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Wow, what a great day.
And all bunch of information in my head
was swimming this morning as I was listening.
So as Aaron was saying, yes, I've been in physical fitness
and wellness for about 20 years.
And from there I decided I had to do more.
I was working with a lot of clients
who were coming post rehab.
And so I decided to go ahead
and further my education in physical therapy.
And that's where I ended up working with stroke survivors
and creating the program that I did with Easterseals.
So I don't mean to be the Debbie Downer here,
but let me talk to you just for just a minute
about what it means to have a stroke.
So just imagine your life,
and suddenly you can't move one side of your body, it stops.
What if you can't get outta bed, can't sit up,
can't get dressed, can't go to the bathroom,
and when you start talking,
the words aren't coming out quite right.
And then what if you all of a sudden can't do the things
that you did automatically?
And then what if the medical society
or the medical community says,
"We can't do anything to reverse this"?
And then what if the doctors tell you,
"This is as good as you're gonna get"?
Hi, my name is Tony Cherry.
I am 58 years old and had my stroke at 54.
When I woke up from it, my neurologist asked me
to move several of my extremities.
When I was unable to, he told me
that that was as good as I was going to get.
Now, mind you, nothing moved.
And now mind you also, this is a doctor.
And I told him, "Bullshit.
You don't know who I am and this is not gonna,
I'm not gonna be like this for the rest of my life."
So I'm gonna introduce a lot of my clients to you today.
So my job today is
to take all the wonderful sciences out there,
all the wonderful information that we have,
all the wonderful techniques that we've been given
through the science world.
And I'm gonna show you what they do and what I do
with all that beautiful science that we have.
I don't understand how it all works up here,
but I do know it works out here.
So as Tony was saying, that is the life of a stroke survivor
and their caregivers.
This is what they're left with.
So the medical science is telling us
that their best hope for recovery
is within the six months to a year.
And so insurance kind of drives the protocol in a way
for our clients to get outta the hospital,
to go to rehab, to go to home health.
And what we teach them, which is very important,
we teach them to do ADLs using their unaffected side,
forgetting about the side that is affected.
And we just kind of teach them to get them in, get them out.
And that's really important. But that can't be the end all.
You can't stop it there. They have to continue on.
So what does recovery look like?
Recovery looks like, let's get them moving,
let's get their brain, their body to connect
and then let's get them physically conditioned.
So when I was working in therapy,
one of the things that I began to see was
that they were doing repetitive motion,
boring, nothing to it.
And I thought, "Oh my gosh, if this is what it's all about,
it's boring for me, it's gotta be boring for them."
And it was driving me crazy
and I knew it was driving them crazy.
So what I decided to do was take a program
that was repetitive and make it
so they could actually do recovery activities
and do task-driven things with their hands, minds, brains,
everything we could do.
So when I was working with them,
a lot of my clients came to me.
And as you know, stroke clients, when they come to you,
they usually have some sort of what we call spasticity
or tone, high tone, which means their bodies don't,
they don't have the mobility.
So they're tight, their muscles are tight,
their joints are tight.
So when I watched these guys and I watched
that we weren't allowing them to do what we thought,
what I believed that they could do,
I believe they could do more.
So I believe truly that if we give them the opportunity,
if we give them the structure,
if we give them the motivation,
and if we give them the chance,
they will rise to the challenge.
So just because these guys don't talk
doesn't mean they don't think or understand.
Just because they don't move well
doesn't mean they can't learn to move.
And in my world, because we're hesitant to challenge them,
doesn't mean they won't work hard to rise to the challenge.
So this is what I do. This is our studio.
This is where they come and they do their work.
They're with me anywhere from three to five hours a day.
And these are some of my guys.
And of course we do have a lot of fun and we do laugh a lot.
I was just talking to Heidi and we were talking about,
you know, giving out as a caregiver and as a provider
and the energy we put out and do we get the energy back.
And I gotta tell you, we do. We have a great time here.
So what we've designed is a program
where we wanna get their body moving,
we've gotta get them moving.
So without having good mobility, we can't get them to move.
Then we work on connecting the brain.
We work on the brain to the body,
just like we've heard all day today,
how important exercise is
in the brain and the connection there.
And then the last thing we do, we gotta get physically fit,
because there is research out there that says
they have got to work out,
we've gotta get them cardiovascularly healthy.
So again, the clients come to us with stiff joints
because of the lack of mobility
due to contractures or stiff joints.
So before we can actually get going on the exercise
and to get the benefit and have adequate exercise,
we've gotta get them moving.
So my physical therapist and I, we do joint mobilization,
which kind of sounds scary and it's really not,
but we're just trying to get those joints to loosen up,
so we can actually get a range of motion,
something that we can get the optimal movement we need,
'cause without that we're not gonna get any cardiovascular
or any exercises.
We've also added in soft tissue mobilization, which is,
as some of you guys would say was massage,
but we actually get into the tissue
and we actually move it around so that we can, again,
get that range of motion.
And then we are doing passive range of motion
to what we call active range of motion.
And then we are doing a stretching program
'cause all the muscles need to be stretched
so that we can keep the mobility of the joints.
So once we get the the body moving,
we got the joints moving,
we got some more mobility, better range of motion.
So what we've found in our research is
that we're seeing a lot of improvement
and some really good recovery through mental imagery.
So we've been starting to practice with a lot of this
and we've just started doing this about eight months ago,
and we're seeing some really
interesting fun things happening.
So one of the things we're doing,
this is called mirror therapy.
And the, the premise behind this is
that it will help create skill mobility.
It actually helps decrease pain, possibly decrease neglect,
and some sensory impairments.
So this is Dave, this is one of my clients.
He is doing both hand, upper extremity and lower extremity.
He's basically looking into the mirror.
His right hand, which is affected side is behind the mirror.
His unaffected side is moving the object in the mirror
and he's watching his hand in the mirror.
And what that does is it kind of,
the brain perceives the right hand meeting, the left hand.
It's an interesting phenomenon.
The first day we had him do this,
he was probably 15 minutes into the activity
and we'll do things like wash the table,
we'll stack plates, we'll, you know, fold something up.
And they were pressing down on.
So we're trying to get different tactile feedback
through his unaffected side.
And he was doing this for about 15 minutes
and he stops in the center of it.
And he said, "Wait a minute."
I said, "What do you mean wait a minute?"
He goes, "There's something happening in my right hand."
And I said, "What do you mean?"
He says, "I don't know, my shoulder's tingly."
And that's 15 minutes in.
I'm just, I'm getting kind of excited.
Of course, I don't wanna show too much excitement
'cause we are just starting working on this stuff.
But he started showing
some really interesting movement patterns
of his elbow and his hand.
And he's got a very stiff hand.
Little story about Dave here.
He is a skier.
We got him skiing after about a year of me working with him,
I got him set up so he can go skiing.
We did all adaptive ski exercises so he could go wall sits
and you'll see him do that here pretty soon.
But he was skiing and he came down the hill,
was standing at the bottom of the hill and fell,
not skiing, he fell standing still and broke his wrist.
Sadly it was his affected side.
And so he came to us and, of course,
I was clapping when he came in
'cause, well, at least you broke your arm
doing something you enjoyed.
But he's real stiff.
But we started seeing some mobility of a wrist
that actually had not been set quite right in the cast.
And he's getting some mobility.
And again, here's his feet. We're doing both legs.
This was something we wanted to try
'cause we've got lower extremity
to work on in upper extremity.
So we wanted to try with the legs.
So this is another client, this is Don.
He has been doing the mirror therapy as well.
And then once we get through the mirror therapy thing,
we really try to push the utilization
of their affected hand.
So in Don's case, he's been,
he's still doing the mirror therapy, still doing.
So we're kind of doing what we call,
I hate to use the word forced use,
but I'm forcing him to use his affected hand.
So this is Don.
If you notice his tremor.
So this is the beginning of his exercise
and he did this for about maybe 20 minutes
after doing the therapy of the neurotherapy.
And now watch.
No tremor.
So does mirror therapy work? Does forced use work?
Yes.
I'm real proud of Don.
He also has started skiing,
so we've got him up skiing now too.
Okay. And this is Rudy.
Rudy is a fairly involved right side effect.
And I wanted him to practice some of the finer motor skills
'cause he's pretty good with his left hand
'cause he writes with it and everything.
But he had so much problem with this,
just using his left hand,
again, his right hand is behind the mirror.
You can kind of see how he's having difficulty doing that.
But after a couple days he came back and was practicing.
He came into me the next day and did again.
And then the third day he came in and did this again.
No problem. He just did it automatically.
Just went right into it.
So even using his unaffected side, looking in the mirror
and I challenge you guys to go home
and stand beside a mirror.
Look in the mirror, don't look at your other hand
and don't look at this hand
and try to see if you can do that.
It's actually quite interesting
to go backwards and forwards.
So once we've done all of the mirror imaging
and we do the forced use, one of the things
that a lot of stroke survivors have when they walk,
they curl their toes or they internally rotate their legs
or their knees are stiff or they walk,
they come down into a lock position for stabilization
when they stand, during the stance phase of their walk.
So this is don.
We, again, we've been doing the leg in the mirror,
we've been doing weight bearing,
and so on this particular day
we decided we gotta stop curling his toes because it hurts.
Try walking some time
with your toes curled up in your shoes; it hurts.
So we spent about three weeks of me
crawling on the floor with him holding his toes up
so he would stop curling those toes
when he planted his foot.
And we did this over and over and over
and he was finally practicing at home
and I got his wife to help us out.
And this is the result of what happened.
Now watch him go backwards.
Watch him bend his toe. There you go.
So again, we got the body mobile, okay?
We're working with the brain through the mirror therapy.
We do the tactile movement and then they practice.
And this is one of the results we get.
So there's additional research out there
that talks about just visualization.
The mirror therapy is part of that visualization thing.
It's that imagery.
But then we started talking about doing visualization
and the power of the brain.
And we've heard that all morning
about the power of the brain
and how it can do so much over the body.
And again, I don't understand all the stuff
that goes on up here,
but we started doing some visualization
and the way we start this is
they either lay on the mat table or sit in a chair,
it depends on what activity we're trying to get them to do.
And we have them think about a task that they want to do,
raise their arms, reach for a cup,
whatever it is in their brain that they wanted.
So we have them quietly sit still
and they visualize that affected side reaching for
or grabbing or whatever it is in their brain.
They just think about it
and they just visualize it happening, just visualize it.
Then we come back and we say,
"Now we want you to you to visualize this,
but then we want you to try to move that affected side.
Just try it."
And most of the time, you know what?
It doesn't move.
And that's okay because I want them to feel that connection,
like Heidi was having this student today,
close your eyes, what do you feel?
Do you feel the air around you?
We're trying to get them to, to feel what's going on.
And then the last step we do is
we still keep their eyes closed.
Then we take them through the range of motion physically,
I actually physically move them through that range of motion
that they're trying to create.
So this last one here, this is Rudy,
he was the one with doing the hand thing.
And about six months ago,
we started doing this exercise, again, it's visualization.
I'm abducting his arm and I'm asking him to close his eyes
and pretend to bring, you know, have him bring his arm in.
So about, I don't know, 15 minutes after we did this,
I came back to this again and he started doing about 75%
of the movement with his arm without my help.
And that was the day I cried because I could not believe
after five years post-stroke, he's moving his arm,
and he has never had any movement
prior to this of that affected side.
So does it work? Yes.
Is the science that we're learning today work? Yes.
I wish we had more.
So this is Rudy and he's done a phenomenal job.
He's my poster child.
So now that we've got the brain
connected through the visualization,
we're doing the mirror therapy,
one of my clients called me up
and he has what we call a receptive aphasia.
And receptive aphasia is where you can talk to him.
And it's kinda like Charlie Brown,
the wah-wah-wah-wah with the teacher.
He can't understand the words we're saying,
but he called me up and said, "I'm reading a book
and I'm talking to my body."
And I said, "Well, what do you mean
you're talking to your..?"
Says, "I want you guys to start doing this."
I said, "All right, we'll start doing this."
So we actually encouraging our clients
to talk to or think to the extremity.
Again, it's that visualization
kind of brain/mind over the body thing.
And what he told me was he started doing that
and he woke up one morning and what he calls synced up,
his shoulder didn't sink up and he was kinda laughing
and he said, "It just didn't sync up.
So I decided to go back to sleep
and tell my body to do its job.
And when I woke up, my shoulder was hooked up
and my toes and my fingers on my left side were moving."
And again, these guys don't move.
Now can it be just an accident?
I don't believe so.
I don't believe it, because I've seen Gary,
which you'll meet here in a little bit,
I've seen him go from not walking, being in a wheelchair
to walking with just a single point cane.
So I believe it does work.
Okay, so then we start adding in the physical piece of this.
Now we have to go into the physical portion.
So this is Tony and we're doing sit to stand exercises
because we all stand up and sit down
and stand up and sit down.
And nine times outta 10 he will lean
on his right side to get up.
Well, that's going to destroy his knee one day.
So we're working very hard
and you can see my hand is really hard on his foot
pushing to give him that tactile feedback.
So we do the mirror therapy, we do the visualization,
and then we're gonna do that tactile feedback of and work.
And here's Tony again.
We're teaching him to kneel,
because he A, wants to get on the floor
so he can be with his cats.
And I'm thinking, okay, you gotta get off the floor.
So we practiced kneeling at this level
before I put him on the floor.
And trust me, when we did this exercise,
he was scared spitless, he was so nervous.
He toned up and his leg went straight.
And it was like, "All right, you gotta relax."
So we played the visualization thing and I said,
"I want you just to close your eyes,
pretend you're bringing your foot up, bring it up."
And we repeated that until he could actually get it up.
And we got him kneeling.
Once we got him kneeling, he thought he was done.
I said, "Oh no, we're gonna work on your core strength."
So again, here comes the strengthening piece,
the piece of it that goes along with that physical exercise.
So we're doing a reaching exercise
which requires balance and core strength.
And he's done a phenomenal job with this.
This was after about three times of doing this
and this is where we ended up.
So now we put it all into that physical strength
and endurance and everything.
This is Dave, I told you we are doing ski sit, wall sits.
And this is his ski exercise.
So this is the beginning of his ski exercise.
He's not quite ready to go on to the further.
He's been not exercising like he should,
but we were getting him up on his toes.
So he actually has a right side effect and he'll that.
And this is Rudy again you met with the hands.
So this is about two and a half weeks ago.
And if you watch his right hand, he's gripping on his own
and he's pulling down using his laps.
And when I met Rudy three years ago,
Rudy was in a wheelchair, actually this has been five years.
He was in a wheelchair.
I saw his potential and said,
"You're not staying in a wheelchair."
So about three months later I got him up,
started standing him
and we got him walking on a hemi walker.
So now he walks with a walker.
So additionally then we add in the cardiovascular exercise
and all these guys do some kind of cardio
every single time they come in.
We monitor using heart rate monitors
and we maintain a safe heart rate
based on the cardiac therapy protocol.
So this is my guys all working out.
And along with all the things we're doing,
we're doing the mirror exercises,
we're doing the the visualization,
we're doing the mobilization, all these things all together,
they're getting endurance, cardiovascular health,
strength and stamina, which is huge for these guys.
So when you take all of those things
and you combine all of those things, the mobilization,
the brain connect to the body, then we exercise
and all of those things together,
these are the results that we're getting.
And I'm so proud of my clients.
I can't tell you enough how hard they work.
So this is Tony's paintings.
He started painting about two and a half years ago
and these are some of his oils that he's been painting.
This is Gary that I was talking to you about,
talking to his left arm to tell it to move.
And if you'll notice his right hand,
or sorry his left hand, it's actually on the bike.
I dunno if you can see it. His guy's mitten on.
But this is him in the Grand Tetons riding his bike.
And just in about a month and a half ago,
we took the client's rafting.
Now if they weren't mobile,
if they didn't have that brain body connection
and they weren't physically fit, we couldn't have done this.
But they're all willing to get in those rafts
and head down the Colorado River with us.
And this is Rudy. The first one is about a year ago.
Say flamingo.
Ligo.
Fla.
La.
Fla mingo.
Put together.
Flamingo.
Got it!
Okay. And this is him about six months later.
How are you?
Fine, thank you. How are you?
Fine.
(Karen laughs)
So he has gone from speaking single words
to sentences with inflection.
I dunno if you notice his voice in "I'm fine. Thank you."
And this is Don.
Remember I told you I had some clients
who were driving and skiing.
This is Don.
And look at him getting in this He-Man truck. (chuckles)
And there he goes.
And this is one of my other clients which I have introduced.
And this is Diane and her husband.
They hadn't danced in five years.
So now, she's dancing.
And this is just one more proof of the science
that we're doing does work out here in the physical world.
It happens in here, but it happens out here.
So I'd like to leave you with this. We can't stop.
Please, don't stop the science, get more funding,
let's work with the legislation, let's get more funding
to learn more about the brain so we can help these guys.
There is really true recovery for stroke survivors.
It's there.
However, just doing mobilizations
and just doing the combination of the brain/body working
and the physical exercise is not quite enough.
These guys have to have consistent work, hard work,
as a matter of fact, very hard work.
They have to be able to have the science behind
what we're doing for them.
So they feel like they are getting somewhere.
And they have to have motivation.
And that's our job is to motivate them.
And based on that and all of that, all that combined,
I know and I truly believe that stroke survivors can recover
and they do truly have a substantiated reason to hope.
Thank you.
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