Ep 092 -- FES for Stroke Survivors

Olivia and Emilee were my two, awesome inpatient OTs a couple years ago, and we stayed in touch after I left the hospital.

One day, Olivia told
me about the amazing new $40K rehab bike they just got. They were getting great
results with patients. It's too bad my stroke didn't happen a year later.

The new device was the RT300. It combines therapy, eStim, and data with exercise to help patients improve their core, their leg use, their arm use, or all three at once.

So Olivia put me in touch with Restorative therapies.


The brain controls
the muscles and makes us move by sending electrical signals through our nerves
with various chemical processes. After stroke the brain may no longer be able
to do that to certain muscles. That's how we get paralysis, hemiparesis, and all
sorts of similar issues.

That also means that
we can bypass the brain and move those muscles by sending an electrical signal
directly to the nerves at the muscle to stimulate them to make them move. This
is great because movement is important to both health and recovery.

And that's what
eStim does.

The most popular
eStim for Stroke survivors is TENS. This is the type I used in the hospital and
later at home. I attach a couple electrodes to my affected arm, and for 30
minutes, my hand will open and close. Or my wrist will go up and down. Or I'll
do something with my shoulder.

Combining eStim with
exercise is great therapy and promotes recovery.

And the units cost about $40 on Amazon.

FES is the type of eStim you'll find in the Bioness products and the WalkAide. These devices use eStim to prevent foot drop and replace an AFO. The user wears it strapped below the knee as they walk, and it stimulates the muscle that lifts your foot as you walk.

I tried them both
and had some good results with the WalkAide. At $5,000, though, it didn't make
enough of a change in my life to justify buying it.

IFES is the
technology Restorative Therapies uses in their RT300 bike and Xcite treatment
device. The use eStim on up to 12 muscles at once in a specific, timed pattern
to accomplish a task. It's complex, but it can help the brain relearn to do
these things in the future.

Therapies Team

Jim Janicki Headshot

Jim Janicki is the President and CEO of Restorative Therapies. Jim has an extensive management background in sales, R&D,  and operations in the chemical, medical, diagnostic, pharmaceutical, and biotech industries. He joined Restorative Therapies in 2018.

Wendy Warfield headshot

Wendy Warfield is the Clinical Education Manager. She makes sure that patients, therapists, physicians, and researchers understand how to most effectively use the Restorative Therapies devices. Wendy is well-suited for this role . She began working at an Occupational Therapist in 2003, and bring that survivor focused perspective to the work that she does.

Me and the xCite

Some weeks back, I
got to try the xCite. I got to work with the reps Stephanie and Michael when
they visited the Seattle areas.

Unlike the bike, the
Xcite is only for clinical use. It features a series of preprogrammed
activities like reaching for a water bottle or brushing your hair. It fires the
nerves in sequence so the muscles do what they need to do for me to complete
the act.

Here are some
pictures and a video from my experience.


Stroke Stories

Stroke Stories Podcast logo

On another note, Stroke Stories, a UK podcast focused on, well, stroke survivor stories, featured my story on episode 50. You can listen to it here:

The show mostly
features UK survivors, but more recently has been including folks from other
parts of the worlds. I enjoy listening for the wide range of folks the bring on
the show.

It's also different
from other podcasts in that it features a narrator rather than a host and a
guest. Basically, the person who interviewed me does not appear in the show.
His job was to help me tell my story and get out of the way. In that respect,
it's more like a radio show.

Definitely check it
out and add it to the list of podcasts you regularly listen to.

Hack of the Week

Wendy's hack for us
is to keep moving. Movement is important to recovery. It keeps the muscles and
tendons healthy and flexible. It's important for cardio vascular exercise.

Getting the
appropriate exercise helps with heart health, blood pressure, and can reduce
the risk of another stroke.

Even if we have
physical limitations today, moving as much as possible makes future recovery
more realistic.

While some exercises
may be better than others, you don't have to get caught up in details. The
important thing is to just keep moving.


Restorative Therapies on the web


Restorative Therapies on Twitter


Restorative Therapies on Instagram


Restorative Therapies on YouTube


Restorative Therapies on LinkedIn


Restorative Therapies on Facebook


Kennedy Krieger Institute






TENS on Amazon


Emilee on Strokecast


Lana Malovana on Strokecast


Dr. Shah and Sentinel Healthcare


Lauren Sheehan on Strokecast






Jim janicki on LinkedIn


Wendy Warfield on LinkedIn


Stroke Stories Podcast


Bill on Stroke Stories


Where do we go from

  • To learn more about the RT300 bike, the Xcite device, or Restorative Therapies, check out their website at  https://restorative-therapies.com/.
  • Ask your PT or OT about their thoughts on IFES.
  • Share this episode with someone in your life by giving them the link http://Strokecast.com/RSI
  • Subscribe to Strokecast and Stroke Stories in your favorite podcast app so you never miss an episode
  • Don't get best…get better.

Here is the latest episode of The Strokecast


Surfer, Author, and Survivor Blake Hill's Journey


Blake Hill is an over achiever with an easy going attitude. Talking to him, you get the sense of a calm guy going with the flow, but underneath, he is paddling like crazy to get to the next big wave.

After surviving a stroke, the turbulence in his life continued to increase, to the point where he was biking up a mountain in Canada and knew it was time to write Westfalia. We explore the events leading up to his mainly auto-biographical novel in this episode.

To listen to episode, click the player above or click this link.

About Blake Hill

Blake wears a dark blue shirt and looks at the camera in a headshot that appears to be taken outdoors in front of trees.

Blake is often thought of as a quiet person. Put a strong cup of good coffee in him and he becomes a chatter box. Although quiet on the surface his brain is always engaged and bounces from thought to thought. If you ask him his greatest accomplishment in life. It would be his role as Dad. Blake has two amazing children. He has spent countless hours flying on airplanes and traveling the world with his pro-surfer son. They have chased waves from California to Europe, Mexico, Indonesia, Japan, Australia and countless other destinations. He’s the proud dad of a daughter who’s strong and independent with a passion for dance.

Blake’s professional life began in the movie business doing lighting for movies and TV shows. During this time period he would balance working on set with cultivating his passion for writing. His day would typically begin at 3am. He honed his craft for writing screenplays while also working on the set of movies. Over the years he amassed a collection of ten screenplays and a children’s book along with having his poetry published many times.

Once his children were born he chose to quit the movie business and focus on his kids. This was truly an amazing time in his life and a true gift from the universe. He is truly grateful to have had so much time with his children while they were growing up.

There’s an adventurous spirit that lives within his soul. He’s been riding motorcycles since he could walk. He’s raced motocross, hare n’ hounds and spent days riding across the Mojave Desert and camping under the stars. His rides across the USA have taken him through blizzards, tornadoes, and across the Arctic circle.

His passion for life was dimmed one day when he encountered a stroke. It was as if a light switch had been turned off. This experience was beyond humbling and fueled his passion for living even more. He’s not only physically strong but he’s mentally fit. The stroke tested his will and mental fortitude. He kept the event private with only a few friends knowing about his mental capacity. He was challenged by the everlasting question of; how are you feeling? His focus was on healing and getting his memory back. He didn’t want the constant reminder of what had happened. His physical self is truly one hundred percent. His mental self is challenged occasionally with loss of memory. He is extremely grateful to be where he is today on a physical, emotional and spiritual level.

The cover of Westfalia by Blake Hill

Blake’s typical day begins at 4am with an awesome cup of coffee, splashed with cream while spending some quiet time with his two dogs. He works out with free weights, resistance bands, hikes with his dogs and tries to surf every day. He believes that keeping active mentally and physically is the key to happiness. He’s 55 years old and with each and every wave he surfs, he strives to ride the next one better than the last. He truly feels blessed for his amazing life.

You can find Westphalia at Amazon* or wherever you find your books.

Writing Practice

Blake's method of writing combines old school and new.

He starts with a distraction-free environment. To keep himself in the mindset of writing every time, he listens to the same music -- Jackson Browne's Solo Acoustic Volumes 1 and Volume 2.*

He also does all his drafts on yellow legal pads.

These habitual behaviors help ease the brain into writing mode.  It's another way of leveraging the power of neuroplasticity -- the nerves that fire together, wire together. By reinforcing these patterns repeatedly, it makes it easier to write in the future.

Then, he takes his handwritten drafts and types them up. As he types them in to the computer, he's doing a first editing pass.


Blake talks about the importance of visualization.

He describes how athletes learn to enhance their performance by visualizing that performance. In their mind they go through the movements, activities, and successful results. The idea is that parts of he brain can't distinguish between actually doing a thing and visualizing doing a thing. You get extra practice. 

Last year, Peter Levine, author of Stronger After Stroke, talked about the same thing. Peter talked about it from thew scientific/medical perspective.

According to studies with FMRI machines, when you watch someone walk or run, you activate the same part of the brain that lights up when you actually walk or run. Imagining the activity gives you similar results to doing the activity.

The best parts of visualization is that it's free and completely harmless. There is no downside and there is a significant upside. So when you have a few moments or hours as you try to get back a limb or control your jaw, take some time to imagine yourself doing it again and again.

To learn more, listen to my interview with Peter G Levine in this episode.

Hack of the Week

Blake talked about his strategy for dealing with the massive life changes after a stroke.

  1. Accept where you are. You can start to fix a situation or otherwise address it.
  2. Process it. Spend some time with the situation and feel your feelings about it. Ignoring your feelings isn't going to help.
  3. Forgive yourself for your feelings. If your feelings are counterproductive, that's okay. Forgive yourself for feeling that way. Then you can work on the situation or reality that you are in.
  4. Visualize where you want to be. Leverage the power of your brain to engage your natural neuroplasticity. Figure out how you want your life to look, and visualize your life that way and your abilities that way. Do it again and again.
  5. Use your mantra. A preferred phrase or mantra can help you center yourself and bring your mind back to focusing on your priorities and where you want to be.


Helpful resources for more information.

(If you don't see the links below, visit http://Strokecast.com/ByBlakeHill)

Where do you want to go from here?

Here is the latest episode of The Strokecast


100% with Stroke Survivor and Porn Star Misha Montana


Misha Montana puts 100% into everything that she does. From her prodigious and impressive collection of tattoos, to her work ethic, to her unconventional career choices, to now her commitment to raise awareness of the challenges of post stroke life.

Misha joined the stroke club this past spring when her COVID-19 infection spawned a blood clot that slipped through her PFO and lodged in her brain at the age of 31. Despite memory and energy level challenges, along with lingering hemiparesis, she quickly returned to work, determined to not let her stroke stop her.

About Misha

A view of Misha Montana from her right side as she looks at the camera. An Eye of Sauron tattoo is visible on her right shoulder. Her left hand is in her long, black hair

Misha Montana is an adult film star/Director and the Chief Brand Officer and Production Manager for AltErotic. Misha lives in Reno, NV and Los Angeles and cares for her special needs son. In her off time Misha is a cyclist and bodybuilding enthusiast with interest and education in political science and psychology. Misha suffered a stroke on April 14th, 2021 and had heart surgery to repair a PFO shortly after. Misha is an advocate for stroke awareness and is extremely passionate about the cause.

What is a PFO?

A PFO, or Patent foramen ovale, is a hole inside the heart. Roughly 25% - 33% of people have a PFO, including me.

The heart has 4 chambers -- two on the right and two on the left. When blood comes into the heart, it enters on the right side. From the right side of the heart it goes to the lungs to dump carbon dioxide and pick up oxygen for the rest of the body. From the lungs, it goes to the left side of the heart. Along the way, blood clots that accumulate in the system naturally get filtered out. The left side of the heart sends this now oxygen rich blood to the brain, toes, and everything in between.

At least that's how it's supposed to work after birth.

Before birth, while we are still building organs and body parts in the uterus, there is no oxygen for us to breathe. There's no air. We instead get all of our oxygen nutrients, and other stuff through the umbilical cord attached to our mothers system. Since there's no air, there's no reason for blood to go from the right side of the heart to the lungs. It goes straight from right side to left side through the PFO - the hole between the right and left.

That hole is supposed to close on its own shortly after birth when we start breathing air. For most people it does. For up to a third of people it does not.

As we get older, that hole may or may not cause a problem, depending on how big it is and how prone we are to developing blood clots. It allows unfiltered, unoxygenated blood to bypass the lungs and go straight to the left side of the heart and on to the rest of the body.

When a blood clot sneaks through the PFO, bad things can happen. That's how Misha had her stroke. A clot formed as a result of her COVID-19 infection, slipped through her PFO, and lodged in her brain.

She has since had her PFO surgically closed. It's a fairly simple procedure, as internal heart surgery goes.

Other folks on this show have also had PFO related strokes, including Christine Lee in the pre-COVID times.

My PFO did not cause my stroke. Mine was due mainly to high blood pressure. As part of the stroke protocol at the hospital though, they did find the PFO. A follow-up exam afterwards, which involved an ultrasound device put down my throat (thankfully with some awesome sedation) confirmed it was there, but likely too small to cause a problem. They decided to leave it alone.

But now I have a ready excuse for why I was never an endurance athlete.

Driving After Stroke

Misha talked about driving herself to the hospital. Jo Ann Glim did the same thing when she had her stroke.

Both will tell you now not to do that. It's a bad idea.

Of course, I don't blame them. At the time our brains are dying, we are not making the best, most informed decisions.

But what about after stroke?

In the US, driving requirements are set at the state level. Whether you can legally drive after stroke depends on where you live. In most states, if you have had a seizure, you can't drive until it's been at least 6 months after your last seizure.

For other brain injuries, it's more varied. I'm told that a stroke will suspend your license in California. In Washington state, where I live, the state does not suspend thew license of a stroke survivor. The day after my stroke, legally I could drive. That would have been a terrible idea because at that point it simply would have been dangerous.

Driving after a stroke is something to discuss with your doctor and occupational therapist. The decision will depend on whether you can get in and out of d a vehicle safely and operate the controls safely and competently. It will depend on you vision and visual/auditory processing, cognitive abilities, emotional stability and more. There is a lot to consider.

They may refer you to a driving therapist -- someone who specifically trains people with disabilities and brain injuries to drive. They may teach you new skills, or they may simple provide a comprehensive assessment of your ability to drive safely.

I started driving again about 10 weeks after my stroke. I had an assessment with a driving instructor, which included an in person interview and a road test. After riding with me as I navigated the ridiculously tight parking garage in my building and the small, dense roads of my neighborhood, he signed off on me driving and sent the recommendation to my physiatrist.

It cost me roughly $500 and that was not covered by insurance.

I did get two modifications to my car. I added a spinner to the steering wheel so I could manage it with one hand, and I added a turn signal extension so I could use my right hand for that, too.

Oh, and I got my disabled parking license plates!

Driving is a major step in living a new life and having the freedom to get stuff done, especially if walking or public transit are more challenging after stroke. It's also an inherently risky activity with life and death consequences that ought not be taken lightly.

Choose wisely.

Adult Entertainment Industry

As far as I know, Misha is the first professional adult entertainer that I have had an extended conversation with.

Given the scale of the industry, I imagine I have had extended chats with other current or former professionals in the field, but given the stigma it wasn't something that came up.

(Though there was that woman on a Northwest flight who struck up a conversation and when I asked her field of work said, "I provide miscellaneous personal services," and then quickly changed the subject.)

What I really liked was how Misha describes the community and her colleagues. Talented, hard-working, kind and compassionate people just living their lives in an unconventional field and dealing with societal stigma. Often condemned and criticized for their choices by the very people consuming their content.

I don't have strong opinions on it. As long as all involved are consenting adults that's really what matters.

Misha's work in porn is the proverbial elephant in the room here so I can't very well not comment on it. Yet I don't want to make it the whole focus of the conversation, because that would disregard my guest's individualism. And I must restrain my inner thirteen year old from making silly awkward jokes.

So despite opining for six (now seven) paragraphs (and making it about me), the best thing for me to do here is listen to what folks have to say about their experiences.

Hack of the Week

Misha talks about the importance of her planner for keeping track of appointments and other reminders. After stroke or brain injury that impacts executive function, we can't just keep all this stuff in our heads. Even without brain injury, it's probably not a good idea to keep it in our heads. The logistics of life take space and energy in our brains. Using a planner - digital or paper can make a big difference in effectively managing our lives.

The other thing it can do is provide a place to write or to journal. There's value in getting our thoughts out of our heads and onto a list or into a paragraph. I find things will rattle around in my skull until I can record them elsewhere. Even if it’s a stressful thing or a worry, getting it down somewhere actually reduces my stress because at one level, "it's been dealt with."

Paper and pen are one way to do it. Typing on a keyboard or tapping on a phone screen are another. Voice memos or selfie videos are another. Find a way to journal or record your thoughts that is compatible with any deficits you have and that works for your comfort level


Where do we go from here?

Here is the latest episode of The Strokecast