A Voice Over Booth Nearly Becomes a Coffin for a Stroke Survivor

Paul Strikwerda is a voice over artist. You may have heard is voice in commercials and other projects. Now, he is also a stroke survivor.

The stroke he suffered in his voice over booth engaged multiple primal fears (except for spiders) and is one of the more terrifying I've heard.  I'll save the details for the interview itself.

The genesis of this episode is that I wanted an answer to the question, "Is voiceover a good career choice for a stroke survivor contending with disabilities?" I was referred to Paul, by Anne Ganguzza of the VO Boss podcast (another great resource for the VO field), and in this episode Paul and I discuss that question and so much more.

If you don't see the audio player below, visit http://Strokecast.com/MSN/VoiceOver to listen to the conversation.


Who is Paul Strikwerda?

Paul Strikwerda holds his chin in his hand as he faces the camera, A microphone hangs from above on the right of the imager

Paul Strikwerda was born and grew up in the Netherlands. He studied music in college and began a career in radio after graduation.

Life eventually took him to the United States and an unexpected series of events led him down the path of a voice over artist.

Paul wanted to do more than read scripts for clients. He wanted to help other artists in the VO field. He would go on to write "Making Money In Your PJs: Freelancing for Voice-Overs and Other Solopreneurs"* and expand his blog on NetherVoice. He offers an unvarnished view of what life in the VO field is like and what newcomers need to watch out for.

For those who want to grow their skills as voice over artists and voice over business people (you have to be both to succeed) Paul offers coaching programs. As he says on https://www.nethervoice.com/coaching/:

It’s not enough to be outstanding. You need to stand out. Voice overs are the invisibles of the entertainment industry. Competition is increasing, and clients aren’t going to book you if they don’t know you exist. You need a plan to put you on the map, so clients can find you, hear you, and hire you. Let me be your visibility coach, and help you attract the jobs you’re dreaming of doing.

What is the Voice Over field?

The Voice Over industry is one most people don't think about, but it is one that we've encountered throughout our lives. Every time we hear a narrator on TV or listen to an audio book or hear a corporate voice mail system or listen to the introduction to this show (Thanks, Tim!) or complete eLearning with a person speaking, or learn about pancakes, we are listening to a voice over artist at work.


The breadth of the field is fascinating.

The industry itself is facing some growing pains with technology and the increase in computer generated voices. There are some growing pains there. Technology has also led to a democratization of the field in some respects. Microphones and computers for editing have gotten cheaper and more widely available. Home studios are within reach of more people. Some of the same technology trends that drive podcasts drive voice over work

Lots  of people toy with the idea of becoming voiceover artists so, especially at the entry level, there is a ton of competition. As Paul explains, though, it takes a lot more to be successful than the ability to speak into a microphone. A voice over artist needs to be a business person.

The need to sell their services. The need to audition well. They need to write contracts and collect from clients. They need to have a handle on the assortment of ways they can license their voice. And they still need to act and edit and produce.

If you are thinking about a career in voice over, and you're will to do all the stuff that goes along with it,  Paul's coaching services might be a good fit

How does AFib cause stroke?

The heart is made up of four chambers. Blood normally flows from the upper right to the lower right to the lungs to the upper left to the lower left and then on to the rest of the body. Moving it efficiently from one place to the next requires a precise rhythm -- the lub-dub of the human heart beat.

When someone has AFib, or atrial fibrillation, it means the rhythm isn't quite right sometimes. Maybe different parts of the heart are out of sync, or part vibrates too fast or the heart rhythm itself fluctuates in an odd way.

When this happens, blood doesn't always leave the chamber it’s in when it's supposed to. And when blood pools or collects in the heart when it shouldn't, it can start to coagulate. It forms clots. Then when the heart beats one of those clots that formed due to AFib can shoot off to another part of the body.

If that clot makes it to the brain and gets stuck in a blood vessel, you have an ischemic stroke.

So how do you treat it?

Well, first you have to find it. Since it is irregular, that's not always easy. Some people will get a surgically installed monitor that will track their heart rhythm for a couple years. Others (like me) will have to wear a device like a Zio patch for two weeks to look for abnormalities.

Bill shows a Zio patch taped to his chestBill wearing a Zio patch to check for irregular heart rhythm.

If doctors find or strongly suspect AFib affects a patient, they have a few treatment options.

Blood thinners, or anticoagulants are one option. These medicals like Eliquis and Xarelto are more aggressive at stopping clots than antiplatelet medication like aspirin or Plavix (Clopidogrel). They require additional blood tests and monitoring and put the patient at greater risk of bleeding because that's exactly what their supposed to do.

Paul had an ablation therapy. Doctors either freeze or burn some small amount of heart tissue. This disrupts the way electricity flows through the heart, which helps normalize the heartbeat. It's a fascinating technique and eliminated the problem for Paul.

You can read more about the procedure from Johns Hopkins or from the Mayo clinic.

Some people, if their unusual rhythm is too slow, may need a surgically implanted pacemaker to keep the heart moving enough blood quickly enough.

As more people become aware of AFib and research continues, the future of treatment may change dramatically.

In defense of social media

A lot of people claim to hate social media. The conversation is even louder in December 2022 with Elon Musk's takeover of Twitter. Hate speech, privacy concerns, online bullying, the growth of influencer culture, and more have all made it fashionable to hate on social media.

And there are a lot of problems with it. By allowing folks with fringe and extremist views to connect and validate one another's views, it has likely allowed those views to become more common. I'm not defending that.

That same mechanism, though, has allowed people with disabilities to find other like-minded folks.

Stroke and other disabling conditions are isolating. Appearances of disabled people in media are still rare. After stroke, many folks leave their jobs, removing another vector for social experience. Friends and family members may pull back from stroke survivors either because the survivor is no longer able to participate in the same activities or because they are uncomfortable around a person with disabilities. Or because the survivor is a living reminder that they could find themselves in the same situation.

And disabilities themselves make social connection hard. Aphasia impacts conversation. Mobility challenges make it harder to go someplace to meet someone. Vision or equilibrium challenges may make it unsafe to drive.

That's to say nothing of the assortment of cognitive, sensory processing, emotional, and fatigue related challenges a survivor may live with.

And then we can look beyond the stroke world to our neuro cousins in the MS and TBI communities, and beyond that into the broader world of people with disability.

Despite the billion+ disabled people in the world, it's easy to feel the despair of feeling alone.

Social media changes that. Or at least helps with it. People with disabilities are able to connect with one another across the street and around the world. There is power in the shared experience -- of finding someone going through a similar experience. There's power and hope in being able to support each other -- to build on the success of others to drive our own recovery and that of others in the community.

To be able to raise a voice and say, "This is my hidden reality!" To be able to see that the way someone else treats us may not be right and to have that reinforced by people all over the country.

There's power in giving everyone a literal or metaphorical voice. To demonstrate to the world that we're here and we're not going anywhere.

Whether it's on Facebook, Instagram, Tik Tok, IRC, MUDDs, Discord, YouTube, or whatever, we can leverage those platforms to empower us to live our best lives. Or to share a simple message of support.

Look for communities that resonate with you in a supportive fashion. Follow hashtags like these to start and try others to build your community:

  • #Stroke
  • #StrokeAwareness
  • #StrokeRecovery
  • #BrainInjury
  • #LifeAfterStroke
  • #Aphasia
  • #Mindset
  • #CripTheVote
  • #Disability

Social media allows us to connect and that connection is so important to getting more out of life.


Raising voices in social media isn't just about supporting our own lives; it's about saving others. And you can help save other's lives by sharing the stroke warning signs far and wide.

We know time is essential.

We also know that over the past 20 years or so there have been tremendous changes in stroke treatment - new ways to save lives and reduce the severity of disability. That, of course, assumes treatment begins as soon as possible.

And to make that happen, people need to recognize that a stroke is happening and contact emergency services immediately.

So share the stroke warning signs in English and Spanish far and wide -- BE FAST and AHORA.

And if you have the warning signs to share in another language, share those, too.

Stroke symptom graphic highlighting BE FAST (Sudden change in Balance, Eyesight, Facial symmetry, Arm control or speech/language means it is time to call and ambulance),

A graphic of the AHORA pneumonic device to help spanish speakers recognize a stroke.

June Hawkins writing workshop

June Hawkins is a stroke survivor in Canada helps stroke survivors connect (or reconnect) with their creativity through the power of writing.

Her program is called, "With a Stroke of my Pen" and with her cofacilitator, writing prompts, and exercises she helps other survivors explore their world in writing.

The next cohort starts soon. To learn more, visit http://www.withastrokeofmypen.ca/

Hack of the Week

There are two things that Paul found critical to going through recovery and living with disability.

The first is to have a dedicated partner who can advocate for you. It's not easy to navigate the healthcare industry with sudden, unexpected brain damage, and a supportive partner makes a huge difference. Finding the right person to be your partner in life, of course, is not always the easiest task.

The other element which may be easier to cultivate is to develop a "stubborn positivity."

The right action-oriented attitude is what gets us developing the right mindset for recovery. It helps us expect to get better and it drives us to do the work -- the exercises, the metal health care, the repetitions, etc. -- that will ultimately help us drive the neuroplastic change in the brain that empowers recovery.


Where do we go from here?

More thoughts from Paul

A red field with Paul Strikwerda's head shot in the middle. The text reads: A vocal booth is a terrible place to have a stroke. Voice Over artist Paul Strikwerda shares his story of stroke and recovery in this conversation. And he answers the question, "Should stroke survivors pursue work in voice over?" New episode on your favorite podcast app with Paul Strikwerda (@NetherVoice) http://Strokecast.com/VoiceOver Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A person sits on the floor and does their taxes The text over the image read: Being self-employed means that there really are no typical days. There's no nine to five or off on weekends. There's no steady work, no steady paychecks. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of two hands shaking The text over the image read: My day was like 80% finding work and 20% doing the work. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a person sillouetted against the northern lights The text over the image read: Ultimately, I was responsible for my own destiny, and I love that about this type of work, but it's not for everyone. I can tell you that. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a person in a business suit angrily pounding a desk. The text over the image read: Well, I tell people I have the most demanding boss ever because you know nobody will demand as much of you as yourself. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a pretzel The text over the image read: And when I regained consciousness, I was on the floor of my studio, painfully twisted like a pretzel, gasping for air, and I tried to get up desperately on both knees, but I couldn't. It was as if my brain's messages did not reach my muscles and I'd never experienced anything in my life. And then the phone rang. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a woman with her face covered by plastic The text over the image read: I, at that time, did not have any ventilation in that booth, so as I was laying there on the floor it dawned upon me that I was slowly using up all the oxygen in my hermetically sealed, unventilated studio, and I couldn't even shout for help because who would hear me? - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of an ICU monitor The text over the image read: And the next thing I remember is just waking up in the ICU, and my wife was by my side. And for the next two weeks it would be attached to a network of tubes, with all kinds of beeping sounds and measuring all kinds of vital signs. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a couple. One is sitting on a rollator. The text over the image read: We often forget to think about our caregivers, too, when we talk about our stroke story, but I Owe her my life and I'll be forever grateful to her. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of 5 people dragging a finishing net The text over the image read: I tried to drag my left foot with me. It just feels like it's not part of myself. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a bunch of eggs wit drawn on faces. The text over the image read: When I share my emotions, it gives other people permission to do the same. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of the disability logo stencilled on a concrete wall The text over the image read: Once you get this label of being handicapped, you're no longer seen as somebody who's reliable -- who can who can do what he promises to do. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a plant sprouting after a forrest fire The text over the image read: The way you approach what's happened to you is vital to your recovery. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a microphone on a mixing board The text over the image read: I wasn't only recovering from a stroke, but I was really training to become a better voiceover. I was training to become a better voice actor. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a library book shelf The text over the image read: It started with a single word. A word became a sentence, a sentence became a paragraph, a paragraph became a chapter, and eventually a chapter became a book. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of two hands holding a lit candle. The text over the image read: Every time you do that little thing you make a little bit of progress, and you know that there's hope. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a neon arrow outline on a graph The text over the image read: The more progress you make, the more encouraged you are. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of an open plaza in a city The text over the image read: Something that was normal to me was very special to other people. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a budding lotus The text over the image read: You need to create an environment for yourself where you can thrive. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a skull on a black background The text over the image read: I've lost my fear because the worst thing that could have happened to me already did. I almost died, so there's nothing to be afraid of anymore. And boy, that's a burden off my shoulders. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

A picture of a sunrise over a valley The text over the image read: I don't believe in a God who punishes or who hands out favors. - Paul Strikwerda Paul Strikwerda, AKA Nethervoice, on http://Strokecast.com/VoiceOver

Here is the latest episode of The Strokecast


Memory and the Brain: How it Works and How it Doesn't Work

Memory is not as reliable as we like to think it is. And that's not a stroke thing. It's just the nature of memory.

Of course a stroke can impact memory as well. It can hurt our short-term memory, like in Christine Lee's stroke ( http://Strokecast.com/Christine). It can impact whether or not we can "remember" vocabulary, like in the case of aphasia. We may find our memory stronger earlier in the day than later in the day.

This week, I speak with the host of the Brain Science podcast and member of the Podcast Hall of Fame, Dr. Ginger Campbell about ow memory work in the non-damaged brain. We explore some of the misconceptions that govern memory , its accuracy, and even how it impacts the criminal justice system.

If you don't see the audio player below, you can listen to the conversation at http://Strokecast.com/MSN/BrainScience


Who is Dr. Ginger Campbell?

Dr. Ginger Campbell poses for a traditional headshot wearing her white doctor's coat

Dr. Virginia “Ginger” Campbell is a physician, author, and science communicator. She is the author of “Are You Sure: The Unconscious Origins of Certainty”* and she is a member of the Podcast Hall of Fame (2022). Dr. Campbell began podcasting in 2006 when she launched two shows: Brain Science and Books and Ideas. Both feature interviews with scientists, but Books and Ideas includes more diverse guests including science fiction writers. In 2018 she launched Graying Rainbows, which took her interview skills to a more personal level. Brain Science is still going strong and is widely regarded as the best podcast about neuroscience.

Dr. Campbell spent over 20 years as an emergency physician in rural Alabama. In 2014 she went back to the University of Alabama in Birmingham where she completed a Fellowship in Palliative Medicine. She now practices Palliative Medicine at the Veterans Administration Medical Center in Birmingham, AL, where she enjoys both patient care and teaching residents, fellows, and medical students.

Dr. Campbell enjoys sharing her passion for science and especially neuroscience. Her goal is to make these topics accessible to people from all backgrounds.

Memory is not a Recording

One theme that comes up frequently is that the brain is not a computer and memory is not a recording.

The dynamic nature of memory means that our "mental records" of events cand and are supposed to change. Each time we recall an event, we rewrite it. Maybe we add new data or interpretations. Maybe we purge less relevant details.

The whole evolutionary purpose of memory is to keep us alive so we can reproduce and propagate our genes. Of course that's the evolutionary purpose of every aspect of our biology. Our existential, theological, spiritual, philosophical, or metaphysical purpose is different, but that's a separate discussion.

Memory is not intended to provide an accurate, societal record of all events. It's meant to help us survive.

Criminal Justice

Eyewitness testimony and stranger identification is the least reliable form of testimony in court. In addition to challenges like cross-race identification, even our most traumatic memories lack accuracy. Again, the memory is there to keep us alive, not to ensure the right person goes to jail.

We often read about the flaws of eyewitness testimony. The fact is memory is often not accurate enough to convict someone beyond a reasonable doubt (the standard in the US). Fortunately, the proliferation of dash cams, cell, phone recordings, and police body cams provide an often more accurate supplement to memory. And the advances in DNA identification and analysis provide a further level of certainty.

There are likely still hundreds or thousands of people in prison around the world solely because of someone's memory.

Is everyone who claims to be innocent actually innocent? Of course not. Are some of them innocent? Surely.

Any assessments and accusations, especially about strangers, need to be taken with a substantial grain of salt.

Podcast Hall of Fame

In Spring of 2022, Dr. Ginger Campbell was inducted into the Podcast Hall of Fame. 

The honor recognizes her commitment as a science communicator/educator. Talking about science and making it accessible to everyday people and voters is essential to our future as a society. At one level, we have learned so much about how biology and climate work, it's astounding.

At the same time we are still plagued by anti-vaxxers, flat earthers, and climate change deniers who deny science. They can win adherents due to lack of skill of many in the science community when it comes to communicating with the general public.

In all fields, scientific and otherwise, the deeper the experts get, the more likely they are to be speaking a different language -- one of assumptions and vocabulary and lines of thought that are unique to the field.  What's often missing is an ability to translate that expert language from the field of experts to the general populace, who may have their own expertise in their own fields.

That's why shows like the Brain Science podcast are so important. And it's why I hope I can make my own contribution to the space with this show.

By the way, Ginger is not the only podcast hall of famer I've had the pleasure of interviewing. A few years back, I interviewed Dave Jackson from the School of Podcasting on my 2-Minute Talk Tips podcast.

You can listen to that episode here:

Hack of the Week

The simplest way to improve your memory is to pay attention to things you want to remember. That means repeating people's names when you meet them, or repeating appointment information as you make the commitment.

The more you repeat it, the more brain resources you commit to remembering something. When it's important to remember, tell your brain that it's important to remember and why. Give yourself the context you need.

If you hear something out loud, say it out loud. Then handwrite it. Engage more parts of your brain and body to secure important pieces of data in your memory.

A bonus hack to keep your brain sharp? Engage socially with people because the brain craves variety and novelty. And few things are as random and unpredictable as people.


Where do we go from here?

  • Text BrainScience to 55444 to get 5 Things You Need to Know About Your Brain, and to subscribe to Ginger's newsletter. And be sure to check out her podcast Brain Science to learn more about the brain and neurology.
  • Share this episode with someone you know by giving them the link http://Strokecast.com/BrainScience.
  • Subscribe to the free Strokecast newsletter at http://Strokecast.com/News.
  • Don't get best…get better.

Here is the latest episode of The Strokecast


How does remote speech therapy work? Lenora Edwards Explains

When most stroke survivors go home, that's not the end of recovery or therapy. They often get to go to an outpatient facility a few times a week to continue making progress with PT, OT, and speech therapy. It's great when that's feasible.

Unfortunately, it can mean spending several hours to attend a 45 minute session. An it may require that not only from the survivor but also from a care partner. Transportation logistics, scheduling challenges, etc. can take energy that would better spent on recovery and rehab.

But do we really need to travel?

The pandemic radically sped up the adoption of telemedicine and remote healthcare. Facilities added infrastructure and patients learned to use Zoom and Teams. A lot of therapy -- especially speech therapy can be done online with a remote therapist.

Lenora Edwards is a Speech Language Pathologist with Better Speech. Better Speech has more than 150 therapists around the US offering remote Speech Therapy.

In this episode, Lenora tells us how this works, how it helps, and when remote therapy doesn't make sense.

If you don't see the audio player below, visit http://Strokecast.com/MSN/BetterSpeech to listen to the conversation.


Who is Lenora Edwards?

Lenora Edwards looks at the camera in this headshot. The Better Speech banner runs across the bottom.

Lenora Edwards is an ASHA board certified Speech-Language Pathologist.

Throughout her career as a speech therapist, she has enjoyed treating and evaluating a wide variety of speech and language issues across the lifespan.

Aphasia, Apraxia, and Dysarthria

These are three common speech challenges after a stroke.

Aphasia is trouble finding words. A person has all their thoughts, feelings, and smarts, but they just can't access the vocabulary to express themselves. They're not dumb, and they still have all their intellectual capability and processes. They just can't use words.

In some cases, they can understand things fine; in others, they lose the ability to understand words, too. Sometimes they can read and write. Sometimes those functions break.

Apraxia is a challenge of getting the words in the right order. Once you can access your words, and pull them off a metaphorical shelf, you still need to chain them together into sentences and paragraphs to communicate with other people.

Dysarthria isn't a language issue itself; it's a speech issue. Dysarthria happens when we have trouble with the mechanics of speech -- tongue, larynx, jaw, and lip movements for example. This is what had for a little while. My hemiparesis wasn't just my arm and leg, but also the muscles on the left side of my face and mouth. It resulted is some slurring and mild pronunciation challenges. Overall, it was one of my milder deficits at the time. Most folks thought it cleared up in a couple weeks; I continued to notice it for 6 months.

One fascinating aspect of all this is just how much goes into language and communication. There are so many different ways it can go wrong, it's a wonder anyone can speak at all.

Adjective Sequence

We learn our first language intuitively We pick it up as a child from those around us, cultural tools, our environment, and later school. We don't learn the rules first. We learn them after we've already been using them for much of our lives.

In English, adjective sequence is one of those rules. Many of us heard or read the children's books about Clifford, the big, red dog. Just saying that phrase will trigger a memory for many folks. Even if this is the first time you've heard about Clifford, you understand what I mean. You may not be aware that by big, I mean house-sized, but you get the point.

If I mention Clifford, the red, big dog, it seems wrong. And it is because in English (in the US, at least), size adjectives come before color adjectives. That's the rule. When did I learn this?

Last year. Seriously.

I never knew this was a rule before, but I "knew" it was a rule. I knew it intuitively from hearing and speaking the language for 50+ years. I think that's the experience most people have.

It's one of the reasons language is so fascinating. Two sentences adhering to the core rules of grammar with all the same words come into our awareness, and one of them is simply wrong. And we may not know why. But we know it.

Adjective sequencing is an interesting topic. You can read more about it at Grammarly.


English is a phonetic language. We build our words with letters and letter combinations that make sounds that align with the sound of the words when we speak. We can create any written word with just 26 symbols.

Other languages are symbolic. Characters may not represent a sound, by a symbol. Combining symbols and impressions of images and concepts is how to create words. Many languages from Asia are primarily symbolic languages. Learning to "spell" words is more complex, if you can even call it spelling.

Language is continuing to evolve, though. Over the past 30 years, we've seen the definite increase in symbolic elements coming into our written communication. For example : )

Using the keyboard to create symbols from letters grew rapidly in the online communities of the late 80s and early 90s. Gradually, we started to see Emojis, or dedicated symbolic characters come into the mainstream of communication, to the point where we now have hundreds of them. 😊

Abbreviations and acronyms have become words. We know what lol, WTF, AFK, and more mean at a glance even though we might never say them out loud. They exist mainly in our typed language.

One thing I like about emojis is that they can add nuance to our text-based communication. The add a flair to the conversation that might have been a tone in the voice in a vocal conversation. They help add emotion back into text that got stripped out when we started typing.

And since they're visual, everyone can understand, right? I mean a smiley face transcends borders and language, right?

Well, all languages evolve, even emojis. At one point, the eggplant and peach emojis just represented a vegetable and fruit. Over time, they've come to be stand-ins for sexual activity. If you don't know that, it can make for some awkward situations.

With abbreviations, it matters, too. For some, LOL means "laughing out loud." For others, it means, "Lots of Love." Knowing who your typing with and that you both have the same interpretation matters.

There was an interesting thread on the Ask A Manager site about this recently. It discussed the face with steam coming from the nose. 😤 This may even look different on different devices. But if someone sends that to you, does that mean they are working hard or does it mean they are angry. You can read the thread here.

And this is one more reason why language is such a fascinating area and why aphasia really sucks.

Hack of the Week

We've heard it before because it is so important -- be patient, and allow those around you to be patient with you.

Our own recovery takes time. It's a marathon, not a sprint. Reacquiring abilities can take years.

It's equally important for others in a survivor's life to be patient. There is an instinct to help as much as possible -- to rush and open a door, to take things from a survivor to carry them, or to finish their sentences for them. But don't. sure, help if asked. Or if you want to offer help, that's okay. But when a survivor declines help, respect that decision.

The way to learn to do things again is to do them. We have to be patient with ourselves and others to make that possible.


Where do we go from here?

  • Check out the links above to learn more about Lenora and Better Speech.
  • Share this episode with someone you know by giving them the link http://Strokecast.com/BetterSpeech
  • Share your Win of the Week by calling 321-5Stroke and sharing it in a voicemail.
  • Don't get best…get better.

Here is the latest episode of The Strokecast


The Truth About the COVID-19 Vaccine and Stroke! Plus, how to do your Research

More than a million people in the United States have been killed by COVID-19 in the past 3 years. The numbers would be much higher, but the vaccines were developed with amazing speed. Time and again, the vaccines have been shown to be safe and effective.

Yet some people persist in claiming the mRNA vaccines are causing an epidemic of stroke.

The data is clear. They do not. If you want to reduce your chances of stroke, get the vaccine.

The new thing that causes stroke over the past few years is COVID-19 itself. If you want to decrease your chances of having a stroke (or another stroke) don't get a severe COVID-19 infection. And the simplest thing you can do to reduce your chances of getting a severe COVID-19 infection is to get the COVID-19 vaccine.

If you do catch COVID-19 despite the vaccine, the data shows it will be much less severe and much less likely to be fatal. 

In addition to protecting yourself, you are also helping to protect others who may not be medically eligible to get the vaccine.

The COVID-19 mRNA vaccines are saving lives every day.

In this episode ...

In this episode, I talk with data scientist and epidemiologist Dr. Remle Crowe about the research studies coming out now that show what we already knew from earlier research: the COVID-19 vaccine does not increase your risk stroke.

We talk about several studies, and we talk about how you can do your own research on the credibility of these studies and evaluate how well they reflect the scientific reality of our world.

In this post, you'll also find links to a bunch of these studies that you can read for yourself.

Start by listening to this conversation. If you don't seed the audio player below visit http://Strokecast.com/MSN/vaccine to listen to the whole conversation.


Bill Monroe wears a red T-Shirt and is in need of a shave. One sleeve is rolled up to reveal two bandaids on his upper arm over a tattoo of a brain.I got my Bivalent COVID-19 booster and my 2022 Flu shot on the same day in October.

Who is Dr. Remle Crowe?

Dr. Remle Crowe stands in front of a blurred office background wearing a white blouse and blue blazer

Dr. Remle Crowe is an expert in EMS research and quality improvement. From truck clutches to clinical care, she has shown how research and improvement science work to solve problems across fields. Prior to earning a PhD in Epidemiology, her EMS career began with the Red Cross in Mexico City as a volunteer EMT. She has authored numerous peer-reviewed publications related to prehospital care and the EMS workforce. Now, as a research scientist with ESO, Dr. Crowe routinely uses EMS data to improve community health and safety.

Dr. Crowe previously appeared on the Strokecast in episode 132 to discuss the AHORA pneumonic to help Spanish speakers recognize and respond to a stroke. When it comes to stroke, Time is Brain regardless of which language you speak.

A Sampling of the Studies

When we claim the data indicates that the vaccine doesn't cause an increase in stroke, what data are we talking about? How did "they" analyze it? Who reviewed the studies to ensure they were accurate? Where can you read the details yourself?

As Dr. Crowe explained, there are currently a whole bunch of studies that are coming out. That makes sense; it's roughly 18 months since the vaccines against COVID-19 became widely available. To conduct sound research, you need a large pool of people to look at. You need to take some time to see the results. You need to write up those results. Then you need to submit them for publication. Publications will then need to review before publishing them.

That brings us to where we are today with all these studies now becoming available. Let's take a look at a few of them, and I encourage you to click through to the details and read them yourself. Click the study titles for more.

Surveillance for Adverse Events After COVID-19 mRNA Vaccination

This study published in JAMA (Journal of the American Medical Association) looked at nearly 12 million doses of the mRNA vaccine given to more than 6 million people.

This is what they learned:

"The incidence of events per 1 000 000 person-years during the risk vs comparison intervals for ischemic stroke was 1612 vs 1781 "

In other words, the time period at greatest risk for stroke did not see an increased risk.

They concluded:

"In interim analyses of surveillance of mRNA COVID-19 vaccines, incidence of selected serious outcomes was not significantly higher 1 to 21 days postvaccination compared with 22 to 42 days postvaccination. While CIs were wide for many outcomes, surveillance is ongoing."

COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25 U.S. Jurisdictions, April 4–December 25, 2021

We talked about this report from the CDC Morbidity and Mortality Weekly Report during the episode.

This study looked at infections and deaths among vaccinated folks and unvaccinated folks. The rate of infection and death from COVID-19 was much higher among unvaccinated folks than among vaccinated or vaccinated and boosted folks.

The report says:

"Rates of COVID-19 cases were lowest among fully vaccinated persons with a booster dose, compared with fully vaccinated persons without a booster dose, and much lower than rates among unvaccinated persons during October–November (25.0, 87.7, and 347.8 per 100,000 population, respectively) and December 2021 (148.6, 254.8, and 725.6 per 100,000 population, respectively) (Table 2). Similar trends were noted for differences in the mortality rates among these three groups (0.1, 0.6, and 7.8 per 100,000 population, respectively) during October–November."

Even though the vaccine does not guarantee a person will avoid COVID-19, it greatly increases their chances of avoiding infection. And if they do become infected, the vaccine greatly increases their chances of survival.

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

This study in the Journal of Neurological Sciences looked throughout the published literature and found just 43 incidents of stroke following the vaccine administration.

"AIS has been reported as a rare complication within 4 weeks post COVID-19 vaccination, particularly with viral vector vaccines. Health care providers should be familiar with this rare consequence of COVID-19 vaccination in particular in the context of VITT to make a timely diagnosis and appropriate treatment plan."

The report specifically called out the risk of “viral vector vaccines” (and, again, it’s a shockingly small risk). The most common viral vector COVID-19 vaccines are those from Johnson & Johnson and from Oxford-AstraZeneca.

The mRNA vaccines from Moderna and Pfizer are not viral vector vaccines., indicating that those appear to be even safer.

The recommendation is not to avoid vaccination. It's an extremely rare complication. The recommendation is to watch for signs of stroke, which is something we should be doing all the time anyway.

Association Between Vaccination and Acute Myocardial Infarction and Ischemic Stroke After COVID-19 Infection

This article, published in JAMA looked at what happens after a COVID-19 infection for both vaccinated and unvaccinated folks. If someone does get infected and, does their vaccination status reduce the impacts of infection? Yes, it does.

In fact, folks who got the vaccine and the got COVID were LESS likely to have a stroke or heart attack after their COVID infection.

"This study found that full vaccination against COVID-19 was associated with a reduced risk of AMI [heart attack] and ischemic stroke after COVID-19. The findings support vaccination, especially for those with risk factors for cardiovascular diseases."

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

This study in the UK looked at patients who had been infected with COVID-19 or who had received the vaccine. More than 30 million people were part of the study. The conclusions were clear:

"Increased risks of haematological and vascular events that led to hospital admission or death were observed for short time intervals after first doses of the ChAdOx1 nCoV-19 and BNT162b2 mRNA vaccines. The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population."

Even if there is a slight risk from vaccination, the risk from the actual disease is much higher.

COVID-19 vaccine not linked to increased risk of stroke

Not all research becomes available without a subscription. Researchers at Cedars-Sinai have found similar results to other studies though and have come to the same conclusion.

"Newly compiled data evaluated by researchers in the Department of Neurology and the Smidt Heart Institute at Cedars-Sinai shows that COVID-19 vaccines do not raise stroke risk--but that severe COVID-19 infection does. Physician-scientists hope this growing body of evidence, highlighted today in an editorial in the peer-reviewed journal Neurology, will ease the minds of individuals still hesitant to be vaccinated."

Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex

We talked about this study in the conversation with Dr. Crowe. At first glance it is concerning. This is the conclusion:

"Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine."

That does seem scary for young men, and there are a couple things to keep in mind.

First, the number of events was so small that it's tough to draw firm conclusions. When you get down to such low numbers, that stats can do weird things.

Second, this was based on the adverse event reporting system. That does not prove causality. It just flags something to look at more closely if there are large numbers. Which there are not.

The point of all this research, though, is to learn more and compile more and more evidence. And ultimately to let the body of evidence guide decision making and recommendations.

What we know at this point is that the risk of stroke after a COVID-19 infection is much higher than the risk of stroke following a vaccination.

And the risk of stroke after COVID-19 infection is much lower in folks that have been vaccinated than it is in those who have not been vaccinated.

COVID-19 is not gone. It is still out there in the world infecting people, killing people, and giving people strokes.

Billions of vaccinations later, this is what the data tells us.

The simplest way to reduce your risk of stroke is to get the vaccine and stay boosted.

Do Your Own Research

We talked about a bunch of research in the podcast, and we looked at a bunch of reports above. You don't have to just accept my commentary or Dr. Crowe's. You can read the reports yourself and look at the data and see why the vast majority of medical professionals have concluded the vaccines are safe and effective.

Dr. Crowe offered a number of tips to help you do your research. You'll find them and more in this list.

Tip 1

Search research focused search engines and directories to find studies and resources. Google Scholar and PubMed are great places to start.

Tip 2

Look at the Publication that publishes the research. Is it well known for scientific rigor? Does it have a strong requirement for peer review of articles? Or can someone publish in it by simply paying a fee?

Tip 3

Search for the publication's Impact Factor. The more other publications that cite its work, the higher the number. A publication with a higher impact factor is likely more credible.

Tip 4

When you get to the actual study, look at what type it is. If it was a case study, that's interesting. If it was a randomized, double-blind, placebo-controlled study on a large scale, that's even better. If it was a systemic review evaluating hundreds of other studies, that's stronger still.

Tip 5

Look at how many people were part of the study. A few dozen is interesting. A few million is much more likely to yield credible results.

Tip 6

Look at the results of the study, relative to the size of the study. A few results out of a dozen is one thing. A few results out of millions of subjects is another matter altogether.

Tip 7

Look at the goal of the study. What were the authors hoping to demonstrate? Did they succeed? Why or why not?

Tip 8

Consider confounding. Studies generally deal with a subset of the population -- a limited number of people -- and seek to extrapolate those results and draw conclusions about the broader population.  For those conclusions to be valid, though, the group studied needs to be similar to the group the study extrapolates to. The more different the groups are, the less reliable the results.

Tip 9

Finally, does the study demonstrate causality or just coincidence? There’s a reason folks will often say, “Correlation does not equal causation.” For example, the FDA Adverse Event Reporting System (FAERS) Public Dashboard is a collection of negative things that happen to a person after they get a vaccine. It's not a list of events caused by the vaccine. If a person gets hit by a bus after getting the vaccine, that can go in the database. It's an adverse event. That doesn't mean the vaccine caused the bus accident. Read the study carefully to see if the authors claim a causal relationship and if that relationship is supported by the evidence in the study.


The last time Dr. Crowe was on the show was to talk about the AHORA messaging to help Spanish speakers recognize and respond to stroke. It's basically the equivalent of the BEFAST messaging we talk about a lot in English.

Here is the stroke warning pneumonic device in Spanish. Download it and share it far and wide.

A graphic of the AHORA pneumonic device to help spanish speakers recognize a stroke.Reconocer los signos de un accidente cerebrovascular y responder rápidamente. ¡Llame a una ambulancia si observa estas señales!

Let’s look at a translation.

Letter Abbreviation for Spanish Description In English
A Andar Tiene dificultad para andar? Tiene problemas con el equilibrio? Do they have difficulty walking? Do they have problems with balance?
H Hablar Tiene dificultad para hablar o entender? Usa palabras que no tienen sentido? Do they have difficulty speaking or understanding language? Do they use words that don't make sense?
O Ojos Tiene algün cambio de vista? Tiene visiön doble? Tiene dificultad para ver con ambos ojos? Do they have some change in vision? Do the have double vision? Do they have difficulty seeing with both eyes?
R Rostro Tiene la mitad del rostro caido? Tiene un repentino dolor de cabeza como nunca se ha sentido? Do they have one-sided facial droop? Do they suddenly have the worst headache of their life?
A Ambos Brazos Tiene dificultad para levantar un brazo o una pierna? Tiene debilidad en un brazo o una pierna? Do they have difficulty lifting an arm or a leg? Do they have weakness in an rm or a leg?

And, of course, here is the BE FAST messaging for English speakers.

Stroke symptom graphic highlighting BE FAST (Sudden change in Balance, Eyesight, Facial symmetry, Arm control or speech/language means it is time to call and ambulance),Recognize the signs of a stroke and respond quickly. Call an ambulance if you observe these signs!

Both sets of symptoms look for the same thing. The AHORA messaging includes legs and headaches. The BE FAST messaging specifically calls out calling an ambulance.

Regardless, the more people that can recognize a stroke as it is happening, the better off we will all be.

Pop Culture Moment

During the conversation, Remle mentioned she is a big fan of the movie Sliding Doors. It's an examination of how simple moment can change the course of your life. What path lies ahead if we catch that train or miss it?


Or what happens if we turn right instead of turning left?


In reflecting on the past, it's easy to get fixated on thing were so much better back then, but it's never that simple, is it? Billy Joel reminds us that:

"The good old days weren't always good, and tomorrow ain't as bad as it seems."


Other Shows

Journal Club

Remle mentioned her show, PCRF Journal Club, which is a journal review webinar that meets each month. They go deep into looking at the latest research studies that are coming out. The focus is on research around EMS -- the ambulance and transport industry.

If you'd like to learn more, check out its site here: https://www.cpc.mednet.ucla.edu/pcrf

Successful and Disabled

I was also recently featured on another podcast focused on being successful as a person with disabilities.

I joined host Christ Mitchell on the Successful and Disabled podcast to share my story and discuss how I use mindset to drive my recovery and other goals in life.

Listen to it here. If you don't see the audio player below, visit http://Strokecast.com/MSN/Vaccine to listen to the conversation:

Hack of the Week

Reading a paper book can be challenging with one functional hand. It's even harder if you try to do that while eating a meal. Why? Because books don't always want to stay open on their own. You have to hold them open, which makes it harder to pick up your cheeseburger.

I use my phone to address this problem. I open the book and then lay my phone across the open pages. It's just heavy enough to keep the book from snapping shut so I can enjoy feeding my belly as I also enjoy feeding my mind.

Give it a try.


 Where do we go from here?

  • Check out the links above to learn more about why getting the vaccine is safer than not getting the vaccine
  • Share this episode with someone you know by giving them the link http://Strokecast.com/vaccine
  • Do you have a recent win or victory in your recovery? Share it by calling 321-5 STROKE
  • Get your vaccine and booster to protect against COVID if your doctor advises it
  • Don't get best…get better

Here is the latest episode of The Strokecast


Walking with Electric Pants

A minor electric signal is all it takes to move a couple hundred pounds of human.

When we walk, the brain sends a signal through the spine to the individual muscles of the legs, feet, and core to manage the complex orchestra of contraction and relaxation that makes balance and walking possible. After stroke, the brain may stop sending all or some of those signals. That breaks the ability to walk. It happened to me and millions of others.

There is nothing wrong with my leg, though. The muscles, joints, tendons and nerves in my leg, foot, and core are all still there and as fully functional as they were before the stroke. They're just waiting for he signal from my brain which, in the beginning, never came.

Rehab was about getting the brain to send that signal again. And it started sending some of it. It's not as complete as it used to be. Or as strong. But it's enough that I can walk with my cane and brace well enough, and not quite as well without my aids.

But, again, it's a brain issue, not a leg issue. If you can send a signal to those muscles without the brain, can you effectively get those muscles to move and walk more effectively? Yes you can.

That's what Neural Sleeve from Cionic does.

In this episode, I speak with Cionic CEO and founder Jeremiah Robinson about the Neural Sleeve, why it works, how stroke survivors can learn more, and how his daughter inspired this product.

If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation.


Who is Jeremiah Robinson?

Jeremiah Robinson is seen from the shoulders up in a white bitton down shirt with a faint plaid patter smiling in an open office floor space

Jeremiah Robison is the Founder and CEO of CIONIC, an innovative company that builds lightweight and durable bionic clothing driven by powerful algorithms that adapt in real time to each individual's mobility needs.

He started the company in 2018 after his daughter was diagnosed with cerebral palsy and he was frustrated at the lack of effective technology available to help improve her mobility. Four years later, CIONIC introduced the breakthrough, FDA-cleared Cionic Neural Sleeve, the first product to combine sensing, analysis and augmentation into a wearable garment.

Prior to CIONIC, Jeremiah spent twenty years at the intersection of data, algorithms, and the human body, driving innovation in sensing and machine learning at Apple, Openwave Systems, Slide, and Jawbone. Jeremiah has a BS and MS in Computer Science from Stanford University.

Jeremiah's daughter

Jeremiah's daughter, Sophie, was apparently in a rush to meet this amazing world. She was born early, weighing just 2 pounds, 4 ounces. She developed Cerebral Palsy in the process.

Cerebral Palsy (CP) and stroke are similar conditions. In fact, as Dr. Heather Fullerton explained in episode 49 ( http://Strokecast.com/PediatricStroke) roughly 50% of CP is caused by stroke in utero or shortly after birth. CP is the result of not enough oxygen getting to the right part of the brain at the right time of development. Brain cells die or don't develop or don't form the right networks the way they should. As a result, a child can develop any number of challenges around mobility, speech, dexterity, and more. Just like adults (and other children) with stroke.

The damage from stroke in the brain is also, in part, due to lack of oxygen getting to the right parts when they need it due to a disruption in the blood supply.

Stroke survivors have a lot in common with our neuro cousins in the CP and MS communities, to name a few.

Jeremiah talks about wanting to help Sophie with her gait, as any parent would. Jeremiah was in a position to do something about it, and the Neural Sleeve comes from that experience.

Sophie herself is now 12 years old and has developed a presence on Instagram with the family's nonprofit at @WAWOSORG. Sophie shares her own inspirational tips and exercise strategies for other kids with CP or other disabilities.

View this profile on Instagram

WAWOS (@wawosorg) • Instagram photos and videos


FES stands for Functional Electric Stimulation. I talked about the technology in more detail in episode 92 - Electrodes and a Stationary Bike — FES for Stroke Treatment.

I've used eStim in therapy while I was inpatient and then at home, too. Devices are available on Amazon for $30-$50.* You put 2-4 electrodes on an arm or leg, roughly at either end of a muscle. The AA battery powered unit sends a minor electric signal to the electrode. The nerves at the end of the muscle detect it and think the brain is sending the signal. The nerve then contracts or relaxes the muscle.

The muscle is doing the actual work. It can be a great way to help an affected limb get some exercise, stretch some tendons, and generally not waste away. In the shoulder, it can even treat subluxation.

FES is the next level of eStim. Instead of just making the muscle move, it makes it, and other muscles move much more precisely to accomplish a specific function. In the case of Restorative Therapies, this was to coordinate movement to drive rahab.


Some of the more well-known FES devices are those from Bioness and Walkaide. They specifically stimulate the muscles that lift our toes (the dorsiflexors) to eliminate foot drop while walking. They are an alternative to an AFO. The look like a cuff that a person wears just below the knee. They work great for some folks, but not all. They're also not typically covered by insurance.

I tried them both earlier in my post-stroke life. The Walkaide worked better on my gait, but at $5K-$6K to buy the unit (in 2019), I decided the benefit simply wasn't worth the cost for me. For others, the device is a great solution. Author Maddi Niebanck who survived a stroke at 22 and was in episode 97 uses the Bioness and is a big fan.

The Neural Sleeve takes this technology further. As Jeremiah explained, the network of electrodes in the device means that precise placement is not as important. Software can adjust for that.  With its larger assortment of electrodes, it can also stimulate more muscles and address other aspects of gait. And it looks less like a home-release ankle monitor.

The rental aspect of the Neural Sleeve also makes it more accessible to more folks, similar to the approach adopted by show sponsor Motus Nova for its rehab device.

The best rehab gear is the gear you won't need forever, and that rental becomes much more compelling. At least under the American model of health care financing.

Cionic Images

You can get a look at the device in these images. Or visit http://cionic.com.

An animated GIF showing the Neural Sleeve from an orbital motion

No Plateau Podcast

Many stroke survivors have heard of Saebo. The make a series of devices for survivors. One of them is the Saebo Step, which is an alternative AFO. They sent me one several months ago, and I use it as my summer AFO. Specifically, it's the one I use when I wear short pants or sneakers.

They also have a podcast called the "No Plateau Podcast" which is a great name for a stroke oriented show. And I'm the guest on episode 6. It was a lot of fun and I didn't have to do the editing.

In the episode, I share my stroke journey and we talk about the good, the bad, and the ugly of stroke rehab. We also talk about what I mean when I say, "Don't get best…get better." And we talk about some of the inequities affecting female presenting and BIPOC stroke survivors.

You can listen right here. If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation. Or go directly to the audio at this link.

And check out more episodes of the No Plateau Podcast on Saebo's website or in your favorite podcast app.

Hack of the Week

Jeremiah recommends patience. Recovery is a journey as we well know, and we can take it just a piece at a time.

It's also important to capture the process in notes, video, audio, and/or pictures. As we make progress day-by-day we won't see it. It's only when we look back at our records that we see how far we've come.

And of course this aligns well with the idea of "Don't get best…get better." It's that incremental progress that matters…little bits every day that over time add up to success and goal achievement.


Where do we go from here?

Here is the latest episode of The Strokecast