Stroke Survivor Bootcamp with Dr. Phil: "Walking Speed, the 6th Vital Sign"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, talks about how a stroke survivor can regain their pre-stroke walking speed.  

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. I am so excited to be here with you today. And the question that I want to start out with is what if one of the most important numbers in stroke recovery really has nothing to do with your diagnosis? Like nothing to do with your age, nothing to do with your impairment scores, how good you were at walking from day three, four, or even in the first six months? What if the number that mattered the most was actually your walking speed? Now, this may seem like an interesting number because you know what does walking speed have to do with your ability to get dressed? What does walking speed have to do with your ability to uh you know walk your dog or even make some you know meals? Like what is it, what does it have to do with that? And it honestly sounds like a metric or a way to measure, you know, something that just therapists want as a way to see if you're improving, right? But today I actually want to challenge that. I want to challenge that walking speed is you know, it's it's just something simple. Because there's a group of researchers that made a bold argument. And what they argued was that walking speed, it's not just a gate measurement or a walking measurement. They argued that it should be treated as what they called a functional vital sign. And it's something that tells us like real meaningful information about how a person functions in the real world and then how a person actually lives. So today we are gonna go pretty deep into this. And seriously, I'm I'm so excited about this because this changed the entire way that I looked at my practice as an occupational therapist. It was something that I I didn't focus on for the first oh five years of of my career. And in fact, in the first five years of my career, I I did the opposite. I I pushed people to go slower so that things could look better. And that is that that made it so that they they didn't focus on their walking speed. And so we're gonna talk about why walking speed actually matters and what the research actually says, at least in this article, and you know, what kind of a life different walking speeds actually support. Because if you go faster, you may end up having a better quality of life and a better ability to participate in life, versus if you go slower. Now, we're also gonna talk about Kevin and what a year of focused, consistent, intentional training that actually focused on speed looks like when you do it consistently every day, and it's a year later. And then we're gonna talk about why so many people want the outcome but are not willing to build the process, you know, the the support, the the strategy that's actually gonna get them there. And here is the tension that I want you to sit with from the very beginning of this episode. A lot of people say that they want to walk better. I mean, I cannot tell you how many people say to me, send me messages, say it to my face that they want to walk better. But few are actually willing to train in a way and do what is actually necessary to make changes so that they can increase their ability to walk. That gap between wanting and doing is really something that we're going to also address in this episode. So let's just start with the research because this paper is going to give us a foundation that is so much stronger than just faster is probably better, or yeah, you should learn how to go faster. So here we go. So the first thing that I want us to recognize is that this particular paper uh it is a scholarly review, not a randomized control trial. And if you remember in the past episodes we've talked about there's different ways that you can make sure a research study is actually going to give you uh less biased information. And that is that that's going to be something that's like a um it's randomized. So randomized, right? You don't you don't know what's happening, and it's a specific trial where you have two separate groups. So you'd have one that's gonna be what we call the control group, and the control group is the one that it's just gonna be the typical, like we're not really gonna change anything different, and usually in in research, what happens is this controlled uh this control group, they they get what we would call typical therapy, and that's gonna be things like lifting weights, focusing on strength, you know, walking somewhere between, you know, 300 to 500 steps in a session, um, you know, not pushing speed, uh having low intensity, because that's the majority of these sessions. You know, you think about your sessions, you're sitting down, you're doing sit to stands, maybe you're taking a few steps, you know, you're taking a lot of rests. Um, you know, that's gonna be your typical therapy. And then what you would have on the other side is gonna be which is what you're comparing to typical therapy, is gonna be a type of intervention. So a strategy that somebody's gonna be using. And that strategy, in you know, it could be anything. It could be, let's let's see if we if we count to 20 before we walk, is that going to make it so that you have more control than if you just start walking, right? I mean, it I mean, that's obviously nobody's done a test like that, but that's that's an example, right? There's the control, this is what everybody's doing, and then there's the actual um test, the intervention that we're wanting to see if it's better than the the original. And that's gonna be a controlled trial. And then if they don't know who is in what group, and the people in the group don't know what they're getting, that's called that's that's that's gonna be where it's a double blind, where both the person who's assessing and then the and and doing the training, and then the person who uh who's in it, they don't really know exactly what they're getting. And that is one of the best ways that you can make it so that if you look at research, the outcome is you you can trust that outcome way more than something on a maybe a lower scale that didn't set up like that. Now, being a scholarly review, it's it's a review, which really just means that the authors, what they did was they went through a whole bunch of evidence, they went across so many studies, just focusing on a maybe a particular question. And the question that they asked was, what does walking speed actually tell us? And how should clinicians actually use it? So they focused on on that. And in this, in this actual review, um, it's it's called Walking Speed, the Functional Vital Sign. And it was written by Middleton, Fritz, and Lussardi, and it was published a little bit over 11 years ago in 2015. Now, the this matters in you know, when we're talking about this, it's it's gonna matter because you know what these authors are are not saying is that one intervention actually caused one result in one population. They're actually trying to make a bigger claim. They're saying that this measure when it's when it is measured across multiple settings and so many diagnoses that uh it gives us some information that is uh so important. And you know, uh the the big thing from this, you know, is that the big thing from this is that as as people uh try to figure out what the best thing for you as a stroke survivor, you know, to focus on, you know, is we want to be able to know that in across all different settings, all different diagnoses, if this is something that makes a big difference, then that's something that we want to make sure that we put into everyday practice because that's going to make the difference bigger and make it so that you can participate in life better when when you increase in those in those areas. Now, one thing that I absolutely love about this particular article is that when they went through and they did these reviews, they didn't just keep it to one diagnosis. They actually wanted to see what walking speed does to individuals across lots of different diagnoses. So here's here's some of the diagnoses that were part of these reviews or these studies. So just older adults that were living in the community, uh, chronic stroke. There you go, guys, chronic stroke, and that's anything that is six months after stroke, uh incomplete spinal cord injuries, um, hip fractures, um, multiple sclerosis, Parkinson's disease, Huntington's disease, Alzheimer's disease, and dementia. So all of these diagnoses were a part of this, the these reviews. So when we're talking about understanding the power of walking speed, this is taking it across so many diagnoses and making it so that we can we can see the impact that walking speed has just in general across all different types of of issues and and problems and and uh and and struggles that people have actually have. So what does valid mean? Well, valid actually means that it's telling us something meaningful, and it's just not a number for the sake of a number. So when when they found you know that this number, you know, it was pretty common among these this group of people that were experiencing these symptoms or these things, the number actually is telling us something meaningful. What does reliable mean? Reliable really means it gives us consistent information. You can measure it today and again next month and trust that what you are comparing is real. So if we are looking at what they found here, it's that they they found that the the walking speed actually was going to be the same uh depending on it didn't depend on on what type of diagnosis it actually was. And then sensitive, sensitive actually means that it can detect change. So if something shifts, so meaning walking speed, if it has the ability to to uh increase or decrease, then what the studies that they looked at were able to do was to detect or identify something changed because of actual walking speed. So we're not just talking about something that is just convenient, we are actually talking about a measure that is is useful in the clinic and and in your therapy, and that is a very big deal. Now, here's the part that actually really when I read this, it it stopped me. And that's that, you know, and I've said it a little bit already, but that's that walking speed has been shown to predict. And I think that's really, really important because as a clinician, and really you as a as a survivor, if you know what your walking speed is, then you can you can predict really where you where you are heading, what is what is actually happening to you. And so response to rehab, functional dependence, frailty, mobility disability, cognitive decline, falls, institutionalization, uh getting hospitalized, uh heart heart events, dying, all of those things, all those things can be predicted by walking speed. At least that's what this article states. And so when you look at your walking speed, you're not just looking at your legs, you're actually looking at the function, you know, the risk, your health status, and in many cases, you're looking at your future trajectory. That's that's heavy. Because I think I think some you know, one of the things is that we want to have hope, right? We want to have hope that what we are doing is actually working. And we want to know that we're able to progress and move forward and go in a particular direction. Well, if we know what our walking speed is, we can actually identify and figure out where we are heading. Because this is going to help you actually focus on living and getting to the point where you can thrive in life. This is not a oh my gosh, you're doomed. This is a now I know what I need to focus on, so let's go. And remember, anything that we ever talk about, it really truly comes down to this is something that I, as a stroke survivor, I want to I want to make sure that I give it my all. Because I'm always going to give you, here's what the uh research says, and then let's do something about it one step at a time. And so that's the frame that I want you to carry for the rest of this episode. So why do they call it the functional vital sign? So the phrase vital sign, you know, it's it's one of those those things when we think about what vital signs are, they are actually like quick measurements that are practical practical, repeatable, and deeply informative. So specific vital signs. You think about and when you were in the hospital, they had to get specific vital signs, things like blood pressure, your heart rate, uh, your how how quickly you're breathing, what your temperature was. I mean, I was a CNA for four and a half years, and those were the things that I had to get every oh three hours or so, three to four hours. Because these vital signs would be oftentimes the first things that that would help us predict that something wrong is going to happen. And so they're they're really important because they can help us make decisions, they can help us track if something's changed, and it's something that should be able to easily be communicated across different different people. And in this in this study where Middleton they argue that walking speed actually belongs in that conversation. They explicitly, you know, what they support is designing it as as and putting it as the sixth vital sign. And because it does have predictive power. And it's because a good vital sign, it's it's not just something that you can measure, it's something that tells you something important about what is actually happening inside of an individual. And what they found is that walking speed tells us a lot. It tells us how much functional capacity a person has. So what you're capable of doing functionally. It tells us something about your general health status. And in many cases, it tells us whether a person is likely to manage the demands or what is required to do life well, or if they're going to do life poorly. Now, if we think about what that means in the context of stroke recovery, there are so many activities that are quietly built on mobility. Things like, okay, we need to get to the bathroom in time, we need to move through the kitchen safely, answer the door, carrying something from one room to another, making it through a grocery store. I mean, that's a huge one. I just did that with somebody this week, and and man, that that it you get into a store like Walmart, like a super, super Walmart, or you get into a Costco or a Sam's Club. Man, that is so much walking, and and that's you know, walking speed is something that will predict whether you can actually do that. Uh keeping up with your family. In fact, this week, as I was talking with Jeff, one of the things that he talked about is he went with somebody, you know, one of his friends, and they were they were walking, and he kept telling them, I need you to slow down, I need you to slow down because you're going too fast. Uh navigating a parking lot. We walk through a parking lot, and as we and you stroke survivors, you'll be able to connect with this. Walking through a parking lot, and then getting to that point where you have to cross from the parking lot, and then there's that that that road that you know it just goes right in front of wherever, you know, whatever the store is, and and there's oftentimes cars there. I mean, having to having to do that in a quick manner, that's that's hard. And these are not like athletic events, they feel like athletic events, but they're actually just life tasks. And if your walking speed is too low, and this this will ring true to so many of you, your world gets smaller. And it's not because you stopped wanting more, it's not because you gave up, it's because the demands of the environment they actually start to exceed what your capacity is to meet them. So when speed drops, life narrows. Now, on the flip side of that, when speed improves, life has the ability to widen. More independence can happen, more mobility that's actually useful, more confidence. I think that's one of the biggest ones I've seen is more confidence and less reliance on others. And then the last one that I want to write here is more participation in the activities that actually matter to you. Now, the the article is not claiming that every single increase in walking speed is automatically going to transform every area of your life. But what it is trying to make a strong case for is that the number actually matters because it's going to correspond or it's going to relate to real categories of function and real levels of risk. And the clearest way to see that is through what what I call specific cut points. Now, this is where the the paper actually is going to become very practical. And this is the part where I want both clinicians and survivors who are listening to both lock in on and to really think through. So Middleton and her colleagues, they they don't just say that it matters in abstract, you know, just uh like, hey, it matters, so think about it. What they actually did, and if you can if uh you can get the paper, there's a there's an actual chart where they show what you know a particular walking speed and meaningful outcomes that are associated with that. walking speed and they treat it as like a it's like a a sign or a a um a banner for what kind of function is actually gonna be possible at different speeds and you know they they list functional walking categories that every clinician should actually know so I'm gonna say these for you um there there will be on my website I have a blog and it will actually have these these uh these parts um it'll have it there so you can you can go on and and look and see what they are and I'll make sure that I put the uh the chart on that on that blog as well um and you can get you can access that by going to www dot stroke survivorboot camp dot com and then at the top you'll be able to see more click more and you'll see blog and click on the blog now let's go through these categories 0.1 meters per second and that is what they call physiological ambulation like you can move but here's the here's the thing walking it's not serving you in any real functional sense yet so if you can walk at 0.1 meters per second that's great you can walk but it's actually not at a speed where you're you're able to be functional yet 0.23 meters per second this is what they call limited household ambulation now this type of individual if you're walking at 0.23 meters per second you're walking mostly within the home but man there's so many constraints so you're able to get around in the home but there's there's some constraints there's some places you can't go if you just add 0.04 meters per second to it at 0.27 meters per second you have unlimited household ammulation and you can move around your home just a little bit more freely then here's the big one 0.4 meters per second now most people when they look at this 0.4 meters per second in therapy this is kind of like the this is the uh we'll say gateway where they say now you're able to actually move around in your home and it's it's it's you know your your home speed here's the thing you can walk around at 0.4 meters per second but that still takes so much effort and so much time that most people as long as they have somebody there with them if they're walking at 0.4 meters per second what happens is they're going to typically ask for somebody else to do it for them because it's gonna take a long time and it still takes a lot of effort when you're walking at 0.4 meters per second. But at 0.4 meters per second you have some community ambulation you you could ambulate in the community but it's in very limited ways here's the other big milestone that therapists usually are like okay great this is this is this is where you this is where we want to say you are you're free and that's at 0.8 meters per second now that's community ambulation is what they were saying in this article and you can manage many and I I think that's an important word many of the real world walking demands that community life actually requires now here's the thing it's it's really interesting because whenever I've you know worked with somebody and and they're they're walking at 0.8 meters per second they still they still struggle to keep up with the demands of walking out in the community and it's still really really difficult and in this article they don't actually say this so this is something that is just coming from Dr. Phil the way that I'm interpreting it so take it for what it is it's just my interpretation. But when you look at this this uh this uh graph you can see at one meters per second is the moment where it's like a threshold it's kind of like a a moment where individuals who can get to one meter per second and that's walking 20 feet in six seconds if you can if you can do that then that is the moment where people start to take over and actually own their life they start to actually do things on their own they're they're able to do ADLs successfully and independently they're able to start doing things like bringing in groceries and actually doing the pieces that you know most people would consider are required to be thriving in life. Now just quickly I want to go over a few of the pieces and this is what they found if you're walking at 0.4 meters per second you would still be at a very high risk of hospitalization and falls and it be at a high risk of of of of death also at two years you have an increased probability of of decreased mobility and ADL disability and you're just barely just barely getting out of this severe walking disability range that's at 0.4 meters per second and then when you go to 0.8 you're barely getting out of this limited community ambulator role but and you're and you're having an increased independence in self-care but you still have cognitive decline at a moderate risk in five years if you're walking at 0.8 meters per second and you still require interventions to reduce falls and you have still increased risk to be hospitalized within a year and you still need help typically for personal care. That's at 0.8 meters per second now guess where all of that actually starts to go away you start to be able to do household activities and it's the threshold of where you're less likely to be hospitalized or have a bad thing happen to you and you know and you're independent in your ADLs and and able to uh have an increased independence in your own self-care that happens at one meter per second so with this episode there's there's a goal I want everybody to start paying attention to as a stroke survivor it's that one meter per second uh speed when you go to your physical therapy and occupational therapy ask them to time you and set up 20 feet so just 20 feet and ask them to time you and to see how fast you can actually walk 20 feet and make that a goal what you want is to be able to walk 20 feet in six seconds now that may seem really really difficult and it is it's it's hard but it's doable it's something that you can reach but you do need guidance and you do want to make sure that somebody is there as you push your speed. So that's not something I would recommend doing on your own. What you want to do is make sure that you do it with your therapist. Okay but that one meter per second is think about that as like that's the threshold to thrive. And so if you really want to get to that point where you're just owning life and instead of having life pass you by you are passing through life like you're making life do things for you and another thing this this week this this happened uh we were actually talking it was last night and there's this there's this phrase that I want you guys to start talking about and to to remembering and that is instead of working for your body like you are actually working for your body you're trying to get your body to do things and you're working for it you want to get to the point where your body is working for you. So it becomes automatic it becomes something that you do on your own and then your body actually works for you. That's what happens to when you are able bodied your body was working for you not you working for your body and so as as we go as we think about this episode I mean we've been going for a good amount of time on this walking speed but the thing that I want you to remember is that the faster you can get the more you get to this point where you make your body work for you instead of you working for your body. Now if you go to your therapist and you say hey I want to I want to measure my walking speed and they they maybe they don't know how to do that. That's it's possible. What you do is you tell them you say okay I want to set up 20 feet so mark out 20 feet and then what you do is you start about oh three to four feet behind the line so at about 24 feet and you tell them to start the timer as soon as your foot crosses the the uh the line at we'll say zero feet and then to stop the timer as soon as a a part of your your body your feet crosses the 20 foot mark and then what you need to do with that is you need to take the the number whatever however many seconds it is and you do six divided by that number so let's say you are walking you you can do it you can do 20 feet in 14 seconds. Let's say that's your number you take six and you divide it by 14 that is going to give you your meters per second score and so that can help you identify and then you'll be able to go onto my blog and and see where you're where you're currently at now here's the thing you have to promise me that when you look at that it will not be a oh my gosh I'm doomed because that's that's that's not the way to do it. What you have to say is oh my goodness this is not where I want to go I want to get to where I can thrive because it's totally possible 100% you just have to be willing to put in the actual work and to do what's necessary in order to push yourself push yourself in a way that makes it so that you increase in your abilities because you are worth the effort. Every single person here listening you are worth the effort that it's going to take to regain that walking speed and to be able to regain your life. Now one thing I want to highlight and this is really really important there's this concept in occupational therapy that's called occupational genesis so don't get turned off by that by that word but this this occupational genesis it is essentially a the process that every single human being goes through to develop their identity and it happens over years and years and years of struggle and years of trying something and getting good at it and then increasing your skill in it and and struggling as you increase your skill and it becomes you now that process you have to go through that again so it's not just a matter of like I gotta get back to who I was it's actually you have to learn to love the process that is required to to learn who you are now and to regain an identity because it can only be done through doing and I think oftentimes we you know because in the medical field I think it does us a big disservice in the medical field when what we are when what we're saying is hey come in we'll heal you and you can go out and you can leave because it doesn't take into account this it doesn't take into account that when something happens to you you are no longer the same and many times and especially in stroke you can't be the same and you have to be okay with relearning who you even are and that is really difficult to do like super difficult to do so as as as you go through you know this this episode and as we as we go through so many other things guys it's worth the struggle but yes it sucks but you can do it and being a part of of Dr. Phil's program and you know I have some exciting things that are that are are on their way that are coming out and I I seriously cannot wait to to share these things with you guys. And they will help you be able to do it even without a traditional Dr. Phil boot camp. And that is something that I I can't wait to make sure is available to everybody. And so as as you as you go through this just remember regaining who you are because you feel like you've lost you yourself because you have but regaining who you are that takes time but it takes more than just time it takes time while doing I'm gonna repeat that it takes time while doing it's not just something that can happen like quickly. It's something that requires repetition exposure consistency volume and a clear target of something that you're wanting to accomplish and if you do that guess what's going to happen it's going to feel like you are incapable of doing doing and getting where you want to go but through that process you will gain the ability to do what you want to do and to go where you want to go but it only happens through doing just remember when it all comes down to it walking speed matters and getting to where you can increase your walking speed that's going to take time and it's going to suck and it's going to be hard but it is worth every step even though it feels like you're trying to move a mountain for more information or to sign up for a bootcamp just go to StrokeSurvivorbootcamp.com I'm Dr.

SPEAKER_01 38:27

Phil and I'll have more right doing the left stroke survivors and remember there's still a beautiful life after stroke time to move on to our survivor spotlight of the week and the one that I wanted to spotlight his name is Kevin.

SPEAKER_00 39:35

Now Kevin lives over in uh over in uh Great Britain area and uh this is about almost oh man a year and a half a year and a half ago was the first time I met Kevin and he reached out to me and he said hey essentially do you believe that I can get back to running and get back to to walking better now he was walking but he was walking with a pretty severe um limp you know the the stroke the stroke walk I said absolutely here's what you need to do you need to make sure that you're increasing your effort and intensity and you need to be taking thousands of steps a day and it needs to be every day well over the past year and a half I have watched as Kevin has you know posted these different updates and shown what he's doing he's doing high rocks competitions now and he's pushing he's getting to where he's I mean he would he would jog he would jog and jog and jog and man it looked so funny like it did not look it didn't look right like an like normal walking or normal jogging but that man kept pushing and it's not that it's not the you know there's there's this uh there's this this piece where you know in in our field and and I think just throughout throughout life we s we celebrate when somebody does something you know we highlight as this like this big big thing when somebody uh is able to do what everybody what an able body person is able to do and we're celebrating that the person can walk and just man good job on being able to walk well you know what to me that's not the issue the thing that I think not everybody does is the ability to face the unknown to face the struggle every day and to consistently do something over and over and over without stopping now that that is something that people struggle to do and that is what I celebrate. When somebody makes has an accomplishment when somebody's able to walk when somebody's able to do something that they've been trying to do for a long time and even if it's not a long time it's just something new like during a boot camp I'm gonna celebrate that they did it. But it's not that they did the actual task or did the actual walking or the steps it's that they didn't allow themselves to stop. And it's that they kept focusing and pushing and persevering and that is the exact definition of Kevin I saw a video of him just the other day and of him just you know he put his phone down and then he walked away and he was talking about how he could finally after so many years of a after his stroke he was able to he was able to do lunges and I think the part that was just kind of brushed over that I just hadn't seen and it just it it it shocked me was when he walked away from the camera I could barely see a lip it gets me emotional but um within my own life this the the whole thing of being consistent and showing up every single day and doing the same thing and making the same decision every day in in hopes that you're going to improve even though you don't see it on a day-to-day basis that is really really tough to do and the only way that you know that it's happening is you know months to years down the road when you look back and you go oh my goodness I'm no longer that same person but you don't actually see the change Kevin Kevin is a perfect example of that and he's somebody that I would absolutely love to get on this show so that you guys can learn from what his what his uh his secrets are because that It it takes it takes a lot to consistently show up every single day. So Kevin, I wanted to officially give you a shout out and just to say, you know what? Not that you're walking, not you that's not the piece that's inspiring me. The piece that is inspiring me is the same piece that would inspire me with anybody that's trying to do anything that they're that they that they want or that they're struggling with. And it's that you show up every single day and you you get after it. And by doing that, you are seeing results. And congratulations on that, my friend. Because that is so, so cool. Gosh, guys. I want to share one other piece. You know, one of the things that one of the things that, you know, I've been asked before multiple times is why is it that I care so much about the stroke community? Because guess what, guys? I don't have a family member. I don't have anything personal, anybody personal or personally close to me that has had a stroke. A stroke has not impacted my my family's life yet. And so why on earth do I care? And I won't go into all the details, but here is the piece that I've come to realize of why I care so much. When I was 12, I didn't want to be here anymore. I wanted I I I had a plan. And I was so down. I felt like there was no hope. It was lost. And I felt like I c I I felt like what's what's the point? And I had a really cool experience that obviously I'm still here today. And I won't go into that experience, but the pain that I felt the hopelessness, the loss, not knowing not knowing if any w any effort that I gave would actually yield or create a result. And feeling the frustration and terror and fear and hopelessness that came from that state of mind, I don't want anybody to have to experience that. And I found, and it's not just stroke survivors, but uniquely stroke survivors to a certain depth, are so prone to experiencing this depression, this this feeling, this feeling of hopelessness, because everybody else gives up on them. Everybody gives up. Even though the research says otherwise, people give up on them. And because of that, man, I I don't want anybody to experience what I did. There's a reason I can talk and say things in the way that I do and the way that it connects with you guys. And it's because I have felt the depth of the emotion. Now, I didn't feel it because I had a stroke, but I felt it because I lost a particular part of myself. I lost control. And yeah, guys, I don't want you to have to experience that for one more day. So that's why I do what I do. That's why I do these boot camps, that's why I push, that's why I'm I'm on social media, that's why I've I've left the the comfort of a of a a guaranteed paycheck. And why I need your help. Keep pushing this out there to so many people. Because I don't want I don't want to have anybody have to deal with what I what I experienced any longer than they have to. And if I can be a source of hope, I want to be that. Because by all means, I don't want to ever hear about somebody who is in such a deep depression that they can't that they don't feel like they can actually get somewhere. Guys, you are valuable. And you are worth it. Now let's uh let's let's uh let's get to the secret of the week. Secret of the week, we kind of talked about, but walking speed is not a vanity metric, it is an access metric. So walking speed is a way for you to measure if you have access. Many people think that speed is about looking better, you look normal, it's about impressing your therapist, about all those pieces, but and that it's an optional piece. But I actually think that it should be a necessary piece. You need to focus on increasing your speed. Because increasing your speed is is going to essentially give you more permission to thrive and participate in life. So, secret of the week is that speed it's not it's not just some measurement. Speed is actually essential and critical to you getting to participate and to thrive in life. Now the breakdown. I want to just go through what we've talked about in just as as simple as as I can. So here we go. Walking speed tells you three things. One, what kind of walker you currently are. Two, what kinds of environments you may realistically handle at your current level. Three, whether real change is actually happening over time when you measure it consistently. Now that means that walking speed can actually guide your expectations, it can guide your hope, it can anchor your goals, it can educate you know your family, you. And it can track progress in a way that is honest and objective. And it can help you focus your your your efforts on what's actually going to make a difference in your recovery. So if you're a survivor, the question is not just am I walking, the question is is my walking fast enough for the life that I want. And for you clinicians, don't just record the number. Make sure that you interpret it, translate it, and teach it to the individuals that need to hear the value of their walking speed. And tell them where they are currently going at their current speed and that they need that it needs to increase. Because it's a predictor of where somebody is going. Okay. So there's a couple of uh there's a couple of uh uh uh questions that have that have come up. And one is that people want to know more about my boot camp. Now, let me just give you a little bit of an outline. My boot camp is something that I created about a year and a half ago when I was watching somebody on a treadmill. Her name's Anna, and I remember sitting there thinking, man, if I just had two days with her, I would change her life. So I reached out to her, and luckily she said, Yes, come, I'll try it. So I said, Okay. And I worked with her for six hours, and in six hours she went from walking 20 feet in about 18 seconds, and with a with a cane, to 20 feet in about eight seconds. Like point about 0.8 meters per second, point almost point uh 0.9 meters per second, like right around there. That's a massive increase in just six hours of work. And then I kept repeating that same framework. And now it's progressed over time. And so essentially, here is what a boot camp is. A stroke survivor boot camp is an opportunity for a stroke survivor to see what they are actually capable of, to get uh a program that uh will help you reach the goals that you want to reach and help you get into a mindset that's going to provide you with the support that you need in order to actually make a difference and gain the identity that you've been wanting so badly. And it will change your life. That is the thing that I keep hearing from so many people, and because it's based in the the foundational principles and theories of occupational therapy, it's focused on you in your context, your life, and it is specific to you. So we make sure that the things that you want to accomplish and the dreams that you want to accomplish, I help get you set up on that path. Now, does that mean that in my time that I'm with you, it automatically we're gonna accomplish everything that you want to get done? No. But you know what you will have? You'll have a template on how you can actually get there. And then it's up to you to do the work. Now I have uh again, I have something that's coming out and I can't wait till it gets till till I finish it. But it's gonna be something that will help help anybody do this. And to do it from your own home. Now, obviously there's gonna be some limitations, but essentially you're still gonna be able to do it. And so I am so excited about the boot camps and where they're heading. And so that is what a boot camp is. Now it usually is three to five days. It can be more. It can be less. It just depends. I'm working with somebody for nine days coming up at the end of this month. I'm currently working with somebody for six days. Now, the more that more time that I get to work with you, the more you're going to get. And that is the closest thing to a guarantee that exists. When it comes to neurore recovery. So that's the question. That's that's one of the major questions that I'm gonna answer this week. And to end, we're gonna talk about the tough truth of the week. Here's the tough truth. If you are not willing to love the uncomfortable, you will not get where you want to be. Now I'm not saying that you have to enjoy every second, and I'm not saying you have to pretend it's easy. I'm saying you have to learn to value to be okay with the uncomfortable. Because the uncomfortable that is where actual meaningful change is going to exist. That is where real walking improvements are actually going to happen. Things like effort, repetition, frustration, fatigue, discipline, patience, honest feedback, and the humility of doing those basic things over and over and over again without knowing a guarantee and being okay with mistake, and that mistake is gonna happen, and that this feels this this doesn't feel safe, it doesn't feel comfortable. Learn to love that. Because if you don't I I would be willing to bet that you will not get to where you want to go. And I think that's the thing that a stroke does the most to somebody. Is it puts you in this position where you have no other you have to. You have to be okay with that concept. Because if not, you're just gonna be sitting around hoping and waiting for something to heal that is not going to heal. Okay. So here's what I want you to do. This is our weekly challenge, our call to action. If you're a survivor, I want you to find a way to measure how fast you can walk 20 feet. If you can't walk 20 feet, measure how far you can walk. And the time it takes you to get that far. So if it's five feet, great. How long did it take you to get there? And then work towards beating it. If you're a clinician listening, measure the walking speed of every single person you're working with this week. And then come back to the Middleton et al. And measure it to what it actually means and where they're currently at. And then start promoting speed. Make sure that you're safe. If you are wanting to learn more about how to do high-intensity gate training safely as a clinician, I have a few things that are coming out, and also I am currently available to uh have you join me on any of these boot camps. And the way that you can contact me is through www.stroke survivorbootcamp.com. Go there, send me a request, and I will happily send you an email, get on a phone call with you, and let's figure out how we can help increase your abilities, your skills, and your confidence in working with individuals who've had a stroke and help it so that they actually get the change that makes a big difference in their life. Guys, thank you for being with me. I'm Dr. Phil, and just remember one step at a time. I'm Dr. Phil, and this is Stroke Survivor Boot Camp.

SPEAKER_06 59:14

Breathe.