Stroke Survivor Bootcamp with Dr. Phil: "Why Changing the Challenge Changes the Brain"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, talks about variability within high intensity and to add variability to make sure you challenge the brain enough so the brain is uncomfortable and that it can learn how to adapt to an ever changing world.  

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_00 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 welcome back to another week of Dr. Booking. I am Dr. Phil, I am an educational therapist and certified personal trainer. I actually started my career working with kids with disabilities in school district. And after a year, I went and got an opportunity to work at an inpatient neuro rehab and fell in love with working with individuals who have neuroissues. And in particular, uh I became very invested in individuals who'd had strokes for a variety of different reasons. And I got uh the opportunity to get trained in specific uh skills that made it so that I got to the point where I it didn't matter what somebody wanted to try, I was confident in my own skills and abilities that it made it so that I could I could do that with I do whatever it is that somebody wanted to practice. And being an occupational therapist, um the biggest piece that I look at is somebody's performance. So how are you performing in uh whatever it is you're wanting to do, but also in everyday life? And that is going to take a bunch of different approaches, strategies. And the one that I was always obsessed with was uh it's called remediation. But the easiest way to think about that is how you get somebody better. So, how do you actually change the person's skill sets or uh help them gain more ability? Those that was that was the approach that I've I've been obsessed with for the last oh eight, eight and a half years of my career. And I loved, loved, loved working with stroke survivors. And I was I was introduced to high-intensity gate training uh as an occupational therapist, which some of you may be going, well, that's kind of crazy, that an OT is specializing in helping somebody get back to walking. And, you know, I I would at first I think I would have said, Yeah, I'm I'm crazy, which we all know. I I'm a little special kind of crazy. But I I really loved the uh the benefits and the things that happened when somebody increased their ability to walk. And when I was able to partner with a physical therapist who also cared about walking and was willing to do high-intensity gate training, oh man, guys, the the changes that I was able to see were incredible. And uh I I got so kind of sick of only being able to make a small amount of change that I decided to get into academia where I could help somebody, uh I could help teach the next generation of therapists and get that get it so that at least they were trying to do the things that actually provided or got change and were doing things that were evidence-based. And that is something that I have been doing for the last two and a half years, and uh about a year and a half ago, almost uh see, it's almost two years ago, um, I did the very first uh stroke boot camp. I had this idea because high intensity gate training, uh, if you do it within the context you and you use the evidence, but man, in comparison to traditional therapy, it just it makes uh it makes the individual get so much better at a faster rate and helps somebody regain their mobility in uh a time frame that uh I I think I think a lot of therapists and survivors um they they don't believe is real. And man, I just if you've ever watched any of my boot camps or if you've ever watched, you know, some of the stuff that I do, um it's almost like you can't believe what you're seeing. And the things that are um I guess secondary to the movement, which I actually believe are some of the most important things, is that the individual gains so much confidence. Anyways, I can talk about my boot camps like crazy um because they have they've changed so many people's lives, including my own. And I I mean I wouldn't be doing this podcast if it weren't for this idea of a boot camp. And I have gone now full-time into doing these boot camps, and um I do this and I teach at UNLV in their doctoral program, and I also am an expert witness in personal injury cases, so I get asked to um evaluate somebody's abilities, and then I testify in front of a judge and a jury um about what somebody is capable of doing and how much assistance that they actually need. And that has been my life for the last year and a half, and uh a little bit more. Um, you know, I I realized they hadn't really talked much about me, but um and I think rightfully so, but I I have I have four kids. I have an amazing wife, and uh you know one thing that people don't really talk about when you decide to go and do something on your own, and if you're married, um man, your spouse has to put in so much trust. I mean, I have I have girls that do dance, and it's yeah, it's it's it's crazy. And I I have one of the most amazing people in the entire world that I get to go through this life with, and um yeah, I feel I feel pretty blessed and pretty lucky. And so with that, uh I just I wanted to give a little bit of an introduction, um, you know, and and kind of get us started on this on this podcast, um, just so that you guys could get to know me just a little bit better. But um today, man, I am guys, if you can't tell, I'm always excited about the topic that I'm gonna I'm gonna discuss. Um but this particular topic today, um, I I believe is the one piece that um makes what I do very different from uh a traditional therapist, uh traditional physical therapist, but even a uh physical therapist who knows how to do high-intensity gait training. Um I believe that this part is what sets me aside and and I get different results because of how I understand today's principle. And if you guys can take a minute to really understand this principle, it will start to change your lives in ways that you haven't been able to experience yet. And uh so if you guys remember, um, the way that we are gonna go through this podcast is we are going to first talk about a particular research study. Now, I think it's extremely important that we get the opportunity to talk about the research itself. When you're looking at you know somebody that's saying that they can help you, there's there's a lot of value in their lived experience. Uh, I know many survivors who um are doing their best to show that what they did helped bring change into their life and that they do have something to offer. I think that um when it comes to how you decide to listen and to put your efforts into things, I think that it's really important that you actually understand the evidence behind the strategy or whatever it is that somebody is saying, if you do this, then things will change. Because the reality is, I mean, they know what worked for them, but chances are they they aren't in the same they weren't in the same situation you were in. And so it's really important to see somebody and work with somebody who sees the entire picture and can see the different puzzle pieces that are out of place. And as you as you work with that person, they should be able to help put the puzzle pieces together. Um, because some of you, your puzzle pieces are crazy hard. It's not a typical puzzle, and it doesn't it doesn't look the same. And that's something that needs to be accounted taken into uh account or it needs to be accounted for. And so as as we go through these podcasts, I always want to make sure that we have at least one article that we're going to highlight. Because as you learn these articles, what it's gonna do is it's gonna help you uh start to start to understand what is actually required for change. And so the outline is gonna go as follows. We're gonna go over the evidence of the week. Then I have a survivor that I am going to highlight um this week, somebody who I've been working with who is just showing up. And I just I just wanted to highlight and and give some kudos to uh to this individual because this person, um, this person is doing some amazing stuff. And then I'm gonna go through the secret of the week. Um, this is usually something that's it's a it's a truth that is usually overlooked by therapists or um um survivors, and it's it's a thing that uh you don't want to miss. Then we're going to um do what's called the breakdown, where I'm going to teach a little bit more in depth about a core concept or framework or a way uh like a particular uh skill, and I want to make it practical, something that's easy to apply. And then there's ask Dr. Phil, and so as questions have been submitted, um, this is an opportunity for you to uh to ask questions and to kind of help guide where you want the discussion to go. And then I'm going to give you the tough truth of the week. Um, this is going to be something that uh it's kind of like the thing that everybody or people know, but nobody's willing to say it. And so it's gonna be something that is always aligned with evidence and it'll be respectful, but it's kind of the tough truth that you have to hear. And then lastly is your weekly challenge. So let's let's get started with this. What if one of the biggest issues or biggest problems in stroke rehab is that we as therapists or you as stroke survivors, you make practice way too predictable, way too routine, because you know, if we think about it, real life is not predictable. You know, wherever we go, it's going to change. You know, if we go from the hallway to the driveway, the driveway is different than the grocery store. Uh the grocery store is different when you're tired versus distracted or carrying something. And it's never going to be the same. And yet what we do in practice oftentimes is let's just do repetition, you know, let's do 10 sit-to-stands, rest, 10 sit to stands, rest, and everything is clean movement. And it's very predictable. Uh, very rarely do we as therapists put you in situations where you are going to fail and you're going to actually s uh make some pretty big mistakes. Now there's there's reasons for that. Um, but as we start going through today, you know, we need to ask the question, what if what if the nerve nervous system needs more, or if it gets more than just repetition, is it gonna change? Is it gonna improve? Is it gonna be better? Is it gonna make it so that you feel more confident and you have more ability? You know, what uh you know, does it need more challenge? Does it need more variability? You know, variability is you change what you do, so it's not just going forward walking, it's also backwards, sideways. Um and that is actually where we're going to be talking about today. So there's a study that was led by uh Dr. George Hornby, and this was published in 2015. So we're talking 11 years ago, this was this was published, and uh it was a what we call a randomized controlled trial. Now, a randomized controlled trial is a setup or it's a way that they are setting the study up in a way that um makes it so that they're not cherry-picking, they're not selecting who they think would be best for the intervention that they're trying to test. And they randomly assign stroke survivors, at least in this case, stroke survivors, into two different groups. Now, one group is gonna get the thing that they're testing, which is high-intensity, uh high-intensity gate training, specifically with uh the perspective of adding variability. So instead of just walking straight forward on a treadmill, it's walking in multiple directions on multiple surfaces and uh uphill, downhill, changing the environment. That's one group. And then the other group got uh what we would call traditional or typical um therapy. That's gonna be what you guys are experiencing right now, most likely, because high-intensity gate training is not prevalent in I would say 98% of um of rehabs across the the United States and especially across the world. And so the goal of this test is as you as as they go through and they they do this intervention, they use this strategy with somebody, what they want to do is they want to compare. They want to compare if the new strategy is going to give better results when compared to what everybody does right now, you know, when it comes to traditional type therapy. And so Hornby and his colleagues, they they actually got about 151 people that they screened. Now, I mean, within a test, you want to be able to control as many variables or as many uh things as possible. So if you're just trying to test if something works, you want to get rid of all the pieces that could throw it off, right? That would make it so that uh maybe, maybe there would be change, but you couldn't say it was because of the intervention, or um maybe you have something that uh prevents the intervention from being able to work. Uh, for example, if somebody had uh really poor um really poor ability for their heart to pump blood throughout their body and to do it efficiently, you know, something like that. It would it would be it would be something that would prevent them from actually doing the intervention. And so they ended up out of that 151 people, they ended up having uh 33 people be part of this test. Now it's not huge, it's not a it's not a massive test, but 33 people is, I mean, it's it's a decent size. And 16 were randomly selected to be in the experimental group. Now, this is the one that was high intensity gate training with variability, uh, or doing things not just straightforward on a treadmill, it's now let's start moving around in different directions. And 17 were in the control group, which was slow, focused on um on typical movement and getting um and focusing on on um lower repetitions. Now one thing that they you know that they found is that one person um you know ended up not being able to participate because I mean that the idea is that the people who are assessing, the people who are grading the individual skills, uh they don't know, they don't know who's in what group. So all they are doing is just assessing. But somehow in this test, one of the individuals actually either made it known or something, but they they made it so that the assessor knew that they were in the experimental group. And so that led to now the numbers being 15 in the experimental and 17 in the controlled uh or the typical therapy group. Now, all these individuals they were roughly one to six months out. So they weren't yet what we would call chronic. Now I want to point this out because what I've what I found when I talk to stroke survivors is that they don't realize that high-intensity GATE training is something that they could do, you know, of course, being approved by your physician, but it's something that you could do like three to four days after you've had a stroke. I mean, I I specifically have worked with multiple stroke survivors on day five, day four after the stroke, and I'm taking them up 114 stairs, getting their heart rate into the target zone, the things that that we do, and seeing crazy good gains early on. And so that's that's something I just want to point out. And in this study, what happened was is that they had an average of about three months, a little bit over three months was the average uh three months after their stroke. That's the average um length of time somebody had uh had been uh after their stroke. And so you have uh 32 people that are a part of this, they're about you know somewhere between one to six months uh away from their from their stroke. And what happened was both groups they trained for up to 40 one-hour sessions over 10 weeks. So uh over about two and a half months, and it was about four to five sessions per week. Okay, so now that we have that set up, it's is that this is why I love studies, is you know, if they're set up right and they're done well, it's really cool because you have it's almost like this, okay, now what happened, right? And so if we think about or if we ask that question, this is what they what they said. The experimental group, all they did was walking, but they did it at high cardiovascular intensity, so just high intensity. They targeted about 70 to 80 percent of heart rate reserve, which by the way, is I mean, that's that's that's high. And they did it in multiple contexts. Like multiple, whereas the control group got a more conventional mix. So, yes, they worked on gait, they worked on transfers, your sit to stands, worked on balance. Uh, here's exercises that you can do, stretching, massage. I'm assuming, you know, uh they did focus on some stairs, and but everything was lower intensity. And they targeted roughly about 30 to 40 percent of heart rate reserve. So that would be low intensity. So now you're able to even compare within this study what happens if somebody is at high intensity versus somebody that's at low intensity, and this is all based on the heart rate. And this is there's some crazy numbers in this. So throughout the course of this study, basically the experimental group averaged about 2,358 steps per session. I I if we're talking in an hour. Now, for you stroke survivors, can you imagine getting over 2,000 steps in an hour? I mean, it's it's a lot. And uh, you know, if you have a step counter, I you know I want to challenge you to see if you can get close to 2,000 steps in an hour. Now the control group averaged about just under a thousand steps per session, so 948. The uh at the end when they took the numbers, the experimental group, the high-intensity training group, they averaged about 74% of heart rate reserve, which heart rate reserve is a way that you can calculate how hard your heart is working, and it's really specific to you. And the control group was around 40%. Now, this is the crazy part. When we take into account this the uh results, um at the very end of this um what I said, 10 weeks, at the end of this 10-week um study, the experimental group, the high-intensity gate training group, they self-selected walking speed, uh it improved, sorry, their self-selected walking speed improved by 0.27 meters per second. Now that's basically, let's say, let's say you're walking 20 feet, and you're walking it uh when you're starting, you're walking it about maybe it takes you a second to foot, so 20 seconds. I mean 0.27 meters per second, you they basically improved by somewhere around five seconds when it's like that. I mean, that's that's huge. That is a massive, massive gain. Um, while the control group only improved 0.09. So when they selected, like they were they were able to select their speed. All right, now here you go. You select your speed. This is, you know, um, I'm assuming um, you know, it was just you know, they just said, okay, now just go ahead and walk this at whatever pace you would like. And 0.27 meters per second faster. Okay, now one thing that we do know that I will go over at some point is that the faster you walk, the more likely you are participating in life. So walking speed matters. Now, when they did what's called the six-minute walk test, this is basically see how how far you can walk in six minutes. And the experimental group improved by a hundred and nineteen meters, while the control group improved by 30 meters. So, do you guys see what's happening here? It's really interesting to me because what happened in both groups? Well, what happened in both groups is that both actually improved. So here you have a you know, you have you have an intervention that is just it's everywhere. But therapists don't want to give it up because what do they see? They see that 30 meters of improvement. But what they don't understand and what many stroke survivors don't understand, and they're getting this change with their therapist, and they love their therapist. But I mean we're talking we're talking difference between, you know, 30 meters to 119 meters. So let's put that into perspective. 30 meters is essentially like one-third of a football field. Okay, so a third of a football field, where the 119 meters, which is about 390 feet, so it's almost 400 feet. That's like walking more or longer than an actual football field, including the end zones. Isn't that crazy? So, I mean, the the difference is that it's like, okay, great, in the same amount of time, you were able to progress to walk farther, but a third of a football field farther. Whereas this other group and what they did made it so that they could walk over a football field in the same amount of time. Guys, I mean, if I'm sitting here and I'm sick of this, I'm waiting to get somewhere, I'm waiting to improve, I'm waiting to for my body to to come back. Something like this, and what this test and what I'm you know, we'll go over in future episodes, it's telling you that there's a possibility that there's a strategy that you can get I mean, what is that? I mean, that's almost that's four times four times the change. I mean, that's that's an insane amount of change. That's no tiny signal. That's that's not that's not a tiny change. And guys, that that is a meaningful distance. You think about this, like, okay, so let's say these individuals who, you know, they now made it so that they could walk 100 feet more. I mean, basically they made it so that they could walk into a grocery store, go to the produce section, and walk out. The individuals who now can walk 390 feet made it so that they could go to the the produce section and then go down multiple aisles and get the cereal and the other items that they need. And then they can go through and they can walk, you know, walk the I mean for the most part, the entirety of the store. I mean, that that's just so it's so crazy. So I just when I when I read some of these studies that happened, you know, I think oftentimes um, you know, most studies, they it's like, hey, there's significant difference or significant change. And the significant change is so minimal that I mean, really is that an intervention that is gonna make a change? Is that an intervention that's gonna change your life? I mean, take multiple studies as we move forward through this podcast, or not this particular one, but different episodes. But guys, this test or this experiment that they did, it's very clear that if you do intensity plus variability, you're gonna have much better outcomes. So let's talk a little bit more in a little bit more depth about what variability is you know actually is. So when people typically hurt hear the word variability, um, they they may they may think like, okay, well, we just do different things. And oftentimes they think it's random, is less skilled, um, because doing, you know, and and facilitating or using my body to and cueing with my words, um, helping somebody walk in a typical way, that does require a ton of skill. I mean, I get it. I was certified in a particular uh approach and intervention that that's all I did. I did that for four and a half years, where I facilitated somebody's body, but it was low intensity, and I had that skill. Still do. And that's that's not that's not variability. Basically, according to this study, variability is just that people they weren't just staying in a sterile environment, meaning that they weren't just staying on flat ground. They were training across multiple different areas and walking backwards, sideways, um uphill, downhill. So here's some of the things that they did in the test, in the experiment, is they went on a treadmill and they walked at higher speeds. So not just not just a simple or comfortable speed, it was higher, scarier speeds. They worked on uh what's called perturbations, but basically where somebody is pushing, pulling, um, causing you to make mistakes. They walked in different directions. They went on inclines, declines, they stepped over obstacles, around obstacles. Instead of walking on a treadmill only, they walked over ground. They did a ton of stair climbing. And in some cases, in this particular test, they added some weighted vests or leg weights. Um, so this is still early on when they didn't have all the pieces put together. But that's kind of cool to me is you know, there's there's a there was a test in 2010 where they demonstrated that if you increase intensity and um you got you got better outcomes in comparison to traditional. But now what it is is if you increase intensity and you add this variability, going over all these different places and training in different ways, you're gonna have even better outcomes. So the nervous system itself, your highway communication system, it's not just being asked, can you repeat something? It's basically saying, being told or asked, can you solve movement problems? Can you solve here? You go, this is something that's happening. Now you're making a mistake. Can you solve it? Can you fix it? And it's putting that pressure on your body. Now, your body, it's not responding the way that it was before, and so it's really scary. But if you have a skilled therapist that knows what they're doing, they can help you experience that, and that is going to be one of the biggest benefits that you could ever have as a as a therapist. So just remember this variability, it's not chaos, it's it's not just doing random things, it's not just okay, now I'm gonna go backwards and I'm just and just throwing this out there because that's what a majority of therapists are gonna hear. What's gonna happen is they're gonna hear variability and they go, oh, I got it. But there's still so much more skill to choosing what to add as a variability piece. How do I change something so that uh so that it's it's how do I change something so that it's intentionally increasing something that I want to increase? And so when we think about, okay, we have that, like there's some things that people usually get wrong. And you know, a lot of people still believe that recovery is going to happen the best when movement is kept slow, controlled, and error-free. I'm gonna repeat that. A lot of people still believe recovery is going to improve the best when the movement, what you do, is slow, controlled, and error free. Okay, so I want you guys to think about your therapy that you're going through, or if you're a therapist listening to this, what therapy you're giving. And does that sound like what you do or what you've experienced? Because I know it was for me. And it does, I mean, it sounds very logical, but this particular paper really pushed back on that. You know, the the whole idea is to contrast the two, and what they found in the results was just staggering. You do high-intensity gate training with variability, there's going to be bigger gains than if you do controlled, slow, um, error-free type movement. Now, they at this point they weren't putting pieces together yet. They didn't have all the pieces together yet, but they were discovering that if you add variability, then things change. And just remember, if you're training right now in a way that is controlled, then you go out of the clinic and guess what? You're now in a life that is uncontrolled. I've heard it said to me before, and I thought this was funny. Um, it's basically that you go back to the wild, right? And I I love that. I think that's so that's that's so funny, but it's it's very, very true. That's what it feels like. When you leave your clinic and you leave the safety of your therapist, it's like, man, I'm going to the wild. So if your therapist isn't training you to live in the wild, then when you go back to the wild, guess what you're not going to be doing? You're not living. You're not going to use what you learned because you haven't done it in the wild and it's scary. So variability, just in review, is the concept that instead of just walking in one direction and walking on flat ground, change it up. Add going backwards, sideways, up and up a hill, down a hill, upstairs, upstairs, backwards, upstairs sideways. Spinning, pulling something, like whatever it is, adding something different is going to make a big, big change. For more information or to sign up for a boot camp, just go to Stroke Survivor Bootcamp.com. I'm Dr. Phil, and I'll have more right after this.

SPEAKER_01 36:59

Hey, it's Christopher Hewling joining me in other Stroke Survivors from across the country and around the world, doing the life of the Stroke Stroke Survivors Cruise from May 11th to the 15th, 2026, for Queen's Cruise. Stroke survivors as well as family and friends. Join us as we just take this I didn't just enjoy living life. So join us in May 11th to the 15th for Caribbean. Making round trips from Los Angeles and making port stops in Catalina and some out of Mexico. For more information, just go to www.testrokechannel.tv. That's the strokechannel.tv. And remember, there's still a beautiful life after stroke.

SPEAKER_00 37:56

So it's time to do what I call our Stroke Survivor Spotlight of the Week. And I am going to give a shout out to Chuck. Now, Chuck had a uh had a stroke um a little bit ago, and I went and got to work with Chuck uh two times. And you know, one of the things that's really interesting to me when I work with people is that every single person, the first time I ever meet them, they there's two things that happen. One is you start to see this hope start to create, you know, to creep in to their mind. You see it in their eyes, you see that they want this. They want to get better, they want to be able to participate in life more. They don't like the fact that life is controlling them. And every single person deals with that in a unique, different way. And the way that Chuck deals with that is that he adds humor. Man, that guy is hilarious. And yet as as I started to work with Chuck and push him, of course the the humor stayed. But the change started to really exist. And I am so proud of this man. Like, because I I worked with him two days, we got some really cool change, we were able to show improvement, um, and we were able to, for the first time, make it so that he could get in and out of the tub by himself. And it's just you know, uh the fact that he can get in and out of the tub or the fact that he's walking, that's not that's not the incredible part. To me, the incredible part for every single stroke survivor that I've I've worked with is that when I lead them to what I call a cliff, it's a cliff moment, it's the moment where I ask them to do something that is actually fairly high risk, or it's on like their top three fears that they have since their stroke, and I ask them to do it. The part that I want to highlight is that they do it and they trust. That is insanely difficult to do. Insanely difficult. And that is the same for not just stroke survivors, that's the same for myself. Stepping up and doing something that is difficult or is something that I don't I don't really I'm afraid to do. Man, I I respect stroke survivors who allow me to take them to that point where they're terrified, and then they take that step. And Chuck, Chuck's done that. And then they, you know, I I worked again, I worked with them two days. Then what they did was they bought a heart rate monitor. And once they got the heart rate monitor monitor working and on, every day this man is sending me a screenshot of his workout with uh it's a it's a graph of how his heart is performing so that I can see the intensity. The dude is a stud. And I just I I feel so much I I feel so much gratitude that I get the opportunity to work with Chuck. And so, Chuck, here is your shout-out because you are going places, and I am so excited and grateful that you're gett letting me be a part of this process with you. So it's uh it's one of those things that you know continues to push me forward to know that what I'm doing is is worth it. Because seeing the change and the fire that comes out in people when they when they experience what they're capable of, yeah, see that's that's what I'm talking about. Now, let's move on to what I call the secret of the week. Now, the secret of the week is that the nervous system, your the the highway in your body that signals you know, they move around and they they that's how they travel, it does not become adaptable. It doesn't learn by only practicing one version of the task. Meaning that it may be great that you can that you can do it in a particular setting. So as soon as you know you're hooked up to everything, you've had your your um you have everything set up, and then you can do something, that's great. But what about when you don't have that? You know, I liken this, you know, here's an example. Um the example is so I I coached I coached competitive soccer with uh young athletes. Um I helped start a soccer club in Utah. And in this process, I was I was in charge of the you know seven to eleven year olds. And during this time, typically, this is where uh a soccer player is learning how to do the moves, how to gain the ability to dribble the ball and the ability to um to really hone their skills. And one of the things that um typical uh coaches would do is that we We would, you know, we would put them in a situation we would teach them a move, we'd teach them dribbling, we'd teach them things, but it would be in such a controlled environment that the kid would get successful at it. And then what would happen is they'd get into the game, and guess what would happen? They couldn't do it. In fact, they wouldn't even try it when they got to the game. And it wasn't until I realized that if I don't practice in the way that makes it so that it resembles what the game is like, the individuals won't ever even try it. They won't try it. They won't try it in the game. And that is very, very, very true to stroke survivors. And not just stroke survivors and complete spinal cord injury, traumatic brain injury, any diagnosis where they're nervous or scared. If you don't train or push them, or if they don't, if if you know you survivors, if you don't allow yourself to experience or push yourself in the way that life requires, then what will happen is just like my soccer players, they would get real in fact there were some kids that they were so good at dribbling the ball, juggling it, manipulating the ball. And they could do it when nobody was trying to take the ball from them. But as soon as somebody came in and tried to take the ball from them, they'd fail. My fault for teaching and not actually getting them in positions or situations where they had to practice when somebody was trying to take the ball away from them. So think of it like this. The secret of the week is if you don't start practicing doing something in multiple ways, you are not going to gain the ability to do it when life actually is trying to knock you down. Because it always does. Right? Life always knocks us down, there's always the unexpected, and you will not be able to get there. So as we move forward in this in in this podcast, and as we're all we're coming to an end, the thing that I I want I want you guys to recognize in the simplest way that you can even look at this, this is the way this is the thing that you can take, you know, I've said all these things, you know, it's been forty forty-six minutes, um, it's been a a good amount of time. And I've said a lot of things. I want you to think about variability, which is a which we found is a very important piece when it comes to intensity and getting where you want to go. I want you to break it up into five categories, five areas. So get your pen out, pause the podcast, because I want you to remember these. And these are five simple ways that you yourself can change or add variability or suggest to your clinician, your your your your therapist, suggest one of these five changes. First is the direction. Change your direction. Don't just walk forward, walk backwards. I cannot tell you how many how many clients I work with where I start I ask them to walk backwards, and they're two, three years out. And they go, This is the first time I'm walking backwards. That surprises me like crazy. Walk to the right, walk to the left. Change the direction. Number two, change your speed. Increase your speed. Slow down. If you change the speed, that's adding some variability. Number three, change the environment. Don't just walk in the same place. Don't don't do the same route. Don't stay where it's safe. Obviously, if you're gonna go somewhere where you don't understand or know and you don't have the skill yet, go with somebody skilled. Honestly beg your therapist to take you on a different path. Take you outside, walk on the on the the concrete, walk on the sidewalk, walk on the hill, change the environment. Number four is that you change the surface. So instead of just walking on, say, tile, walk on carpet, walk on grass, put blankets on the ground and walk on that. Now obviously, the more that you change the surface, the more dangerous it is. So you need to make sure that you're if you're gonna change something again, always have somebody skilled there first. Now if you do a boot camp and you work with me or one of my certified therapists, guess what? You will have somebody that you can you can do that with. The last one is change the demand of what it is you're doing. So that can be done through adding weights or resistance. Now again, every single one of these, there's a certain level. You can you can you yourself can think of different ways how to do this, but it also may not be targeting the thing that you really want to get better at. That's why you need a therapist that actually knows what they're talking about, because they will essentially fast track. They'll change it so that you know they'll they'll add resistance, they'll add things to you, you know, to what you're doing, uh, to specifically target something that is the next piece that needs to happen, next piece of the puzzle. And as they do that, you'll change even faster. So that's it. The the five ways that you can change variability in your life is change the direction you're going, change the speed, change the environment that you're practicing in, change the surface you're walking on, and change the demand of the task. You can do that last one by adding resistance. Okay? So just remember that when it comes to when it comes to variability, what we're learning about today, and if in and partnering it with high intensity training, you have power. You can suggest one of those five changes to your therapist. Not just suggest, I would I would demand. I would say, no, this is what I want to do, I want to get better at this. Because I will guarantee that if they haven't done it from day one, they're not gonna do it very quickly. So you might as well take control and demand that you want to do a different direction, go in a different direction. And if they're not willing to, then ask for somebody different. Now this is the one that I always have the hardest time writing and putting together, and it's the tough truth of the week. I am continually finding and hearing and seeing multiple people on social media that are um they are promoting their experiences as survivors and promoting them as a way that makes it so that they understand or know how to get somebody better, how to improve. Now they may have some decent things, but the har tough truth of the week is that you need to be careful about who you actually buy strategies and information from. Now you need to be careful for a few reasons. One, they most likely do not know how to adapt it to you. And if they are trying to adapt it to you, they're guessing. Second is that they may be asking you to do something or telling you to do something, that is dangerous to you. And I mean dangerous in the way of like you could get really hurt. So those two things are huge. And I'm gonna say the fourth thing is that just because somebody has experienced what you experienced, it does not mean that they know how to get something back. I cannot tell you how many times I hear somebody talking on a live, somebody talking on a post, and I'm listening. And the things that they're saying, it's not backed by evidence. And in fact, I know hundreds of survivors that have tried those exact same things and they didn't gig change. So but yet it's being it's it's being touted or it's being said as they know. Because they're you know, because it's what they did, and it's how they've gotten back to full use of their arm, full use of their leg. And I'm telling you right now, that is so misleading. It is so misleading. They do not know how they got their arm back, and honestly, a majority of it is that is a little bit of luck. And their brain just made those connections. So, what you do want to make sure that you spend your money on is somebody who, first and foremost, has the education and training on how to actually interact with the the brain and the body. It doesn't even have to be me. I you know, truly it doesn't. But I keep seeing people putting out, hey, here's my five-step guide, here's my this guide, here's this guide, and you know, here's the free version, but you know, you can pay 20 bucks and you can get this version. Don't fall for it, please. Because chances are it will only work for a few of you. So, I mean, I'm always here. I'll give you the straightforward, honest answer. Even even ask those who uh you know, if it if it's something that I don't believe is gonna benefit you, I'll tell you. So please feel free to reach out to me and ask. So if somebody is asking you for money, do not give your money until you actually know what it is that is is the workings behind why they're doing it. So if somebody's saying, hey, I can do this, or if you do this, you can improve, ask for the evidence. Any evidence other than them, or even somebody else who's saying that it's working. Ask ask for what is the science behind what it is that they're doing. Why does it work? If you do that, then your money will be safe, and you can have money to put it towards things that actually can get change. That's something that I've really struggled with over the last few weeks as I've been watching. And you know, again, my goal is that I'm gonna help you guys navigate through this landscape of craziness. And I'm here to help if you if you want to have a fast track to seeing your capacity and your capability and how you can improve. I use a very, very science heavy and science-backed strategy and intervention on how to get back your mobility, specifically your ability to walk. Upper extremity, I will tell you right now, there is there's there's there is no actual like this is the best strategy. It doesn't exist yet. Not quite like what I'm what I'm talking about with high intensity gate training. That is currently the best strategy that exists out there. And it's the best way that you can gain change in a much quicker way or get more change in the same amount of time. So guys, the one thing that I really don't ever want you to experience is that feeling that comes when you have hope in something and then you try it, and then you don't have success or it doesn't work. Now that's possible even if you work with me. That's totally possible. So but you want to make sure that you limit that possibility because it is really, really easy as a stroke survivor to feel down and to feel like you can't get anywhere. And my dedication is to help make it so that you gain your autonomy, gain your ability to be independent, and to be able to do this on your own. If you guys are interested, go to www.stroke survivorbootcamp.com. There you'll find resources that are continually being added to my my uh media. Um, I have books, you know, of how you can increase your lower extremity, increase your ability to walk. It's the guide back to walking. Um, I have that, and that is is done in a way that makes it so that it doesn't matter where you're at. I give you strategies based on your level, where you are at. And just remember, variability matters, increasing your intensity matters, and all you have to do is just remember it takes one step at a time. I'm Dr. Phil, and this is Stroke Survivor Bootcamp.

SPEAKER_02 58:47

Breathe in, count it out. Every scar is around.