Stroke Survivor Bootcamp with Dr. Phil: "Changing Your Environment Changes Your Trajectory"

In this episode of "Stroke Survivor Bootcamp", Dr. Philip Lamoreaux, OTD, OTR/L, CPT, explains how changing your environment and your mindset will greatly make a difference in your stroke recovery.

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

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

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

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

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

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

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

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

Transcript

SPEAKER_06 0:00

That's one of my biggest frustrations. People, you know, saying that they they looked up research and they found that stroke survivors plateau after about a year, six months. And, you know, essentially what that is stating is that stroke survivors can't progress after a year or after six months, or whatever that number is based on who you're talking to. That is not true. If you don't change the environment, then where you are at is where you're going today. With over 10 years of experience working with stroke survivors, and I've worked with them in both the hospital and community setting. Now I currently teach at the University of Nevada, Las Vegas as an adjunct professor, and I run my own businesses as an expert witness in personal injury, and I run my stroke survivor boot camps all over the world where I get more change in three to five days than many individuals are getting in eight to twelve months of regular therapy. Now I do this by combining both the beauty of occupational therapy and high-intensity gate training interventions. And I do it in your unique environment. Now, this combination has led to multiple stories of survivors gaining the ability to walk without their canes, beginning to jog, surf behind a boat, and get back to hiking in the great outdoors. So if you or someone you know could benefit from what I do, please send them to www.stroke survivorbootcamp.com and fill out a request form so we can get connected. And seriously, thank you so much for being here in this journey with me as I really try my best to support those of you who have experienced a stroke or your loved ones have experienced a stroke. And I just am so grateful for this opportunity to uh have a voice and to connect with you all in this way. So come along with me as we really discover different principles, strategies, and information together that's gonna help enhance your or your loved ones' stroke journey and help help you or your loved one get back into a state of joy and feeling of control over your own outcomes. Now, today's episode is really near and dear to my heart, and it's something that I have I have talked to so many people about over the you know past 10 years of being an occupational therapist. And it's also a conversation that is really difficult to have, I think. And so as we go through today, um just just be in a state of discovery with me. So one of the questions I have for you guys is what if the reason you don't feel ready or you feel like you're plateauing is because you're actually waiting. Waiting for something, waiting for change, waiting for healing. What if the issue is that you're just waiting? Now I know as I've talked to so many survivors, one of the biggest ways that survivors will uh explain their their experience is that it's it's a process, number one, and that they're just waiting for something to come back. And that sometimes, you know, something comes back and you know they uh it like you know rightfully so get really excited when something new starts happening. Well, today we're going to discover and discuss just this concept of waiting. Now, um I understand that uh that stroke rehabilitation, I mean, and just having a stroke and getting into life, it takes a lot. Really, you know, the your body has changed, it's not responding or reacting the way it used to. Your your mind may feel like it's a little bit a little bit slower or there's there's like a fog. And the one thing that I have seen consistently with every stroke survivor that I've ever worked with is that there is a there is a state of fear that over time becomes a constant companion. And we're gonna talk about fear in in just a minute, and you know, this con this concept of it being a constant companion, but just just keep keep that in mind. And you know, the reality is that most people, not not specific to stroke, I mean this is every single person, is that you want to feel ready before you take the next step. You know, I was having a conversation with somebody the other day, one of the most uh amazing therapists that I've that I've ever met, and this individual um has has allowed fear to prevent them from taking a taking a step in a direction that they feel confident and called to go. And the they won't take a step until they've really thought through and planned and put everything together. And it's it's amazing it's amazing to watch because you know what they produce is something very, very solid. But also there's some instances and situations where things can get missed. And it's no different with survivors, especially when it comes to everyday life. But guys, the thing that I have consistently seen over and over and over as I've worked with stroke survivors over these past ten years is that feeling ready almost never comes before doing. Readiness and feeling ready for something comes after doing. So you're not you're not gonna feel ready and then do do something. What I'm saying is that you do the thing, you do something, and in the process of doing, you end up feeling ready. But it only happens if you're doing. So that order actually matters. And what I see so many stroke survivors doing is that and and and also loved ones and therapists, is that we are using this order backwards. I mean it's in it's in the words that we use, you know. It's it's you know, we we use the words like we're healing, we're waiting for movement to come back. And you know what? The thing that I keep seeing is that if you if you go that route, if you do the waiting route, you're gonna be waiting a very long time before anything or if anything even comes back. So today we're gonna be talking about that. Now, your nervous system, it's it's what I like to call an adaptation machine. So think about what adaptation means. Adaptation, in the you know, the easiest way to think about it is that when I am doing something in a certain way, so let's say I am walking down the street, and as I'm walking down the street, on the sidewalk, up ahead, I see that they are redoing and reworking the sidewalk. So I get up to the sidewalk and I have a couple of options. If I have gone straight the entire time and I've just walked on the sidewalk my entire life, I, you know, I could just keep walking straight. Now there's wet cement, I have to climb over some barriers, and ultimately, you know, I may get my shoe stuck, or you know, I may not actually make it through. Or, which most of you guys that are listening are like, well, why don't you just go around it? Well, yeah. Or we can go around it. Now that going around it and doing it in a different way is an is an example of adapting. So when we talk about our brain and how it works, it's it's really interesting because the brain has the ability to make new connections all the time. Now, how fast we can make those connections that that is something that happens, you know, um, and is impacted by a lot of different things. But let's just keep it simple. Our brain can adapt. And it's going to adapt every day as you come up and experience different things. Now it's the brain isn't going to um isn't just going to adapt when we come up to a problem. So because we see a problem, the brain doesn't just automatically adapt. In fact, the brain wants to say, no, you go this this way, this route. And usually the brain is going to say what the easiest or want to go the easiest route first. So instead of going a harder route, the brain's gonna go the easiest route. And that is that's a really tough thing because the easiest route isn't always the best route. So during today's episode, we are going to uh talk about how the brain is going to adapt to what you repeatedly actually expose it to. So, and that's not that's not that's not just a metaphor. I mean, that is how the brain actually works. We're going to talk about why so many of you, survivors or your loved ones, get stuck. And it's not because you're not trying, and it's not because you're not motivated, but we're gonna talk about how the environment itself, your environment, plays one of the biggest roles in your brain's ability to adapt. I'm gonna introduce you to Rita, who is an incredible human being that had a stroke and I have done a boot camp with, and we're gonna talk about what happened to her and how that relates to changing the environment and how that allows the brain to adapt. And we're gonna talk about how you actually can take back control of what your nervous system is being asked to do every day. So here is here's what I want you to actually sit with from the beginning. Your environment is either training your recovery or training your dependency. There is no neutral middle. Every day your environment is shaping your nervous system, and the only question that you need to ask yourself is which direction are you going? So, as always, we're gonna start with the evidence of the week. And today we're gonna go through Kleiman Jones. Now, Kleiman Jones is an amazing uh article that it's it's a foundational article when it comes to the nervous system. And Kleiman Jones, they were two physicians who got together and they were going to a conference and they put their heads together and they said, What are what are the you know what are the most important principles or um building blocks to explain neuroplasticity or your brain's ability to adapt, your brain's ability to grow new connections? And as they they put their heads together, they came up with 10 principles of now. Here this part, it's not just principles of neuroplasticity, it's principles of experience-dependent, experience-dependent neuroplasticity principles. So that just implies that these are things that require doing. These are things that require your experience. So let's kind of go through that uh at least at this beginning. So let's kind of just explain what's happening in your in your nervous system. Now remember, nervous system is made up of your brain, your spinal cord. So your brain is is you know the part that's in your head, that thought and movement and so many things originate from or start from. And then you have the spinal cord which goes down your back, which that's think of that as like one of the biggest highways or freeways. And then from the freeway, you have all these little exits that go out from the spinal cord, and they're these pathways, which are your nerves, and they go out to different muscles and different parts of your body, and as the brain sends signals, it goes out through those pathways and to make it so that your body does what you want it to do. So that part of yourself is actually built to adapt and change all throughout your life. It's not an option, it's not, well, some people it adapts to and some people it doesn't. No, that is actually how it is designed from the moment you're born until the day you die. Your nervous system is designed to be shaped and adapted and influenced by what you do, what you're experiencing, and as the focus of today's episode, what your environment is demanding from you. Now, after a stroke, that job of the nervous system, it doesn't stop. Like it's not like you have a stroke, that part of your brain, you know, it dies, and then all of a sudden you lose that ability to adapt, you lose that ability to change. No, that is not true. In fact, that is that's one of my biggest frustrations, guys. One of my biggest frustrations is when I hear neurologists, therapists, um, family members, people, you know, saying that they they looked up research and they found that stroke survivors plateau after about a year, six months. And, you know, essentially what that is stating is that stroke survivors can't progress or can't adapt, or their brains just for some reason stops adapting after a year or after six months, or whatever that number is based on who you're talking to. And that just doesn't make sense. It makes no sense, guys, because here's the here's the thing if our brain is built and designed to adapt, to make change, then it makes no sense whatsoever that we can't that that it just stops doing it just because you had a part of your brain that was damaged. Nope, the brain still is going to actually actually keep working, it's still gonna you know work over time, and it's just trying to figure things out, and so that adaptation, guys, it doesn't stop, it actually becomes way more important, it becomes so so big because now your nervous system at this moment in time, especially right at the beginning, it's reorganizing around these new circumstances. Essentially, you think about my example of you know walking down the sidewalk and they're redoing the sidewalk, and now you're trying to get to the other side of the sidewalk, and well, you can't because that's in the way. Those new circumstances, those new blocks, you know, blocks are are now in your brain. And so you you have to make a decision, you have to figure out a different way to actually make it around those those those new those new blocks. So ultimately, guys, the the question isn't if your nervous system is going to adapt. It's you know, that's not a question. It will adapt actually every day and without your permission. It's just what are you going to choose to have it adapt to? Or where are you going to have it start adapting? Now, Kleiman Jones, they they really started to lay this out in 2008. And you know, a few of these principles you've definitely heard, like use it or lose it. If you don't engage in an actual activity, if you don't engage in something, well, the system, you know, the the pathway that that uh is you know associated with that is going to weaken. There's use it and improve it. If you actually engage in doing something and you do it in you know in a meaningful way, the system is going to you know, your your brain is going to put more effort and energy towards that type of activity, and it's going to improve. Now they also focus on what's called specificity. And when it comes to adapting, the brain is going to adapt specifically to whatever experience you give it. So if you give it specific experiences that have to do with what you're trying to accomplish, well, guess what? Your brain is going to start adapting in that direction. Another one that they pointed out is that repetition actually matters. Now, neuroplasticity, it it's it's kind of a funny thing because you know it takes an incredible amount of energy and effort to actually make new neurons grow. So to help them grow, it takes a lot of effort. Repetition, where you ask it to do it again and again, think of it like think of it like this. If you've had kids, this will ring true. But when you ask your kids to go and clean their room or to clean the bathroom, do something like that. And if all you did was ask them one time, just one time, are they gonna go clean it? Chances are they're not. They're gonna get distracted, they're gonna have something else that comes up, they're it's it's it's not, you know, kids kids aren't gonna just do it the first time you ask them. And sometimes, some days, you have to ask them and remind them over and over and over. And sometimes, especially when they're young, you have to be there with them, continually guiding, directing, uh, and sharing with them and telling them what it is that they need to do. When we're thinking about adaptation and the brain's ability to change, you know what? Our nervous system is kind of like a kid that you just ask to go and clean the bathroom, and you have to be there every step of the way. So repetition is like the amount of times that you have to actually ask or remind your child to go and clean the bathroom. Now there's another one that is is very Very close to every occupational therapist that's out there. We've been talking about this, and our entire profession is founded on this, and that is the concept of salience. And salience matters. Now, salience is just a fancy word for it means something to you. And the brain is going to prioritize if something has meaning. So it's going to prioritize making new connections or adapting around something if what you are trying to do has meaning. And then the other piece is that time matters. Now there's a couple different ways to look at this, and I'm going to point out one in particular. Time matters has to do with the amount of time that you are intentionally trying to do something. So if you have your environment set up to where you're constantly having to try to adapt, an example would be you want to learn how to walk without a cane. Well, if you just moved your cane into a whole nother room and you had to get up every single time and actually walk without your cane to go get your cane, that would be a that would be time every single time that you get up and when you go to sit down, that you would be putting towards trying to get your brain to make that connection. So how much time are you actually putting into it? And then the one that is the most important, the most important in all of these things when it comes to your brain's ability to adapt is the concept of intensity. Now, intensity is going to be defined as the level of demand that you put on your system. So you put on your body, it's the it's the the difficulty of what you are actually making your body do, the effort that your body has to go through, not your mind, but your body. So, you know, here's some examples. You know, if you avoid doing stairs, well, the stairs will get scarier. So if you don't actually do it, you're gonna lose your ability. If you sit most of the day, then standing actually becomes more threatening. So if you don't actually get up and move and take steps and you don't do it a lot throughout the day, well, then you're gonna lose that ability. Your brain will adapt to the environment you make it experience. So if the environment that you're making it experience is sitting around all day, well, your brain's gonna adapt and say, well, okay, I don't need to be able to do all these things because you know you don't do them very much. So if you, you know, another example is if you walk only in like perfect, controlled, flat, quiet conditions, like a quiet environment, you won't go out into the real world. Your brain will adapt and it will make it so that when you're in your house, yeah, you you get better at walking. But it will only adapt to that. And so then when you get in another situation where it's not your house, not your environment, well, the brain hasn't adapted to it, so your performance will actually go down. Now just realize that this is not like a this is not like a character flaw, this is not a you flaw, this is not anything. This is just your your system, your brain, doing exactly what it's designed to do. It it's designed to adapt to whatever is put in its path. Is one of the most amazing things about us humans. It's that we have the capability to adapt to whatever gets put in our way. Now, the biggest problem with humans, this is not just stroke specific, however, it comes out really strongly in many stroke survivors, but just in humans, we avoid we seek comfort and we seek safety, and we avoid exposing ourselves to something difficult, to something that would make us struggle, that would that would make it so that we have a mistake. Now, there's usually good reasons for that. But if you think about you as a stroke survivor, right from the get-go, one of the first things that you were likely told is don't fall. Don't fall. Don't fall, don't fall, don't fall, don't fall, don't fall. And basically, what we have conditioned you to do, you know, if you think about like what the environment of what we've done as therapists is that we've created an environment where we say, don't adapt anymore. We'll let your brain adapt to this environment that doesn't actually have you moving, doesn't have you trying things, doesn't have you, you know, attempting to go upstairs and putting in effort. And so then guess what happens? Guess what becomes the norm? It's a lack of living, a lack of trying. And that becomes the norm. So your system, right from the beginning, and the way that we have things set up, is that it's going to respond to what you what we're allowing it to do. The people who have improved the most, and the people who have defied the odds, the people who have who have proven the doctors wrong, are the people who don't sit and wait. They are the people who s who live in this state of uncomfortable and state of continued need to adapt. Now I want to talk about something, you know, that really I think is one of the biggest preventions to using this truth that we've just set up right now, that the brain has this ability to adapt and change, and that it always will, and that is this concept that we well, the brain, the brain will always experience some level of fear. Now, when we are afraid of something, our initial typical response is to avoid. Now, when we avoid, we don't allow ourselves to get into an environment or to experience an environment that will challenge us in a way where we could actually fail. Now, most of the time, this has to do with, you know, for stroke survivors that they're afraid of falling. So what happens is you won't walk as much because as soon as you're on your feet, guess what? You have a much higher risk of falling. You won't let go of your cane because you have a higher chance of falling. You won't go outside because the terrain, the ground is is uneven, it's unpredictable, and you have a greater chance of falling. Now that is all very true. It also is something that is led and and uh guided by your fear. Now that fear is warranted. That fear is legit, guys. It's completely part of this process. However, if we think about it just in this context of what we're talking about today, fear prevents you from experiencing or doing things that will create or cause adaptation. Your brain won't actually adapt because guess what? You won't put yourself in those positions that require adaptation. So, one thing that I just want to point out very clearly. The sooner you can face your fears, now, especially if it's something that causes more uh it has it has a higher risk, then yes, you want to make sure that you have the right equipment and right individual there. That's actually one of the things that makes my boot camp so uh valuable and different, is that I will find that piece that you are afraid of, and I will give you just enough support so that you can be successful even though you'll make mistakes, but you won't injure yourself, and I will make you go through and experience whatever it is that you are afraid of. Now that demand then gets put on your brain. Your brain then has a choice. Actually, it doesn't even have a choice if you think about it. It has to adapt because that's its job. It will try to run, it will try to avoid. But if you if if you know you continue to experience and go through the things that cause fear or causing you fear, then guess what happens to the fear? The more you do it, the less fear is present. That's huge, guys. That's huge. So as we're as we're thinking about this concept of your brain is constantly adapting, let's let's talk about probably the biggest piece that you can actually control. Like you guys have control over this to a certain degree, and that is your environment. So here's what I want you to make a connection that most people won't. Now, in occupational therapy, we have a framework, we have a you know something that we got that we're guided by, and it focuses on your context as one of the most important pieces to your engagement and participation in everyday life. Environment uh can either be a facilitator, like it can make it easier, or it can actually be a barrier. And what we can do, or what you can do, is you can change the environment so that you can be successful. Now, you can also change the environment so that it creates difficulty. If you do that and you create difficulty within your environment and you challenge yourself, the brain will adapt. Now remember, anytime you change something, you know, and you you add something that's gonna make it so that your brain has to adapt, there's a higher chance of making a mistake. So when you do that, you're gonna want to make sure that you have somebody present that can help you. But changing your environment will shape and change the different patterns that you that make up your your day. You're gonna now do it in a different way. You also will have uh different habits, routines, roles, rituals, these things that actually make up your day, they will change if your environment changes. For example, if you have your favorite lounge chair, what would happen if you got rid of it? I know some of you are squirming in your seats as you're listening to this. What if you got rid of it? And what if you put a chair that wasn't comfortable instead? Would you spend more time sitting or would you spend more time moving? Now, your environment has created a situation now that has made it so that you your brain has no choice but to adapt and make it so that this is different. What if you got it to where your environment, you know, your your yard, something like that? What if you got like a let's say you know a pile of dirt, spread the dirt around so that it made roly hills in your backyard? Now, it when you needed to go outside and to do something, and you have to now go over those rolling hills, guess what? It's going to make it so that your brain has to adapt. Your environment is going to shape or change how you do something. And whether you realize it or not, or whether you want the responsibility or not, your life is the catalyst. You think about what a catalyst is. Catalyst is the part in a situation that makes something happen quickly and easier. Your environment is one of the biggest catalysts to make it so that your brain will change. So you can look at your environment and you can look at things and you can change the environment in a way so that you know what? Your nervous system, your brain, again, has no choice, but it will adapt. Now, one thing that is that I just want to put in here anytime you are adapting, it is really uncomfortable. It's not fun. But guess what happens as you live in the uncomfortable? Change. And it becomes easier and it becomes more comfortable because your brain changes. Think of it as like it's a temper tantrum almost. When you start to make change, when you change the environment, when you start to experience it, it's kind of like you know, a little two-year-old that starts to have a temper tantrum. It starts to scream at you, it starts to yell. But guess what? When the environment doesn't change, and when you know the kid doesn't get their uh get what they're screaming about, guess what they'll do? They'll stop screaming. They'll also stop asking about it, and things will change. So think of it this way. If your world, your environment, your life is asking nothing, your brain is gonna give back nothing. If your world is asking a little, so if your environment is asking a little bit of you, then your brain is gonna change just a little. But if your world is asking real, meaningful demand, your brain is going to give real, meaningful change. And the more that you change your environment, the more it requires you to do, the more your body will change. So most stroke survivors that I've met, they have a home environment that really is asking less of them than what their brain and body actually need for change. And it's really not because anyone meant harm. There's usually a lot of different factors that go into this. You know, it oftentimes, though, it's because the they you know they they feel more pain. They're it's it's more difficult, they you know, they're not they're not comfortable. And the family loves them, spouse loves them. And so then the environment is modified so that you can have more access as a way to make life easier. For example, a bedside commode, a brief, something that, you know, you know, a bedside commode where you can sit it right next to you and you just do a little transfer over. Well, you never learn to have to actually hold your bladder. Now I'm not advocating that every single person needs to do this, but I'm using it as an example. If you don't change the environment, then where you are at is where you're going to stay. Hey, this is Dr. Phil. If you're a stroke survivor and you want to regain motor function, improve mobility, and build real confidence in your recovery, then I want you to check out one of my Stroke Survivor Bootcamp training sessions. These are intensive, hands-on experiences designed to push performance, improve function, and help you get back to doing more of what matters in your life. Go to www.stroke survivorbootcamp.com and let's get you back on track one step at a time. So changing the environment is the easiest way to actually get real change. So as you are thinking about this concept of your brain's ability to adapt and you know, not having a not experiencing a plateau. What I want you to realize and recognize from this is that you can change your environment, which will require your brain to adapt and change. And this is where boot camps, this is where Dr. Phil, what I do, this is where I become so valuable, is that what we do in our boot camp and what I can do for you with a video call, a you know, a video session, um uh texting back and forth, what what I can do is help change your environment to create the demand that will require more change. Because I think what we do is we sit here and we have this life, we're sitting here, all of us, and our brain gets used to routine, different roles, different rituals, and it gets used to comfort. And what happens is that I as an individual will not change that unless there's something that requires change. So I won't adapt until something else makes that change. So if I need to be that person that that says, hey, make this change, I'm all for it. Set up a set up a meeting, set up a call, let's go for it. But if you as the the spouse or as the family member can advocate and push for that change to happen, great. Just remember, there's going to be frustration, there's going to be a tantrum of some sort. So get ready for that to actually happen. Now, I've been saying this throughout, but I just want to make sure that I'm very clear. I'm not saying, you know, throw caution out the window and just change the environment so that you know it demands everything. I'm not I'm not saying do this in a reckless way. I'm I'm not saying, you know, is to push every individual into hard situations, right? That's that's not that's not necessarily the message. The message is if you have a low demand environment, it's going to make things safer. But it's also going to make it so that you stagnate and plateau. And you know, after a stroke, you want you know safety does matter because you are at a higher risk of falling, you are at a higher risk of injury. And there's a place and a time for low demand. But let's be real. If you look at every single stroke survivor, every single loved one, you look at yourself, we all have something that we can change or ad or you know change in the environment that will require adaptation. Here's a perfect example. Let's say you want to get more fit, but you work at a desk job. Well, guess what? A way that you can require the brain to adapt by changing your environment is twofold. You park the farthest away that you can. And then you just have to walk farther every day. That one environmental change can have a big impact. Maybe you use the elevator and you're up four flights. Well, what if you stop using the elevator and you use the stairs? Yeah, it's gonna require you to get there earlier and it's gonna require some change, but that's the whole point. It requires your brain to actually adapt and change. So when we look at this, the reality is that if I don't actually change the environment or allow the environment to change, then really I'm accepting that there's a plateau, and I'm accepting that that's where I'm at. If you are not okay with that, then I would highly suggest that you get on a call with me, set up a session, set up a consultation, you talk with your family members, you talk with your therapist, you find what can change in your environment, that you can remove, that you can add, that will require you, because you have no other choice, to adapt. And the thing that you can that you can uh have confidence in is that your nervous system is going to adapt if you make that change. But it's gonna require that you do it even in the moments when you're not motivated, even in the moments when you're tired, even in the moments when you can when you feel like you can't. Guess what? If you don't have that recliner there anymore, and you're just so tired and you want to sit there and watch TV or you want to look at TikTok, well, maybe I mean now you don't have it, so it's a little bit more difficult to actually do it. Which will change what you do. Maybe instead you go and you do the dishes. Maybe instead you go on a little walk. This conversation is really uncomfortable. It's it's not it's not a it's not a fun conversation to have because I think every single person feels like they're giving everything that they can. And the reality is you are. But your brain is fighting against you. The way it's designed, the way it's built, it's designed, it's fighting against you. Because your brain is is designed to go the path of least resistance. And because it's designed to go the path of least least resistance, guess what's gonna happen? You are going to find that you don't actually want to change. Because if you did, you would have already made that adjustment already. And then the other piece is that even if you want to change, you're not willing to do whatever it takes to change. And so sometimes we need somebody on the outside that can help give us the confidence that we can make those changes. So here is the question that I want every single survivor and every clinician, every spouse to ask themselves this week. What does your current environment require from you every day? Sit with that. Not what does it allow, not what does it tolerate, but what does it actually require? That's different. For example, my environment requires that if I want to go to bed, I have to go upstairs. We have about sixteen steps to go upstairs to my room. That environment requires that I know how to do that. If I didn't have stairs in my house, guess what? My environment like I I may not actually be that gr I may I may not be as conditioned to going up and downstairs. Because my environment doesn't actually require it. We have um you know, we have a slanted driveway. Just that alone. If I want to go down to the sidewalk, go get mail, well, I have to go down that that slanted driveway. So think about what in your environment is re is required. And then ask yourself a deeper question. And that is how can I change my environment to require more? That is the biggest thing that you can get from this session, from this session, from this uh episode. It's what in your environment requires you to move, requires you to do things. What in your environment makes it so you don't have to, and sometimes it's your loved ones. So that's all that's a really difficult, difficult thing. But oftentimes it's something else in the environment. And then ask yourself, what can I change in the environment that requires me to actually adjust and change? And then confirm with your physician, confirm with your therapist that that's a good choice and do it. I'm always open for a consultation. I'm always open to have a discussion with you to figure that out. And if you do that, you will start to see actual change. Because your brain has no choice but to adapt and change. For more information or to sign up for a bootcamp, just go to stroke survivorbootcamp.com. I'm Dr. Phil, and I'll have more right after this.

SPEAKER_00 51:30

Hi, this is Christy from Wheelchair Escapes. I specialize in travel for the disabled, making their travel dreams a reality. Besides planning your vacation, I can also arrange for special needs equipment to make your vacation experience even better. I have over 26 years of hands-on wheelchair travel experience. My husband has MS and he hasn't walked for 26 years. And we travel and fly with both a power chair and a manual chair, and you can too. I can assist with land vacations or cruise vacations. I do plan a group cruise twice a year, and that helps my first-time travelers know that they are not alone. I am there to assist. Besides my travel experience and special knowledge about wheelchair travel, I am paid by the vendor, not by you. Where do you want to go? Most likely I can help you get there. Please visit my website, www.wheelchairescapes.com, or give me a call at 603-382-3596. And let's start planning your vacation now. Thanks and happy travels.

SPEAKER_06 52:54

And I'm gonna I'm we're gonna talk about the same principle, and that's Rita. Rita is one of the most amazing human beings I've ever met. She has had a massive fear of walking without her cane. And I went and worked with her, and as we started out, I mean, she had so much fear that the way she was walking was she was sitting back, like really sitting back, and and you know, preventing any sort of forward leaning, which is what we all do when we walk. We basically catch ourselves as we fall. And she would not allow herself to get into that position or situation that she would lean forward, and it was because she had these massive fears. The first was a fear of falling. Now that fear had really organized her life. Every transfer, every step, every choice that was made throughout her day would pass through that filter of fear. And the second was the fear of driving on the freeway. And think of it as the same pattern. And the longer that Rita avoided it, longer that the environment didn't demand that she keeps pushing, the more these fears, the more she hit a plateau. And just kept dreaming of when she could do it, when she could experience life without it, but never got there. So guess what I did? I put her in situations where she had no choice but to experience falling, to experience being in dangerous situations. Now, I'm a skilled uh individual, so I could do that. And I had her going up and down a very, very tall staircase that looked so scary. And then what really put it together was that I took her to this to the beach and we walked on the sand. Now, sand is the most difficult thing for a survivor to walk on, hands down, no question. And we did that. And guess how many times she fell? She fell about four or five times as we tried to go up and over these little sand, you know, sand mounds. She fell four or five times. She got up, did it again. She was so afraid. But yet, the environment required that she still stood up, got up, had to take steps again. In sand that was moving underneath her feet, that was super scary. And because the environment required it, her brain started to adapt. Guess what happened the next day? Next day I get there and I show up, and Rita says, you know, she has this brightness in her face, and she says, I want to throw my canes away. I was just, I was floored. I was shocked. This is a woman who, for the last year, we'd been telling that she she didn't need her cane, because she didn't. And she on her own at this moment said, I want to throw my canes away. It's a perfect example of seeing your environment and saying, you know what? I'm going to require in my environment that I that I improve. So, we walked about a quarter of a mile to the garbage can with four canes. She took them, threw them in the garbage can, and hasn't used a cane since. Guess what's starting to happen? She's gaining more confidence, her mobility is improving, and it's because the environment required it. It is one of the most beautiful things for me to see when somebody allows the environment to change so that they can change, so that they can rise to the occasion. And guess what? She drove on the freeway. And guess what? No longer did she drive to Starbucks, drive up in the parking lot, sit there and look at people inside, and drive away. Now, she drives to Starbucks, she drives to places, walks in, no cane, pays for her own her own food, and in her words, she feels more normal. That was because of a simple concept of requiring your environment to be the adaptation, to be the thing that makes the change happen. Because your brain will adapt, no question. So, if you can't tell what the secret of the week is, it's that your environment is either training your recovery or is training your dependency. There is no third option. Every day your nervous system is responding to what your environment actually asks of it. Every day the patterns of your life are shaping the patterns of your brain. And every day, the demand and the level of your context is teaching your brain what to expect of you and what is required. That happens whether you choose it or not. It's the way of the brain. And most survivors never choose it. Their environment stays whatever it became after the stroke, and the arrangements made in the first few weeks become permanent. And the protection becomes the new normal. And the training plan was actually set by somewhat of an accident and then never truly revisited. Recovery requires you to take back authorship of that. You don't have to overhaul everything overnight. You do not have to pretend that the fears are not real. You don't have to pretend that your body is something it is not. But you do have to look at your environment and ask honestly, what is this training me towards? If the answer is that you're more dependent, then that is a place to start. Not with anger or with shame, but with clarity. Remember that your environment is your training ground. So make it train you toward the life that you actually want. In a nutshell, everybody. Your nervous system adapts to what your environment repeatedly asks of it. The brain is built to change based on the experience it gets. And what you repeatedly do shapes what your nervous system gets better at. And your environment, it's going to determine what you repeatedly do. Guys, that is the principle of your context. And whatever your environment is going to require you on a daily basis is going to become your actual real training plan. So for the survivors listening, care partners that are listening, the question is not: am I working hard enough? Am I doing enough? The question is, what is my world asking of me to do every day? And for you clinicians that are listening, the instruction is look at the context, not just the person, not just the impairment, but their context. And help the survivor and their family see what the environment is actually training. And then help them shape the environment that trains the right thing. Effort without environment is going to be exhausting and slow and not get them where they want to go, and it's going to create plateau. But if the environment requires effort, the plateau is not going to happen. So when we move to the tough truth of the week, if you keep waiting to feel ready, you'll just keep waiting forever. Because the nervous system does not produce readiness from just thin air. It's going to produce it from actually doing, repeating, being exposed to different things, and from real demand from your environment. Without those things, there is nothing for your brain to actually change and adapt toward. So the system is going to stay where it is, and you're going to plateau. And that isn't failure of effort. That's really just failure of the design. And you can work really hard at changing your environment so that it makes it be something that trains you towards where you want to be and where you want to go. So here's my challenge for you. Look at your environment, identify what is actually being required of you, and find one thing this week that you can change in your environment so that something new is required of you just because the environment changed. I can promise you that if you do that, the only option is that your brain will change. It will adapt. So it's worth it. And the amount of work that you do will then start to actually make change that you can see and that you can start being excited about. Now, guys, if you are interested in working with me, go to www.stroke survivorbootcamp.com and you can fill out a form and get in touch with me. And I do three to five-day boot camps, which are intensive sessions where I come to you or you come to me, and we work on change on really learning how to live in demand. I help set the environment up so that you can actually get change. And then what happens is your brain has no choice but to change. So if you're interested, reach out to me through www.stroke survivorbootcamp.com. And guys, I appreciate you going through this journey with me. Some of these things that we talk about are really hard to talk about, but they're so important that you understand and that you hear it. I'm Dr. Phil, a licensed occupational therapist and certified personal trainer. And if there's one thing that you get from ever listening to these episodes, is that just remember all it really is gonna take is you to take one step at a time. I'm Dr. Phil, and this is Stroke Survivor Bootcamp.

SPEAKER_05 1:04:59

Breathe in the city. Show some chicking down the door Left side, heavy right side light, brain rewiring in real time. Every slow step still award you in You fall on it, you stand on town again.

SPEAKER_03 1:06:28

You say it hurts We say you heal You say you say I'm scared We say that's real Don't you feel shouting on this making yours You clamps your teeth and hit the floor Stroke survival boot camp Command and let go Fire in your muscles Flood in your soul We rise, we fall, we rise up higher than before Stroke survival boot camp You can't get down the door This is for the days 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 here Strokes of the Bible