Journey To Independence: How An Occupational Therapist Supports Patients Through Holistic Care with Avrielle Rykman Peltz

AIH 44 | Occupational Therapist

 

One of the biggest responsibilities of an occupational therapist or OT is to identify a person’s limiting factors with regards to the activities of daily living. Avrielle Rykman Peltz, OT and Chief Operating Officer of the Restorative Neurology Clinic at the Burke Medical Research Institute is an expert figure in neurological upper and lower limb recovery. She advocates on using occupational therapy to help patients regain strength and function of the limbs using proper assessment and cutting edge robotic technology. Avrielle highlights breathing efficiently and posture as vital aspects of recovery. Being an OT is an encompassing profession that not only focuses on a patient’s physical injury but on the psychological aspect of it as well.

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Journey To Independence: How An Occupational Therapist Supports Patients Through Holistic Care with Avrielle Rykman Peltz

Sean, guess what time it is?

It is the first day of stroke month.

We’re getting into stroke awareness month here and that’s pretty important to you.

It’s something that I never thought I would even know anything about or even want to know about because, at 39, I did not know what a stroke was. I had no idea. I had no clue. I was invincible.

You certainly learned all about stroke.

I learned quickly what a stroke is. It’s not so fun. However, it’s looking at every one I’ve met and look at the blessings it’s given me. It’s to find acceptance and to find the good behind it all or to find the gold below the darkness. I’m going to a chiropractor at a health event. This doctor has helped me tremendously put my body back together. He’s a chiropractor.

We love chiropractors because after going to Reno and talking to a few of them, I understand what chiropractors do now. They are the leaders in holistic healing. They’re the MDs of holistic healing and their whole thing is removing obstacles so that the innate energy of the body can flow and help it heal.

When you stop the oxygen and blood going to the brain, it causes a stroke. If the dam is blocked up and the water can’t flow or the oxygen in the blood can’t flow into the body, it breaks. I believe that with stroke, our guest who’s coming on is so profound.

Our guest, Avrielle, the analogy she made to a stroke is to imagine that you have your neurons or neural connections that are electrical wires. When you have a stroke, it’s like water got poured on them and they short-circuited. Healing after stroke is a process of trying to dry out the wires, allow them to reconnect and start working properly again.

I didn’t know what goes on post-stroke but the therapies involved are extraordinary. You have the occupational therapist. You have speech therapists. You have physical therapists. They work as a team to revive the survivor to make sense, to heal and to move forward.

What Avrielle went through so well is multilayered aspects of the healing process from physical to mental to emotional and how they all intertwine into healing from a stroke or healing from a brain injury or trauma in general. She’s dedicated to helping as many people heal as she can. She’s here. She’s fired up. She’s excited.

She works on the East Coast in New York. We were referred to her by two friends of mine, Matt Jacob and Brad Berman, who are both stroke survivors as well. She’s leading the cause. What I love about her is that she’s open to whatever is possible to help that person heal. If it’s a prescription from an MD or if it’s a breath work or just posture work or anything that gets that person to move. What’s her line?

It’s, “Motion is lotion.”

She is a wife, a mom. She leads this support system. She’s into research.

She was an occupational therapist. She got into research for healing neurological illnesses, stroke, TBI or anything in that ballpark. She’s part of the research team that’s helping to figure out ways to help the brain heal. If you know someone that has had a stroke, you’ve had a stroke or someone you love has had a stroke, just share this with them and help promote awareness around this issue. If you haven’t had the chance to jump over to iTunes yet and subscribe to the show that’s one of the easiest ways to help support the show. Drop a five-star review. Let us know what you love and thank you to our audience. Let’s go to deliver more of that.

Thank you for everything. If you feel alone, if you’re going through a brain injury, if you’re a stroke survivor or even a veteran, check this episode out because we talk about something that is so profound. That is about, if you show up and you keep moving, you’re going to improve but find people like-minded like us, the community that we’re going to build, we’re building, it’s going to be awesome.

Avrielle, welcome to the show. How are you doing?

I’m great. Thanks for having me. I’m excited to be here. It’s Stroke Awareness Month.

It’s Stroke Awareness Month.

Yes, it is.

What’s a stroke?

Lack of oxygen to the brain causes the stroke. It’s the same as the heart attack when you hear people have a heart attack. It’s a lack of oxygen to the heart that causes damage to the heart. While a stroke is a brain attack, it’s lack of oxygen to the brain.

If anyone’s not completely aware of what stroke is, it’s probably a good month to become aware. Avrielle, let everyone know who you are and we’ll go from there.

My name is Avrielle Rykman Peltz. I am a mother, a wife, a daughter. I’m an occupational therapist by degree. I went into the field of occupational therapy more like a personal story because I was in the world of dance and drama for many years. I was a professional dancer for an entertainment company. I was in the entertainment field. I was dancing from when I was a child all the way through college and graduate school, and that was my profession. When I was twenty years old in my sophomore year of college, my father who was 47 years old at the time had a devastating hemorrhagic stroke. He had a stroke that was caused by a brain hemorrhage. That day, in a blink of an eye, changed my life and my family’s life forever. I took a year off of college to take care of my father.

You are in battle when you are in war and you are in battle when you are surviving and living and thriving after having a stroke or brain injury. Click To Tweet

At the time, I was a Drama and Dance major in New York at a university called SUNY Purchase, which is known for drama and dance. My father was in the hospital for almost a year between emergency room, having emergency brain surgery, transferring him to NYU Medical Center in Manhattan and going from rehab to rehab and being at the hospital for joint diseases where Gloria Estefan was many years ago when she had a broken back. My father was on the brain injury unit there where she was later after her accident. I learned all about the medical field, stroke recovery and brain injury. I was fascinated by it. My new personal mission was obviously to help my father but I tried to help as many people out there with stroke and neurological issues.

When I went back to college, I changed my degree. I went back to Purchase and I pursued a degree in Psychology because I knew that I wanted to go into the field of occupational therapy. I went on to get my Master’s degree in Occupational Therapy from New York University. Here I am now several years in the field. Although I’m an occupational therapist by degree, I’m actually the Director of the Restorative Neurology Clinic, which is a specialized clinic at the Burke Neurological Institute in White Plains, New York. That’s my educational and career story in a nutshell.

What was interesting to me about that story is that you were going to school for Psychology and Occupational Therapy. You are already in a roundabout way practicing in that profession because of what your father had been through. You gained this hands-on experience while you were going to school for it.

It was tough. Being there, I would see people not have the best experiences in rehab. I would see therapists come over and interacting with patients. I would say to myself, “Why are you in this profession if you’re going to be treating people poorly? Why are you doing this or treating this person this way?” For me, I had a bad taste in my mouth from certain events that I witnessed when my dad was in rehab that I said, “I don’t even have a degree yet, but I will remember this forever.” I’ll remember that when I become a therapist. These are the to-do and to-do-not, that I will not do certain things. There were some eye-opening experiences also when you’re going through a trauma like that.

Why OT? Can you talk about OT to the world?

Occupational therapy is a misleading term because many years ago when it evolved, the first occupational therapists were nurses. After World War I and II, what someone’s occupation was, was how they spent their time. It was found that after soldiers were wounded in wartime that when they occupied their time doing things, they got better quicker thus, the term occupational therapy was coined. For many years, I look at an occupational therapist as a life skills therapist. It bridges the gap between all therapies. Unfortunately, in this day and age, the term occupation people associate that with your job or people say, “Do you just help people weaving baskets and doing fine motor coordination?” I’m like, “No, there’s much more to occupational therapy than that.” If someone has any injury or illness, the occupational therapist’s job is to identify what are the biggest limiting factors or problems the person has with becoming as independent as possible with their daily life routine.

If they cannot be independent, we have to educate the patients that we’re working with or their family members to help them and maximize as much independence as we can. What’s unique about occupational therapy is that we have very defined education and training not only in physical disabilities but psychiatric and psychological coping mechanisms. When you have a physical disability, it may or may not be apparent to people. When you have a brain injury or stroke, it’s a silent illness that people think that if you can walk and talk, you’re fine, not realizing that you are healing from a devastating issue that needs remedy. Anything that’s inhibiting you from independence, it can be psychological of being able to cope if you have memory deficits or problems remembering day-to-day things that are going to impact how you are going to be able to function independently.

Not only in your home by problem-solving, getting dressed or brushing your teeth again, but if you want to get back to driving or going to work or becoming a mom, becoming a parent again. It’s psychological. It could be physical. We have very precise training in both psychological, physical injuries, illnesses, and how to cope and be able to get as independent as possible. We work closely with physical therapists, speech pathologists, physicians, social workers, recreational therapists, and anyone and everyone that can help in the team and also ultimately the patients, their caregivers and their family.

AIH 44 | Occupational Therapist
Occupational Therapist: Lack of oxygen to the brain causes the stroke.

 

Thank you for your service. You did the ADLs necessary. If you could talk about ADL, it’s so important for us.

ADLs are Activities of Daily Living. I always make my first joke when I meet with my patients, I said, “Do you know what PT is, that physical therapy?” I’m like, “PT means Pain and Torture. Do you know who I am? I’m the OT, the Other Torture.” I don’t want it to be torture. I want people to feel that therapy is going to help them. You want to customize your occupational therapy, physical therapy or speech therapy whatever your needs are. You have to customize it to what your goals are. Those are my biggest questions. When I meet someone for the first time, I say, “I’m the other torture, but no matter what I say, this is you, your life and your body. You need to tell me what is most important for you to be able to do and what is limiting you at this time.” Whenever I meet a patient for the first time, I don’t care what other people say. I want to hear it from you if you’re able to physically tell me or if you trust your caregiver to express what your needs, wants and desires are. Obviously, I’m going to listen. The first thing that I say is tell me the three most important things you want to get back to doing that you’re not able to do now. Those are going to be our focus points.

My three was to guess which were to get dressed, which I did with my left and my right. I couldn’t put on a shirt. The left arm was weak and I kept getting the shirt. I still do it inside out and my brain’s still with me but it’s with repetition and repetition. The other one was using the bathroom. I’ll never forget because as a male, you want to be independent. I was in a diaper for so long. The bed pans sucked. To help me get to the toilet, I’ll never forget the worst PTSD I had was when the OT got me to go to the bathroom. They put a sign on my door saying, “Sean can now use the restroom all by himself.” My friends would come in, who were SEALs look at me and go, “What is this going on?” I’m like, “I can now go to the bathroom all by myself.”

It’s not just the ability. It’s getting your dignity back. What was your third? You said dressing. You said bathroom and what was your third?

To shower, someone has to stand over me and shower because I couldn’t stand up. I couldn’t get my balance. I couldn’t figure out how to turn on the hot and the cold. You guys are just so sweet and so nice because, at 39, I was a three-year-old kid. My brain had to re-learn everything.

Thank you for highlighting occupational therapy. Occupational therapy works initially on activities of daily living like you’re describing. You want to be independent and people get upset. They get angry when people try to chime in because sometimes you do feel child-like. You’re not a child. I have to share something with you. I did not have a stroke. I did not have a brain injury. I was so excited to be on your show. When I was driving to work, I had my shirt all backwards. I was at a red light. I had to shimmy around my shirt.

What’s great is that you’re able to humanize us because we laugh about it now. The OTs are in the line of fire with that person. No one realizes it. When you have a stroke or a brain injury, you’re angry. You’re frustrated. You’re irritated. My OT was so sweet, both of them. I had several going in-patient, back home OT, home health, then back to recovery again with outpatient. It’s tough because you have to understand you brought calmness to it.

The biggest thing is a lot of people say, “I want to walk,” and that’s mostly physical therapy. My job is, “Where do you want to walk to. Do you need to get to the toilet? Do you need to get into bed? Do you need to get into your plane if you’re a flight attendant or a pilot? Do you need to get into your car? What do you need to do?” That’s where the bridge is and why occupational therapy is so important. People unfortunately coined the term, “My physical therapist.” I said, “No, I’m the occupational therapist.” What’s that? Life skills therapist. People think that. Thank you for acknowledging your OTs because it takes a team and a village. It’s not just the OTs. I feel like OTs are a strong component in bridging the gap and pulling all the therapies together to help you get back on track with your life.

When someone is occupied they're going to get better faster Click To Tweet

Listening to you describe the origins of occupational therapy and how you said that when someone is occupied, they’re going to get better faster. A common theme that comes up on the show is having a purpose and direction. When you have a purpose and direction even if it’s small, even if it’s doing something a little every day, it helps you to have a mission or a purpose.

You can attest to this. I was writing a book many years ago. The theme of my book is fear and hope. When this happens to you, when you have a stroke or a brain injury as the person and also as the family, your life is upside down. You are fearful, “Will I ever be normal again? Will I be able to go back to work? Will I be able to hold my child again? Will I be able to feed myself?” There’s so much fear of the unknown. We, as OTs, the occupational therapist and the medical treatment team, we can give you the hope that things will better. You can be yourself. The biggest thing for me is where people don’t acknowledge and that’s why it’s important as an occupational therapist, having that the psychiatric and psychological training is that you’re going through a grieving process.

Early on in my career, even when I was finishing up grad school, I would do grieving groups with my patients. They’re like, “Why grieving?” You think of grieving as the death of someone or divorce. You can look at grieving as loss of a job. This is a change in your life. You lost your job. You’re grieving a new change in your life. When you have a stroke or a brain injury or any neurological condition or even an orthopedic change in your life, you have to change and adapt to your new self. You might go through those anger stages, denial and being really irritated to the world and yourself, guilty and you’re going through those same stages of grieving because it’s not that you died. It’s you’re grieving the old self, you have to become a new self and live in new life. That goes for you and it goes for your family members. I do focus on a lot of that.

I would love to go into from your perspective to understand the grieving process. How do we come back from that?

It’s one of two things. One, I usually recommend if you can find a good support group. We have the core people that you may trust and lean on. What I found with grieving sometimes is if you do go to a regular support group. If it specializes in grieving, I usually recommend doing a closed grieving group. Meaning that if you start on day one, you stay with the same group along the entire journey together. Sometimes when people go to grieving groups, they have an open group that you may be at a different stage in your grieving process. Sometimes let’s say you’re a year out or four years out post-recovery and you’ve already passed these stages and you’re in a group. All of a sudden, the newly injured person or a new person that’s just starting the grieving process comes in. I’m not saying it’s not going to be helpful but sometimes it can open up old wounds that you’re like, “This isn’t right for me. I’m not at that stage. I’m not relating to it.”

Usually, I recommend that if you do seek out a grieving group that you might want to look into a closed group where you can work together. You’re all working at around the same stages. New members don’t come in and interfere with your process if you need something formal. The ultimate end of your grieving process is usually acceptance. Sean, talk to me about maybe your process. Do you feel you went through a grieving process or still in that? Everyone is different. Everyone has different coping mechanisms and coping strategies. As an OT, I usually like to identify that one-on-one. If I can help in a group setting, obviously we’ll create or foster that group environment. For anyone else out there that might not have that support or those groups around where they live, it’s important just to understand and recognize that the anger you may feel or the guilt that you may feel is normal.

It may have something to do with the actual stroke or brain injury because there’s also a very high correlation between having a stroke and becoming depressed. I do recommend that you also speak to a neuropsychologist, a psychologist or a psychiatrist to make sure that you have the right diagnosis. If you’re dealing with healing from a stroke, you have a compound to depression, you might not have the motivation that you may need in order to get better and heal quicker. That’s number one. Number two, you might be in that grieving stage that you may or may not be aware of. That needs to be identified and you can help yourself or have people around you to help you with it.

You did ask me a question where I was with this whole thing. You’re so correct. You summed it all up. Avrielle, I will say to you it’s a journey. It’s a marathon. It’s not a sprint. I’ve told people that. That’s why I was so inclined to create the StrokeHacker group online because it gives people the option to talk to other people like myself. I’ll go out there on a whim, but I’m not a big fan of psychiatrists. If they don’t have experience in brain injury or stroke, the first thing that they want to do to me is giving me a medication, which is going to numb my brain. I don’t want to numb my brain. I don’t want to change my chemistry. I want to work through my recovery.

AIH 44 | Occupational Therapist
Occupational Therapist: The ultimate end of your grieving process is usually acceptance.

 

I totally understand that. I’m very holistic also. For me, the last resort is medication if not needed or surgical intervention if not needed. You would like to do more conservative means. It’s more of making sure that you have the right support around you. That scares people and a psychiatrist might not be your first line of defense that you’re going to go to. If you have a very good solid occupational therapist or even anyone on your medical team, it could be your physical therapist or speech pathologist, the nurse that you love, anyone that can help identify what is normal that you’re going through. If it’s normal, it’s normal grieving and normal healing but you don’t feel you have to get to that stage, it’s more of a dangerous feeling. If you ever have thoughts of hurting yourself or hurting anyone else because you’re so depressed, that’s when I would say seek help from maybe a psychiatrist. Seek help from a team that can recognize those things and can help remediate whether it’s conservative methods by speaking to people, whether it’s nutritional supplements that aren’t a hardcore medication. Sometimes when you take a medication, the side effects can be worse than the actual symptom.

I was a test subject for many things. What I learned with Taylor here and my team is to breathe and to meditate; yoga, breath work, to eat the right foods, to heal the gut from inside out. That is where I’m profound and where I would take not just anybody but everybody who’s going through a traumatic injury with the brain, the veteran, someone who played a professional sport where they were hit in the head. I am such a proponent for chiropractic work and the wellness side of things. I love MDs. The MDs saved my life, Avrielle. We know Brad Berman. We know Matt Jacob. They both have been on the show. We all talk about this. My team was built around an online community because for me to show this support group over here, the age is different and people all have their own opinions of it. I go out there and we start speaking.

I started speaking now to groups. I love it but I know exactly where people are at because I’ve been through it. It’s an interesting dynamic because I get pushed back all the time from people like, “What do you mean you see a chiropractor? You shouldn’t be adjusted or touched or worked on.” I said, “My body needs a massage. My body needs to be adjusted. My spine needs to be aligned. My nervous system has to be repaired.” My MDs aren’t going to put their hands on me. They’re going to check for BP. They’re going to check for a pulse. They’re going to check for a heartbeat. They’ll start to prescribe or they can refer me to an OT or a PT.

That’s funny that you said that because you asked about my history. When my father was going through this and he was in a coma, we didn’t know whether he’s going to live or die. The first day we were in the hospital, someone came over and said, “Would you like to donate your father’s organs?” My mom said, “What are you talking about? He’s not dead. Get out of here.” We had all these crazy things happen to us going through to this unpredictable journey. The biggest thing is you have to not look at going right to medication or right to certain things that could be harmful. You have to look at holistic approaches, the nutritional aspects, the overall healing and looking at this as a lifelong journey.

You have to identify the right resources out there for you to be able to do that. I’m so happy and grateful that you did start the StrokeHacker group to help as many people as possible. I do believe in chiropractics. I do believe in Tai Chi. I do believe in breathing and meditation because they are very helpful. Everyone has different issues and things going on with them. There are different needs. Not one thing is going to help one person in one ailment. It has to be a variety of different things that work for you.

Tell me about the robotics you have because that interests me.

You talked about repetition being key and doing the same thing over and over. Back in 2006, I was working at the Burke Rehabilitation Hospital in White Plains, New York. Dr. Bruce Volpe, who is a neurologist at the time, heard about me. He met with me and said, “Would you be interested in jumping ship, working at the hospital and coming into the research world? I’m starting up a robotics research program. I would love to have you run it.” I said, “Sure, why not? It’s a new experience and a new opportunity.” I didn’t know the world of research. I ended up taking the job. I’m so grateful that I had that opportunity to learn about it. I’ve done multicenter trials using robotics. I know that scares people or intimidates people sometimes. Robotics are devices. Imagine if you have a weak arm or hemiparetic, hemiplegic arm or paralyzed arm that we will set your arm or hand off onto the device. You’re playing a video game. You’re using your arm or your hand as a joystick.

Robotics provides repetitious movement over and over that’s standardized and systematic so that you can hopefully regain normal movement again after a stroke or a brain injury. I’ve done multicenter trials nationally and consulted internationally to try to spread awareness about the use of robotics and to see if it helps people with their recovery. I don’t want people to get the notion that a robot can take over someone’s job. They can’t except you look at robotics as a tool that can help in your neurological recovery. It’s like you’re learning to walk again and you may have been placed on a treadmill. A treadmill is a tool that you use to help with your walking or cardiovascular health.

Sometimes when you take a medication, the side effects can be worse than the actual symptom. Click To Tweet

Robotics provides a systematic repetitious movement. There are newer devices on the market. I’m most familiar and have the most experience using Bionik products. They were developed initially out of IMT, Interactive Motion Technology. They created a commercialized company called Interactive Motion Technologies that is now the Bionik. They have different fleets of machinery to help on arm and hand recovery as well as leg and ankle recovery. There are other companies out there that also work with the military for exoskeletal walking devices. Robotics provides the ability of someone to do hundreds and hundreds of repetitious movements during one therapy session.

Why I was saying robots can’t take over a therapist’s job is because you need a clinician or a skilled clinician to be able to identify the need for a robotic intervention. That clinician can determine what might be the best intervention for that person. They can prescribe what they feel would be the right type of robotic device. It could be actuator driven where the robot will take over the movement or it can be a body weight supported device where patients will move and they’re doing most of the work and they just need that gravity eliminated out of their movement pattern. I know I threw a lot out to you. Let me know if you have any specific questions about that.

What results have you had with the robotics?

The results vary. I’ve seen very positive results anecdotally from what I see in my clinic. There is a gold standard evaluation called the Fugl-Meyer that is used worldwide and what that is it looks at how normal does the arm function compared to your unaffected arm after having a stroke. Many years of my research has focused on dosage. What is the right dosage? How often should you have the therapy? How many days a week should you have the therapy? How many times should someone repetitiously move during a therapy session? Do you start on the shoulder part of your arm or should you start on your hand first? What we found in six to twelve-week trials is that the right dosage is around 1,000 repetitions per treatment session, which usually takes about an hour to an hour and a half to complete a full module using the Bionik devices that I described. We usually recommend a day of rest in between your exercises. For instance, if you go to the gym and you work on your arms now, tomorrow you should work on another body part to give those arms a rest.

We usually recommend that with the use of robotics that if you’re working on your shoulder or elbow therapy on a Monday, you take a day of rest on Tuesday, come back on Wednesday and you can work on that joint again. We found in our research that an alternating protocol of every other day of exercise with that specific joint or muscle has been beneficial. I’m not saying it’s end all be all. What we’ve noticed over time is that seems to be helpful for people. In the Fugl-Meyer scoring world, patients do make changes. Typical changes on a Fugl-Meyer score that will be clinically significant for you as a patient is a score of three. I see a clinically meaningful difference in patients between typically a three to a seven-point change on a Fugl-Meyer.

What that means is, Sean, you were saying that one of your biggest goals was to be able to go to the bathroom again. When someone says to me, “What does a three-point change on Fugl-Meyer mean to me as a person?” It may mean to you whether you have the ability to lift your elbow up to expose your armpit so you can put deodorant on again versus not being able to lift that elbow. A three-point change on a Fugl-Meyer score could mean the ability of wiping your own butt again or not, being able to physically reach around to your buttocks to do that or being able to hold your loved one’s hand again by not being able to squeeze those fingers before robotic therapy and getting a three-point change on that Fugl-Meyer and squeezing that hand again. Although a three-point change may not be a big change on a numeric scale, in a real-life person’s world, it can mean everything. That’s what that means.

I want to hear your perspective now on what have you seen in your experience. With someone who’s gone through a brain injury or stroke, what can they start doing or implementing beyond traditional therapies, beyond the acute crisis care and if they don’t have access to robotics? Is there anything you’ve seen, in your experience working with clients and patients of things you can start doing in your life now that is going to benefit you immensely?

I will give you the general regimen that I usually recommend to everyone. I call them my sexercises. We’ll get into talking about sex too because that’s an important aspect of life that people always shy away from. That’s part of your inactivity of daily living. We call it the forbidden ADL in occupational therapy because no one ever wants to talk about sex. It’s a huge part of your life because there is the term sex life. My sexercises are the staple exercises that I usually recommend to every neurological patients, cardiac patients or even an orthopedic patient. The reason why I called them sexercises is that each exercise starts with a letter S.

AIH 44 | Occupational Therapist
Occupational Therapist: Robotics provides the ability of someone to do hundreds of repetitious movements during one therapy session.

 

One, every day or every morning you should practice standing and sitting. My second staple exercise is I usually recommend do a squat. You went from a sitting position to a standing position. I call it the dirty toilet squat. Imagine not wanting to sit on a dirty public toilet and you squat over that dirty public toilet. Don’t sit on that toilet and hold that squat position for ten seconds. The third staple exercise of my sexercises is to sit at the edge of a bed or your wheelchair, a chair, a mat. Sit at the edge, cross your arms and lean back and then sit up. My third S of the exercises is your sit-ups because balance isn’t only just leg strength. You need your core strength. I usually recommend if you have no time to get to the gym to do your exercises, to go to therapy or you don’t have the means to do those things. If you can sit at your bed and do these exercises every day ten times or I usually say pick your favorite television show and during the commercial breaks, do these three staple sexercises. That’ll keep you healthy and you’ll be able to be functional again.

You can get onto that low chair or that little bench if you go to the mall and have to get up from the mall without having difficulty or being embarrassed going to a restaurant and trying to get out of an armless chair. It’s difficult for you to get up or going to someone’s house for a holiday and my patient went to an unfamiliar bathroom. She sat on someone’s toilet and she couldn’t get off. She was stuck there and was so embarrassed she didn’t want to yell because she was sitting on a toilet in someone’s house. She finally remembered that I always say nose over toes. Get those legs wide and push on the back of the toilet or pull on that doorknob, whatever you need to do, lean forward, nose over toes in your sexercises. She remembered that and she got up. That’s why I recommend doing that. On the other end, if you do have means, you have to stay active. I know it’s difficult but whether it’s taking a walk, I usually say just take a walk. If you don’t get outside, get up three times a day and walk around your apartment, walk around your kitchen or walk about around your house because again I always say motion is lotion.

You want to make sure that your joints stay nice and loose. If you go to the movies and you’re sitting and watching an hour and a half to a two-hour movie, you can’t sit in the same position for a long period of time. You need to shift and move because it gets uncomfortable. Sometimes people get very weak after having a stroke, a brain injury or any neurological issue that they can’t move a lot. They can’t shift. I usually say, “Try to get up or do those things that I described and that could help you.” I’m not going to discriminate the young because it just depends on your personal motivation. The more active you are and the more motivated you are to get healthy and to stay active, do it.

Try to do it every day. Even if it’s five or ten minutes out of your day, like Nike says, “Just do it.” Your body is a machine that needs to stay healthy. People take care of their cars on a regular basis. They go to get their oil changes. If you don’t take care of your body, it’s not going to be there for you in the long run. It’s a marathon. It’s not a sprint. When you have a stroke or a brain injury, this is a life-long illness or issue that you have to deal with for the rest of your life. You need to stay active to be healthy.

Everything you’re saying is so spot on to us, our mission and our show. We say, “Show up.” You say, ”Just do it.” People have to want to show up. If you don’t show up, you can’t move, you can prove.

Motion is lotion.

I do have a question for you because maybe you can help me personally. I do everything you say, the yoga and the meditation. I do my walks. How do you deal with spasms? What is your advice for spasms because I get a lot of spasms.

It depends. I would say that if you’re having spasms, you need to make sure you’re hydrated. You need to make sure that you’re drinking a lot of water because sometimes when people have cramps or spasms, it could be related to your water intake. Sometimes people develop something called clonus, which is an abnormality and their legs will start to shake. One trick to deal with that is let’s say your leg starts to uncontrollably shake, if you just gently place your hand or have someone place their hand above your knee, between your knee and your hip on your thigh and gently press down, it will stop the spasms or the clonus. I know that you’re anti-medication. For someone that has significant spasms, they will give antispasmodic medication. That would be last resort for spasms. It depends on how it’s interfering in your day and if it’s limiting you in any way after, which you need to speak to your physician.

Your body is a machine that needs to stay healthy. Click To Tweet

My advice is based on my story. I’m not a doctor. I’ve got to go out there and say to the world, I have tried the Baclofen. I have tried the drugs and they didn’t work for me. I’d rather put the weight bearing down on my knee to clonus or the spasms than start altering with my drugs. I tell my stories and have to do this because my attorney will get on me but I’m not a doctor. Seek a professional word. Seek your doctor.

The other thing is stretching. I usually say, “It’s not only about movement.” Don’t think of exercises, just movement. I said motion is lotion, but you have to stretch. Depending on where you’re getting these spasms or people have tight arms and they want to be able to move again. If your arm is tight and you’re not stretched, you’re doing a disservice. You’ll never be able to move again. You have to stretch whether it’s a quick stretch of pulling that wrist down or stretching those legs or bringing your toes up in bed or asking someone to help you, stretching is also very important.

I love you’re saying you teach the yoga. You take me with you to yoga. Tell the audience, Avrielle, what you do to me with the stretching and the yoga poses.

For me, breathing is so important. Whether you take yoga or Pilates or anything that you do, remember when you have a stroke, it’s a lack of oxygen to the brain. People don’t know this but when you yawn, everyone is like, “You’re tired, that’s why you yawn.” That’s not the reason why you yawn. You yawn when your brain needs oxygen. Your body is saying, “I need oxygen to my brain,” therefore, you yawn. It’s a way of taking quick oxygen into your brain. Usually, you yawn when you’re tired because your brain is not at full capacity. If you’re getting ready for your podcast the next day and you’re not sleeping. You’re like, “I have to look up this information on my guest and it’s 1:00 AM.” You’re not thinking of full capacity and you’re yawning.

Breathing is so important. Whatever your medium is, I say you have to breathe and I always say, “Smell the flowers in for two, in for the nose, blow out for four. You want to blow out.” I always say, “Smell the flowers through your nose and then blow out those birthday candles, in for two out for four.” It’s more important that you get rid of that stale air, carbon dioxide to bring more oxygen into your brain because remember blood brings oxygen to your brain and all of your organs. To stay healthy, you need to incorporate the proper breathing when you’re exercising. If you’re not exercising and you’re even sitting, watching TV by you breathing into the nose and out through the mouth, you could strengthen your diaphragm, which is the biggest muscle used for breathing but people aren’t aware of. I just said muscle.

Your diaphragm is a muscle. It is the major muscle responsible for breathing in the body and when somebody has a stroke or a brain injury, usually people get very tired very quickly and they say, “I have no endurance. I don’t have any stamina. I need to take naps.” Not realizing that maybe it’s not only that your arm might be weak after having your stroke or your leg might be weak. Your diaphragm could be weak. It’s a muscle. The nerves aren’t speaking to that muscle. You need to breathe in order to strengthen that muscle, which is another overlooked part of the body after a stroke, a brain injury or spinal cord recovery. I want to make that very important. Core strength, doing those seated sit-ups, doing any planking exercises and Pilates or doing those yoga hold is very important. Breathing to bring oxygen throughout your body, to your brain and strengthening your diaphragm is very important.

I love all of what you’re saying. What I did with Sean back in the fall was we started going to yin yoga or restorative yoga depending on what studio you’re at. What it is it’s a class where you can use blocks, straps, a bunch of pillows, props, blankets. You’re typically holding a posture between five and ten minutes. It allows someone who has mobility issues to slow down, get into a stretch, feel a stretch and breathe into the stretch versus a normal yoga class are typically too fast paced for that. They’re a little bit more stressful. What I usually teach in terms of yoga, because I used to teach yoga, is that it’s a way to not only calm the nervous system, but it’s also a way to strengthen the nervous system.

The pathway to doing that is through the breath. What I’ll usually teach people is that you’re putting yourself in a physically stressful position. Let’s say, you’re stretching your quad and it’s intense. In the process of stretching your quad, if you keep breathing deeply, you’re training the nervous system and training your body to not perceive that as stressful because the deeper you breathe, the more you’re triggering the rest and digest side of the nervous system. Through this process you’re, one, calming the nervous system by breathing deeper and two, you’re strengthening it by building resilience, by consciously putting yourself into the stretches but maintaining the depth of breath throughout. That’s why in yoga, they teach deep breathing as this core principle. I think it’s very misunderstood. It’s about oxygen. It’s about strengthening the diaphragm. To me, it’s more about strengthening and calming the nervous system. As you do that over time, you’re building resilience in a safe environment that you can take with you out into the world.

AIH 44 | Occupational Therapist
Occupational Therapist: To stay healthy you need to incorporate the proper breathing when you’re exercising.

 

You touched upon a few sparks of thoughts that I have. I love that you said posture because posture is key in your recovery whether it’s breathing, it’s arm movement, it’s being able to walk again and I’ll tell you why. Positioning is key and posture is very important for many reasons. I’m going to tell your audience to just do a quick thing. If you can do this also, I want you to pretend someone punched you in the stomach. I want you to bring your shoulders all the way forward like your body is in a big C. I want you to slouch. Get into a slouch position. Two things, try to take a deep breath in this position. You should feel restricted. The other thing is, if you have the strength to lift your arm all the way up to the ceiling in this curbed position, I want you to do that. Everybody stay in your slouch position, try to, one, take a breath. Number two, try to lift your arm as high as you can go. Keep your arm up to the ceiling and I want you to get out of that crouched position and sit up. Sit all the way up. Bring your chest out and shoulder blades back. Take a breath and look how high you’re able to bring your arm.

In the slouch position, you probably, one, have a restriction with your breathing. Number two, you probably could only bring your arm up to about three-quarters of the range that you could physically do. Taylor, you’re in the military so you know you have to stand up straight if you’re going to want to salute. Stand up straight or sit up straight, take a deep breath in and feel how good that feels. Bring that arm all the way up and you can see you can bring your arm all the way up to the ceiling. That has to do with your posture. If you don’t have a good posture and you’re not focusing on that, you’re not going to be able to breathe well. You’re not going to have the best endurance and you’re also limiting your recovery because you won’t be able to use or maximize how much movement potentially you may have.

Those are core principles that I like to teach in any class but a one-on-one with people. Breathing is very important. One last thing is that I took a game-changing course many years ago and the title of the course was, If You Can’t Breathe, You Can’t Function. People don’t realize that the same muscles used for breathing are also your postural muscles. No matter what, breathing will always take over because it’s survival. You need to focus on your posture and your postural muscles in order to stay healthy and in order to breathe well. That’s why exercise or walking and focusing on your posture in addition to the breathing are so important. Thank you for sharing that because that’s crucial.

One of our core principles over here is not just breathing but hyper-oxygenating the body. We had on a company, you may or may not have heard of them, it’s called LiveO2. They have designed a system to hyperoxygenate the body and brain. They’ve designed it to where you can get 24 times the amount of oxygen to the brain to help it heal.

Is that a hyperbaric chamber or something similar? I know of hyperbaric chambers that can do things like that. Is that what that is?

No. Imagine being on an exercise bike wearing an oxygen mask and pedaling. The whole premise of it is you’re exercising because you’re trying to get your heart rate up to force blood through the capillaries. They have an oxygen separator that concentrates oxygen at about 80%. One, you’re hyperoxygenating the air you’re breathing. The genius of what they do is they also have a switch they can flip that makes you start breathing air that simulates at a high altitude. What that does is it causes a reaction in the body that shunts blood to your vital organs and brain. As soon as you’ve shunted blood to the vital organs and brain, you’ve increased the heart rate. You flip the switch back to the oxygenated mode. You’re sending more blood flow and more oxygen to your vital organs and brain, which is giving them the energy to do what they’re designed to do, which is to heal. In Mark Squibb’s word, he’s the CEO of the company, it’s, “You’re cleaning the pipes.” Once you clean the pipes and you unblock the pipes and you hyperoxygenate the body, amazing things happen.

I’m not familiar with that. Thank you for bringing that to my attention. I definitely want to look into that. For healthy people, that’s great. I caution anyone with any issues like pulmonary issues or COPD issues that could be secondary speak to your pulmonologist before doing something like that. From my experience with working with pulmonary patients is that if someone doesn’t have the ability to have a full oxygen saturation, anything below let’s say 90% is considered unhealthy. Anywhere between 90% to 93% or above, it’s usually healthy. Anything lower than that, if someone doesn’t have the natural capacity of having a healthy saturation level, they may need supplemental oxygen.

The issue is that people that can’t have healthy oxygen saturation at a normal level, sometimes if your body cannot saturate and you give someone oxygen, it can scar your lungs. People with pulmonary conditions that are on oxygen, the physicians usually set the oxygen levels to a certain amount of liters. Liters are per hour which is safe for the body to take in. Not knowing enough about this new technique that I’m very fascinated about, I would just caution anyone with a pulmonary diagnosis associated before doing that to check with a pulmonologist regarding the oxygen saturation levels and what is healthy or not for their own body.

No matter what, breathing will always take over because it's survival. Click To Tweet

I met Taylor by getting on this machine in the beginning. My left side is weak. It wasn’t getting enough oxygen and he was able to get it from 60%. I ordered a machine. It’s coming to my house and my office. The CEO has been on the show. We’re determined to get his machine out to the stroke centers, out to the military active and veterans immediately because of what he’s done with his case studies and his test studies. It peaks performance. The pulmonologist is a whole different world. Thai Starkovich is our military advocate. He can’t wait to get his hands on this because he thinks you’re making what I call the super soldier because you’re giving them oxygen a lot more than you need.

Remember what I just told you is that when you yawn, your brain is asking for oxygen and obviously being in the military you have to be at your peak performance. It has to be sharp and has sharp skills. I could see the value in something like that.

This deals with the fight or flight because as you know with stroke, we’re always in fight or flight all the time and this calms it down and brings the body to balance as well.

You can have a delayed response whether it’s speaking and not getting your thoughts out or even your response to losing your balance or trying to reach for something quickly could be delayed. The breathing, this can maybe help to expedite that breathing that we talked about. That’s important to do naturally.

It’s one of those tools that is helping encourage this deeper breathing and awareness around how important it is. I’ve got one more question for you. This is what we ask everyone who comes on the show and that question is, what’s your inspiration, Avrielle?

My inspiration initially was my father, being able to get my dad healthy and being able to get him to live a normal life. We were told that he has less than 10% chances of living and if he does survive, he’ll be a vegetable. We were told whatever regains back in the first six months to a year that’s all he’s ever going to get. Many years later, he’s still alive and kicking. He gets better every single day. My inspiration is the naysayers, people that try to push you down to say, “You won’t be able to do this and you can’t.” You overcome. That’s why you are called a stroke survivor. That’s why when you had a craniotomy or any type of brain surgery, or shunt surgery. My father has a giant scar on the top of his head from his shunt surgery or his aneurysm clipping. Those are his battle scars.

You are in a battle when you’re in a war and you are in battle when you are surviving, living and thriving after having a stroke or brain injury. My inspiration is people like you Taylor and Sean. That’s what motivates me and gives me a passion for what I do to help as many people out there as much as I can and bring the best of the best technologies, robotics, cutting edge technologies out there. The newest, the latest and greatest to bring awareness and help people. My inspiration is people like you. I’m grateful for that. I’m grateful that I would never wish this upon my worst enemy of having something like this happen to someone. Out of every negative comes up positive and if that never happened to my father, I would have never left the entertainment world to go into the medical field, to learn about occupational therapy, and to do what I did before and to do what I do now. I want to circle back to something that you talked about, doctors are not giving the time with you. When I was back in school, one of the main reasons why I wanted to be an OT versus a physician was my time with my patients.

I felt that you would go in you would see your doctor. I’m not knocking doctors, I love doctors. Obviously, we need them. Your doctor would see you and say, “What’s wrong with you? What’s going on?” They would be with you for five, ten minutes or twenty minutes and say “Bye, see you later.” That’s why I chose not to be a doctor. I wanted to go into OT because I wanted to be in it with my patients. I wanted to go on the journey with them and be able to problem solve and work together. Not just the hi-and-bye moment but to be able to work with them through whatever they were going through and spend the time with them to get to know them, to have the proper diagnoses, to have the right treatment plan and to be able to work with their families. That was one of the main catalysts of why I wanted to become an occupational therapist versus becoming a physician or a physician assistant. It’s the time that you have with your patient because I’ve had patients that I saw several years ago that I still speak to on a daily basis or a weekly basis until this day. Those are my inspirations to help everyone or anyone going through a stroke or neurological issue that can live their best life moving forward.

Thank you so much, Avrielle. For anyone our audience, if you love this episode, please share it with someone who may need to know all the wonderful words of wisdom Avrielle is dropping on. I think Gloria has something she’s writing to me. How do people contact you and get involved with your mission and what you’re doing?

You can go online and you can look up the Burke Neurological Institute in White Plains, New York and there will be a link to the Restorative Neurology Clinic. My direct email and telephone number access is there, as well as the link to the clinic and all of the wonderful research that is going on at the Burke Neurological Institute to help with impairment production. That is the best way of reaching me. You can look up at the Burke Neurological Institute in White Plains, New York.

Thank you so much, Avrielle. Share this episode with someone you love, someone you care about and someone who needs to hear this message.

You have to invite me back so we could talk about the big forbidden ADL of sex. One thing to address with your OTs and your doctor is talking about that during your recovery because it was a big part of your life. Do not be embarrassed or ashamed from bringing that up or talking to anybody about that.

We’ll talk about sex next time.

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About Avrielle Rykman Peltz

AIH 44 | Occupational TherapistAvrielle Rykman Peltz is an occupational therapist who is an expert in neurological upper & lower limb recovery using cutting-edge robotic technology and standardized upper extremity assessments.

Avrielle has been specializing in stroke/cerebral vascular accidents, spinal cord injury, brain injury and pulmonary dysfunction for more than a decade. She is an exceptional recruiter and has spear-headed multiple national and international research studies funded by the National Institute of Health, in collaboration with Burke Medical Research Institute, Weill Cornell Medical College, Massachusetts Institute of Technology, Harvard University, The Veterans’ Administration and private funding sources. Avrielle is the Co-Founder and Chief Operating Officer of the Restorative Neurology Clinic at the Burke Medical Research Institute, which is a specialized rehabilitation clinic for treating people with neurological injuries and illnesses using cutting-edge technologies.

Avrielle is an expert evaluator in the Fugl-Meyer motor/Sensory Assessment and The WOLF motor and time assessment. She is certified to administer the NIH stroke scale, the Modified Rankin Scale and an expert in therapeutically treating patients with multiple diagnoses. Avrielle has conducted experiments administering tDCS Brain Stimulation in neurological patients and also has been a professional clinical consultant on many published studies involving upper limb recovery and robotics. She has traveled nationally and internationally to train other medical professionals in the field of neurological recovery and the use of robotics.

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