Stroke Survivor Bootcamp with Dr. Phil: "How to Improve After a Stroke"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, talks about what matters when you want to get change in your ability after a stroke, no matter how long it has been since you had your stroke.

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

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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. It feels so good to be back with family. I it's crazy when you are away for as long as I am when I go on these boot camp trips and I go to different states. Man, I miss being with my family. And so coming back and being with my family, it feels so good. And uh I actually am just about to leave again. Um this week I am getting to go to Los Angeles and I am going to be at the Abilities Expo. This is something that I've never been to, but I am excited to go and hopefully meet a lot of you and be able to help you see what it is that I bring and what high-intensity training can bring to you, and what uh a stroke boot camp can actually do to impact your life in a very positive way. Now, this week's episode, man, I'm so excited about this because I would say so far, out of everything, this is the one thing that matters more than anything that I've talked about. Specifically, what matters when you want to get change? Now, one of the things that is a pretty common thing that we hear in the stroke community is that after say six to twelve months, you are kind of where you're at. You hit a plateau and you're not gonna be able to get back to where you want to be, or you're not gonna get any better because you know what? It's just your new normal. And the thing that I continue to find is that there is nothing farther than the truth uh than that. And that is that you absolutely can change, even two years, three years, four years, you name it, it is possible for you to continue to make new connections and regain more performance and more ability than you even did in the first six to twelve months. However, that's not typically what happens. Typically, what happens is that you get introduced back into the world for the first six months, and there is a demand that you essentially rise to the occasion and you live at a particular level that is going to make it so that you can access life in a particular way. The issue comes in is that you go the route of what your brain really wants you to do, which is to go the path of least resistance. In many ways, this is what happens. And your brain is always trying to find the most efficient way to do something so it doesn't have to make new connections. It likes to go the pathway of old connections or well-used connections. And so, what that actually comes out to be is that uh after about six to twelve months, most people are kind of in the swing of things. They are, you know, they've pushed themselves to a certain level and they've gotten to a point where they are able to get around and they are getting help from others, but you know, it's how life actually is. And they kind of end up waiting to get to where they, you know, waiting until something else comes back and you know, hoping that they can increase their ability. Well, that is one of the things that I actually do, and what a stroke boot camp does is that I don't wait around. You don't have to. The evidence shows us that we don't have to wait, and what the evidence tells us is that it is possible for you to take charge of your own gains, your own recovery, and that really the only thing that is preventing you from gaining more ability, more mobility, more uh movement happens to be what you are doing in your life and how much demand you are putting on your body. Now, that is why you take a boot camp because I show you what you're capable of. I show you what is possible and I show you how to increase your own ability so that you don't have to ever experience a plateau. You just always have to be pushing and challenging your limits and your abilities. Now, as always, make sure that you are doing things, especially if they're new, you're doing them with your medical team, that being your physician, making sure you're getting approval from him or her, and make sure that you are also getting your therapist on online with you, making sure that they are supporting you and helping you, especially if it's new movement, especially if you're pushing yourself in, there's a potential danger that you really should have somebody there to help make it so that you don't get injured. Are you guys ready to learn about the most important thing in your recovery when you're trying to make new connections? Let's get going. So, in our last episode, we talked about what I call the the forge, or it's the the part of our analogy, you remember with the forest and with the axe, it's the piece that makes it so that the axe itself is sharper and that the the wood itself, you know, on the axe is stronger and that the metal is stronger. That way, you know, it takes less swings to cut down a tree. And that is the value of BDNF. And we talked about how you could essentially prime your body or flood your body with BDNF by doing aerobic intensity before you actually work on something like trying to get your arm back or trying to get your your movement back. The best is when you actually combine that your movement actually brings intensity because that ends up getting you more BDNF. Makes it so that you're you're actually um you know trying to make connections while your body is producing or making BDNF. Now, we talked about heating up that stubborn steel so that uh your brain itself is ready to make new connections. And honestly, your axe or the the the way that you are trying to cut down those trees in our analogy is is sharp enough that it takes less attempts and it is easier to do. Now, I'm sure those of you that listened to our last episode, um, you have been actually sitting there going, okay, well, how how much is my heart rate beating? Or how how um am I getting my heart rate up enough in order to have my body make that BDNF? And I've talked to some of you, and you guys have already gone to your therapist and said, Hey, I want to learn more about BDNF, and I want to flood my body with BDNF while we are doing our therapy. And I love that. That seriously is one of the coolest things. So please uh contact me, send me a send me a message. You can send it through the podcast app, or you can follow me uh on TikTok or Instagram at the OT Professor, um, or you can go to www.stroke survivorboot camp.com and you can send me a message through there. Now, with BDNF, um you know, you have we've figured out how to make the axe sharp. But here is the hard truth that today we have to face. That is a razor-sharp axe that you have resting against the the bark of a big oak tree that's in front of you is never actually going to cut it down. I know that's kind of a hot take. If you don't actually use the axe, then the axe isn't gonna do what it's designed to do, which is to cut down a tree. So, for decades in stroke rehab, us as therapists have told survivors, told you that you need to be careful, you need to go slow, you need to not learn a bad habit. You know, we told you to take it easy and don't push too hard. And the analogy of the tree, basically what we've done is we told you just tap the tree. Don't don't hit it very hard. And that way you can make a perfect cut line and you can cut the tree in a perfect way. You know, we kept therapy safe, slow, and meticulously careful. And because of that, honestly, as therapists, we have left a massive amount of recovery on the table. So think about it like this: if BDNF is the sharpness of the blade, then intensity is the swing. And we're talking about the actual like physical driving effort that's required to force your brain to rewire or to force yourself to use the axe to actually cut down the tree. Guys, I mean another way to say this is we're talking about why working up a sweat isn't just about fitness, but it can be about a strict neurological requirement for your brain to make new connections. Now, like I said before, I'm Dr. Phil, and this is Stroke Survivor Bootcamp. So, plant your feet and let's learn how to swing that axe nice and hard. So, to understand how to actually swing the axe, we have to define what intensity actually means. As therapists and also as individuals, we confuse putting in a lot of time as we are actually working in high intensity, but they're two completely different things. So let's kind of break down the mechanics of intensity itself. So, first is we look at this as the dose. So the dose is well, we'll take into the analogy of our of our um forest. The dose is the number of swings. Basically, you know, we talk about the dose, and you know, a word that we'll use is practice, right? We'll say practice, practice, practice. We'll ask how many steps you took or how many times you reach for a cup. And what we do understand and know is that the literature is very clear that higher doses will lead to better outcomes. That is if it is combined with what we define as intensity. Now intensity itself is essentially the effort that you're putting on your body. So how much your how much effort you are putting in to uh into your body. So the number of swings can contribute to that, but really dose is just the number of swings. Dose is the number of times that you try to make that connection. So if you take 1,000 kind of half-hearted swings at the tree, you'll end up really with not much of a cut in the tree, and maybe one or two trees you know being chopped down. Even though repetition is going to be necessary, repetition without power is really just going through the motions. So then we have to go to the second piece, which really is the power of the swing, and that is the physiological force that is behind the swing. So it's the the way your heart and your your nervous system demands movement when you are trying to use your body. Now, where I'm getting a lot of the information, you know, is through years and years of multiple uh multiple studies. However, in 2025, just recently, uh Dr. George Hornby and his colleagues put together an article that very nicely synthesized the last 20 plus years of evidence when it comes to intensity and and intensity's value. Now, um Dr. Hornby, you know, basically you know, just demonstrated or through what they what they uh had done through multiple studies and other uh scientific studies was that how hard you actually swing is what you know swing the axe or how much effort you're actually using your body or or putting your body through, that is intensity, and that it is the single most critical factor in regaining your ability to walk. So I'll repeat that. What we find in the literature is that the amount of effort that you are putting on your body when you are learning to walk is the most critical factor in regaining walking ability. Now that's going to be because you when you do that, your body increases BDNF, which sharpens the blade, but then also you are doing thousands of repetitions and you are being so specific and precise to where you are actually swinging your axe that you are cutting a specific path through the forest. One of the things, one of the things that I see quite frequently with individuals is that they're kind of like aimlessly working towards something. So they've heard the term intensity, but you know, the problem is they don't know how to guide the intensity. Now that's something that we'll talk about in later episodes, but I just I I want to make sure that I uh I put that in here uh just a little bit. Now, Hornby's team actually defines high intensity as working between 70% to potentially all the way up to 97% of your age-predicted heart rate max. Or if you know what heart rate reserve is, it's they say that it's working between 70% to 85% of your heart rate reserve. Basically, what this means is that your heart is pounding. This is oftentimes when you find yourself sweating and having a hard time to hold a conversation because you're breathing hard. Now, again, like I said, why does intensity matter? Really? It's because getting your heart rate up and pushing your your body in these ways is going to let's say it let's let's say it this way, it triggers a massive alarm bell in the nervous system and it signals the brain that the current way of doing things isn't working and that there is a need. Now I'm gonna repeat that there is a need, like there is something that is so like you have to have this type need that the brain needs to make a different connection. If you do not have intensity in it, then that alarm bell, that focus on doing something that is a uh like that that focus on your brain really making sure that it is going to put in the work to make that connection, that is not gonna happen if there is no intensity. So let's kind of put some things together. So why do we need to swing the axe so hard? Like, why is it that we have to actually put that effort in? Why can't we just tap the tree until it eventually falls? Why can't we just keep doing things with lower intensity and it not and it not have issues? So what the literature talks about is a concept in neuroscience that's called error-based learning. So when you increase your effort, chances of error is going to increase. That's scary. However, if we want to gain new connections, guys, this is a massive, massive piece of it. Now, let's think about your time in the clinic or time with your therapist. Have you have you ever been practicing a particular move or taking steps and your foot catches or you make a mistake and your therapist like stops you, pauses you, and says, wait. And they correct you, they teach you, they educate you, they put their hands on you, and they help you uh fix your form. You know, they say your form is breaking down, let's slow down and let's do it right. Uh, doing things right or do it normal, and you should practice doing something in normal. That's the thing that uh is very common and that I said for many, many years. And the reason is because what I believe is that if I had somebody practice a movement that was not normal, then what would happen is my brain would lock in those bad habits, and an error or doing something incorrectly terrified me. Now, there's a lot to unpack with that. Um, I mean, one of the things that is true is that you have to do so many repetitions of doing it exactly in that one way for that to become something that is just locked in and becomes habit. Now, I had been uh practicing as a therapist and using this type of an approach, low intensity, don't make mistakes, for oh, about five years before this particular study came out by Leach and her colleagues. Um, that basically was an article that focused on four ways that you can teach somebody how to learn to make new connections. Now, the thing is that, and I'm not gonna go into this a ton because I think that should be for later, later episodes, but I'm gonna touch on it just a little bit. And basically, what we started to learn is that your brain or our brain is gonna operate on a system or a strategy of prediction and error. So basically, your brain, it always is trying to predict what is going to happen next. And so if it believes that it can predict, then it will try to uh jump the gun or or move ahead of where you're currently walking or how you're currently walking, and um it ends up um it ends up making a you know a specific decision, and sometimes it makes a mistake. And you know, for example, you know, sometimes you know, we think that there's gonna be another tree right in front of us, and so without even thinking about it, we just take a step forward and start to swing. And instead, uh we miss, we miss the tree. Um and that gives us a particular set of feedback, right? And that feedback ends up being from sensory, uh, you know, throughout our body, and it goes all the way up to our brain, and then it the brain goes, Oh, I made a wrong prediction, and so then it makes a correction. Now, that is very big because that particular moment is where the brain goes, Ah, okay, I went down the wrong path, and now I need to maybe I need to kick your lip my leg harder, I need to lift my leg up higher, and it makes that correction, which by the way, increases the intensity. And so, really, what we want is to have this error, because in a lot of ways, error is the fuel for neuroplasticity or to start neuroplasticity to happen, those neurons trying to make those connections, and ultimately it's Going to send a signal to my cerebellum, which is a smaller part of your brain that deals with balance and coordination. And it's going to say, Hey, what we did just failed, and we need to rewrite this pathway immediately. So essentially, I swung the ax, and then immediately it says, Oh, hey, you missed. So you need to actually redirect or swing or take another step forward or swing in this direction in order to start cutting down another tree. So if you never swing hard enough to make a mistake, or if you never put in enough effort or intensity to make a mistake, and you only do slow, perfect movements with a lot of assistance, then just like what I said with that alarm bell, it never rings. Neuroplasticity doesn't really happen, at least automatically. And the brain's going to assume that everything is fine and it's not going to bother building a new pathway. Now, in the article, you know, Hornby and his colleagues in 2025, they found through multiple studies, multiple, that when you push survivors to a high enough level of intensity, even their form that was messy, it wasn't, you know, you know, I talked when I was talking about earlier, it wasn't normal movement pattern, that if you added intensity to it and and had variability, that due to the effort and the body trying to discover how to move again, the individual's abilities to move in a normal way actually got better than if you tried to do the same thing, you tried to work on movement in a lower intensity and using perfect practice. Ultimately, guys, in order to make a new connection, you have to have the force of the swing to make it so that change actually happens. You guys need to hit the wood hard enough so that you actually feel the vibration through your bones, and that vibration is basically telling your brain that you know what? Change is happening and it needs to keep happening, so do it again. Now, I can hear some of you guys listening to this and thinking, okay, but I'm I you know I am swinging the axe with everything I've got. And yet I don't feel like I'm changing. Now, one thing I want to point your your thoughts towards is that what you perceive or what you think is happening may be true, but also may not be true. You might actually not be swinging the the axe very hard, and you could be doing more. What we need to do is we need to make sure that we are monitoring our heart rate. So I love to use a continuous heart rate monitor that uh makes it so that I can tell at any moment the amount of effort you're putting in, if that actually is uh the amount of effort that you can give. If I see that it's low, if I see that your heart rate is low, then I am going to uh I'm going to push and I'm going to require that you do. Now, the other piece is that uh if you give more effort, you tend to actually be uh in a more precarious situation where you will likely fall or you'll likely make a mistake. Now, again, I said earlier that error is actually a positive. We love error. One of the things that I keep talking about with my survivors when I do a boot camp is that error is necessary. If we can gain a relationship with error, making mistake, and that it's a good thing, and that we do it in a controlled or safe environment, then we are where we need to be. But we want to make sure that we have error. But here's the thing: if you can't make that connection or you can't make that relationship and make it a positive thing, then you will never allow yourself to give enough effort to actually make the change that's necessary. So here's the thing: I'm not asking you to be reckless. The evidence isn't asking you to be reckless. Uh, basically, what I'm asking you to do is to uh participate in a controlled struggle, controlled effort. Now, in the clinic, this is the easiest place to do it because usually you have somebody who's skilled, and usually you have equipment that can help you when you make a mistake and you might fall. And this is where your therapist is to uh not hold the axe for you. Um for the most part, it's not to hold the axe for you, it is to actually guard you while you're swinging it. So what this might mean is that you have a uh body weight supported harness and you have some of your body weight that's lifted up, and or you're using a um you're using a body weight support system. Each one of those things is going to make it so that you can be safe as you try to do things so that when you miss a step and you're putting your effort in, you still are safe. Now, if you go to uh my my website, www.stroke survivorbootcamp.com, I actually have a DIY or do it yourself, uh homemade bodyweight support system that you can use over a treadmill. If you don't have to buy the treadmill, then you can do it for you can do your own bodyweight support system for uh I think it ends up being around $180, um, which is crazy cheap in comparison to what other people do and what the medical, you know, uh medical grade type stuff is. Um those end up being around like the $30,000. So if you can get one for yourself, um go to my website under the books, and you'll be able to find that out and get the instructions and get links to where you can um get access to to these and how you set up your own body weight support system that will allow you to do this safely. Now I've thought about thrown around, you know, how do I how do I describe or explain you know the where you actually want your heart rate to be? And I think a good way to look at it is we're gonna call it like the Goldilocks zone. Okay, it's the Goldilocks zone of intensity. Now, remember Goldilocks zone is that it's just right. And what I mean by just right isn't that it feels just right. That's not what I'm saying. What I'm saying is that it's in the zone between 75 to 97 percent of your age-predicted heart rate max. Now, I will go into all of that, and uh, if we do a boot camp, I help you figure that out. What is your age-predicted heart rate max? Now, if you go outside of the 97% on the higher end, you put yourself at a risk of having a um uh a medical issue, something like potentially um like a heart attack, or uh you basically make it so that you are um putting yourself at risk. The other thing is that if you the higher you go, the higher your heart rate goes, the quicker you are going to want to uh stop. And so the the goal is that you increase your intensity and you really stay between that 75 to maybe 90 percent um so that you can go longer. Because as long as you are in that 75 to 95 percent um anywhere in there, you're making the same amount of BDNF, as far as we know. The difference is, are you giving enough effort? And if you want to give more effort to try to make that connection, then you may want to make it so that your heart rate is a little bit higher. But you don't want to go outside of that 97%. You don't want to go higher because that actually can that's putting you in, say it's putting you in danger. Um, if you go on the opposite side, so the lower end, then what will happen is that your brain uh won't be making the BDNF, and your brain will go, you know what, you don't really truly want me to make this connection. You don't want me to make this new connection. So I'm not really gonna put in all the effort to make that connection. That is what you will find, or that is what will happen if you go on the low or moderate end of intensity. So that's anything below 75% of your age-predicted heart rate max or 70% of your heart rate reserve. Where you want to be in what we say it is the Golix zone is making sure that your heart rate is staying between that 75 to 95% of the heart rate max, and you want to get somewhere around an hour a day for five days. Okay, now it's not an hour straight. Um, however, I found that that is the most effective and efficient way to do it, but you want to essentially get up to an hour every every day. Now, the other part is that um, you know, you if you are failing a hundred percent of the time, like you're trying and you're failing and you're not able to do what you're trying to do, then what you're trying to get yourself to do is just too hard. And you need to simplify it a little bit more, or you need to get a little bit more support. And that's where having a boot camp or talking to a professional who understands how to actually implement high-intensity training, somebody's been trained by Dr. Phil, that's going to be that that will be something that we can address. If you are succeeding 100% of the time and you're not making any error, then what you are doing is too easy and likely are not in the target heart rate zone. It is possible that you are in the target heart rate zone, but likely you are not. We want you to essentially succeed about 70% of the time and make errors about 30% of the time. So when you're looking at all of this and you're you're thinking about how many errors you're making, really 70% of the time you want to be successful, and 30% of the time you want to be making errors. Now, the amount of intensity, so focusing on your heart rate, and then the amount of errors that's happening as you're trying, that you can think of that as like the uh brain is now being forced to make a new connection. And because you have the heart rate up and you have BDNF flowing through your body, you're prepared, and that pathway is going to be more likely to actually stick. So, really, as we think about today, um we've connected some dots. So, first things first, you increase your aerobic intensity in order to sharpen the axe before you start trying to chop down the trees. And then what you do is you step out in front of the trees and you start swinging the axe with intensity, with effort. And if you can combine those two together, then what's going to happen is your brain is going to make more connections. Now, the way that you do it and how you actually put all those pieces together, that is what I am here for. That is what a boot camp does. That is what I show you, that is what I teach you. I give you a template on how to actually do that. And then from there, you can be your own boss. But I do suggest that you set up a boot camp with Dr. Phil. You can go to www.stroke survivorbootcamp.com and send a request or a message, and we will start to get that set up. Now I want to talk about one individual. I'm going to talk about uh his name is Jesus. Now, Jesus is somebody that was in a bed. Um, I may have already talked about him in the past, but uh it's just so critical that if I already have, bear with me because um it this is a perfect example. Jesus was two-person assist to get out of bed. He required two people to walk him, and he they they could not get him to move his leg. So he needed to make new connections from his brain to his leg to get it so that it would actually move and swing forward. When I had gone there, he had been turned away by five outpatient clinics. Those five clinics said, You have plateaued and this is your new normal, so just get used to it. And luckily for him, his wife, his wife didn't agree. She saw what I was doing and she heard about what I was doing. She showed up at the hotel so that I could do an assessment. And as soon as I saw him, I took him upstairs. She's like, oh my gosh, nobody's taken him upstairs before. And I was like, Really? That was doable. I could do that. I mean, it was a lot of work, but it was doable. I proceeded to, you know, when I came to his his house for a boot camp, I worked with him for five days. I proceeded to put the focus on increasing amount of effort through walking. Essentially, I pushed to make sure that BDNF was being created and that the demand was enough that there were some errors. I built a do-it-yourself bodyweight support system, had him in that over a treadmill, and I had it to where there was enough that he was doing about 70% and making errors, 30%. I allowed him to make those corrections, and his brain decided to or actually started to make those new connections. In five days, he went from being told that he could not walk with anybody and he had no movement in his right leg, to where he was able to walk with his arm around his wife, and he could kick his leg forward and stand on it and move. And really, um, there was a little bit of uh neglect or inattention, most likely, that made it so that I could not really feel safe having him uh do it with a um with a hemi walker, but he could do it with somebody with his arm around somebody and he wasn't putting weight on them. He then walked into the clinic and showed them what he was able to do, and it it just it was an incredible experience. Jesus ended up through giving effort, was able to remake those connections, and then when I came back a few months later, worked with him for another week, guys, he hadn't lost anything. Those connections had stayed, and we were able to build on that and get more and more and more connection. When we left, he was able to walk with a Hemi Walker. Now remember when we go back to BDNF and how some people, I just want to put this, some people they have a genetic uh setup that makes it so that they are their their axes duller. So even if they give more effort, that still doesn't mean that they're going to make new connections. That's a part that's actually really hard is that sometimes people are giving so much effort, but yet they have a sharp or a dull axe, and trees just aren't cutting down as much. Those are the individuals that have to learn to love effort. So I'm gonna talk about this for a second. One thing that I I frequently share with people and I talk with people is that you have to learn to love being uncomfortable. Now that is n that is so true when it just comes to stroke survivors in general. If you want to improve, you want to make new connections, you want to get more mobility back, you have to actually be okay with being in a state of uncomfortable. Living in that state will eventually become normal. And then you have to find a new uncomfortable. And then as you live in that new uncomfortable, it becomes normal, and so on. Each one has higher stakes, each one has higher potential risk. As you continue, as you keep pushing, you can get more gains, but it does require you to live in that state. Those of you that have that genetic mutation that makes it so that BDNF isn't produced as much and it's harder, and so you're actually swinging a dull axe, you guys have to love it even more because you unfortunately you're going to most likely be in this process for longer. But the process is still the same. Get aerobic intensity, increase the demand on your body so your heart starts pumping more, and triggers your body uh to generate or to make the brain-derived neurotrophic factor that will at least start to sharpen your axe more than if you hadn't. Now that is really, really critical. Okay? Um the other piece that I want to talk about intensity in and of itself, um, you know, majority of people are going to quit when they have somewhere around like 40% uh left in the tank. Now that at that moment, your brain is going to scream at you. Your brain is going to scream saying, Stop, stop, you don't have enough, you you you you can't do any more. You need to stop, you need to stop, you need to stop. And I have proven time and time again that majority of the time, that's just the brain saying, Hey, we need more stuff for later, so um you can stop now, but instead of saying it that way, it screams and it tells you that you're dying, it tells you that you're you're putting too much effort in. And in a lot of cases, that actually isn't true. It's also why you do want, when you do this, you do want to have make sure that you have a clinic a clinician with you that knows what they're doing so that they can monitor and figure out if it truly is, you know, you should stop. Because sometimes it is. Now, the other piece is that mental state of living in the uncomfortable, but also living in the effort. Getting into that, you know, 40% of your energy and your effort, you still have that much left, but man, you've been working hard, that is really tough to live in. It's really tough to experience, and it is ridiculously hard. One thing that I always tell survivors when they come to a boot camp is that what you're about to do is the hardest thing you've ever done. And it's hard because your brain is going to scream at you and tell you that you need to stop. But the reality is, in many cases, you don't need to stop. I use a lot of different data and experience to identify whether or not you do need to stop. So sometimes I push people. I'll give another example. I had an individual who really wanted to learn to walk. That was his thing. He wanted to learn to walk more than anything. And so I was like, okay, are you sure? Because here's what needs to happen. You need to increase your heart rate, we need to get BDNF flowing, we need to put that demand, you need lots of repetitions. He's like, Yes, that's what I want to do. So I go, okay, let's go to the stairwell. So I take him to the stairwell and I start taking him up the stairs. Now he had hemiplegia in his left side, and it was really difficult for him. After five to seven steps, stairs, he started yelling at me, saying, Stop, I'm done, I'm tired, I can't do this, I'm done. But as I'm looking at his heart rate, his heart rate was still super low. And, you know. I mean I just was like, you just barely started. Like, we got this. So I kept pushing him and pushing him and pushing him. We ended up getting up and down a hundred and fourteen stairs in that time. Now, he was yelling at me time and time again and it loud enough that people from different floors were peeking their heads into the stairwell saying, Hey, what's going on? Are you okay? Do you need help? You know, and I was like, I'm fine, we're good. He's got it. And then at the end, when he started to um get to the last few steps, he stopped screaming, and all of a sudden he was I mean he was he was like limp. I was doing a lot of the work leading up to that. But at the end, it was like, ah, I got it. And he actually did the last few steps of it by himself. And I was like, really? What? Because he was he was saying he was so tired and he couldn't do anymore. But then as soon as he made the decision that he could, guess what he could do? He could do it. So I think that oftentimes it's a mental thing where we go, I can't, and so therefore it shows up in weakness or I feel tired or I can't do it. When the reality is you can do it, you just have to make that decision in so many times in so many situations. At the end, we're as wheeling him back to his room, he stops the wheelchair, he looks around at me, and he says, Thank you. Thank you for not stopping. Thank you for making me do it. I was like, I got you. Because I do. One thing that I do understand really well is how can I push somebody to the point where they end up able to continue past that I have 40% left and still get stuff back. I can tell you countless stories of myself, of others. Uh in fact, I I'll tell you this last one. I was running rim to rim to rim of the Grand Canyon. It's 44 miles and it has 10,000 plus feet elevation gain over that entire run. And I was I was going and I had made it all the way back and I had literally one mile left. I had been running for 14 or 13 and a half hours. And as I'm going, man, my my brain is telling me I can't do it anymore. I'm so tired. I need to sit down. I need to I need to stop. And I I sat there and I and I I gave in a little and I stopped. And then I was like, you know what? Keep going. My mental, I made the decision, keep going. Well, guess what? All of a sudden there's energy. I keep going, keep going, keep going. It took me about an hour to get up that last part, that last mile. But I was able to do it. Even though I had told myself my brain was screaming, saying, you need to be done, you need to stop, you need to rest. And then guess what I proceeded to do? I proceeded to drive home. Where then I stayed up late that night. I mean, I was dead. I was so tired. Because I had ran all night. And I proceeded to stay up with my family. And guys, so much of what we do or what we are capable of has to come down to a decision that we make to at least get going in that direction. And our body's gonna have to have to have something, somebody skilled, somebody, you know, especially with a stroke, somebody who knows how to get that part of your brain to automatically make that movement. That is necessary. And that's why you get a boot camp. That's why you get and work with somebody who's been trained by Dr. Phil. We are more powerful than we actually know. So to close this episode, here is your actionable takeaway for the week. I want you to change how you talk about your effort. So, in your next therapy session, your next workout, your next whatever it is that's gonna require you to put in effort. When your therapist asks you how you're doing, what I want you to do is I want you to say don't just say like I'm okay or I can do this. I want you to start to actually give yourself like a rating. Now, what it's called is a Borg scale of perceived exertion. But basically, zero to ten, we'll we'll do that. Ten is the hardest you've ever worked, and you can't work any harder, and zero is rest. And if you give them a number, that will be at least one way that you can start talking about the effort that you're giving. And then the second thing that I want you to do, that I want you to change about how you talk about your effort, is that I want you to say it in a way that is focusing on um recognizing that you have more in the tank. So when you have that part in your brain that says, you need to stop, you need to stop, you can't do this, this is too hard, whatever, I want you to start saying to yourself, yes, it is hard. But I'm gonna do more. Not I can, but I'm doing more. Make the decision before you get there. Because that is when the decision will be carried out. So, guys, when you talk to your therapists, when you talk to the people the the your loved ones, guys, you can take control of making sure that you have a sharper axe by increasing your heart rate and getting BDNF to be built into your system, and then give more effort while doing what it is that you want to get better at. If you need support because you're afraid of falling, then go to my website www.stroke survivorbootcamp.com, go to book series, and you can find a uh document for um building your own body weight support system. I have links, I have the exact stuff. All you need to do is just get the stuff, and then you can have it built for you, and then you can start doing sessions on your own and be safe. And you can do that at home. You don't need to wait, you can do it at home. Now you will feel two things after you actually experience true intensity. And most people have not experienced actual intensity until they work with me. You will feel actual fitness actual exhaustion. And then what you will feel is satisfaction. Satisfaction for the work that you just did and that you just put in to getting yourself where you need to be. You can you can be done knowing that you cut down that you cut down enough of these trees to start to have a pathway that will stay a pathway. And remember that you can get your heart rate up and get BDNF in, but if you're not directing where you're swinging the axe, you're not gonna make the pathways that you actually want. So, make sure that the direction that you're swinging your axe is in the direction that actually gets you real change. Guys, thanks for being with me. You are powerful, you have the ability to make new connections no matter where you're at in your recovery. And just remember, you have to have intensity, and you can do it one step at a time. I'm Dr. Phil, and this is Stroke Survivor Bootcamp.

SPEAKER_02 52:52

Breathe in, count it out, every scar is around. Every step is still step too.