Latest / Broken Brains with Bruce Parkman / Traumatic Brain Injury and Recovery: Stephanie Rimroth's Groundbreaking Insights

Transcript

Traumatic Brain Injury and Recovery: Stephanie Rimroth's Groundbreaking Insights · Broken Brains with Bruce Parkman

• 0:11
  Speaker 1: Hey folks, welcome to another edition of our podcast, Broken Brains, with yours truly Bruce Parkman, where we look at the issue of repetitive head trauma and what it's doing to our soldiers and athletes in the form of repetitive head impacts and repetitive blast exposure, and the ongoing epidemic of mental illness that's resulting from the damage to these children's, athletes' and veterans' brains, and what we have to do as a society to prepare ourselves and do a better job to take care of these people, to reach out across the universe of brain researchers and scientists and patients and advocates, to find people out there that can tell you stories and make you aware, because this is a widely unknown phenomenon and we need to be aware of this given the impact on us.
• 0:57
  Speaker 1: And anyways, today, another amazing guest.
• 1:00
  Speaker 1: I'm going to put on my glasses so I can read her bio.
• 1:01
  Speaker 1: It's awesome.
• 1:02
  Speaker 1: I'm going to put on my glasses so I can read her bio.
• 1:05
  Speaker 1: It's awesome.
• 1:07
  Speaker 1: Stephanie Rimroth is an active-duty speech-language pathologist in the United States Public Health Service Corps at Eglin Air Force Base, home of the mighty 7th Special Forces Group.
• 1:13
  Speaker 1: She specializes in traumatic brain injury and predominantly works with 7th Special Forces Group, ASSOC PJs and combat controllers, as well as EOD and Navy divers out of Panama City Beach massive and wonderful facility to run out of there, targeting cognitive and communication changes that occur after they've been affected by TBIs and repetitive blast exposure.
• 1:37
  Speaker 1: She's practiced as a speech language pathologist for 16 years, working with TBI and acute care, acute rehab and outpatient, and most recently at the Eglin Intrepid Spirit Center as a contractor for two and a half years and at the main hospital as well.
• 1:52
  Speaker 1: She's married to a Green Beret absolutely the best people in special operations.
• 1:56
  Speaker 1: So are your Navy SEALs.
• 1:57
  Speaker 1: Love you guys, though, and she understands the importance of advocacy and quality medical treatment on behalf of soft professions.
• 2:04
  Speaker 1: This is going to be an amazing show and, Stephanie, thank you so much for coming on the show.
• 2:08
  Speaker 1: Tell us, how did you get into all this?
• 2:10
  Speaker 1: I mean, what got you started on this path?
• 2:13
  Speaker 2: First off, thank you for having me.
• 2:14
  Speaker 2: It's an absolute pleasure to be here and speak about what I love.
• 2:17
  Speaker 2: Honestly, how I got here was figuring out what I didn't like.
• 2:21
  Speaker 2: I ended up in an acute rehab hospital.
• 2:23
  Speaker 2: I'll be back up.
• 2:25
  Speaker 2: I was tired of shoveling snow in New Jersey.
• 2:26
  Speaker 2: I was tired of it.
• 2:27
  Speaker 2: I didn't know much about what I wanted to do.
• 2:28
  Speaker 2: It was about 15 years ago.
• 2:29
  Speaker 2: I was a new speech pathologist.
• 2:31
  Speaker 2: All I knew was I wanted to be somewhere warm and I applied to a job in Hawaii and I got hired and yeah, and it's nice and warm.
• 2:38
  Speaker 2: I had an uncle out here.
• 2:45
  Speaker 2: So I came to Hawaii and initially they put me on the spinal cord injury floor and although I loved the work I was doing and I gosh, I had some of the most passionate clinicians working side by side with me it was really hard to see people that some of the spinal cord injuries I'd have to tell them daily.
• 2:55
  Speaker 2: You know they were also TBI sometimes.
• 2:56
  Speaker 2: But I'd have to tell them certain things weren't going to get better.
• 2:59
  Speaker 2: We were working on compensation more than we were working on restoration and I couldn't stomach that.
• 3:04
  Speaker 2: I just didn't.
• 3:04
  Speaker 2: But then I'd see these TBIs and I'd go, ooh, like there's hope there's, they can get better, you know.
• 3:10
  Speaker 2: And so I fell in love with the idea that the brain is neuroplastic and that you know, we can make changes consistently and you see neuroplasticity up to the age of 90 sometimes and I love the hope that that patients, that I could give those patients daily.
• 3:24
  Speaker 2: And then I don't know if you've ever heard of Dr Mark Ashley.
• 3:28
  Speaker 2: He runs the Center for Neuroskills.
• 3:29
  Speaker 2: He came down to do a talk on mild TBI and I fell in love.
• 3:37
  Speaker 2: I fell in love with the idea of what it was.
• 3:38
  Speaker 2: I fell in love with the fact that there was so again this 15 years ago.
• 3:40
  Speaker 2: There was less known about it then than there is now and I just loved the idea that this was an up and coming area for clinicians to grow and for patients to get better.
• 3:49
  Speaker 2: And so I became the TBI girl and I applied for the TBI lead position and I served in that position for about three years at that hospital, which is where I met my husband.
• 3:57
  Speaker 2: And I met my husband two weeks before he left for selection.
• 4:00
  Speaker 2: So I knew happy artillery officer Matt, who was serving as an SFO, who is having a blast living life as a young, you know, army Lieutenant in that you know, in Hawaii, and then I got to see what selection did to him, and then I got to see what airborne school did to him and slowly my love for TBI and my love for him transformed into I'm watching him break down little by little, mentally, physically, cognitively, and it.
• 4:29
  Speaker 2: It really kind of put everything into perspective for me that this is where my focus needed to be, that he had an advantage that he had me at home.
• 4:37
  Speaker 2: I watched from the beginning, I saw who he was, I saw what this is making him become and I was able after, you know, we spent two years while he was at the course at Fort Bragg and then, you know again, I'm a warm weather person, so threatened him to have to geo bachelor his whole life if he chose a cold place.
• 4:54
  Speaker 2: But we ended up at seventh group because I spoke to him I said you pick Kentucky or Fort Bragg and I'm telling you you're going to geo bachelor the rest of your life.
• 5:03
  Speaker 2: So, we ended up coming down to seventh group.
• 5:06
  Speaker 2: I got hired at the Eglin Intrepid Spirit Center about a year and a half two years after I.
• 5:10
  Speaker 2: We came down there and again I fell in love with the idea that we had this interdisciplinary model of how to work with these patients, that to watch their eyes open.
• 5:20
  Speaker 2: When you tell them, I believe you that there's something wrong.
• 5:23
  Speaker 2: I understand, I know, I don't see it on your face and for me, bringing awareness to them what their brain is doing, explaining to them the mechanisms.
• 5:33
  Speaker 2: And you know, you know, as being part of this population, you don't want to just know what to do, you want to know why.
• 5:38
  Speaker 2: You want to know what's happening, what, what is wrong with me.
• 5:42
  Speaker 2: And don't just tell me because I look fine, I'm fine.
• 5:44
  Speaker 2: Be honest with me.
• 5:45
  Speaker 2: And don't just tell me because I look fine, I'm fine, Be honest with me, you know.
• 5:46
  Speaker 2: And so having that, being able to have those frank conversations with them and being embedded in the community, brought me where I'm at today.
• 5:53
  Speaker 2: I met my now supervisor, Dr Thomas, who is probably one of the most brilliant minds I've met in brain injury medicine.
• 5:59
  Speaker 2: He did his fellowship at Kessler.
• 6:00
  Speaker 2: We had a great foundation and he.
• 6:06
  Speaker 2: We were able to get the active duty billet for me to just move laterally to work under him at in the Eglin Neurology Clinic and I've been there two and a half years and it's it's been the greatest job of my life.
• 6:13
  Speaker 2: I love what I do, I love the community I serve and every day I learn from people, they learn from me and I just.
• 6:19
  Speaker 2: It's been such a rewarding experience.
• 6:28
  Speaker 1: Well, good for you, man, and I and I really appreciate what you're doing for our veterans and anybody you come across.
• 6:30
  Speaker 1: And and let's talk about TBI, because you know, TBIs are events and there's no doubt that they impact a soldier, whether it's, you know, hitting his head on a parachute landing, fall side of a vehicle getting out, or, you know, mma you know everybody's got those octagons now.
• 6:46
  Speaker 1: But when it comes down to you know that, do these?
• 6:48
  Speaker 1: You know, obviously these soldiers are showing up with a head injury.
• 6:51
  Speaker 1: What about repetitive blast exposure?
• 6:54
  Speaker 1: What are you currently looking at in that area in terms of assessments or diagnosing these individuals?
• 7:03
  Speaker 1: You know, how are you getting there?
• 7:04
  Speaker 2: I'm glad you asked that, because another thing about this population is we are taking the top 1% of people and then taking tests that are normed on not the top 1% you know and then telling them look, you scored normal, you're fine, and sending them out the door.
• 7:22
  Speaker 2: And so, honestly, a lot of times I find a lot of the standardized testing does not capture their true deficits.
• 7:29
  Speaker 2: It doesn't capture how this is affecting them in their daily lives.
• 7:32
  Speaker 2: So a lot of my testing I use methods that are subjective.
• 7:36
  Speaker 2: There's a lot of kind of question answer type subjective tests.
• 7:39
  Speaker 2: The SAIDI is one of them.
• 7:40
  Speaker 2: It's a test of inventory of deficits and some of the ways, because I don't want to know what the test is telling me.
• 7:48
  Speaker 2: You can hunker down for 30 minutes and do everything really well and get this great test score.
• 7:52
  Speaker 2: What the test you know the person administering the test doesn't see is the three-day migraine you have after, the irritability you go home with after that because you gave everything you had for three days into that 30 minutes.
• 8:03
  Speaker 2: You have the capacity to do that.
• 8:06
  Speaker 2: It's what you guys have been trained to do, but nobody sees the aftermath, and I think that's where I also have the advantage of.
• 8:11
  Speaker 2: I get to see it when I come home.
• 8:15
  Speaker 2: I see the aftermath of what happens when my husband has to go at something for way too long, that he needed a brain break, you know.
• 8:21
  Speaker 2: So, anyway, to go back to your question, a lot of it is just subjective symptoms and I was listening to some of your prior episodes.
• 8:24
  Speaker 2: The physician that you, the PM&R doc, that you spoke with in one of your first sessions, talked about memory being the second biggest complaint, next to migraines, and I will agree with that.
• 8:34
  Speaker 2: It's one of the areas and a lot of people you know, like the art therapy.
• 8:37
  Speaker 2: They come to speech and they go.
• 8:38
  Speaker 2: I talk fine.
• 8:39
  Speaker 2: Why am I here?
• 8:39
  Speaker 2: I'm like how's your memory Terrible?
• 8:41
  Speaker 2: How's your memory terrible?
• 8:43
  Speaker 2: How's your focus terrible?
• 8:44
  Speaker 2: How you know, how is your word finding god awful?
• 8:47
  Speaker 2: That's why you're here.
• 8:48
  Speaker 2: You're here because I'm here to work on these areas with you, and so a lot of times, by by just a lot of question and answer, I can kind of see how is this affecting them in their everyday life and what can we do to mitigate some deficits, as well as work under the restoration process and, as I said earlier, a lot of it's awareness, a lot of it's helping them understand the mechanisms.
• 9:07
  Speaker 2: Initially, this is a population that's very used to.
• 9:10
  Speaker 2: You see it, you hear it, you know it, you move on.
• 9:12
  Speaker 2: You don't need to process anything.
• 9:13
  Speaker 2: You don't have to put effort into processing.
• 9:15
  Speaker 2: It would just happen.
• 9:15
  Speaker 2: Well, post-tbi, post-anxiety stress, ptsd, when all these things come into play.
• 9:20
  Speaker 2: They hear things, and I always use the example If your wife were to ask you to pick up cheese on the way home, how are you going to remember that cheese?
• 9:28
  Speaker 2: No, probably not.
• 9:30
  Speaker 1: What it's not.
• 9:32
  Speaker 1: I'm in trouble, man.
• 9:33
  Speaker 1: I'm getting cheese, you know.
• 9:36
  Speaker 2: But how many times if on the way out the door you get a text that you know soldier's in trouble or something's going on.
• 9:41
  Speaker 2: What happened to the cheese trouble or something's going on, what happened to the cheese In one ear and out the other.
• 9:46
  Speaker 2: So I always explain to them that if your brain is not in the state to receive that information, if your system is upregulated, you're really not processing things in the part of your brain that we need you to process them.
• 9:54
  Speaker 2: And can you?
• 9:55
  Speaker 2: I mean, when did you go to remember back to selection and SUT and all these things?
• 9:59
  Speaker 2: What do they teach you to do?
• 10:01
  Speaker 1: They teach you there was no SUT then there was no select when I went through it.
• 10:05
  Speaker 1: Oh wow.
• 10:08
  Speaker 2: Okay, what do they teach you?
• 10:10
  Speaker 2: They teach you to get into an upregulated state, get into your subcortex and work well there.
• 10:15
  Speaker 2: When you're doing a drill in the shoot house, when you're doing Sephalic or all these different drills, they're not looking for you to cognitively process your next move.
• 10:23
  Speaker 2: They're looking for reaction.
• 10:24
  Speaker 2: They're looking for you to be able to manage your heart rate, manage the shaking in your hands and perform.
• 10:29
  Speaker 2: But that's not the part of your brain you need to be in to remember cheese on the way home from the grocery store or as you move up in rank and it becomes more administrative and less operational roles.
• 10:39
  Speaker 2: How do you then sit there and work on manning and budgeting and the aspects of it that you were not trained for in the course?
• 10:46
  Speaker 2: So that's a lot of what I break down and work on with these guys.
• 10:50
  Speaker 2: I sit there and I'll talk to them about where I'll teach them where they're at in their brain.
• 10:54
  Speaker 2: I love there's an activity I love to do where I'll do a quick card game and I'll get them fired up and I'll get them going and then I'll stop them and go name three things that are blue and they're like blue, blue, blue.
• 11:10
  Speaker 2: I don't know what's blue?
• 11:10
  Speaker 2: How can I not think?
• 11:10
  Speaker 2: And they get real frustrated and I say you know, take a second, okay, and then all of a sudden 10 things come out.
• 11:12
  Speaker 2: How come I couldn't do that If you're not in the part of your brain where your cortex is, where your word finding is?
• 11:17
  Speaker 2: You know, if you can't get to your dictionary, I don't care if blue is the easiest question I've ever asked you in your life.
• 11:22
  Speaker 2: You're not in the part of your brain to process that.
• 11:26
  Speaker 2: So then we'll go back to the activity they're like.
• 11:27
  Speaker 2: But now I'm slow.
• 11:28
  Speaker 2: I'm like because you're thinking too much.
• 11:30
  Speaker 2: You know that shift between that automatic subcortical type fight flight, freeze movement versus I'm cognitively processing her question, I'm giving a good answer.
• 11:39
  Speaker 2: And to teach them to manually shift, not just automatically go into that when they get up regulated, that's something that I find, yeah, a lot of people lack and it's super important because, again, once we move up in rank and they move up in roles, well, you can no longer just process in your subcortex and get through the day that way.
• 11:58
  Speaker 2: You know, my favorite question is when they go.
• 12:00
  Speaker 2: I go from zero to 60 so fast and I look at them and I say when the hell was the last time you.
• 12:06
  Speaker 2: You go from 50 to 60 fast, but you live at 50.
• 12:11
  Speaker 2: No wonder you don't sleep, no wonder you don't downregulate, no wonder you're irritable at home or at work.
• 12:17
  Speaker 2: We've got to figure out how to start getting you back to zero and helping you understand where you're at in your brain.
• 12:22
  Speaker 1: Now what happens when you know, like in the terms of TBI but more importantly, rbe, where the brain is damaged?
• 12:29
  Speaker 1: Okay, the brain is damaged and we know that impulsivity, aggression, you know a lot of your executive functioning all comes from here, and this in contact sports takes a lot of damage.
• 12:40
  Speaker 1: But you know there's RBE, right, it's coming through the whole brain, it's coming through the air and all that.
• 12:45
  Speaker 1: So are you conducting any tests to assess them for the amount of blast exposure they've had while you're working with them?
• 12:54
  Speaker 1: If they come to you with memory loss, like I've got horrible memory, it's improving.
• 12:59
  Speaker 1: But you know, memory loss, impulsivity, a lot of these things that these guys are dealing with, that might be because of their lifestyle, which is right.
• 13:07
  Speaker 1: Yeah, we run a 50, you know it's all drinking girls and blowing shit up, I got it.
• 13:10
  Speaker 1: But there's also, you know's all drinking girls and blowing shit up, I got it.
• 13:12
  Speaker 1: But there's also, you know the the the impact of their careers physiologically on the plane, right?
• 13:17
  Speaker 1: What are you seeing that now and the people you're addressing and how are you diagnosing?
• 13:23
  Speaker 2: so with that again it's.
• 13:24
  Speaker 2: It's unfortunately and you know this, with mild tbi it's very subjective, there's not a lot of imaging, there's not a lot of imaging, there's not a lot of testing, but I do.
• 13:32
  Speaker 2: That's the next conversation is you manage this well, and then the TBI started and then the hard landings compounded.
• 13:39
  Speaker 2: So maybe this was always their personality, maybe this was sort of.
• 13:42
  Speaker 2: But now with the TBIs you can't control the aggression, you can't control the, you know, you can't get to sleep, no matter what you try and do.
• 13:49
  Speaker 2: And that's where I feel like there's that extra facet of injury that then you know, we already had certain aspects of things that might have been what drove them into this career, but the injury is now what's debilitating them, that's what's keeping them from being as successful as they want to be moving forward.
• 14:06
  Speaker 2: I mean, like I said, we have the top 1% of people physically, cognitively, mentally, going into this career.
• 14:12
  Speaker 2: But you know what I mean, that's not what they trained to do and that's not what they are trying to move forward and do, and so it's.
• 14:23
  Speaker 2: It's really hard for them to then come in and you know, to personality wise, it's really hard to ask for help, it's hard to say in a group of alpha males.
• 14:27
  Speaker 2: I'm having trouble.
• 14:27
  Speaker 2: I'm having trouble remembering.
• 14:29
  Speaker 2: I missed that brief, not because I got stuck somewhere else, because I totally forgot about it.
• 14:33
  Speaker 2: All the excuses in the world and I just totally forgot.
• 14:36
  Speaker 2: And you know, that's when they finally.
• 14:38
  Speaker 2: You know, I'm trying to get patients in younger.
• 14:41
  Speaker 2: I'm trying to get the guys in at 10 years that want to do another 10.
• 14:43
  Speaker 2: Because if we can pave a highway early, we can fix potholes easier later, rather than trying to pave a dirt road at 20 years.
• 14:51
  Speaker 1: You know that's a good point.
• 14:53
  Speaker 1: No, I mean it's.
• 14:53
  Speaker 1: I like that saying it's.
• 14:55
  Speaker 1: You know, the issue is when, when you're seeing them, they've already been impacted.
• 14:59
  Speaker 1: Now you can.
• 15:00
  Speaker 1: You know, I want to finish my 20, I got careers they don't want to talk and you are.
• 15:04
  Speaker 1: You're dealing with a very closed segment of population where you know, even though we've done a lot and I'm, you know, I very cognitive of what USOCOM is doing for brain health.
• 15:15
  Speaker 1: Nobody's prioritized brain health more than USOCOM.
• 15:18
  Speaker 1: Yes, and so you know the.
• 15:21
  Speaker 1: You know, but you know they can only impact the active duty population, the folks that can see it.
• 15:27
  Speaker 1: So when they come to you and we now know they're and we could talk offline about scans, are you doing any blast aggregation like GBEV or MBEV?
• 15:37
  Speaker 2: We don't have any of those capabilities.
• 15:39
  Speaker 2: Unfortunately, the funding it's a funding thing.
• 15:41
  Speaker 2: We don't have the type of capabilities, and part of it, too, is there are limits to what's technically.
• 15:46
  Speaker 2: You know, soldiers don't want to be in studies like that Because if they go over a certain limit is that going to put them behind a desk, you know.
• 15:53
  Speaker 2: So it's hard to get the people to want to participate and get those studies done if it's going to limit them, because now we're seeing things they don't want us to know they have.
• 16:02
  Speaker 1: You know that's a good point now, because those are simple calculations.
• 16:05
  Speaker 1: But once those numbers get high, you know, the issue is how do you prep these guys to go back after they're done and get the treatment that they deserve, right?
• 16:14
  Speaker 1: And that's one of the things, as a foundation, that we're working on now.
• 16:18
  Speaker 1: But you know you, you know it's, it's it's getting them in and then for treatments I mean, if you, if you have it, if you have a guy that's in your order, right, that's been running a lot, it's got a, it's got a history of tbi or mt you know what are you doing for treatment.
• 16:34
  Speaker 1: Are you doing anything out of the box now?
• 16:37
  Speaker 1: What do you got in your toolbox to help these guys?
• 16:41
  Speaker 2: out.
• 16:41
  Speaker 2: So some of the, a lot of it, I am more strategy based than I am activity based.
• 16:45
  Speaker 2: I find that, again, salience is really important.
• 16:48
  Speaker 2: So if I'm just if I'm telling someone, I need your memory to get better, I need you to attend longer to process.
• 16:53
  Speaker 2: I'm going to give them strategies.
• 16:54
  Speaker 2: I'm going to say, as you're having a conversation with your wife, visualize what you're talking about, elaborate on it.
• 16:59
  Speaker 2: Don't just say yes, I'll get the cheese, I'll get the cheese on the way home.
• 17:02
  Speaker 2: I have to pass Publix, it's on my way.
• 17:05
  Speaker 2: Make go further Outside of the box.
• 17:08
  Speaker 2: There are some modalities we use.
• 17:09
  Speaker 2: So I know I'm not sure if anybody has spoken about a modality alpha stem.
• 17:13
  Speaker 2: Alpha stem is one of the ways we they work on down regulating the brain they were just, uh, not approved by va for veterans, no, okay.
• 17:23
  Speaker 1: well, I had a conversation with a lady and she was so pissed off because veterans would come there and these alpha stem devices and explain what they are to our, our viewers, um, and all of a sudden, bam, she couldn't she couldn't re, you know, prescribe them anymore to guys.
• 17:40
  Speaker 1: And she's had amazing results with those things Tell our viewership.
• 17:44
  Speaker 1: What the, what those devices are.
• 17:46
  Speaker 2: It's a cranial device.
• 17:47
  Speaker 2: It's a transcranial device.
• 17:48
  Speaker 2: You put um ear clips on, or I mean, there there is, there is probes for pain as well, but in the tbi realm of things, we'll keep it there.
• 17:54
  Speaker 2: Right now, uh, you put ear clips on.
• 17:57
  Speaker 2: The best way I like to describe alpha stem is um, because I'm an analogy person.
• 18:01
  Speaker 2: I like to.
• 18:02
  Speaker 2: I like stories that people can go home with.
• 18:03
  Speaker 2: So if I were to tell you, I need you to get the shoes out of my car, and all I hand you is a key I don't give you a make, a model, I don't give you anything.
• 18:11
  Speaker 2: You have to jam that key in every lock in order to try and turn one of the locks that will finally click.
• 18:16
  Speaker 2: We'll see which one.
• 18:17
  Speaker 2: We're going to get there.
• 18:18
  Speaker 2: We're going to get there.
• 18:18
  Speaker 2: We're going to jam it in every lock.
• 18:20
  Speaker 2: That's what a medication does.
• 18:21
  Speaker 2: Hey, we're targeting anxiety.
• 18:23
  Speaker 2: We're going to give you this med anxiety.
• 18:33
  Speaker 2: Alpha stim is the fob.
• 18:34
  Speaker 2: Alpha stim is I'm going to push a button, I'm going to put a signal through your brain and the areas that need to create balance will find balance through that signal.
• 18:38
  Speaker 2: So, although all the cars in that parking lot are going to feel that signal, only one car is going to open because there's only one car that's receptive and needs that signal at that moment.
• 18:46
  Speaker 2: So alpha stim is very similar.
• 18:48
  Speaker 2: Instead of a medication that has to be jammed in and has to, you know, there's side effects Is it even effective by the time it hits the right receptor?
• 18:58
  Speaker 2: Alpha stim is going to send a signal to all the cars in the parking lot, but only the car that needs it.
• 19:00
  Speaker 2: So the reason that's important to understand is because it can help anxiety and depression.
• 19:04
  Speaker 2: Well, how One needs upper, one needs a downer, right.
• 19:06
  Speaker 2: So if, but if you create balance, if you think of it as creating balance, it's going to help anxiety and if someone who's anxious come down, it's going to help someone who's depressed.
• 19:17
  Speaker 2: Maybe get a little kick and come up a little bit, it's going to downregulate pain, right.
• 19:21
  Speaker 2: So we are going to then feel better.
• 19:23
  Speaker 2: We're going to be either more alert or we're going to be a little less anxious.
• 19:26
  Speaker 2: It is a phenomenal tool and until 3-6-24, it was also I prescribed them in the, in the hospital as well, for active duty patients.
• 19:36
  Speaker 2: As of last March, as of last, I probably in the course of a couple of years, prescribed over 200 of them.
• 19:41
  Speaker 1: For active duty.
• 19:41
  Speaker 2: So that's my, if you want, out of the box it is, and the most important part about it is creating that balance in the system allows the system to be receptive to healing.
• 19:51
  Speaker 2: A lot of time, because of the upregulation whether it's through injury or just through anxiety or through whatever the cause is, or accumulation of all of it the brain is not in a state to heal.
• 20:02
  Speaker 2: It is in fight-flight freeze.
• 20:04
  Speaker 2: Injury can cause that, ptsd can cause that.
• 20:06
  Speaker 2: If you are in fight-flight freeze, your body is not focusing on healing at all.
• 20:11
  Speaker 2: It's not even focusing on feeling pain.
• 20:13
  Speaker 2: All it's focusing on is getting through the next, whatever exercise step, whatever it is.
• 20:17
  Speaker 2: How do we fix that?
• 20:19
  Speaker 2: Well, we need to downregulate and let the brain be in a state where it can then say okay, I'm not running a rat race right now, I can actually take some energy and focus on healing.
• 20:30
  Speaker 2: So an example I always give my guys is why do we have so many 40-year-olds with double hip replacements?
• 20:34
  Speaker 2: Yes, the work they do is hard, the impacts are hard, but if the body's not healing, what was it?
• 20:40
  Speaker 2: Impingement or some minor injury?
• 20:42
  Speaker 2: All of a sudden, three years later, it's bone on bone.
• 20:44
  Speaker 2: We're keeping people in business doing hip surgeries on these young guys.
• 20:47
  Speaker 2: And it's the same thing with the brain people aren't getting better because their brain's not in the state it needs that equilibrium it needs to find and that parasympathetic-sympathetic balance to allow for healing to occur, to the extent that we need it for them to move forward.
• 21:02
  Speaker 1: So let's talk about this for a second because, like you know, alphastem is a pretty innovative approach and you know we are very well aware that the amount of prescription drugs that are prescribed active duty and veteran populations right now is absolutely to the roof.
• 21:18
  Speaker 1: And it is the first course of action, you know.
• 21:20
  Speaker 1: So now you've got a guy or a girl who's been a lot, who's been hitting the head, who's got issues, and they come into the TMC and they finally get up the nerve to admit that they've got some form of mental illness, right, I mean anxious depression, panic attacks.
• 21:35
  Speaker 1: I've had them all.
• 21:36
  Speaker 1: Trust me, man, I've been through my own journey and they get up there and then the first thing is all right, we got a pill for that.
• 21:43
  Speaker 1: Well, none of these pills.
• 21:45
  Speaker 1: I mean, my daughter is a nurse practitioner of psychiatric medicine and she spends all day getting children and adults that either want more drugs or get them off of them, right, and these are highly, highly addictive.
• 21:58
  Speaker 1: You know SSRIs, snris, benzos I mean they're given benzos out as sleeping pills at a military facility.
• 22:07
  Speaker 1: Can you believe this?
• 22:08
  Speaker 1: So you are taking an approach towards brain health that is necessary because the other approach you know when we can talk about the suicide unchanged rate, right is been, it's just it doesn't.
• 22:19
  Speaker 1: Why is?
• 22:20
  Speaker 1: Why are drugs the first course of action when we know as a community they cause?
• 22:27
  Speaker 1: They's so many?
• 22:28
  Speaker 1: I mean, all right, suicide, suicidal, you're getting ready to kill yourself, I got it.
• 22:35
  Speaker 2: But for mental health, mental illnesses that can be treated, you know, innovative TMS, whatever it is's still emerging research and there's just not enough concrete to fight these pharmaceutical companies that have all the money in the world to do research and to sway politicians and to do a lot of things to get their name out there and their drug as first line of defense.
• 23:05
  Speaker 2: And I think part of it is because results can vary, and unfortunately, when it comes to research results, varying is not a good thing.
• 23:12
  Speaker 2: So if I put AlphaStem on five people and they all report different effects, they might all be great, one might be I'm less anxious, one might be I have less pain, but it looks like it didn't do the same thing for everybody.
• 23:24
  Speaker 2: And how do we-.
• 23:26
  Speaker 1: But it had a positive effect.
• 23:28
  Speaker 2: Agree.
• 23:29
  Speaker 1: And that's my point with you know when I talk.
• 23:32
  Speaker 1: I just wrote draft legislation on making innovative treatments available, working under the TBI billing code to get coverage, and I've got a whole program that I'm submitting to Congress right now because we're not doing enough.
• 23:46
  Speaker 1: And to your point is that the research right now, just from a population perspective, is 90 to 98% positive.
• 23:57
  Speaker 1: This treatment helped me?
• 23:58
  Speaker 1: Yeah, you can't.
• 24:00
  Speaker 1: The brain's all different, right?
• 24:01
  Speaker 1: We all know this.
• 24:02
  Speaker 1: Nobody responds to any chemicals this way and in mental health, according to my daughter, if you get 25%, you know it's like the expected amounts of positive impact when they even prescribe a drug they don't even know if it's going to work.
• 24:16
  Speaker 1: 75% of the time we're over here arguing about cheap electronic modalities that can scale and bring all this joy and hope, as you say, to our population.
• 24:28
  Speaker 1: None of them are available.
• 24:29
  Speaker 1: We need a pill when the pill don't work.
• 24:33
  Speaker 1: Oh, we got a pill for that too.
• 24:35
  Speaker 2: We got a different pill, yep and that, or if there's a side effect, we'll give you a pill for that.
• 24:39
  Speaker 2: But I I really think it's going to happen when we can get more people trying, more people, researching, more people.
• 24:46
  Speaker 2: Showing his data is what drives the decision making.
• 24:49
  Speaker 2: There's drives the decision-making.
• 24:53
  Speaker 2: Um, there's another modality I use all the time that's less well known, uh, called a dolphin microcurrent and, uh, you can ask Denny offline a little bit about that, cause that's actually how we met.
• 24:59
  Speaker 2: We met with me zapping him with the dolphins one day.
• 25:04
  Speaker 2: Uh, but it is almost like a tens unit.
• 25:06
  Speaker 2: The difference is it uses direct current instead of alternating and if you know much about the current that runs through the body, it simulates okay.
• 25:13
  Speaker 2: So just for for listeners, in case they're not have no idea about direct, alternating current, um, direct current.
• 25:20
  Speaker 2: If we had a light on and we use direct current to light this whole hallway, the last person at the end would have the dimmest light.
• 25:27
  Speaker 2: Alternating current allows that current to stay strong and stay.
• 25:31
  Speaker 2: So most tens unit use alternating current to keep that signal, but the body that's a foreign signal to the body.
• 25:37
  Speaker 2: So although it's okay for the muscle that you're putting it on it, it, the heart recognizes it as a foreign, a foreign signal, and it reacts, which is why you can't use it with pacemakers and there's always contraindications.
• 25:49
  Speaker 2: Um, I don't know if I should go on the record saying this, but I've used a dolphin two inches above my grandmother's pacemaker and not even a blip on her radar.
• 25:57
  Speaker 2: Direct current mirrors what the body already has coursing through it.
• 26:00
  Speaker 2: So when you use a direct current device, it actually what I explain to people is like, think about it, like jumpstarting a car, almost like if there's an area of um just energy that's sort of stagnant, which is what happens in injuries, can we jumpstart that.
• 26:12
  Speaker 2: And it uses meridians of acupuncture.
• 26:19
  Speaker 2: But the advantages for a PT or an OT or speech pathologist who might not have the background in doing subcutaneous needles you can use a microcurrent safely without hurting anybody.
• 26:25
  Speaker 2: So I use it all the time.
• 26:28
  Speaker 2: There's a concussion protocol that they go to the.
• 26:31
  Speaker 2: It's one of the courses I took where there is a 90, you do it between 60 and 90 minutes but um a protocol just using those two devices on patients and I've seen great results and it just helps to kind of get things moving again in order.
• 26:45
  Speaker 2: You know there's always disorder, whenever there's pain and injury.
• 26:47
  Speaker 2: So if we can get the fascia to loosen up, if we can get things to relax a little bit now, the brain can do it.
• 26:54
  Speaker 2: You know, the body is fascinating, it can heal itself.
• 26:57
  Speaker 2: Why do you think nutrition and hydration and all these things can make things better?
• 27:01
  Speaker 2: Because the body has the capacity to heal.
• 27:04
  Speaker 2: But if it's in a terrible state, it injured, weak, you know, lack of sleep if all these things are going against it, it's not not healing, it's not surviving, it's not thriving, it's just surviving.
• 27:15
  Speaker 1: And if we yeah, my wife would love you because she's a melt instructor.
• 27:20
  Speaker 1: She had no fascia, she's got me on these rollers and I'm like, ah shit, I mean that stuff don't work right now I carry that roller around.
• 27:28
  Speaker 1: I mean, it does man and I am.
• 27:30
  Speaker 2: I am a craniosacral therapist and I'm also a myofascial release therapist, so I tend to the occiput.
• 27:37
  Speaker 2: I'm always drawn to the occiput.
• 27:38
  Speaker 2: I do a ton of occipital releases.
• 27:40
  Speaker 2: I do a ton of jaw releases.
• 27:42
  Speaker 2: When you look at how much tension people carry in their temporalis and in their jaw it's incredible, when you release some of that, the effect it can have on just their over the rest of their day.
• 27:53
  Speaker 2: You know they walk differently, they talk differently, they chew differently.
• 27:58
  Speaker 2: So I love out of the box I am.
• 27:59
  Speaker 2: I have many times been scolded for being almost too much out of the box because it's not what research wants me to do.
• 28:05
  Speaker 1: You know they want you to write what works.
• 28:08
  Speaker 2: It's why patients keep coming back.
• 28:10
  Speaker 2: And you know in this community it's who you are, it's the name, it's if you.
• 28:13
  Speaker 2: Have you been vetted?
• 28:14
  Speaker 2: Do people know you?
• 28:15
  Speaker 2: And I get requests from people that say so-and-so and so-and-so and so-and-so said I had to see you.
• 28:29
  Speaker 1: And that's the best compliment someone can give because it means that someone else benefited from something I did for them, and other people will as well, and that's why I love what I do.
• 28:33
  Speaker 1: Let's talk about another modality stellar ganglion blocks, sgbs.
• 28:35
  Speaker 1: Do you prescribe those?
• 28:36
  Speaker 1: Or I mean, they're very common in special operations, law enforcement communities, but I've been through them myself, you know very, you know benefited me, I know.
• 28:46
  Speaker 1: Do you do you?
• 28:47
  Speaker 1: Do you prescribe those there, or do you recommend them at a certain point in therapy when something's not working?
• 28:54
  Speaker 2: So as a speech pathologist, it's out of my scope to prescribe it.
• 28:57
  Speaker 2: But I often educate, I talk to them and if they need it and if they're comfortable, I can talk to their behavioral health provider about why I'm making this recommendation.
• 29:06
  Speaker 2: I can recommend, I just can't prescribe.
• 29:08
  Speaker 2: And the reason I tend to recommend it is again what does it do?
• 29:13
  Speaker 2: It's a manual down regulator.
• 29:15
  Speaker 2: If I can get the brain or get the body to, I mean, it calms everything.
• 29:20
  Speaker 2: If I can get them to calm down.
• 29:22
  Speaker 2: Now they're going to sit in their behavioral health treatment session and possibly get further, so they could be a calmer patient for you.
• 29:30
  Speaker 2: You know it's not in me, I'm not in behavioral health, but I tell people all the time if there's defense mechanisms and injury and all this stuff that's getting in the way of you making progress, let's mitigate some of that so you can go 10 times as far in three months than you would have got if you were had your guard up and you were.
• 29:47
  Speaker 2: You know it kind of reduces a lot of that.
• 29:49
  Speaker 2: I am absolutely a hundred percent for it.
• 29:52
  Speaker 2: I have never had a patient the most adverse effect I've had from a patient just based on their what they've said to me is just only lasting a short amount of time and that's not even adverse, it's just.
• 30:02
  Speaker 2: I've had some people say it never lasted more than a day that affected.
• 30:07
  Speaker 1: Yeah, I mean I had done a couple of years ago and I know the doctor that I went to does not recommend he's got a whole nother one with radio frequency because he does not believe in, you know, multiple blocks or you know however you call it.
• 30:22
  Speaker 1: But yeah, it's something that's out there that you know.
• 30:25
  Speaker 1: I think our viewers should check out, if you're.
• 30:26
  Speaker 2: Absolutely.
• 30:27
  Speaker 1: So I mean go into a little bit.
• 30:29
  Speaker 1: And then I want to talk about the Intrepid Center, because they're all fascinating places, sure.
• 30:33
  Speaker 1: So you know, talk a little bit about, you know, for our viewers, if they're listening, you know, or watching, if they're, you know what kind of symptoms should they be, you know, concerned with, if they know they've had a history of either contact sports or repetitive last exposure, right, what, what are, you know, some of the you know symptoms that they might have that could indicate I might have to go get myself checked up because something right here.
• 31:00
  Speaker 2: So you I mean I can go within my scope.
• 31:02
  Speaker 2: It's going to be the cognitive areas or speech, sometimes fluency changes.
• 31:06
  Speaker 2: People just know yeah, so within my scope, I usually the things I usually educate the physicians on these are the things.
• 31:13
  Speaker 2: If they say this, this is a red flag to send them to speech therapy, to cognitive therapy, fluency I have a lot of people that start to stutter.
• 31:19
  Speaker 2: They'll have TBIs and all of a sudden you have these very well-spoken, eloquent speakers that have fluency changes and again, once it starts, it snowballs.
• 31:29
  Speaker 2: And then there's, it's almost like they get so much in their head that they'll, you know, they can't breathe anymore because as soon as they get up it starts, you know.
• 31:36
  Speaker 2: So fluency is one red flag.
• 31:39
  Speaker 2: Another one is word finding.
• 31:41
  Speaker 2: You know people that say, again, I'm in the middle of a conversation and I know the word and I can see it and I can describe it and I just can't get that word out.
• 31:53
  Speaker 2: And I see that a lot.
• 31:54
  Speaker 2: And again, as we said earlier, focus processing speed.
• 31:55
  Speaker 2: I used to be able to write this sit rep in 10 minutes.
• 31:56
  Speaker 2: Now it's taking me 35.
• 31:58
  Speaker 2: Why is it taking me so long to sit around down and write a sit rep or, like I said, the memory.
• 32:03
  Speaker 2: You know, I can't remember.
• 32:05
  Speaker 2: I keep forgetting.
• 32:05
  Speaker 2: I didn't pick my kid up yesterday.
• 32:07
  Speaker 2: I drove past and just drove past the school and didn't pick my kid up.
• 32:09
  Speaker 2: And they're embarrassed because these are people that are doing high level work, for you know, these are really heavy hitters, that are people that are again top 1% of everybody that applied for these things and they're failing and it's not a place they're comfortable.
• 32:23
  Speaker 2: So any of those would be red flags.
• 32:25
  Speaker 2: To come to cognitive therapy, Okay.
• 32:27
  Speaker 2: The other one that I do tell people.
• 32:30
  Speaker 2: You know, vision changes balance, and they'll always say my balance is fine.
• 32:34
  Speaker 2: So do you mind standing up and doing something for me while we're talking?
• 32:37
  Speaker 2: Because I'll tell you the thing I have them do.
• 32:39
  Speaker 2: Are you comfortable getting up for a second?
• 32:40
  Speaker 2: If I have you, so yeah.
• 32:42
  Speaker 1: I do yoga.
• 32:43
  Speaker 1: What you?
• 32:43
  Speaker 2: got.
• 32:43
  Speaker 2: Okay.
• 32:44
  Speaker 2: So what I usually ask them to do because it's really hard to sell the vestibular assessment even I sell the vestibular assessment.
• 32:54
  Speaker 2: Even I don't do the treatment, it's not in my scope but leave that chair right there and turn so you're facing me, but that chair is right there on the side so you can grab it if need be.
• 32:59
  Speaker 2: Okay, I want you to put are you goofy or regular?
• 33:02
  Speaker 2: If you snowboard or ski like when you, ski.
• 33:04
  Speaker 1: I'm pretty regular.
• 33:06
  Speaker 2: I'm left-handed, do a few things put your strong foot in front and, as if you were doing like a drunk test, you know, like where you have one foot directly in front of the other.
• 33:15
  Speaker 1: I've done those before.
• 33:17
  Speaker 2: Okay, so now take your arm off the chair.
• 33:19
  Speaker 2: Okay, bend your knees and close your eyes.
• 33:26
  Speaker 1: Yeah, okay.
• 33:27
  Speaker 2: So we compensate visually for our balance quite often, and it should be our vestibular system that's doing that.
• 33:36
  Speaker 1: Really.
• 33:36
  Speaker 1: Yeah, I don't look at a spot in the wall, I'm on my butt, man.
• 33:41
  Speaker 2: Exactly Because you're saying yep, that's exactly it.
• 33:44
  Speaker 2: You are using your visual system to compensate for issues with the vestibular system.
• 33:49
  Speaker 2: What are you guys great at?
• 33:51
  Speaker 2: You guys are amazing at figuring out how to mitigate it, because you need to perform tomorrow.
• 33:55
  Speaker 2: You can't wait to go to therapy.
• 33:56
  Speaker 2: You got to get back in on the team.
• 33:58
  Speaker 2: Get back in and exercise, do it tomorrow.
• 33:59
  Speaker 2: So you find a way, your system finds a way.
• 34:02
  Speaker 2: If I take that vision out of it, what happens?
• 34:04
  Speaker 2: The vestibular system never got retrained to do what it needs to do years later.
• 34:09
  Speaker 2: So that's where I can say to them when you go see your neurologist, please don't forget how this went and explain to them that you would like to be assessed by a PT or audiologist or whoever is available in that area, to do vestibular testing and see if they can get a concrete objective.
• 34:27
  Speaker 2: You know and unfortunately vestibular treatment tends to be agitate the system to teach it how to, so the treatment can be kind of.
• 34:35
  Speaker 2: It's hard because you have to piss the system off to retrain it, but it makes a huge difference, because what do people do when they ride bikes?
• 34:42
  Speaker 2: They look at signs, they run, they're looking at things and all of a sudden, they're getting dizzy running.
• 34:46
  Speaker 2: Why am I getting dizzy running?
• 34:48
  Speaker 2: Well, these head movements, the stuff they're doing.
• 34:50
  Speaker 2: They don't realize that as soon as they're shifting their vision left, right, up down, moving it around, it's setting their whole system off their vestibular system can't regulate that.
• 35:01
  Speaker 2: So that's yeah, that's a great.
• 35:02
  Speaker 2: It's a quick little test you can have anybody do.
• 35:04
  Speaker 2: I'm not a PT so it's not something I would put objectively in their assessment.
• 35:08
  Speaker 2: I will just say noted vestibular changes.
• 35:11
  Speaker 2: Patient noted, you know, and then recommend they see the appropriate professional.
• 35:15
  Speaker 1: You know it's funny is?
• 35:16
  Speaker 1: You know, I had my own mental health challenges about two and a half years ago and had to find my way back and it got pretty ugly.
• 35:23
  Speaker 1: But you know, all of a sudden, out of nowhere, I'd start stuttering.
• 35:26
  Speaker 1: Always have no short term.
• 35:28
  Speaker 1: I get in a conversation like what was I talking about?
• 35:31
  Speaker 1: Yeah, then you know the whole word search thing, you know, and you know these are all issues that you know.
• 35:38
  Speaker 1: Now we can, you know, we can advertise.
• 35:39
  Speaker 1: Say, look guys, look out for this stuff, because I've got buddies.
• 35:42
  Speaker 1: I played rugby for, you know, years, right, and all my buddies called me up yeah.
• 35:48
  Speaker 2: Four years.
• 35:49
  Speaker 1: You look like a fly half or a winger or something.
• 35:51
  Speaker 2: I was a number eight.
• 35:52
  Speaker 2: I was the second row to number eight.
• 35:53
  Speaker 1: Yeah, All right, second row.
• 35:55
  Speaker 1: Okay, I was a little beefier in college.
• 35:57
  Speaker 1: Okay, good on you.
• 35:59
  Speaker 1: Yeah, we still play.
• 36:00
  Speaker 1: I mean, I just play bagpipes now, man, I can't, I've had too many knocks on the brain but that's.
• 36:05
  Speaker 1: You know, these are the kinds of, these are the kinds of things that our audiences are searching for is like all right now, what do I do?
• 36:15
  Speaker 1: And then you know we always put out information of other scans and assessments that together we should be getting treatment, we should get better treatment, that treatment that you prescribe.
• 36:21
  Speaker 1: But just so you know, out, in my world, all that's out of pocket.
• 36:24
  Speaker 1: Every bit of it is everything that you just mentioned that can help Steli ganglion blocks, you know.
• 36:31
  Speaker 1: Alpha stem, you know all those modalities are out of pocket for our veteran population and it's just not right.
• 36:40
  Speaker 2: It's not okay.
• 36:41
  Speaker 1: Not if it was caused by the military service Right, and that's our point.
• 36:45
  Speaker 1: So, great education tutorial.
• 36:47
  Speaker 1: That's awesome.
• 36:49
  Speaker 1: Tell us about the Intrepid Center.
• 36:51
  Speaker 2: That's actually a perfect segue, because it's one of the reasons why that interdisciplinary model is so important.
• 36:56
  Speaker 2: There are things they might say I'll go to speech but I'm not ready to do this.
• 37:01
  Speaker 2: But having that interdisciplinary model, I can do something and then say you do need to go to PT here.
• 37:05
  Speaker 2: Look see, this is why I know you thought you had no balance issues.
• 37:09
  Speaker 2: So having the resources to be able to see PT OT speech.
• 37:14
  Speaker 2: I watched the show with Jackie Jones.
• 37:16
  Speaker 2: When I tell you she is one of the most phenomenal art therapists I've ever met in my life, so I'm so happy she was able to be on the show with you I'm going to interview an artist.
• 37:31
  Speaker 2: I'm going to go on further and recommend you interview.
• 37:34
  Speaker 2: We had a former music therapist, sally Ann, who is one of the best music probably the best music therapist I've ever worked with, and I had patients tell me I think she sees through my soul, you know, like they were so funny, but understanding how to use the whole brain and I think that's what, when you get these onesie, twosie therapies where you're kind of shifted for one clinic for this and one clinic for that, the model, the NICO model, that intrepid spirit center model is it is an interdisciplinary whole brain model.
• 38:02
  Speaker 2: So Sally Ann and I for example the music therapist I might work on word finding from a very left brain perspective.
• 38:07
  Speaker 2: Let's figure out how to dig into the lexicon, the dictionary, and get what we need out.
• 38:12
  Speaker 2: She's going to target it through rhythm, music, movement and get it coming from the right, if we can get the right to facilitate the left.
• 38:19
  Speaker 2: Do you ever turn a song off as you're getting out of a car and think you know the words until the music's gone and all of a sudden you're mumbling and there are no more words coming out?
• 38:27
  Speaker 1: I don't know the words to the song.
• 38:29
  Speaker 2: So I always joke around.
• 38:30
  Speaker 2: I'm like a lot of times turn the car off and you're like or the music goes off in karaoke and you're sitting there with the mic going oh gosh, come back.
• 38:36
  Speaker 2: I don't know the words.
• 38:37
  Speaker 2: Yeah, and it's because you're using the right to help the left.
• 38:44
  Speaker 2: Think about, even like a street rappers, what do they ask for?
• 38:45
  Speaker 2: Drop me a beat right.
• 38:45
  Speaker 2: With a beat, the words come out and they can flow and they can get things out.
• 38:48
  Speaker 2: So that right brain that is so often turned off in the military community because it's a very analytical, you're a cog in a wheel.
• 38:54
  Speaker 2: There's a certain way to do things.
• 38:55
  Speaker 2: You follow this rubric.
• 38:56
  Speaker 2: That part of the brain gets forgotten.
• 38:58
  Speaker 2: And when you have programs like art therapy, music therapy, you can open up a whole new side of the brain.
• 39:05
  Speaker 2: And we all know I mean anybody in brain health knows the whole brain is better than half the brain in any way, shape or form.
• 39:10
  Speaker 2: So if we can get the whole brain working together, aren't we going to do better?
• 39:19
  Speaker 2: And if we can do that in three months or in five weeks in an IOP where they're doing this daily, you know, and in a setting where this is something that we can see, these progressive changes.
• 39:24
  Speaker 2: I mean, I can remember back to my first left in attention patient where in four days we got him to track to midline and this was a more severe TBI, it was a car accident years ago.
• 39:34
  Speaker 2: Track to midline, and this was a more severe TBI, it was a car accident years ago.
• 39:38
  Speaker 2: But seeing that change and knowing that we were able to use PT doing one thing, I had speech.
• 39:41
  Speaker 2: I had a son talking on the other side.
• 39:42
  Speaker 2: His son was his favorite person in the world.
• 39:44
  Speaker 2: He was on that side.
• 39:44
  Speaker 2: He was going to look for him.
• 39:45
  Speaker 2: You know, using different avenues to reach the brain, how can you fail?
• 39:51
  Speaker 2: You know it's just the best model out there.
• 39:53
  Speaker 2: So I think we need more places like that and in the community we have Craig Hospital, we have Shepherd, we have the Center for Neuroskills, brooks Rehab, we have these that follow that same model.
• 40:09
  Speaker 1: The resources are just a little bit different when you're dealing with regular insurance versus TRICARE, you know, and the only problem I have with the NICO model or any TBI clinic is that for two, three weeks these guys get especially out here where I'm at in the civilian world, the real world, right.
• 40:21
  Speaker 1: Yeah, these guys on their way out get three weeks of the best training, right, and the best stuff they've ever had.
• 40:28
  Speaker 1: They feel refreshed, and then they go to Nebraska or the mountains of Montana or whatever, and it doesn't scale.
• 40:34
  Speaker 1: And then they're on their own and the bad habits come back.
• 40:38
  Speaker 1: And then, especially in terms of when you have brain damage and you don't know it, all you know is you felt better, but you didn't get assessed.
• 40:47
  Speaker 1: A lot of these guys now are getting assessed.
• 40:49
  Speaker 1: But I think that multidisciplinary approach is awesome, the way it helps people.
• 40:54
  Speaker 1: I've heard nothing but good things about it.
• 40:55
  Speaker 1: I'm just pushing for scale.
• 40:57
  Speaker 1: Like you know, this helps you here when you go back to your.
• 41:01
  Speaker 1: You've earned.
• 41:02
  Speaker 1: You've earned this Right.
• 41:03
  Speaker 1: So how do we make that?
• 41:04
  Speaker 2: happen.
• 41:04
  Speaker 2: So it's one of the reasons why I'm more strategy based and less activity based and activity based as clinician.
• 41:10
  Speaker 2: Run A strategy is I am going to give you something I want you to do.
• 41:13
  Speaker 2: Go, run A strategy is I am going to give you something I want you to do.
• 41:15
  Speaker 2: Go do it at home.
• 41:16
  Speaker 2: Go do it at work.
• 41:16
  Speaker 2: Generalize it to all the other environments you have, so when I'm gone, you're already generalizing that, you're already utilizing it.
• 41:23
  Speaker 2: If all I'm doing is putting a light board in front of you and practicing left and right that way, when you go in the real world, what simulates that?
• 41:29
  Speaker 2: It's not salient, necessarily.
• 41:31
  Speaker 2: It's not the bad activity, but I need to, before they leave, move to something that's much more salient to what they're doing.
• 41:41
  Speaker 2: So if I'm working on making visual or verbal associations or working on elaboration technique, for example, that's what I find works very well with this population, because they can't just say I'll brief the commander.
• 41:49
  Speaker 2: They have to say I'll brief the commander on Monday, I'll reserve the room.
• 41:53
  Speaker 2: You know what I mean?
• 41:53
  Speaker 2: There's all these steps.
• 41:54
  Speaker 2: They're very used to having to elaborate on things.
• 41:57
  Speaker 2: Well, why not do that for the cheese your wife needs, for the lasagna, instead of saying, yep, I'll get cheese.
• 42:02
  Speaker 2: Right, I think that's a good analogy, but I'm hungry right now.
• 42:06
  Speaker 2: So the reason I bring that up is because if their wife says, hey, don't forget to get cheese on the way home, they can simply go Ooh, what are you making tonight?
• 42:13
  Speaker 2: And their wife will go I was going to make chicken Parmesan.
• 42:15
  Speaker 2: I love your chicken parm.
• 42:17
  Speaker 2: Oh, I'm excited.
• 42:23
  Speaker 2: Well, guess what?
• 42:23
  Speaker 2: We just went to 90% failure rate of hearing, only to a 30% failure rate because they had a small discussion about it.
• 42:27
  Speaker 2: So the chances of them remembering the cheese now there's 70% chance, which is a lot better than 10, you know.
• 42:34
  Speaker 2: And that's a simple strategy they can generate.
• 42:36
  Speaker 2: So I think that's the key.
• 42:37
  Speaker 2: To go back to your initial question is we need to make these activities and make these programs salient.
• 42:43
  Speaker 2: I loved my program here in Hawaii.
• 42:45
  Speaker 2: We would take people to the supermarket.
• 42:46
  Speaker 2: We would tell them you have $30, and this wasn't military, this was civilian.
• 42:50
  Speaker 2: But we'd say this is the recipe we're working on.
• 42:53
  Speaker 2: What supermarket has one on sale?
• 42:54
  Speaker 2: They would do an activity where they budget it.
• 42:56
  Speaker 2: Then we'd come back and the next day, as a group, we'd cook and they'd have to measure did I buy enough flour?
• 43:05
  Speaker 2: And we'd say, hey, we're working on these memory strategies, but in context of what you're going to do at home, in context of what you might do at work.
• 43:10
  Speaker 2: So we'd sit the one day we'd cut out all the coupons, the next day we'd take them shopping and the third day we do a cooking activity and that carry over.
• 43:16
  Speaker 2: But again, we weren't doing something they couldn't simulate in the real world.
• 43:20
  Speaker 2: We were carrying it over.
• 43:22
  Speaker 2: So, on a on a larger scale, at an ISC, we can go to the commissary, put them in an environment that's overstimulating, tease out something like auditory processing that they don't even understand, walking in, you know and let them.
• 43:33
  Speaker 2: Hey, you understood me three feet away in the clinic.
• 43:36
  Speaker 2: Why are you having trouble?
• 43:37
  Speaker 2: Why are you having trouble understanding me?
• 43:39
  Speaker 2: You're the same distance away, but that background noise is now a factor.
• 43:42
  Speaker 2: It wasn't a factor in my office, so now we might need a referral to audiology to talk about.
• 43:48
  Speaker 2: You know, do we need?
• 43:49
  Speaker 2: Is it hearing or is it processing, do you know?
• 43:51
  Speaker 2: So I feel like we just need to do more salient activities with this population in order to build a foundation that they can walk out of that clinic and not feel like and I do find like PrEP, for example, one of the VA clinics they follow their patients after and I think it's great.
• 44:06
  Speaker 2: They follow to make sure they're still using their whoop.
• 44:09
  Speaker 2: They're followed to make sure that they're still using the tools they gave them.
• 44:12
  Speaker 2: They check to see nutrition wise, are they still following?
• 44:15
  Speaker 2: And that's the key, because if anybody feels like that's great for three weeks and then the clinician forgot about me, what good are we?
• 44:23
  Speaker 2: What good are we?
• 44:24
  Speaker 1: You know, once we get them prescribed into modalities that can help them, all that stuff is good, but it's obviously given a suicide rate we have, it's not it's obviously given the suicide rate, we have it's not sufficient.
• 44:36
  Speaker 1: It's not enough.
• 44:36
  Speaker 1: It's not enough.
• 44:37
  Speaker 1: We have to change the way we have to get out of the box.
• 44:39
  Speaker 1: I'm trying to get them out of that box Absolutely and get it done.
• 44:43
  Speaker 1: So last question on the topic Very interesting topic I think a lot of our viewers are going to be interested.
• 44:48
  Speaker 1: Are there any resources they should look at a website, a book or something that they could, um, you know, take a look at.
• 44:55
  Speaker 1: I mean, I don't know if you've got a website or you know I don't have my own website.
• 44:58
  Speaker 2: Um, I will remind you guys, listen to Jackie Jones.
• 45:01
  Speaker 2: She has a phenomenal website, Her.
• 45:02
  Speaker 2: That one is.
• 45:03
  Speaker 2: Go back to that.
• 45:04
  Speaker 2: If you're listening to this now and you did not listen to the art therapist, please go listen to her.
• 45:08
  Speaker 2: She's phenomenal because she does have a great website.
• 45:11
  Speaker 2: Um, but there are some books that I do recommend my patients read.
• 45:14
  Speaker 2: Um, the body keeps the score is one of them.
• 45:16
  Speaker 2: So that, that, yeah, vessel bander Cole, uh, he is the father of trauma.
• 45:21
  Speaker 2: He worked with patients with PTSD before PTSD was even a term.
• 45:25
  Speaker 2: Um, so he's up in the Boston area, but he is a phenomenal.
• 45:28
  Speaker 2: His book is written very well.
• 45:30
  Speaker 2: Anybody can read it.
• 45:31
  Speaker 2: It is.
• 45:32
  Speaker 2: The first half of the book is all about trauma and brain injury and just what trauma does to the brain.
• 45:37
  Speaker 2: The second half are treatment modalities.
• 45:39
  Speaker 2: You know it is a little more trauma focused than it is more TBI, but for people that are afraid of EMDR or afraid of empty chair or afraid of these different techniques that are being brought up, it goes through what they are, how they work and why they're effective, and so it just gives like again, you guys want to know the why.
• 45:56
  Speaker 2: Don't just tell me to pull these tappers and sit there and I'm going to start thinking of memory.
• 45:59
  Speaker 2: Why am I doing this?
• 46:00
  Speaker 2: What is it doing to my brain?
• 46:01
  Speaker 2: He gives all that information and through stories, through patient encounters, through patient experiences.
• 46:07
  Speaker 2: Two other books I love, um Achilles in Vietnam.
• 46:10
  Speaker 2: I'm not sure if you've read that, no, so Achilles in Vietnam, you might actually really like that, because that's very you know, you're the era, but it's a lit buff who's also a psychiatrist I can't remember his background, but he's mental health but also a lit buff.
• 46:25
  Speaker 2: And he parallels the Trojan War with the Vietnam War and just what the human psyche goes through.
• 46:31
  Speaker 2: And he uses Achilles as an example, like when he lost Patroclus, like how did his brain change?
• 46:36
  Speaker 2: He went into this what he calls berserk state and all was lost.
• 46:39
  Speaker 2: And he talks about Vietnam vets.
• 46:45
  Speaker 2: What was it like when they had to do obscene things in combat to survive mentally, to get through the days?
• 46:47
  Speaker 2: And then you know what are they told to do when, when one of their friends passes, like they're just told to get mad and get even.
• 46:53
  Speaker 2: So, when they're in the supermarket and someone upsets them, why are you surprised?
• 46:57
  Speaker 2: They took out the entire cereal aisle?
• 46:58
  Speaker 2: You taught them, they were taught for years.
• 47:01
  Speaker 2: It was ingrained in them in a traumatic experience that you get mad, get even.
• 47:04
  Speaker 2: So he parallels like the human psyche and just you know.
• 47:08
  Speaker 2: But it's through a story, through the.
• 47:10
  Speaker 2: You know he talks about the Vietnam war, but through.
• 47:12
  Speaker 2: And then the second one he wrote was Odysseus returns.
• 47:15
  Speaker 2: I think I was actually just rereading that recently.
• 47:18
  Speaker 2: Odysseus in America excuse me, I have it on my shelf there, but that one talks about Odysseus's journey home and how much of that journey was metaphorical, in the stages he needed to go through, the grief, processing trauma, all these things.
• 47:32
  Speaker 2: It wasn't so much 10 years of him wandering in circles trying to get back home.
• 47:36
  Speaker 2: It was the, the, what his psyche needed to get through to before he could actually walk home and be a part of his family appropriately.
• 47:43
  Speaker 2: And I know you've talked about this on previous episodes.
• 47:45
  Speaker 2: But what do people?
• 47:46
  Speaker 2: People are home within 48 hours and so when do they get to process any of this?
• 47:51
  Speaker 2: And then go home and be a family man and go to church with your family and be normal and do all these things, pretend it didn't happen, like the psyche doesn't work like that.
• 48:00
  Speaker 2: So those are some great books to kind of get a foundation.
• 48:04
  Speaker 2: The other one that I I really love and this is the last one I'll talk about is um is uh, why we sleep.
• 48:10
  Speaker 2: Matthew walker great book that talks about the importance of sleep, and I I stayed away from that because I know other people.
• 48:16
  Speaker 2: I've heard the glymphatic cycle brought up a bunch of times in these shows, so I didn't want to double down on something that's been talked about before.
• 48:23
  Speaker 2: But understanding stages of sleep, understanding why 15 minutes of REM is not enough, If you don't have that slow wave, deep sleep, you're not dumping the junk out and we're wondering why you have buildup of plaques or all these extra proteins that you know.
• 48:36
  Speaker 2: And then we're talking about connections with Alzheimer's later down the line.
• 48:39
  Speaker 2: So how can we get the brain to detox the same way we detox the body?
• 48:45
  Speaker 1: I'll get on that.
• 48:46
  Speaker 1: No, that's great Add to my library, right.
• 48:49
  Speaker 1: I don't have enough, but no, it's amazing.
• 48:52
  Speaker 1: Stephanie, thank you so much for coming on.
• 48:54
  Speaker 1: Thank you, sir, it's been an amazing you know amazing journey here.
• 48:57
  Speaker 1: I really appreciate what you're doing for our veterans.
• 48:59
  Speaker 1: You have a focus and a kind of perception on brain health that we don't see that often.
• 49:04
  Speaker 1: So I really appreciate what you're doing.
• 49:06
  Speaker 1: You know we can, you know we'll invite anybody to reach out to you.
• 49:10
  Speaker 1: You know if they've got their own, you know for you.
• 49:12
  Speaker 1: You know, just you know.
• 49:13
  Speaker 1: If there's a public facing website or something, just let us know.
• 49:16
  Speaker 1: I would invite anybody to look up the Intrepid Centers.
• 49:19
  Speaker 1: I mean, these places are amazing.
• 49:21
  Speaker 1: I went to the one in San Antonio that was dealing with some of during the war, like some of the most grievously wounded soldiers were there and it was just amazing what they're doing to get these men and women back.
• 49:34
  Speaker 1: So thank you so much, really appreciate it.
• 49:37
  Speaker 2: Thank you so much.
• 49:37
  Speaker 2: I really appreciate you having me and I will give information to Denny he can share.
• 49:43
  Speaker 2: I'll give an email address that people or if they want to reach out, I have no problem with that.
• 49:46
  Speaker 1: We'll post it on the website and put it for us.
• 49:47
  Speaker 1: Well, thank you so much.
• 49:48
  Speaker 1: Thank you, have a great day.
• 49:49
  Speaker 1: What you do to our website free book Broken Brains Please download it 88 pages of the most recent information that we have on brain trauma and what it's doing to our young men and women, as well as our veterans and what we have to do.
• 50:04
  Speaker 1: Come to our website.
• 50:05
  Speaker 1: We've got a network.
• 50:06
  Speaker 1: We're making a resource guide for veterans that go to VA and get the coverage that they need, but we really appreciate you following our show Like it.
• 50:15
  Speaker 1: Push it out there wherever you want.
• 50:16
  Speaker 1: Really appreciate you.
• 50:17
  Speaker 1: God bless you all and I'll see you next time on Broken Brains, sponsored by the Matt Parkman Foundation, with yours truly.
• 50:25
  Speaker 1: So take care, have a good one, thank you.