Stroke Survivor Bootcamp with Dr. Phil: "How to Get the Most from Physical Therapy"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, talks about how to get the most from your physical therapy sessions.

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_02 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 here on Stroke Survivor Book Camp, we go over really the things that are required to get change as a stroke survivor and how you can move yourself in the direction that you want to go and get to a place where you feel like you are in control of your life and that you can actually enjoy where you're going and have a plan on how you can get to where you want to go. And today I'm excited because we are going to be breaking down the difference between two concepts that I really, really love to talk about, and that is capacity and performance and why rehab gains have to actually show up in real life in order for what you're doing to really matter. And we're gonna also discuss what you can do right now as a way to close the gap from what you are gaining or what you're working on or doing in rehab, and how you can actually see it start to show up in your life every day. If you're new here, here's what you need to know. Everything in this space is designed specifically to be grounded in real clinical practice, real life, and the evidence. Because the goal of this podcast is to really just show you the things that will actually move the needle and help you get to the point where you are taking control of your recovery and getting back to the person that you would like to be, and really developing a new relationship with the you after a stroke. And today's topic truly is one of the most important ideas in all of neuro rehab. And it's honestly one that really doesn't get talked about nearly enough. And so as we go through today's episode, there's a question that I want you to be thinking about and and listening to see what the answer is, and that is what if someone gets better in the clinic, but they still don't get their life back? So in the clinic, you're working with you know as as a as a survivor or the loved one of a survivor, you know, your survivor is going through a lot of things in the clinic. They're working on movement and trying to regain their movement and to try and regain their life, and it's a it's a lot. And oftentimes we see some really cool gains, you know, in the clinic with with your therapist. It may show up as uh something like a um like you're able to move your leg a little bit more, you can move your arm a little bit more, you accomplish taking more steps than you did the week before, you can do more sitting to standing. All of those things start to happen in the clinic. And the question is, is it actually showing up in your everyday life? And if it's not, then really what what is the purpose or point of going in and going through all that work in rehab? And the struggle is that this happens, I I believe this happens way, way more than we'd like to admit. And I'm gonna go over a uh a study where they actually show that. They show that we get gains in what the person is capable of doing, but it's not showing up in real-world performance. Now, if you think back to your journey or to the journey of clients that you've worked with, you're able to see that, especially at the beginning, you start to get stronger, you start to be able to move things more, you maybe you get steadier in your sitting, you get better on your feet, you may be able to walk with a hemi walker or walk faster, you're able to reach farther. And really, on the the tests, the measurements, you're showing that things are improving. But then you go home and it's time for breakfast, it's time to brush your teeth, it's time to get dressed, and it's still ridiculously difficult. And the bathroom routine is hard, getting into the community is hard, and feeling like yourself is seems it seems like it's out of reach. And something just seems to not make a connection because uh what your therapist is telling you, what you're or you know, if you're the clinician, what you're telling your your survivors is that they're actually performing better. They're showing improvement. And you know, the thing is is that it's maybe it's not actually showing up in in life. And the thing is, this gap, this gap is the difference between capacity, which really means what you can do in a structured setting. So say, you know, in the clinic, it's structured, it's set up for you to have success, and you know, showing what you can do in that structured setting, so it's your capacity, and then performance, which is what you actually do in your daily life. And you know, the difference between these two, you know, it kind of sounds it sounds subtle, but guys, it's not really subtle. It changes everything about how we think about success and rehab. Because I mean, really, if if if you're a survivor and you build real strength in the clinic, but you still aren't making your own meals, managing your home, walking where you need to, or getting back into the roles that actually matter to you, then there's there's a disconnect. There's something that's not connecting, something that's not making that making that uh that connection from what you're showing in the structured setting to what you're actually doing in your own context in your own home. And here's where I personally, Dr. Phil, thinks occupational therapy is truly built for for this moment. And in the OTPF or the occupational therapy practice framework, um it describes what we call occupations. And occupations are essentially the things that you do throughout your day and in your life that have meaning and they have become part of your identity. And these occupations, they're central. They're so central to your health, your identity, meaning, and even your competence, your ability to to perform life. And the OTPF, that's what I'm gonna call it, tells us that occupation can actually be the means, so like what you're you know, what you're actually doing, or it can be the goal that you have at the end. So you can use you can use both of them for intervention, and OTs are gonna do that. And as OTs, they're not just they're not just focusing on your body, or they shouldn't be focusing just on your body's function um and trying to make it improve. The goal of OT should be to improve your performance or your participation in life. So the truth that this episode is actually going to be built around is that getting stronger, or in other words, like I've set up getting capacity or increasing your capacity, it's not the same as getting your life back. Okay, and sometimes those two questions, you know, they they can move together. Um sometimes they don't, and when they don't, the thing is, you know, the questions being if you're increasing your abilities, but it's not showing up in your everyday life. What if you know, sometimes those move together, and I would probably say a majority of the time they don't. And when they don't, we have to ask this question, which is you know, it's not just did therapy work, but why? Why did it not show up at home? And we're gonna go through that today. So let's get into the evidence. So, moving forward, what I'm gonna do every week is I'm going to have a research article, a study, uh, something that will help us understand what the evidence is so that we can start educating ourselves and to understand what the science is behind how we actually make change happen in our lives, but also how do we make it so that we can um we can use what science is telling us uh as a way to get yourselves in the direction that you want to go. And so this week's paper is what this whole episode is is uh kind of based on, but it's by a a a physical therapist named Katherine Lange. And she had some colleagues that helped her with this. And it was this this article was published in 2023 in the Journal of Neurologic Physical Therapy. Um, the title of the article is Improvement in the Capacity for Activity versus Improvement in Performance of Activity in Daily Life during outpatient rehabilitation. That's a lot. But but an easier way to understand what this article, the title is saying, is basically we're comparing if you improve or you get better in the clinic in outpatient therapy when you go to therapy. Um, how does that relate to how you actually do things away from therapy? So, for example, do you increase, you know, if you get an increase in arm movement, does that actually show up at home? Does that show up in the things that you're doing? Um, or if you increase your ability to walk, does that show up at home? Do you walk more? Do you uh do you use what you learn more? And so the the thing uh um the thing that this article, you know, the conclusion of the article give you the you know right up front, but what they found is that people often improve what they can do in rehab without improving what they actually do in daily life. Now I'm gonna say that again. People often improve what they can do in rehab without improving what they actually do in daily life. So this particular study, they they followed 156 people. Okay. Now these 156 individuals, uh, they they were going through just regular outpatient uh neural rehab, and it was across five different clinics in the United States. Now, these weren't like perfect, you know, uh individual, you know, lab lab clients, and you know, this was actual real-world outpatient rehab, and they didn't want to influence anything, all they wanted to do was just gather information. And these were two there were two types of individuals. There were individuals with stroke, and then also individuals with Parkinson's disease. And so, for those of you stroke survivors, I mean part of this data, you know, part of this data really relates to you. It's not solely to survivors, however, the information that we get is actually something that is really important. And what's really cool about this particular study is that the focus of it was uh you know, was not just what could a person do in the clinic, could they improve in the clinic? It was actual, it was what they could actually do in real life. Now they used a bunch of different tests in order to measure what somebody could do in the clinic, or they measured their capacity. And then what they did was they actually put um were called accelerometers. But you know, in your watch or your phone, when you know when you move your phone, it can actually track, it can it can feel that it's moving. Inside the phone, there's something called an accelerometer. Now, these accelerometers, we have these in our watches, in all sorts of devices, especially when it comes to you know measuring our activity or taking steps. Accelerometers are used in that. And so they put these on the wrists and then they put them on the legs of the individuals, and they put them on their hemiparetic side or their weaker side. And so they as they as they did this, they they were able to gather data um on how somebody moved once they were outside of the clinic, and then they could compare that information, you know, how much they moved and what they did uh outside of therapy to what their gains were, you know, what gains they were getting in the clinic. So that's really uh it's an interesting, interesting article because um what they found specifically with stroke survivors is that a hundred percent of stroke survivors improved in their walking. Okay, now let me repeat that again. 100% every single person that came into the clinic, came into therapy, showed improvement in in their walking. However, and this is the craziest part of it all, how many of them per actually improved in performance? So basically saying, hey, 100% of you came into the clinic and then you showed that you could do more in therapy, in the in the gym, and zero percent improved in their performance. Okay, that's that's huge. Guys, that's huge. And survivors, as you're listening to this, if you think about this, how many times did you go into the clinic and something happened and it was really cool and you were able to experience this this change? You're able to experience, you know, that you could move your arm more, you opened up your hand, or you were able to kick your leg or take more steps, and then you went home. And what happened? The chances are the chances are you didn't really do much with it. Now, there's an interesting thing when it goes to the the arm, the upper extremity, and that is that fifty-one percent of the individuals were able to show improvement in their performance. So there's a there is a big, big um, you know, there's there's a uh discrepancy between the two, but essentially what we're saying here is this. When you go to therapy, one of the things that you are at most risk for is you are going to be told and shown that you can you can do more, you have more capacity, you have more capability. Yet when you leave you're not using that capability, you're not using what you've improved in. Now, there's a lot of reasons why that happens, but the thing that matters most with all of this is that this starts to get us into this understanding as as clinicians, you know, for myself as I'm thinking about this, it starts to make me think and question, well, what is it that I'm doing? And is what I'm doing actually making a difference in the individual's life? And then you as a survivors to sit there and think, well, what like if I'm putting in work in in the clinic, why is it not showing up in real life? So now let's let's ask ourselves this question because every single paper that I bring up, everything that we bring up, I'm gonna ask this question how much should we trust this paper? How much should we trust that these results is actually reliable? Now, this is not a randomized control trial, which basically means that they didn't they didn't put people in random, you know, in random groups and then compared them, you know, to to different things. Um, so it it's not gonna tell us how to actually fix this problem, but what this was was like an observational cohort study or an observe uh you know, multiple sites, multiple locations, which I think that's important. So it's it happened at multiple places, and the the level of evidence is somewhere around like mid-range. So it's it's good, it's it's a good level of evidence, but it's not the best. But there are some really, really big uh pieces of information that were observed and found that I don't think can be ignored. I mean it followed people over time, it used multiple, like multiple locations. Um, they studied really what happened outside by using objective data with the the wearable sensors on the hemiproadic arm and hemiproadic leg, and it actually started to capture how much somebody actually used their hemiproadic arms or their hemiproadic legs. And you know, in the study, the the authors recognized that, they identified it, they said that this isn't this isn't like a this isn't top tier, but it's something that we need to start uh you know figuring out and looking at because this is likely what is happening. And my stroke survivors who are listening, if you guys think about your own situation, your own experience, that is likely what you've experienced. You've gone in, you've gone to therapy, you've seen change, and there hasn't really been huge gains. So that's kind of a problem. And the thing that we need to start questioning, I've said it already in this in this episode, but I just I want to hammer this home. And that is that you can't assume that what you, you know, as a clinician, I can't just assume that what somebody gained or show, you know, learned, so if they increased in their capability, I can't just assume that that's going to just transfer into the person's life. And then you, as the stroke survivors, you can't just assume that if you show that you have an increase in your limb swing, you know, kicking your leg or moving your arm, that it takes more than just what's happening in the clinic for you to be able to get to the point where you're living it every single day. And you know, I'm just gonna put a little plug in there for my occupational therapists, guys. If you're you know, with that study, OTs were the ones that were doing the upper extremity. Occupational therapists have this unique set of training that really helps, really helps us understand a little bit more how to use performance or use how you do things in real life. And we are uniquely designed to make the connection between what you gain in the clinic in therapy into what you use outside of real life. So, I mean, essentially, occupational therapists, this is one of my definitions, is that occupational therapists come out of school as experts or best positioned to become experts in somebody's performance, how somebody uses what they do outside of outside of therapy, outside of the actual clinic. And physical therapists come out of school with a greater ability and focus on increasing somebody's capacity or what they're actually capable. So, guys, this I know I've harped on this. I mean, it's been like 20 23 minutes, 24 minutes, but this is a real question that we need to identify, and we need to figure out how do we fix that. Now, I'm going to give you my thoughts in just a little bit, but I'll I'll leave you with this at least at this part before we move on to our survivor of the week. The difference between the two, or how we actually fix this problem, is that we have to actually do what it is that we are wanting to get better at. We, you know, if you go back to earlier podcast episodes and I'm talking about the principles of neuroplasticity. One of those principles is called task specificity, which is just a fancy way to say, um, it's a fancy way to say if you want to get better at something, you do that something. So instead of I'm just gonna focus on moving my finger in and out, if what I want to get better at is using my hand in brushing my teeth, well, instead of using my hand to wipe the table, I should be using my hand to actually try and brush my teeth. And the more that I do that and actually practice brushing my teeth, the better that I'll get at that. There's a lot of evidence that supports that. And so so often, if you think about your your therapy in clinic, it's very much let's do sit-to-stands, let's, you know, lift weights, let's get stronger. But we're missing out on this whole task specificity thing. And OTs tend to focus a little bit more on the, you know, do what you want to get better at, especially when they're using, like what I said, occupation as a means. So using what you love and what you want to do as the intervention, as how we get you where you want to go, that actually starts to bridge that gap. So, my survivors, I'm gonna tell you this very, very bluntly. Yeah, I mean, you know that's how I do. Um, but my survivors, if you are going to therapy and what you are doing is focusing on your strength, and you're spending a lot of time on stretching, massaging, I'm telling I'm here to tell you you are wasting your time. You're prolonging or making it so that you don't get back to where you want to go by doing that. If you really want to get back to somewhere, if you want to get better, you want to get more um performance in your life, guess what? It requires you to go through the crap of doing what it is you want to get better at. So if you want to get better at walking, man, in therapy, you should be spending every second you can taking steps, not trying to increase your ankle dorsiflexion or plantar flexion or increasing your leg strength. Guess what? Your leg is already strong. It truly is just a connection thing. So, I mean, there you go. I go on my little rant. That was actually kind of minor, but it's so critical. So, this study, as I wrap this up in a nice little pretty bow, this study helped us understand or helps us see that what's actually happening in therapy is not helping you get to where you want to go. And the only way, at least in my opinion, that at least that we know now, you need to actually do what it is that you want to get better at. And if you can't, because you have limitations and you likely do, which is why you're going to therapy, you need to use your therapist to be the um, let's say to be the support or the training wheels to help you actually experience what it is you want to get better at. So, my my survivors, this is kind of a little bit of a wake-up call. And you'll hear me talk about this many, many times moving forward, but you have to do what it is you want to get better at. So if you want to be walking, man, you better be walking in your therapy because this whole idea of just getting stronger is a bunch of bull crap.

SPEAKER_00 29:54

Hey, it's Christopher Ewing. Joining me in other Stroke Survivors from across the country and around the world, doing the life after Stroke, Stroke Survivors Cruise. May 11th to the 15th, 2026 for the stream from Los Angeles, California, 15 islands, and stroke survivors, family, stroke, join us, and five, stroke five tests and join living. Special guests join us and more.stripchannel.tv. That's the stripchannel.tv. And remember, there's still a beautiful life after stroke.

SPEAKER_02 30:55

Okay, now um I wanted to take a second. Now every episode we're gonna have this uh stroke survivor of the week. So every week I'm gonna pick a stroke survivor that I'm working with or that I've interacted with and or that I've seen on TikTok, or you know, uh I've seen that they've been putting in the work. And I want to I want to highlight them. And so, you know, this this particular week uh I want to highlight a stroke survivor named Rita. Now, to give a little bit of background, Rita is she she had a stroke, and um she reached out to me about a year ago, and we ended up doing um a three-day boot camp. Um, I didn't get to work with her uh as much, and um Rita has experienced a massive fear of falling. Uh just right before our boot camp, she had fallen and broken her her wrist. And I mean that that girl was she I think I think she's 52, she's younger. That girl was so afraid of falling. And we we tried, we tried our best, and really what happened was we ended up focusing on trying to increase her speed, which we did. We increased her speed, but what happened was we didn't really put effort into focusing on her balance while walking. And so a year goes by, and you know, Rita's big, big goal was that she wanted to walk without her cane. And so as a year goes by, I'm coming back to Los Angeles, and she says she's she says she she wants to she wants to do some more work with me. And that what she wants is she wants to be able to get rid of her cane. So I I go, okay, I have this time, and I start working with Rita, and I do four sessions with Rita. Now, first session, we actually worked on uh increasing her ability to kick her leg. I didn't focus on getting it stronger, I focused on making the connection louder. And Rita, because she's afraid of falling, she she was being really hesitant about uh about letting herself walk with speed. And so we start going through our sessions and have a great session. She's now kicking her leg really, really strong. That that signal was much, much louder. Day two, we focus on stairs. Rita Freaking showed up and did 238 stairs in 80 minutes, less than an hour and a half, and in that time, 70 minutes, 7-0 of that 80 minutes she spent in the target heart rate zone where her body was making brain-derived neurotrophic factor. You don't know what that is, go back to my episode where I talk about it in much, much more detail. She man, she rocked it, rocked that part. And I was so proud of her. She still was hesitant. So I go, okay, I want to, I'm gonna take you to the beach. Now, there's one thing for those of you um that have never done this uh or ever set foot on sand, especially really, really fine sand. It is probably one of, if not the most uh scary thing for a stroke survivor to walk on. And the reason is because they already feel unsteady, and now the ground beneath them is moving, it's it's sliding underneath their feet, and they cannot feel steady. And so putting a stroke survivor on the sand is one of the scariest things for them to experience, especially for the first time. And Rita already had a lot of fear. So we start walking. We start going. I'm doing you know, walking backwards, sideways, and then I see these little hills. And they're small, they're like maybe, maybe three, four foot hills, but they're really steep. And so I take her to these hills, and we start walking up them. And guess what happens? Both of us actually fell on the first one, and Rita ended up falling about five more times as she's trying to climb up this hill, and the the ground is falling underneath her. Nice thing is, on sand is when you fall, it's actually not that it it cushions pretty good. So we were able to, you know, I have a harness on her, so she's not gonna get injured, and I can I can help control as much as possible. And we just we just go and we we're what we walk, we climb, we go backwards, sideways. Remember what I said is that if you want to get better at something, you have to do that something. So we do that. Go through this whole session, about an hour, hour and a half, and with about five or six falls, and we walk back to her car, she's tired. I come back for the final session, and immediately I notice something is different. Rita has just this bright smile on her face, and she looks at me and she she says something to the effect of I'm more confident. I'm not scared anymore. And I was like, you know, I mean, there's that part of me that's like, yeah, I'm not sure about that. You know, I mean, everybody says that, and you know, and so I'm like, okay, well, let me put it to the test. So I take her into her backyard, she has grass, and I start having her crossing her feet over and spinning and walking backwards and doing all these things that before she was super hesitant about. I have her fall again. Of course it's controlled. Again, I have a full body harness on her. No fear. I was like, where did that, where did that person go? She then looks at me and she says, I want to throw my canes away. I'm like, you sure? She had four. And I was like, okay. So we walk, literally, it's about a quarter of a mile away, with four canes. She doesn't, she's holding one cane and I'm holding three. And sh we walk to the garbage cans. And when we get there, um sorry guys. Um this is amazing human being. She takes her cane, she looks at me and smiles and throws it into the garage again. And she's just beaming. So I hand her the other three, and she tosses those three in. Um sorry. You know, the the walking, all those things, that's to me to me that's that's just something that everybody does. So I'm not really celebrating that. What I'm celebrating is somebody who had a massive fear, who didn't believe that she could do this. But by putting in the work and facing it and running with it, this woman, she no longer no longer has fear. So a day or three days later, this is actually yesterday, believe it or not, I get this, I get this call or this text, and Rita says, Thank you, Dr. Phil. You don't know what you've done. I'm walking without a cane, and I'm so happy. And then I say, you know, the best part is that she already had all that, which is very true. It was really just it was a mental, a mental decision to trust what she is capable of. And I asked her, has she gone anywhere yet? Because that was the thing she was so excited about. Was and guys, this this is a woman who she would drive past places like a coffee shop or a restaurant or something and want so badly to go in. And then she'd drive on by. She'd drive into the parking lot, and then she'd drive out. And all she wanted was to feel normal. And so I just asked her if she'd gone anywhere yet, and she goes, yes. My son and I went to eat pizza. I drove out, or I drove, got out of my car, walked in, and ordered. I felt so happy, I feel normal now. Guys, this principle, and the principle on this uh on this episode, which is performance and capacity, what we did was we focused not on capacity, we focused on performance. And performance carries over into real life. And Rita, I just wanted to highlight you this week because I am so flippin' proud. I'm so proud of the courage that you have to to take a step to get up to a ledge, you know, d the uh a a cognitive ledge, and you be the one that decides to take that leap of faith. And in doing so, you've opened up your entire world. And I freaking love that. As you guys uh as we go through this episode, I just want to highlight Rita. And if you're interested or you want to you want to uh you know share, you want to um nominate somebody to be the survivor of the week, um you go down in the where where you listen, there's an opportunity to send to send comments. Um if you will go and type in that individual's name, send me their their um their handle, and that will give me the opportunity to get to, you know, to reach out to them, get to know them, and to see if it's okay if I put them on on the podcast. But I think that everybody should have the opportunity to be highlighted at some point. Um you know, not for the fact that they're walking or the physical gains that they're getting, but really for the mental um the mental uh resilience and the willingness to step out when everything is telling you you can't. And that, right there, that's something that people pay so much. Money that you know people who don't have strokes as something that they pay to get to have somebody teach them how to do that. And you stroke survivors, man, you guys, you guys, as as sucky as it is, it's a built-in setup that you get to learn that. And I just want to make sure I highlight that because that is a very, very, very scary thing to do. But it also brings power. So the survivor of the week is Rita. Rita, keep crushing it. For more information or to sign up for a boot camp, just go to Strokesurvivorbootcamp.com. I'm Dr. Phil, and I'll have more right after this.

SPEAKER_01 44:54

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SPEAKER_02 46:24

And this is something that uh that is is known in the research or in the therapy world, but it may not be something that is talked about very much. Now, the secret of the week, not all therapy or therapists are the same. Now, every single therapist has a base set of knowledge that they get in school, and schools are required to train therapists or teach individuals how to become a therapist. Now, being a professor myself and having developed curriculum, actually developed a whole program, there are specific rules that we need to follow, and that we need to make sure that we measure that students go through and that they learn certain things. So in general, an individual comes out of school as an occupational therapist or a physical therapist or speech therapist with a foundational knowledge of how to do something, but it's very general and it's very, very, very rarely is it specific. So they're so you're not a specialist in anything. Uh in fact, what we're told to do and what we set the curriculum up to do is we want we want to produce what we call generalists. Think of it like a general practitioner. So somebody, you know, like your primary care physician. They go through medical school, they learn all the foundational things of being a physician, and then they they don't go farther into a specific area. They still learn a lot, but they learn to, you know, when you compare to the specialist, they learn a little bit about so many things. And that is so that they can be that first line of defense, first line to guide you to where you need to go in order to actually get the treatment that you need. If you need somebody that's a more specialist, but also to kind of um you know filter through and help with the things that a specialist, you know, you don't need to go see a specialist for. And occupational therapists, physical therapists, speech therapists, that is what happens when we come out of school. Then it is up to us to get more training outside of school in order to, you can say, to become more of a specialist. And the thing is, is that uh, you know, the the here's the you know, the secret or part of the secret is that there's not a ton of really good certifications or trainings out there to actually make somebody a specialist and specifically specifically with stroke survivors. So so much about what people do or what us as therapists know how to do with stroke survivors is what we were taught in school, which is remember it's general, and what we've seen other people do, and then what we figure out on our own. Now there are a few trainings out there, one is uh CNS, another is CSRS, and the thing is those certifications they all they do is they provide more knowledge. But they don't actually do real training. And uh even then the foundation of those those uh programs, uh, and this is my hot take, they don't actually they don't actually uh uh use the most up-to-date evidence, they pick and choose still. And uh they ignore and they ignore some of the biggest, biggest pieces that get real change in somebody based on the ep evidence and based on the science, and uh they show you a lot of cool tricks. So therapists, when they come out of school, they're really not specialists. Now that's something I'm trying to change, something that I'm working on that uh should be coming out in the next few weeks. But um you know the goal is to start actually getting therapists to be trained in a way that actually gets real change, and they can actually truly be called a specialist when it comes to regaining your mobility after a stroke. So the secret of the week is that not all therapy or therapists are created equal. And so it it's okay to tell your therapist you need somebody that has more training. Remember, you are the one that is buying the product, and the product is your your the product is the therapy, the product is your gains. So if a therapist isn't really doing the things that you know I've I've taught you or that I've shared, and they're not really using the most up-to-date research or evidence, then it's time to find another therapist. Don't waste your time. That is that's only going to make it so that it takes you so much longer, and you may never get there to get to the point where you are actually leading your life and running your life. So, Seeker of the Week, not all therapy is created equal. Okay, so um one of the things that um I'm gonna have on my website, uh Stroke Survivor Bootcamp.com, is I'm going to have a a uh a document that you can use to um to help you understand or to use as like uh uh instructions and strategies on how you can um increase your ability to use what you gained in your everyday life. And this is a simple, it's it's seven steps that that I'm gonna go through here, but then in more detail on this on this uh document that's gonna be on my website. So step one is that you need to name the gain. So basically, what you want to do is you want to name what it is that you want to get better at. What is the thing? What is it that you want to do? You need to name that. And the second is that you need to actually connect that. So, what is the gain that you want to get, and how is that showing up in a real something that you do? So, a real occupation, a real um real activity that you do. You need to connect what you want and connect it to something that is happening in real life. Step three is that you and your therapist need to figure out what piece are you not practicing that's making it so that you don't feel confident in doing it outside of therapy. Step four is that you need to actually practice. You need to do, you need to experience, you need to actually try doing what it is that you want to get better at as your therapy. I'm a very, very big advocate for that. And that needs to be something that you should do with your therapist so that they can use their skill to support you in the way that you need so that you can you can improve and get better at it. Step five is that you actually need to then challenge yourself. You need to make it so that you're making mistakes as you're trying this, as you're doing what it is that you want to do. Now you need to do that with your therapist as well. Step six is that you need to have a way of measuring whether or not it's happening. So, how are you going to measure it? Is it gonna be whether you do it at home? Is it gonna be an objective measure that your therapist is gonna show you? Um you need to find a way to measure it. Step seven is it needs to then be built in to your routines. It needs to be something that you do, that you are willing to do every day. And as you do those seven steps, what you are gaining is going to then be used outside of therapy, outside of the clinic. So in order to dive into those seven steps a little bit deeper, go to www.stroke survivorbootcamp.com and you can find it under my uh free uh free documents, free free notes, free things that you can get in order to help you in your journey and um and get going on making that connection from the gains that you're getting to making it so that they are actually working out or you're experiencing them in real life. Now I am adding an another part because I'm starting to get questions in from people and I get questions all the time. So the next part of the episode is gonna be um ask Dr. Phil. So if you have questions that you want answered on a podcast, uh write this is you know, write those in. Um you can do that through the uh actual app that you use to listen to the podcast on. There's there's a way that you can you can contact us uh or you can go to www.stroke survivorboot camp.com and you can fill out a form and just make sure that you're stating that what you want is or that you have a question that needs that you want answered. So then what I'll do is I'll do my best to answer those every week on an episode. So the question that I'm gonna answer today is somebody's asked if I'm getting stronger in therapy, or it feels like I'm getting stronger in therapy, then why does life still feel so hard? And that is a great question. The simplest way to answer this is that life is way more demanding than the way therapy is traditionally done. Life is hard, guys. And I know I'm preaching to the choir, but life sucks. It really is tough. And that's gonna be both physically, mentally, emotionally, cognitively, spiritually, all of those pieces. Life is hard. And so living life, actually going out and and doing it day in and day out when you don't have the supports, and life is kind of like think of life as like the wild. You don't have the supports like you do where you have a therapist with you, and you don't have you don't have uh, you know, uh a you know uh a bed that rises or is high and you know, so it's easier to stand up, and you don't have all of the things out there to make it so that you're successful. That's the reason why, even if you're feeling like you're improving in therapy, that's one of the reasons why life still feels hard. Which is one of the reasons why you can take a stroke survivor boot camp. Because what I do is I come and we live your life. And I help you rise to the occasion, rise to the demand and the level of your life so that life doesn't feel so hard. So that's the question that I'm gonna I'm gonna answer today. Um as more questions come in, um, especially next week, I will I will answer those questions on the podcast. So feel free to to send me any questions that you may have. And the second to last part of every episode moving forward is is what I'm gonna call the tough truth of the week. Here's the tough truth, guys. What you are doing in therapy is most likely not getting you to where you want to be. That's the tough truth. I've talked about it here on this episode. That's that's what actually inspired this episode, and that is that even though you may be improving in certain parts of movement, like you may be improving in movement, you are likely not improving in how you're living it in everyday life. And if that's the case, then what you are doing in therapy is actually not helping you. So if you're not moving as fast as you want to, if you're not moving uh in a direction that you want to go, and you're not seeing it actually show up in everyday life, chances are as much as you love that therapist and as good as a person that therapist is, your therapy is likely not what you need in order to get back to where you want to be. So that's where you can reach out to me and I will help you get things set up. And uh you can come and do a boot camp, or if I'm coming to a city near you, you can you can come and even do just a session. You can reach out to your therapist, have your therapist reach out to me, and I will come train them. Uh I will help it so that they can help you and do it in uh with even more of their clients moving forward. So tough truth of the week is that what you are likely doing in therapy is not actually getting you where you want to go. Now, the last part is what I'm gonna call my weekly challenge to you. So, this week, for my survivors, what I want you to do is pick one one daily activity that you feel like would make you feel more like yourself if it got easier. So, this is not an exercise, I you know, not like doing 10 sit-to-stands, not doing those things. No, I'm talking about like a real activity. So, for example, maybe it's making breakfast, standing while brushing your teeth, carrying laundry, going out to the mailbox, loading the dishwasher, getting in and out of the car, getting on and off the couch. There's lots of different things. And then bring it to your therapist or reach out to me. And let's break it down and let's see what kind of supports you need at the moment so that you can do it successfully, and so that you can start actually doing it and living it in real life. And the call to action, the challenge is that you actually try it this week. And for therapists who are listening, what I want you to start focusing on is I want you to identify whatever it is that you are trying to do, and actually seeing it transfer to real life. So whatever it is that you're trying to get better, whatever it is you're trying to improve, just frame your session in a way that makes it so that it actually is real life. At least the best possible way. And if you do that, what you will see is a greater carryover from just increasing in somebody's capacity to actually living it out in everyday life. So they're increasing in their performance. So if you would like to know or get access to um, you know what article this is, and you'd like to know the the the reference, um, reach out to me uh at the OT Professor. I'm more than happy to do that and to help you um help you find that article and you can read it for yourself. And guys, every single day matters. Both therapists and survivors. And survivors, you have power, but remember it's gonna take the suck and just doing doing the hard things. The hard things of living in order to get where you want to go. And really what matters overall is that you just take one step at a time. I'm Dr. Phil, and this is Stroke Survivor Bootcamp.

SPEAKER_04 1:03:52

Breathe in count it on every sky.

SPEAKER_03 1:06:14

You couldn't lift your head for the silent screen she never said Now shout it for the ones still lying in that bed I'm here, I'm here, I'm not done yet survivable.