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In this episode, Dr. Michael Powers continues the spinal cord injury (SCI) series by exploring its impact on body systems, function, and participation. He discusses acute management and the cardiovascular, autonomic, respiratory, integumentary, and genitourinary changes that influence rehabilitation. Dr. Powers highlights key considerations for safe mobility training and emphasizes the importance of looking beyond functional independence to community fitness, employment, and quality of life.

Key Takeaways

• The SCI continuum of care, from acute management to community fitness and wellness
• Acute medical management and spinal stabilization
• Social determinants of health and disparities in SCI care
• Spinal shock vs neurogenic shock
• Autonomic dysreflexia: recognizing triggers, signs, and appropriate responses
• Orthostatic hypotension and impaired thermoregulation
• Respiratory function, cough, and airway clearance
• Skin protection, pressure relief, and patient education
• Changes in bowel, bladder, and sexual function
• How spasticity can impair—and sometimes assist—function
• Rethinking movement strategies for bed mobility, transfers, and locomotion
• The importance of physical activity, sports, and employment for community participation
• Quality of life after SCI: self-efficacy, optimism, and adaptation

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• Neurogenic Shock
• Race and Socioeconomic Disparity in Treatment and Outcome of Traumatic Cervical SCI with Fracture
• Influence of Physical Activity on QOL in Individuals with SCI
• Evidence-based Scientific Exercise Guidelines for Adults with SCI
• Facilitators and Barriers to Sustainable Employment After SCI or TBI
• Labour Market Participation after SCI
• Traumatic Cervical SCI and Income and Employment Status
• The Economic Argument for Hiring People with Disabilities

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In this episode, Dr. Michael Powers explores spinal cord injury (SCI). Although SCI has a relatively low prevalence and incidence, it is a high impact condition which carries not only significant functional cost but also tremendous financial cost. Dr. Powers highlights the importance of key ascending and descending spinal cord tracts both for recognizing common clinical SCI syndromes and for examining individuals with SCI to determine neurologic level of injury. He discusses the importance of determining neurologic level of injury, and how combining neurologic level of injury with ASIA Impairment Scale provides physical therapists with critical information to establish diagnosis, prognosis, and plan of care.

Key Takeaways

• Incidence and prevalence of SCI
• Cost of SCI, including consideration of lost wages/productivity
• The 3 most important SCI tracts to know
• The 4 most common SCI clinical syndromes
• The ISNCSCI and ASIA exam
• What information is (and isn't) conveyed by the neurologic level of injury
• What information is (and isn't) conveyed by the ASIA Impairment Scale
• Why both neurologic level of injury and ASIA Impairment Scale are needed to determine diagnosis, prognosis, and plan of care

Go Deeper With Your Learning

• Dr. Powers works through a patient case to determine neurologic level of injury and ASIA Impairment Scale (YouTube)

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• SCI Key Data
• Costs of Living with SCI
• International Standards for Neurological Classification of Spinal Cord Injury
• ISNCSCI Worksheets
• Common Errors Made During ISNCSCI Exam (YouTube)

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In this episode, Dr. Michael Powers explores Amyotrophic Lateral Sclerosis (ALS). Although ALS has a relatively low prevalence and incidence, the progressive loss of motor neurons has a devastating effect on function, quality of life, psychosocial wellness, and lifespan. Dr. Powers discusses the important role that physical therapists play in ALS management, including the framework for rehabilitation, exercise prescription, and psychosocial considerations.

Key Takeaways

• ALS as motor neuron disease
• Pathophysiology of motor unit loss
• Known risk factors for ALS
• Limb-onset vs bulbar-onset ALS
• Importance of diffuse upper and lower motor neuron findings in ALS diagnosis
• "Fasciculations are known by the company they keep"
• Pseudobulbar affect and psychosocial considerations
• ALS progression and mortality
• Framework of restoration, compensation, and prevention
• Evidence-informed exercise prescription

References

• O'Sullivan & Schmitz's Physical Rehabilitation
• ALS Environmental and Lifestyle Factors
• Meta-analysis of Military Service and ALS Risk
• Systematic Review Military Service and Related Risk Factors for ALS
• Pseudobulbar Affect
• El Escorial Criteria for ALS
• Physical Exercise in ALS

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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In this episode, Dr. Jamie Dyson shares his personal journey through Guillain-Barré syndrome, highlighting the medical, emotional, and psychological challenges he faced. He discusses the multiple phases of his journey, from initial diagnosis through acute medical management and his successful return to clinical practice, education, and professional advocacy. His story offers valuable insights into patient care, resilience, and the importance of personalized treatment approaches. Connect with Dr. Dyson on LinkedIn or via email: jamiedyson224@gmail.com

Key Takeaways

• Guillain-Barré syndrome onset and symptoms
• The importance of early diagnosis and treatment
• Role of community and family support in recovery
• Strategies for mental health management post-illness
• The significance of personalized patient care and impact of social determinants of health

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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In this episode, Dr. Michael Powers explores Guillain Barre Syndrome (GBS). He breaks down how this immune-mediated polyneuropathy is typically preceded by infection, how rapid and progressing onset of distal to proximal weakness and sensory disturbances is a hallmark finding, the medical/pharmacologic early management approach, and evidence-informed considerations for physical therapy interventions.

Key Takeaways

• GBS as immune-mediated polyneuropathy
• GBS variants
• Incidence and etiology of GBS
• Hallmark history and clinical findings in GBS
• Acute medical/pharmacologic management
• Typical clinical course of GBS
• Prognostic factors and anticipated outcomes
• Evidence-informed physical therapy interventions

References

• Guillain-Barre Syndrome APTA Reference
• Guillain-Barre Syndrome
• Axonal Guillain Barre Syndrome
• Miller Fisher Syndrome
• Guillain-Barre Syndrome and Exercise
• O'Sullivan & Schmitz's Physical Rehabilitation

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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Intensity matters! In the fourth and final of a multi-part series on stroke, Dr. Michael Powers explores best current evidence in stroke interventions including task-oriented training, clinical practice guidelines to improve locomotor function, and clinical practice guidelines on the use of ankle foot orthoses and functional electrical stimulation. He highlights the importance of keeping intensity, salience, and repetitions high during stroke rehabilitation to drive neuroplasticity. He discusses the importance of emphasizing interventions at the participation and activity level, and how treatments which overly emphasize body function and structure are not consistent with the best current evidence nor the recommended approach to examination which was discussed last episode. He hopes that by the end of this episode you will start thinking of your patients as athletes who benefit from high intensity practice!

Key Takeaways

• Neuroplasticity mechanisms
• Adaptive vs maladaptive neuroplasticity
• Lifestyle facts impacting neuroplasticity
• Experience-dependent neuroplasticity
• Factors impacting neuroplasticity
• The importance of exercise and intensity
• Aerobic exercise and brain-derived neurotrophic factor
• Non-locomotor outcomes improved with high intensity gait training

References

• The Neuroplastic Brain: Current Breakthroughs and Emerging Frontiers
• The Combined Influences of Exercise, Diet and Sleep on Neuroplasticity
• Neuroplasticity After Stroke: Adaptive and Maladaptive Mechanisms in Evidence-Based Rehabilitation
• Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotrophic Factor
• Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage
• Moving Forward
• Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis
• Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury
• Clinician Resources for Locomotor CPG
• Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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• email: neuropowerhour@drmichaelpowers.com
• LinkedIn

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Intensity matters! In the fourth and final of a multi-part series on stroke, Dr. Michael Powers explores best current evidence in stroke interventions including task-oriented training, clinical practice guidelines to improve locomotor function, and clinical practice guidelines on the use of ankle foot orthoses and functional electrical stimulation. He highlights the importance of keeping intensity, salience, and repetitions high during stroke rehabilitation to drive neuroplasticity. He discusses the importance of emphasizing interventions at the participation and activity level, and how treatments which overly emphasize body function and structure are not consistent with the best current evidence nor the recommended approach to examination which was discussed last episode. He hopes that by the end of this episode you will start thinking of your patients as athletes who benefit from high intensity practice!

Key Takeaways

• Task-Oriented Training and Neuroplasticity
• Movement is at the intersection of the individual, the task, and the environment
• Key features to consider at the levels of the individual, the task, and the environment
• Improving Locomotor Function Clinical Practice Guideline
• Importance of high intensity in improving walking function
• Intensity, repetitions, and salience more important than normalizing gait kinematics
• Clinical Practice Guideline for Use of AFOs and FES Post Stroke
• AFOs and FES with multiple benefits across ICF domains

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• Shumway-Cook and Woollacott Motor Control, 6th ed.
• Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury
• Clinician Resources for Locomotor CPG
• A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke
• Clinician Resources for AFO and FES CPG

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

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• email: neuropowerhour@drmichaelpowers.com
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Begin with the end in mind! In the third of a multi-part series on stroke, Dr. Michael Powers advocates for starting the examination with collaborative goal setting focused on participation. He outlines how working backward from participation to activity and then body function and structure optimizes therapeutic alliance and helps drive neuroplasticity by emphasizing what is salient to the patient. He then discusses the importance of the review of systems and systems review (and how to distinguish these potentially confusing terms!), before concluding with an evidence-based framework for movement and task analysis.

Key Takeaways

• Importance of collaborative goal setting with emphasis on participation
• Biopsychosocial model and impact on salience and neuroplasticity
• Stroke Impact Scale
• Key factors impacting Quality of Life after stroke
• Prevalence and impact of depression after stroke
• Evidence-based screening for depression
• Review of systems and systems review
• Using the Movement Continuum to analyze tasks
• Standardizing terminology - glossary of terms for movement analysis

References

• O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed.
• ICF Health-Based Rehabilitation Program Promotes Activity and Participation
• Goal Setting with ICF and Multidisciplinary Team Approach in Stroke Rehabilitation
• Therapeutic Alliance in Physical Rehabilitation
• Stroke Part II: Examination and Evaluation
• Stroke Impact Scale
• Diagnostic and Clinical Utility of the PHQ-2
• Prevalence and Natural History of Depression After Stroke
• Impact of Depression on Stroke Outcomes Among Stroke Survivors
• A Framework for Movement Analysis of Tasks: Recommendations from the Academy of Neurologic Physical Therapy's Movement System Task Force

All music courtesy of Free Music Archive and used via attribution 4.0 international license.

• Intro and Outro: Stylin' by JMHBM
• Transitional: Our Reality by Ketsa

Connect

• email: neuropowerhour@drmichaelpowers.com
• LinkedIn

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