weren't able to do that day. so that's one strategy. Another strategy is what we call outcome measures. So I do certain tests on day one. And then after a few weeks, I revisit those tests. So we actually have objective measures to where I can show them, it took you this long to do this. day one, you did it in half the time today, right? And you did it safer and you didn't have to use your hands or, there's different. Variables that I'll add to make a task more difficult. And once they nail it, it helps them recognize, Oh, I guess I am. I'm also tracking quality of movement and I'm also tracking like falls, for example, when we first met, you were saying that you were falling four times a month. When was the last time you fell? I can't remember last time I felt, so does that make sense? sense?

Erin: 36:01

yeah. Thank you. And that, I guess that goes back. I should have asked this question first is when someone comes to you, what do you, what are the first steps, the assessing them and the question asking and all of that. So it's great that's part of it.

Ann: 36:15

Yeah. Yeah. So we try to establish a solid baseline. So during the initial eval, we get a good picture of where they are, where they were and where they want to be. and we gauge like how big is that gap between where they are and where they want to be. Right. Is it reasonable. I never, like I said, I never tell them no. but we do start with baby steps, those small victories.

Erin: 36:39

And then you throw a big party afterwards.

Ann: 36:41

Yes.

John: 36:43

so my question, I'm sure a lot of listeners are thinking about this. I know rehab can take a long time depending on an injury or a stroke or your cognitive abilities or your support system, all these different variables, right? But on average, how long does it take for patients to see the biggest changes? is it like a month? Is it like six months? how long can they expect to see changes?

Ann: 37:14

sometimes, honestly, sometimes I go in, Because we by nature are fixers. sometimes I go in day one and technically during an evaluation, I'm not supposed to intervene yet. I'm supposed to get a true baseline of where they are before we start. But I have a big problem keeping my mouth shut. If I see a problem, I'm going to fix it. But, I always within my evaluation towards the end, I'll do treatment too. And sometimes it's so simple. Hey, have you thought about trying this strategy? have you thought about maybe moving your foot here or using this? and that could be a game changer for them. So a lot of times day one, they can notice a difference to where, wow, I didn't know I could do that. so they, they won a lot of the time that they'll see some kind of change and that motivates them for the next treatment. but as far as consistent change, that's what gets hard, right? without me barking at you, can you do it right? If you could do it in the context of your home, but can you do in the context of your favorite restaurant? so that's ultimately what we're working towards. I want them to be equipped to do whatever they need to do in the environments that they need to function

Erin: 38:38

other things we can do now that will help prep us as we age. And I know there's all different stages, but if it's like, Hey, you know, your nutrition can really set up you up or your hydration can really set you up for when you do come across having, you know, a neurological,

John: 38:58

Well, when you have any sorts of challenges, right? because as we do get older, you know, our muscles start to atrophy, we start getting weaker. We can have falls happen. And so I think what you're trying to ask, and sorry if I'm wrong, but, how diet nutrition play into in hydration, play into your ability to recuperate and yeah, gain. More successful motivation as you're healing from say a fall or a

Ann: 39:24

Yeah. I'm so glad you asked that. so big pillars, more and more research is coming out talking about the benefits of. nutrition. so much so that now Stanford and Harvard are both recognizing nutritional benefits on behavior. So Stanford has launched a medical branch called nutritional metabolic nutrition and Harvard nutritional psychiatry. So where it used to be, as far as what we eat, we used to kind of, you know, dismiss people and be like, Oh, you're just Hippie or whatever it is, right? That's just foo foo stuff, and now we're actually recognizing more and more. I, I have a whole new respect for functional medicine because that is one, area where I, I really do feel like they're getting down to the root cause You know, if you have a headache, there's a hundred different reasons why you could Well, let's figure out why, Whereas traditional medicine, they may just give you pharmaceuticals, and it's not, you know, I'm not bashing allopathic 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 a short period of time, and they just don't have the bandwidth to really dig. 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 to nine hours a night of restorative sleep. And, your body likes routine. Your body is always fighting for a state of balance homeostasis. So your body likes routine and there are certain rhythms or you've heard of circadian rhythm, right? There's certain rhythms are our body assumes, and it likes that. So if you go to bed about the same time every night. And you kind of establish a good sleep hygiene routine. So, you know, don't have an In N Out burger right before bed. So sleep is huge stress management, huge. So I feel like one of the good things about COVID is a. Brought to surface a lot of like mental health issues where we used to shove it under the table. We don't talk about things like depression and anxiety, but now it's been more in the forefront and we're linking it a lot with stress. So we live in a constant state of stress and environment is a huge contributor to stress. what we feed ourselves is a huge contributor to stress. there's all kinds of stress, right? There's environmental, chemical, emotional, physical stress. the more your body is having to rally to overcome those things, the less resources you have to focus on something that you enjoy. So sleep, stress management, movement, exercise. So lots and lots of literature on benefits of exercise on general wellbeing. So we know, just cardiovascular health, lung health, but now we're learning that it also affects, your brain. So when we exercise just like a 20, 30 minute good walk to where you get your heart rate going actually 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 does the planning, the higher level thinking, the, considers consequences, things like that. And your hippocampus, which is the memory center. So the hippocampus also is a big player in stress management, stress and anxiety management. So that's why when you've been sitting at your desk for hours and You hit a roadblock and you're like, I can't even look at the screen anymore. You go for a walk, you come back and things start flowing again. That's what, okay. So sleep, stress management, exercise, and what we feed ourselves and nutrition. We're learning more and more. And it, it makes sense. Our body operates on biochemistry. 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. we've learned like a big piece of chronic diseases, inflammation. So a lot of the crappy foods, fried foods, high sugar foods, highly processed foods are toxins in it and your body responds by inflammation. And what we're learning is when you have inflammation like in your joints. we hurt, we know it, we recognize that, but when you have inflammation in your nervous system, you don't feel pain, but what you do experience is like brain fog and your tolerance for things is less, you know, you're moody. you can't sleep, you can't calm down, you're stressed, you're anxious, things like that. So that's how that shows up. And they've actually linked it to things like Parkinson's and autism and MS and things like that. So when we eat, those highly processed and high sugar foods, it weakens your body's ability to protect itself. It weakens the gut lining, and it actually weakens the brain, the blood brain barrier to our junk. Can get to your brain. that's something else that the research is showing that things we didn't think would cross the blood brain barrier is and, it's crazy.

John: 45:13

Is

Ann: 45:14

that was a long response to

Erin: 45:16

No. Can I say this one comment? I'd say, is that why when we get older, people get grumpier is because they're so inflamed. It messes with our moods and we're hurting.

Ann: 45:27

It could be. Yeah. Yeah, it could be because there.

John: 45:31

to me.

Ann: 45:32

Well, I, find that the older population too, they're less invested in taking the time to eat well. It's just whatever's easiest. Right.

John: 45:41

I,

Ann: 45:41

in general populations like

Erin: 45:43

right.

John: 45:43

yeah, I love that. We're talking about this because it's something I've been passionate about for years. And, we talked about Jim quick's book, limitless in there. It talks about the correlation of gut health. Versus our brain and how, the vagus nerve is transferring nutrition up to your brain and how it operates. And so now I'm a huge advocate of eating, brain healthy foods like avocados, walnuts, you know, dark leafy greens, berries, a lot of those different things. And you're right. I think a lot of people don't realize the importance of what you're putting in your body as far as the quality of the nutrition and how it's going to affect us as we get older and our abilities to function, whether it's, our cognitive abilities of thinking and processing, focusing, and, your memory, but also things like movement, Being able to walk and do all the things physically that we've been able to do for years. So.

Ann: 46:41

Well, I, I like how there's some crossover too. So we talked about how I said, I mentioned, it's not always what you do. It's how you do Right. Same thing with what you eat. Even though you're eating some healthy stuff, if you're eating it in a stressful environment or if you're eating it really quickly, and you're drinking a soda with it, it influences how your body responds to it, which is fascinating. Combinations of different foods, will influence the bioavailability of it it's fascinating.

Erin: 47:14

Have you noticed how the brain reacts with a glucose spike? Like if you're eating something in the order, like you mentioned the order that you're eating something in the how that messes with your brain.

Ann: 47:25

Yeah. something you'll see like in the literature is glycemic index. So something like the higher, it's my understanding, the higher the number, the faster it turns to sugar, basically. now your brain is, is a big sugar hog. It consumes quite a bit because it's the operating system, but when it gets too much, then it just Circulates and, and it can cause insulin resistance and things like that. So we've got to be careful with the sugar intake, but, it's interesting. you mentioned like the gut brain connection and that, that is huge. And we're seeing more and more. I mean, I would say even in just Netflix and, things like that, you're seeing more and more about the gut brain connection, like 95 percent of serotonin is produced in your gut. So serotonin is one of those neurotransmitters that that affect mood, right? the problem with that is it doesn't cross the blood brain barrier unless it's combined with certain foods. So like tryptophan is a precursor to serotonin. So if you eat it, so chickpeas has tryptophan. So if you eat like chickpeas with like a carb, then it crosses the blood brain barrier easier. So protein with tryptophan and a carb and it'll cross the blood brain barrier, make you feel better.

John: 48:54

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 over time, there's an accumulative effect and then you have issues later on in life. So the sooner you take care of yourself, you keep moving. You put in the proper nutrition, you're getting sleep and hydration and all of these things, the better off you're going to be as you age. And I think that's the message that we're trying to get out there with our company, connecting power, connecting people with the resources, the information to make better decisions so that we're more comfortable and we can continue to live the life that we choose. Right?

Erin: 49:33

so no, I agree. Are there things that maybe we might've missed that we didn't ask you that you feel is very vital that our listeners here, like you guys need to know this. This is, or these are ways maybe to prep and be ready when you come and see someone like me.

Ann: 49:49

You guys were pretty thorough. You had some great questions. yeah, you, I think you did a great job. no, I don't think so. Yeah. I think you,

Erin: 49:59

any advice or anything to give out?

Ann: 50:03

don't be afraid to do your own research and don't be afraid to ask questions to your physician. So if their solution is just to add another medication, then it's okay to ask. Hey doc, is there anything else we could take off my medication list if you're going to add this? is there any other alternative? Because what we're finding too is like 80, I think I already mentioned it, like 80 percent of chronic diseases can be managed with lifestyle changes. So, people have been able to get off like their diabetes medication and their heart medication and their anxiety medication by altering their lifestyle. And I'm not saying do that, but, there, there are options like, under the direction of a qualified professional, you can do that and people have been able to make noticeable changes in 2 weeks.

Erin: 50:59

Wow.

Ann: 51:00

yeah.

John: 51:00

I love that. And I think that what people need to understand too, because sometimes I can get almost a little too intense on the changes that I'm trying to make to better my life. And it doesn't take a lot. You can do small changes, start with small, small changes to improve your life. And then be consistent with those small changes and see what happens, right? and I love what you just said, About, not necessarily just taking doctor's advice and taking another pharmaceutical because sometimes we can alter our nutrition. We can get a little bit more sleep. We can hydrate more and that a lot of that stuff is free. We don't have to pay for an expensive prescription, right? So, yeah, this has been fun. I love this topic. brain health to me is one of the most important things as we age. ever. it's, our bodies are going to atrophy, but our minds will too, unless we take care of them.

Erin: 51:56

Yeah.

Ann: 51:57

So it doesn't have to be that way is I think the message. Yeah.

Erin: 52:02

Would you like to ask the last

John: 52:04

Oh gosh. All right. Erin and I are passionate about travel and adventure. So we'd like to know, if there's a place that you've gone or that you want to go, that you're, You're excited about, or you look forward to, or someplace you recommend that our listeners, consider.

Ann: 52:21

Just one place.

John: 52:23

Oh, you can name a couple if you'd like. Yeah, no, we're totally interested.

Ann: 52:27

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 I turned 50 this year. So I think would be cool to kind of circle back there and, and experience the culture and learn more about it. that's at the top of my list. we sponsor several kids through compassion in different countries. So Thailand, Guatemala, Dominican Republic, things like that. I would love to visit kids. I would actually, I would all the 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 states. So that's a goal too. Where my husband and I are big foodies. So we think it's fun to find those local dives and what is a good reflection of the local culture. And the story behind it. We love hearing the stories behind food.

John: 53:30

I love that. I love that you're speaking our language because we're both. if we could just travel and learn about different cultures and try the different cuisines, and the people and hear the

Erin: 53:41

their culture, that's, that's

John: 53:44

living for us.

Ann: 53:45

Yeah.

John: 53:45

thanks for sharing that.

Erin: 53:47

and thank you for being on today. I think this was valuable for our listeners to know, ask those questions, the services provided, talk to your doctor, research who you want to visit,

John: 53:59

Yeah. And I'm excited because I didn't know there was a such thing as a neurologic, rehabilitation therapy that you can, get or you can ask for. So I think that our listeners that maybe are having some declining with their cognitive health that's affecting their abilities to move and do the things that they're passionate about, to know that. You and other providers have that skillset, I think is just awesome. so

Ann: 54:26

Yeah. Yeah. Oh, two more things one, don't be afraid to fail. Try new things. Don't be afraid to fail. and two is, learn something new. Give yourself an opportunity to learn something new. that's a great way to. To keep that process viable, keep your brain sharp is more doing something different that you are afraid to do.

John: 54:51

Jim Yeah, I know I keep referring to Jim quick and I think it's because the book was just such an amazing book, but it talks about as we get older to keep reading, to keep trying to learn new things. And one thing that I thought was a need that I didn't even think about was. Brush your teeth with the opposite hand, maybe eat with the opposite hand, start practicing doing things with the opposite side of your body that you normally don't do because it can help sharpen you. It gives your body that stimulation, that's needed for growth and sharpness. I love all this. I just eat

Erin: 55:28

eat it up. so thank you. He's getting ready to geek out now. for sure. Oh, but again.

Ann: 55:36

thanks for having me.

Erin: 55:37

Oh, it was a pleasure.

John: 55:39

Thank you for tuning in to another episode of Connect Empower. We want to express our gratitude to you for being part of our community, and we hope today's episode has provided you with valuable insights and inspiration to enhance your life and that of a loved one.

Erin: 55:54

We are more than just a podcast. We are a community dedicated to enhancing the lives of our aging adults and their support system. We encourage you to visit our website now at www. connect empower. com. Explore more information about our guests from today's episode and to access our free resources.

John: 56:15

resources. Our mission doesn't end at the conclusion of this episode. We invite you to take action now by sharing the knowledge you've gained today with someone who may benefit from it. Whether it's a family member, friend, or colleague, your influence can spark positive change.

Erin: 56:30

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John: 56:50

I'm John.

Erin: 56:51

I'm Erin. Until next Wednesday.