Communicate without Words

"Communication is the process by which shared meaning is created." 

CO 101

That's the first lesson we learned in Communications class back in college.

Communication isn't spoken words or written words of photos or symbols or sounds or touches. Or even scents or tastes.  Those are all just vehicles for communication. They are the trucks intended to carry the freight of meaning from one person to another.

After stroke, some of those trucks are no longer available. Aphasia and dysarthria may interfere with speech. Hemiparesis may interfere with writing or gestures. Sensory overload and attention challenges may interfere with listening.

And yet communication continues. Because the other lesson we learned in the class CO101 is, "You can't not communicate."

Combine those principles with the idea that your actions always speak louder than your words, and we have deeper understanding of how important it is for clinicians to think deliberately about the things they say and do when working with clients.

Marabeth Quin and Physical Therapist Danielle Stoller joined me in this episode to share their stories and how they came to develop Expanded Practice -- a training program for clinicians that helps them tune their communication strategies to build better relationships with their patients.

Note: This isn’t the first time I talked about communication in an academic context. This was also something I talked about with Drs. Sara Parsloe and Patricia Geist-Martin in episode 111 at http://Strokecast.com/process.

If you don't see the audio player below, visit the original post at http://Strokecast.com/ExpandedPractice.


Who are Danielle and Marabeth?

Danielle Stoller is a neuro physical therapist who helps stroke and brain injury survivors improve their lives through a holistic rehab approach.  Marabeth Quin uses the experiences and insights she has gained from her daughter’s stroke recovery to improve therapist’s understanding of the mental and emotional aspects at play in the recovery process.  Together they co-founded Expanded Practice.

The top half reads Expanded Practice. The bottom half includes headshots of Danielle Stoller and Marabeth Quin

Expanded Practice

Expanded Practice is the training organization that Danielle and Marabeth started  once they saw the need to help therapists connect more effectively with their patients.

Their goal in part is to go beyond the technical details of the tasks that go into a session and to help therapists think more about the client experience -- to connect to the clients as individuals with specific therapeutic, emotional, and psychological needs. That's not about providing counseling per se; it's about understanding the patient and building a trusting relationship with them to promote a more effective session.

In some ways it parallels the work I've done as a corporate training help folks learn how to sell technology products. It's not about the high-tech features of the product. It never is. It's about what those features and those products will do for the customer. Effective salespeople ask themselves, "How will this product or service make THIS customer's life better? How will this benefit them?"

To answer that, they have to talk to their customers and ask questions. They put the focus on the customers' lives.

That focus on the client is something Danielle and Marabeth teach to. As we talked about in the episode,  they teach therapists about the environment they create. If the therapist appears rushed or tense, that will affect the client's perception of what is happening. That increase in tension makes a session less effective.

Here's how Marabeth and Danielle describe the program:

Expanded Practice teaches physical, occupational, and speech therapists to start utilizing the power of positive mindsets and expectations in the recovery process so they can connect with their patients on a more significant level and help them reach greater recovery potentials.  Expanded Practice is passionate about improving the rehab experience for patients and therapists so both thrive and achieve the highest possible outcome.

Stroke Awareness Month

May is Stroke awareness month in the US.

What does that mean for you? Well, whatever you want it to.

It's a month when many survivors will share their stories or post on social media about how to recognize a stroke or just have personal conversations with others they are close to.

Some may choose more subtle signs, like adding a stroke awareness frame to a Facebook avatar or wearing a red ribbon.

Some may give a talk at school, church, or work to help raise awareness.

And many folks will choose to treat it like any other month.

What matters most is to treat it in the way that best supports your needs, goals, and recovery.

And if you want to do something, but you're not sure what, you can always tell folks about your favorite stroke related podcast :).

Or find a new stroke podcast to listen to at http://Strokecast.com/strokerelatedpodcasts.

Hacks of the week

Two guests again means 2 hacks.

Marabeth makes a point of reminding us to keep going. The thing about recovery -- whatever part you're in -- is that it can be easy to stop and give up. It seems so enticing to do that somedays. It really does.

But then you stop getting better. And you may get worse. Even when it's hard, you have to keep going. That's the only way to get to the better days that are coming.

Danielle suggested looking at trees. Even better is getting outside into nature -- even if it's just a short time. There's research demonstrating this helps with recovery.

Getting out and being near the grass and trees and plants helps. And it can be one of the cheapest things you can do to help your recovery.


(If you don't see a table of links, visit http://Strokecast.com/ExpandedPractice)

Where do we go from here?

Here is the latest episode of The Strokecast


When the Pros Deny a Stroke

Olga and her husband were having the vacation of a lifetime. They hooked up a teardrop trailer to their Subaru in NJ and headed out west. The planned to explore the gorgeous landscapes of the Washington State parks before jumping on ferry to Alaska.

On July 19, 2021, at a campground in Deception Pass State Park on the Washington State Peninsula, things started to unravel.

Olga had a brain stem stroke. She felt tingling up and down one side of her body and could not stop vomiting. She felt it was a stroke. Her husband called 911 and they made it out of the woods to a fire house.

The EMT said she wasn't having a stroke.

The ambulance that arrived said she wasn't having a stroke.

The ER staff said she wasn't having a stroke.

The neurologist said she probable wasn't having a stroke and specifically discouraged the tPA that could have solved the problem

And no one sent her to the more advanced hospitals in Seattle for stroke treatment.

The window for tPA came and went.

This whole time, Olga was having a stroke.

Olga shares her story in this conversation.

If you don't see the audio player below, visit http://Strokecast.com/Olga


Who is Olga Wright?

Olga stands in the woods looking at the camera. Shea wears a brown puffy jacket.

Olga is a married mother, grandmother, and recently retired educator. She lives in central New Jersey, where she practices extreme gardening.

She and her husband recently returned from a six-month, 24,000-mile road trip to Alaska and back, with their ultra-light, solar-powered camper.

Her goal is to educate the public and medical professionals at all levels to recognize nausea, vomiting, and tingling as stroke symptoms so that no one else is misdiagnosed as she was.

Olga can be reached at olgawrightstrokestory@gmail.com

Deception Pass

Deception Pass State Park is a gorgeous corner of the state. It's filled with hiking trails (including accessible trails), lakes, salt water shoreline, and campgrounds.

It's also just an amazingly beautiful part of the state. It seems remote but it's also within just a couple hours of Seattle to the Southeast and 90 minutes from Canada to the north.

It's easy to see why Olga and her husband chose to camp there.

Zofran and the Brain

Zofran is a medication I was not familiar with, and it's what finally got Olga's vomiting under control.

It's typically used to help treat nausea associated with chemotherapy. In Olga's case, it was used to treat a malfunctioning brain that was sending the signal of, "OKAY! Everyone out the way you came in!" even though there was nothing left.

The brain tries to protect us in lots of ways. Sometimes those threats are real and sometimes they are not. In Olga's case, her dying brain stem knew something was wrong but didn't know what. It went to an early reflex for poison and just kept trying the expulsion solution because it didn't know what else to do. Meanwhile, Olga's higher level brain functions were still working and trying to seek medical treatment for the stroke.

And this conflict is an illustration that the brain is not one, cohesive unit. It's different parts grabbing different pieces of data and attempting to execute a solution based on the tools at its disposal. The brain does not always work as a single unit.

But back to Zofran. One of the interesting things I learned while reading about it is that Serotonin, one of the brain's "happy" chemicals is also responsible for the vomiting function/command. Zofran works by suppressing Serotonin.

And that makes me wonder how its use as an antiemetic impacts things like depression. I suppose that will be a future research project.

Swedish ARU

The reason Olga and I connected is that she spent her inpatient rehab time at Swedish Medical Center. It's the same place I lived for the month following my stroke. You can learn more about the Acute Rehab Unit here.

Olga was lucky enough to work with OT Emilee who told her about the Strokecast. Emilee was also one of my OTs 4 years before Olga made it there. I interviewed Emilee in episode 20. You can hear that conversation here: http://Strokecast.com/Emilee

I've stayed engaged with members of my rehab team over the years. I've also met other folks on the stroke team at Swedish. Here are some other interviews I've done with the team at Swedish: http://strokecast.com/Swedish

Licensing for PT and OT

The pandemic has brought a dramatic increase in the availability of telemedicine. This is great because a lot of follow up appointments really don't need to be in person. I'd much rather do a 15 minute video appointment versus a 15 minute in person appointment I have to travel to and back from.

In Olga's case, it almost worked out for Outpatient PT. She would be able to continue her travels after leaving the hospital and get therapy on the road via the internet!

It’s a great idea, but it didn't work. Not because of technology or willingness, but because of state level bureaucracy. A Washington licensed physical therapist cannot legally treat a patient who happens to be in Alaska or whatever other state Olga happened to be travelling through.

Hack of the week

Walking is one of the best ways to drive recovery. At certain points, walking 100 feet may be the most you can do. At other points, a mile or two may be achievable. Regardless of the distance, walking as much as you can helps to drive recovery.

The most important thing, though, is to do it safely. Olga uses traction cleats for all her hiking activities. Traction cleats are basically snow chains for your feet. Even if there's no snow, they help traverse the wilds with less slipping and falling. You can find an assortment on Amazon here: https://strokecast.com/Hack/TractionCleats *.

A walker or cane can be great in a city environment, but they are less usable on the trail. What is usable whether hiking in Alaska or going down to the corner bodega is a pair of trekking poles. These are much taller than a cane. As you use them they give many folks plenty of stability and an upper body work out. You can find them on Amazon at http://strokecast./com/Hack/TrekkingPoles *.


Where do we go from here?

Here is the latest episode of The Strokecast