Sunday, January 17, 2016

How I Got an Extra 100 Hours of Rehab

The following article is part two of two parts written by Clay Nichols. Part one is in last week's post titled "Busting Recovery Myths". Clay, as you learned last week, is co-founder of MoreSpeech and Bungalow Software. Both provide Speech & Language Software.

I encourage you to visit his site by clicking on this link: Speech & Language Therapy Software for stroke and brain-injury survivors 


by Clay Nichols

Specific steps I took to get extra, personalized rehab treatment (free) after an injury and made a full recovery.

Previously, I explained how your brain recovers from an injury such as stroke or TBI, and why insurance sometimes doesn't provide enough therapy to make that recovery, then denies additional therapy... because you didn't make progress (what I call the Insurance Catch-22). So, if recovery is possible, but you need more than what insurance typically provides, what can you do?

Here’s what I did.

My Rehab

A year or so ago I had a shoulder problem from too much computer use. (I’ve been creating speech therapy software for over 20 years. All that time on the computer caught up to me.) So off I went to the PT.

She had me do a bunch of exercises to strengthen my shoulder but it was tough to remember the exercises. How high should I rotate my arm, here? I know, you're saying hey, you're overthinking this. If it doesn't hurt you're OK. Well, some of the movements I made caused my tendons to pop. It didn't hurt but when she cringed I knew it was a Bad Thing. And as I did the exercises, she corrected my form quite a bit. If I did those exercises wrong they wouldn’t have the desired effect, or worse, they’d cause further damage.

So, I couldn't remember the exercises and wasn't even following her directions perfectly in therapy. And I'd need over 100 hours of treatment for full recovery. I didn't have an extra $10,000 to spend on having the PT guide me through each of those 100 hours. Also, I'd rather not spend an extra 100 hours driving to and from the PT and sitting in the waiting room.

I'm not complaining. Stroke & TBI survivors have it much worse.

Why Deliberate Practice is the key to improvement

Just Do It is not as effective as Do It Right

Before I explain my nifty solution, I want to point out why I didn't follow Nike's advice and Just Do It. If I wanted the exercise time to have maximum effect I needed to do the exercises the right way, and not just going through the motions (quite literally in this case). Doing 100 hours of exercises improperly wasn't going to help me much.

In his book So Good They Can’t Ignore You, Dr. Cal Newport studied how people improve significantly at a skill. He demonstrated that exceptional skill is rarely due solely to luck and natural gifts, but due to what’s termed deliberate practice.

Put another way, if you just show up and work hard, you’ll soon hit a performance plateau beyond which you fail to get any better. We all hit plateaus. Cal Newport, PhD

Plateaus? Sound familiar? It’s what survivors in speech therapy run up against all the time, as I described previously.

What Dr. Newport calls Deliberate Practice, would translate, in Rehab, to Treatment. If you have apraxia following a stroke, and can't speak, you don't simply try harder to speak, you consult a speech therapist. They would then provide you with specific exercises for the Apraxia. An excellent example of treatment in speech therapy is the the Rosenbek Hierarchy, which is a very specific treatment protocol which research has shown is effective for Apraxia treatment. The idea behind it is that the patient starts with success (getting as much assistance as needed) then that assistance is gradually reduced as the patient improves.

Don't sacrifice socializing!
Practice is preparation, not replacement, for socializing.

Speech & language treatment should not displace social interaction: don’t give up enjoyable time with the family to sit in a room doing drill practice. But don’t expect social interaction, alone, to improve your speech and language as effectively as treatment. Treatment can also provide confidence, which makes socializing more relaxing.

How I Multiplied PT by 2000%

So….can you guess of how turned my few hours with the PT into 2000% more treatment?

I had her video record me with my phone while she told me how to do the exercises, with feedback just for me, like "how high do I raise my arm? This high."

Viola! I had a personalized training video. So, I had clearer instructions, with feedback included as voice-overs during therapy, and I could just watch it while doing the exercises.

I went in a few more times, for a total of about 4 or 5 hours of PT. And those videos let me turn that into over 100 hours of practice.