Stroke Survivor Bootcamp with Dr. Phil: "Brain-Derived Neurotrophic Factor (BDNF)"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, talks about the importance of Brain-Derived Neurotrophic Factor (BDNF) when it comes to stroke recovery.

NOTE: Be sure to check out some of the helpful worksheets that can be accessed by clicking here, or by going to www.StrokeSurvivorBootcamp.com.

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Hosted by Dr. Philip Lamoreaux, OTD, OTR/L, CPT, Stroke Survivor Bootcamp is a practical, hope-forward podcast for stroke survivors and caregivers, built to help you understand what’s happening, ask the right questions, and take back control one step at a time. Each episode blends real-world hospital and rehab guidance with clear, compassionate coaching so you can turn fear into a plan and progress into momentum.

For more information on signing up for a one-on-one Stroke Survivor Bootcamp session with Dr. Phil, just go to www.StrokeSurvivorBootcamp.com

Created & Produced by Christopher Ewing
Hang On to the Dream Foundation

Written by Dr. Philip Lamoreaux, OTD, OTR/L, CPT

Listen each week to the Stroke Survivor Bootcamp podcast with Dr. Phil, the OT Professor, where he will share with you practical tools, real stories, and the mindset to keep moving forward on your road to recovery! 

If you are a stroke survivor, sign up for one of Dr. Phil's Stroke Survivor Bootcamp sessions.  These sessions are proven to help stroke survivors regain more mobility following a stroke.  Just go to www.strokesurvivorbootcamp.com for more information.

If you are a stroke survivor, sign up for one of Dr. Phil's Stroke Survivor Bootcamp sessions.  These sessions are proven to help stroke survivors regain more mobility following a stroke.  Just go to www.strokesurvivorbootcamp.com for more information.

Transcript

SPEAKER_01 0:00

The comments expressed in this program are the personal opinions of the participants and not meant to diagnose or treat any medical condition that you may have. Please consult your doctor or healthcare professional before making any changes to your current medical routine. And I am getting together today from the video. So what has been really cool for me, especially this boot camp, is to see how an individual continues to improve even after having a boot camp experience. And that's partially because one of the principles that I'm going to talk to you about today. Today, we're going to be talking about what I call the oil to your nervous system. Now, if you think about oil and what its job is in a car, its job is to make it so that the engine runs smoothly and efficiently and effectively. So if we take that same principle and we apply it to your nervous system, now remember your nervous system is the system that takes the signals from your brain and helps it travel to your body down to your muscles so that your muscles respond, that they they contract, they move, and then sends it back. That system is your nervous system. And the oil, if we talk, you know, if we use that same analogy in our nervous system, it would make it so that the signals travel easier and so that the actual system is healthier. So brain-derived neurotrophic factor is the oil to our nervous system that I'm going to be talking about today. And it does a lot of different things, and we'll be getting into that in just a minute. But before we get into that, I just want to remind everybody that I am available for boot camps and I have multiple different ways that I can work with you. And so if you go to www.stroke survivorbootcamp.com, you can find all the different ways that you can connect with me or ask for help or get a one-on-one type boot camp, like I'm doing right now with this individual in Vermont. Okay, so in our last episode, we talked about what I call the legend of the inner workings, basically how your body can make new connections. Because if you remember, when you have a stroke, and it depends on where it is, somewhere along the line of the pathway where your brain is trying to talk to your body, it gets interrupted, it gets it gets broken. And so you need to figure out a way how to make a new connection. And we talked about how hard of a process that actually is. You know, needing to carve out new paths. It's often like you're going and walking through a dense tangled forest that uh you have to use an axe and you have to chop everything down, it requires doing a lot of work. And you know, every single person that goes through this process, they experience the struggle that comes from trying to make these new connections. And many of you, instead of sitting and sitting back and waiting, you are trying to like hit it head on, you're trying to attack it and trying to make these new connections. But what I want to talk about today is that it's if it could feel easier and it could be easier than what you are currently doing. So even though you're swinging your axe with all your might and you're trying to clear a path through the forest, you know, really you're trying to clear a path so that your your hand can grasp a cup again, or so that your leg can clear the floor without your toe getting getting stuck on the on the uh the wood or the carpet. And you are using a blade on the axe that feels really dull. It feels like sometimes it even feels like the metal itself is super soft, like you're trying to chop a solid oak tree with a blade made of plastic. And oftentimes you leave the clinic totally exhausted, feeling like you're finding a wall of solid wood, and it may even feel like brick at this point, with a tool that just isn't really up to the task. And so, really, today what I want to tell you is that your body has a built-in biological strategy to change the actual metal of that blade and to change the sharpness of it. And I mentioned it before, but today we're talking about BDNF, which is brain-derived neurotrophic factor. Now, guys, there's gonna be a quiz on this later, so remember brain-derived neurotrophic factor. But in the world of high-level neuroscience, it's really known as an important molecule that's responsible for starting or igniting growth with the actual nervous system cells. So it basically makes it so that, or at least it's associated with your cells that are your nervous system cells, it helps them grow, which is a good thing because growth of the nervous system or the cells is a way that your body can make more connections. And basically, it is an important piece of neuroplasticity that is actually linked or is associated with better functional outcomes after stroke. But when we come back to you know our analogy of the forest, what we're gonna call it instead of BDNF is we're gonna call it the metal changer. So think of it as it is the thing that changes the axe that you are using to swing. So without it, you're gonna be swinging a weak blunt tool. And with it, you're gonna be using a steel that is sharp. And you're going to make it so that the the steel itself cuts through that wood so much easier, and it's going to take less swings. Now, what we're also going to discuss is that some people kind of have a uh stubborn type steel in their blade, or uh the the blade has a harder time getting sharper, and that is just based on their genetics. But most importantly, the thing that you need to understand is that it's still possible to change that blade if you use BDNF or if you implement BDNF. Okay. So to understand how to change the metal of your axe, we have to look really dive into the biology of the brain environment. So oftentimes we think of stroke recovery as just putting in the reps or waiting for my brain to heal. You know, maybe I do this arm movement a hundred times or I shift my weight or I take you know 50 steps. But the quality of steel actually is going to determine how much each rep actually matters. So let's let's start off by looking at the ways BDNF actually changes your metal. Okay. So after a stroke, the brain is in a very fragile and vulnerable state. You guys understand this. Now, trying to learn a new skill with a damaged network of neurons is trying to is like trying to cut through, you know, um a trunk of a tree with like a uh brittle cracked axe. So if the metal is weak, the the tool might snap under the pressure of the work. And this is where BDNF first steps in. So what we understand about BDNF so far is that it acts as what we call a neuroprotectant. Basically, it promotes the survival of the neurons that you have and it protects them from getting worse, or or uh the the word that they use in the in the research is degrade. So basically it can break down, or our nerve neurons can break down. And in our analogy that we're using, BDNF is the the process of making it so that our axe, or you know, axe being the neurons and their connections, it makes it so that it stays intact and it's strong. So think of it as like it it really truly strengthens the not just the metal itself, but the handle as well. So that as you swing, the axe isn't going to break. And so if we think about that now from the concept of our neurons, BDNF strengthens our neurons. It's it's kind of like here's a here's another way to think of it. BDNF acts like you acts like uh weights when you're trying to strengthen your muscles. The more you lift and you know lift weights, and the stronger the weights, the stronger your muscles become. The more BDNF plays a part or is is used in our body, the stronger our neurons become. And remember, our neurons is like the highway from our brain to the rest of our body. So it could be that if we use BDNF, we are no longer traveling along a road that has potholes and cracks and and has all these has all these uh um barriers on it. It actually smoothed out the road and it makes it easier to drive on. So BDNF plays that kind of a role. And I think that one is so important to understand is that BDNF isn't just it's not just gonna, you know, it's not just gonna, you know, make it so that the signals, you know, are, you know, or like a new road is made. It actually takes the road and it paves it out and it makes it easier. So the second thing that I want to talk about with BDNF and what it does is if we think about it in in regards to our analogy, it actually is going to increase the sharpness of your axe. So when you try to relearn a movement, what happens is your brain cells need to form a connection that actually sticks. Like the the brain cells think of it as like their their fingers that are trying to touch, and as soon as those fingers touch, there's something that needs to make it so that it sticks together, so that when they actually wire together or they come together, the brain goes, Ah, there's another road, there's another pathway, and that's the one that I want to do. Now, when they wire together, it's there's a there's a word in in neuroscience that is called long-term potentiation. Okay, I I probably just lost half of you there. Don't worry about long term, you know, that that word. But basically, what this is saying is that it makes it so that the connection will stick and that the pathway will stay much easier and much longer. They basically what they do is is it underlies or it supports the connections that are being made. So it makes us those connections stay longer. So let's go back to our forest. This is the ability that your blade has to hold a sharp edge. So if the blade is sharp, you know, just like with anything, like with knives, with axes, with anything, the more you use it, the duller the blade gets. So this kind of happens in our nervous system. The more we use our nervous system, the harder it is for a signal to make that connection. And kind that's kind of just age. That's kind of just as we get older, it starts to break down. However, this is the cool part. BDNF helps so that the pathway, the highway, doesn't break down as easily and it keeps it stronger. And so, you know, just like you know, you're swinging an axe, you know, BDNF is gonna change the metal so that it's hard enough to keep it so that your axe holds a razor-sharp edge. And what this does is it ensures that when you do a repetition, when you do something again and again, you actually make a clean, permanent cut that actually stays there. And it stays cut. And if we take that to you know, that same analogy to reality, what it does is that when those neurons are trying to find each other and trying to find another pathway around the part that's damaged in our brain, what happens is it makes it so that when they finally make that connection, it stays longer. And so it it makes it so that you can actually have that connection stay, and that it's way more efficient and effective when it comes to when it comes to making new pathways and learning new things. So it's like you it doesn't take as long to learn something because the connection was made faster. Now I do want to talk to a specific group of you out there, and if you know when you look around the clinic and you felt like the person next to you was recovering much faster, even though you're working twice as hard. I want to talk to you because part of it, it it's not your fault, it's not your effort that you're giving, it's not your effort's fault. Um, in our analogy, it might be the actual steel. So not everyone actually starts with the same type of metal, and the literature actually shows that uh realistically, about 30 to 50 percent of the population can carries a specific gene that um it's not very good. It makes it so that recovery and rebuilding is harder, it makes it so that making your pathways or your connections from your brain to your body is a lot more difficult. And if your brain has this type of genetic, we'll call it a variant, your brain is gonna be a little bit more stingy with its BD and F, meaning that your axe blade is made of a much more stubborn kind of uh industrial grade metal, and it takes a much hotter fire, more intensity to actually change the metal and actually get it sharp. So if you've ever felt like your progress is slower than others, it's likely going to be that you're using an axe that has a much harder time to get sharp. So I want you to hear this part really, really just loud and clear. Having stubborn steel or having neurons that have a harder time making connections doesn't mean that you can't clear a path in your forest or that you can't make new connections. What it means is you actually need a hotter forge. You think about a forge, a forge is where iron and steel and metal is heated up to a hot temperature, and then the blacksmith works on it and pounds it out so that it can actually adjust and change? You just may need a forge that has more heat. So you have to be smarter about how you actually prep your brain before you're doing the work, which is going to bring us to what I feel is one of the most important parts of today's episode. So, how do we actually fire up the forge? How do we actually fire up so that our brain it makes it so that the it makes it so that BDNF starts to flood our system and actually start to try and change the metal, change the way that our neurons are connecting and talking to each other. And to do it when we actually want it. So, how do we actually get it to when we're practicing walking or reaching or speaking? And how do we make it so that the brain is primed to lock those pathways in? And you know, there's a lot of different ways that the research talks about this. Um, in this particular study that I am citing, uh Ashcroft 2022, uh, they call it aerobic priming. Now, there's there's a couple of different things with this. Um, we're still trying to understand the research. However, this is something that I think is important enough to talk about. And guys, this is the aha moment. Okay, so please play pay close attention. So, this particular study looked exactly at how could we fire up the forge? How could we make it so that BDNF floods our system? And what they did was they examined the actual effect of exercise on BDNF in stroke survivors. And what they found, again, this is the important piece, what they found is that high intensity aerobic exercise can actively increase increase the BDNF and making it so that there's a higher concentration of brain derived neurotrophic factor. So, guys, I'm not going to get into the numbers because it's not going to make a lot of sense. I mean, it's it's but basically what we need to understand is that the numbers are are pretty incredible and that the researchers found significant improvements in BDNF concentration following just one session of exercise. Just one. And if somebody follows a program of high-intensity aerobic exercise, it increases even more. And so having a consistent high-intensity exercise or high intensity aerobic exercise plan and doing it every day can make it so that you have a higher level of BDNF in your body. So you know what that tells me, guys? What that tells me is that you have power. If I mean think about this. If I knew without a doubt, that if I got up at 5 a.m. every day and I ran two miles, let's just say. Every day and I ran two miles. And I knew that at the end of that, at the end of that run, I can make fifty thousand dollars. Would I do that? Oh, you better believe it. You better believe that I'm getting up and I'm running those two miles every day rain or rain or shine. Because if it's something that is like I can have control over, especially if I've had a stroke, especially because you've had a stroke, what this does is it allows for you to have control over your direction. It gives you control. It's not just a waiting game, it's not just a, well, you know, this is a marathon, and I'll be able, you know, we'll just wait and see what happens. We'll wait and see how I improve, we'll wait and see how my body recovers. No, it's it is something that you don't have to wait and see. It's actually something that you can control now. How cool is that? So if you think about your current therapy routine, just for a second, think about what you're doing. If you go into the clinic and you immediately do your hard work, like the grasping, the fine motor skills, the balance, the walking, and then you know, you get put on a stationary bike for 10 minutes to cool down. It's almost like you're doing it backwards. Now, one of the things that they do say is that you can flood your system with BDNF by just getting aerobic exercise. So you could, if your heart rate goes up high enough, you could get on a stationary bike and you could increase your heart rate enough that your body starts to pump itself with BDNF. And then now that you have BDNF in your in your body, then you go and you work on your grasping, fine motor skills, balance walking. Because you now have flooded your system with BDNF, now what's happened is you've allowed yourself to have a sharper axe when you're trying to cut down the forest, right? When you're trying to make new connections. So let me just go back to an analogy real quick, you know, with that, you know, with that process where you go in, you work with you work with you know your therapist very quickly, and then at the end you do a you know stationary body for 10 minutes. That's kind of like spending an hour chopping wood with a soft tin axe and then putting the axe in the forge after you're done for the day. So you're doing the hardest neurological work when you're when when your axis stopped or when your neurons they're they're they don't have the oil to make it so that the connection is easier. And so what science is starting to tell us is that we need to flip the script, we need to change that that that process. So do high-intensity aerobic exercise first. By doing that, what you are doing is firing up the forge, you're firing up your body so that it's getting the the axe is sharper or that the neurons are are easier to talk to each other. Because aerobic exercise is actually going to help in motor learning and relearning because it is mediated by neuroplasticity. So basically, aerobic exercise is going to impact your body's ability to make new connections. So flood your brain with BDNF. Change the metal of your axe blade right before you take your first swing. So when you really move immediately from that bike or that treadmill to your fine motor tasks, what you are doing is you are swinging a much sharper, stronger axe because the BDNF levels are at their absolute peak. And what you'll find is that the same amount of effort actually gets you farther and gets you new connections that stay around longer. Because what you've done is, you know, in our analogy, you've you're using the right metal and it's sharp. But you know, when we think about our brain, it's that you are increasing the neural connections or making it so that the connections can talk to each other much, much easier.

SPEAKER_00 28:46

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SPEAKER_01 30:06

Okay, so I can hear some of you um in my in my head saying, Dr. Phil, I had a stroke, and you want me to do high intensity exercise? So let me kinda let me kind of address that for a minute. Please don't let the word intensity scare you. And especially high intensity. Guys, high intensity is specific to your own body, your age, and your own current capabilities. Basically, it's about reaching a particular percentage of how high or how safe it is to put your heart. So to get your heart beats. So what we call is the your heart rate max. Every person has a maximum heart rate based on their age. And what you need to do is to essentially get your heart rate up to a particular percentage in order for it to be considered intensity or high intensity. So it's not length, it's not time. It's how much can you get your how fast can you get your heart rate while doing effort. Now, for some of you, that actually might be uh like sit to stance. It's very possible. Some of you, it might be just taking slow steps. For some of you, it may require you to jog. For some of you, it may even require you to jog while pulling 110 pounds. It just depends. Depends on your body, it depends on you. But the only way you know for sure is if you have a heart rate monitor on. And if you monitor your heart, then you know whether or not you are doing intensity or high enough intensity. Now remember, the goal isn't to run a marathon, the goal is simply to get the forge hot enough so that BDNF is actually released. Now, here's kind of my my pro tip. This is a non-negotiable for those of you that have that genetic variant that makes it so that it's harder for you to make those connections. And the reason is because your metal is so much harder to change and sharpen that you absolutely need to have the heat of the forge more than anyone. You need to make it so that that you need to make it so that it is so much easier to connect or not connect, you need to make it so that it's so much easier for your axe blade to get sharper, or you know, when we talk about your neurons, make it so that your neurons get stronger and so that they remember the connections that have been made. If you don't have that, if you don't get BDNF in your body and you don't prioritize aerobic intensity, basically it's what's going to happen is you're gonna keep swinging a soft blade. You're gonna you're gonna keep trying to chop down a tree and it's gonna keep looking like you sh you aren't progressing anywhere. So aerobic intensity is so, so, so critical. So if you're wondering why you haven't made much change, this could be one of those reasons. So heat it up first, or in other words, do aerobic intensity and flood your body with BDNF before you really try and make any new connections. That is going to maximize or make it so that your ability to change improves tremendously. Now, guys, we have we've talked about a lot. Like this, this may this this particular episode may feel like it was a you know a lot of information. You know, we basically have moved from you know the rules of the trail to the actual biological metal changer that makes it so those rules actually work, right? We talked about the rules when it comes to neuroplasticity a few episodes ago, I believe in episode five. And those those principles are still true. So if you don't remember those, go back to episode five, listen to those with this new understanding of BDNF, and that if you do BDNF or get BDNF in your body and you follow those neuroplastic principles, you can make change happen. No question. So let's take a second and summarize uh the the map that that we really drew today, the the journey that we went on. BDNF is the metal changer. So BDNF it doesn't just sharpen the edge. What it does is it actually makes the steel harder. It makes it so that the metal of your axis harder. It makes it so that the ability for your neurons, those individual cells that send an electrical signal from one end of the cell travels down, and it exits the and the other end of the cell into another neuron, and it keeps doing that same pattern until it gets to its destination, it makes it so that those cells are stronger and that they last longer. So think of it as BDNF makes it so that the road from your brain to your body doesn't have as many potholes. It makes it smoother, it makes it so that the connection wants to go down that highway. The second thing is that exercise is the forge. Exercise is the place where you can go and your axe can get sharpened. It's exercise, guys. And you know, oftentimes when we hear the word exercise, there's many of us that you know put our fingers up in a cross and go, no, no, I don't, I don't exercise is a bad word almost. Well, I'm here to tell you that when it comes to your ability to regain your life and to regain your movement, I'm sorry. Exercise is the best way, as far as we know in the literature. As far as we know in science, exercise is the best way. And what exercise does is it essentially makes it so that the brain triggers the making of what we would, you know, in our analogy, it triggers the the making it so that the metal itself gets sharper and it's stronger, so that every single time when you swing that axe, when you try and cut down that tree, the metal doesn't get duller. Exercise is the key. It actively increases BDNF levels. And then what you really want to know is you want to make sure that your timing or you know the timing is is at the point where you don't waste the efforts that you're giving. So if you want to actually maximize the efforts that you give, you want to do exercise before. Essentially, you want to flood your body with BDNF so that when you put in the effort to try and make those connections with your hand, to make those connections with your arm, your leg, anything, your speech even, exercise and getting BDNF in your body will make it so that it happens easier. Now, I I'm don't hear me incorrectly and come back and say, hey, I did exercise and it still was really hard. Well, of course it's going to be hard. Anytime that you want to make a connection from your brain to your body, it's going to suck. It's going to be difficult. But what I'm trying to help you guys understand is that you do not need to have it be as hard as you are currently making it. Or as your therapists are currently making it. It doesn't have to be that hard. It can be easier. Or would you rather have to go through something fifty times? I mean, I don't know about you, but I'd rather do the fifty times. Because what that means is that I can get back to life quicker. I can get back to being me quicker. I can start having goals quicker. And guys, the stroke took so much from you. It took your identity, it took your your your joy, it took so many things from you. So why make it take longer to get it back? BDNF is one of the most important keys for you to get movement back. So one of the things that I I like to do, you know, at the end of an episode, you know, we we have been going for for 40 minutes now. One of the things that I would love to do at the end of an episode is I'd love to share a particular story. Now, I want to share a story of um Serena. Now, Serena, you are probably listening to this. You are awesome, and someday you guys are gonna get to hear Serena's story. But I want to share a little bit about Serena and specifically uh when she did a boot camp. Now, Serena flew to me from Canada and flew to southern Utah, where where I live, and we did uh a three-day boot camp. Serena came to me with a she had a cane. Now she was walking, she hyperextended her knee when she walked, and she was walking relatively slowly, and she was willing to do whatever it was that I asked her. Um now for Serena, getting her heart rate up was actually relatively simple, and so what we were able to do is we were able to start getting her heart rate up right off the bat. Soon as we started challenging her walking, whether that was putting a weight on her ankle, her weak leg, putting, you know, having her uh step up onto like a curb and off the curb, having her go up and down stairs, having her increase her speed by pulling or dragging something, walking in sand that was really hard because it, you know, sand is one of the hardest things for somebody to walk in. Whenever we started to do something, her heart rate would go up into that level that was needed in order to make it so that her body could create this BDNF. Okay, so we spent about two hours in the morning and two hours in the afternoon. And what we would do is we would try to get as much time where her body was making BDNF. And we would usually get somewhere around an Hour an hour where her body was making BDNF. And then what we would do is focus on some aspect of getting better. So whether that was getting it so that she could kick her leg better, making it so that she could walk faster, helping her balance improve. Any one of those things we would work on. And one of the things that was really cool was seeing how over the course of three days, even though she was getting more tired, she was sore, she was getting better. So the main thing that we did focus on was her balance. And she went from being a fall risk and using a cane to walk around to at the end of three days ditching her cane. Because she didn't need it. Her balance score proved that she was no longer a fall risk. She had been working with somebody, with therapy, a personal trainer, for a while before me. And because of what I talked about today with BDNF, when we started working, when we challenged these things, her nervous system was primed and wanting to make new connections. So essentially what I did was I took Serena, took her axe that she was using to chop down the forest in her mind. Made it so that it was sharper, it was a harder metal, and made it so that she had a particular pathway that she was she was chopping down. And because that got zoned in and it got focused, hyper focused on, Serena made a change in just three days. Guys, there's there are s there are some individuals, there are some people. And I would say it's it's a it's a higher number, but there's some people that really what they just need is to be shown how to do this, and then they just run with it. Since then, and it's been about a year. Actually, it's been exactly a year. Man, it was a year ago, like just this last this week that I was working with Serena. I think today was the last day, you know, that I worked with Serena. She uh has uh gotten to the point where now she walks everywhere without her cane. She goes on hikes like she loved doing before, which she wasn't doing before the boot camp. She goes out with friends without worrying about okay, well, what if there's stairs? What if what if it's it's uneven? Like she doesn't worry about those things anymore. And part of that is because of the skills that she learned in the boot camp, and that those connections that were made from her brain to her body, they were connected they they stayed. They stayed connected. Guys, there's one thing that you can learn from me out of all the things that you that you know when you listen, BDNF. As we know right now, at least, and guys, science is always changing, but right now, if you are not focusing on increasing BDNF levels in your body through aerobic intensive movement, you are missing out on making your rebuilding process easier. In fact, you're making it harder. So there's always one thing that I want everybody to recognize. I want everybody to recognize that everything that I say through these podcasts is in an attempt to help you in your recovery so that you can be an advocate and so that you don't have to just trust what a therapist is telling you. And you can guide your therapy. Okay? This is it's it's one of those things where you can go to your therapist and you can say, Hey, I've been learning about BDNF and its uh effect or its impact on uh on our ability to make new connections. And I would like to I would like to uh uh incorporate that into our therapy sessions. I will tell you this, if your therapist says no or that they don't know how to do that, you have a couple options. One is send them my way. I would be more than happy to teach them about how to do this. In fact, we could just do a boot camp with you and them. I've done that so many times. Second is get away from that therapist. They are wasting your time. If they are unwilling to adapt and to progress with evidence that can make your journey easier and make your connections stronger, make your efforts more worthwhile. If they're not willing to do that, run. Find a different therapist. I don't care if you like that person a ton. I don't care if they're an amazing individual. It is a waste of your time. And I don't mean that to be rude or anything, but I do that in a way to help protect. Okay. So here's a strategy, here's something that you can say. You can use you can use some version of this. I've been learning about the effect of BDNF on neuroplasticity or the brain's ability to make connections new connections. Can we try doing 15 to 20 minutes of higher intensity cardio at the very start of our session? I want I want my body to start making BDNF before we practice what you have planned. And like I said, if the therapist is good and is willing to implement new and and upcoming evidence, they'll say, Oh yeah. And they'll look at it and go that you though they'll they'll be proud of the fact that you're taking ownership of your recovery. You're rebuilding. And if not, like I said, find somebody else. Guys, when you have a stroke, it's like you just got placed in front of a forest, and you have to chop down trees in order to make those connections. To make those pathways again. Guys, the brush is dense, the trees are thick, and the journey is gonna be hard. It's gonna be harder if you don't have a blade that is sharp and has a very strong metal. So here's my challenge to you. Get your heart rate up. Of course, once you have your your doctor's approval to do so, guys, that's actually really important. You have to have a doctor's approval before you get your heart rate up. Because there's always something that can happen. It is possible that you can have a negative reaction. Your heart may not be able to take it. So make sure you get your doctor's your doctor's approval first. But once you do, get your heart rate up, start flooding your body with BDNF, increase the neuro connections, and start making that pathway through the forest easier. Start making those connections last longer and easier. And guys, that's it for today. And remember, it just takes one step at a time. I'm Dr. Phil, and this is Stroke Survivor Bootcamp.

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Breathe in. Count it out. Every scar is around.

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Every still standing.