No Plateau Podcast

Spasticity Without the Plateau: Science, Access, and the Path Forward

In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors. Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale. The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix. The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well. In This Episode * Introduction to the No Plateau Podcast (00:00) * Meet Dr. Monica Verdusco Gutierrez (00:59) * Understanding spasticity: Definitions and misconceptions (02:59) * Assessing spasticity: Tools and techniques (08:35) * Treatment options for spasticity (12:38) * Neurolysis: Phenol, alcohol, and cryo (16:23) * The importance of functional goals in spasticity management (22:43) * Introducing the AAPM&R consensus guidance (24:39) * Getting feedback from patients and therapists (28:37) * Botox and other toxin treatments (29:07) * Exploring cryotherapy for spasticity (29:57) * Disparities in access to spasticity care (31:10) * Cost efficiency in spasticity management (36:56) * Caregiver challenges in managing spasticity (42:14) * Communication between therapists and physicians (44:47) * Future directions in spasticity management (51:20) * Conclusion and final thoughts (54:51) Our Guest Monica Verduzco-Gutierrez, MD Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine. Resources & Links * AAPM&R Consensus Guidance on Spasticity Assessment and Management (2024) [https://pubmed.ncbi.nlm.nih.gov/38770827/] * UT Health San Antonio – Department of Rehabilitation Medicine [https://lsom.uthscsa.edu/rehab/] * Monica Verduzco-Gutierrez on LinkedIn [https://www.linkedin.com/in/monica-verduzco-gutierrez/] * Monica Verduzco-Gutierrez UT Health [https://directory.uthscsa.edu/academics/profile/gutierrezm19] * Henry Hoffman on LinkedIn [https://www.linkedin.com/in/henry-hoffman-01a09312/] * Saebo [https://www.saebo.com/?utm_source=podcast&utm_medium=saebo-podcast&utm_campaign=no-plateau-podcast] * On YouTube [https://www.youtube.com/user/SaeboInc] * On Instagram [https://www.instagram.com/saeboinc/] * On LinkedIn [https://www.linkedin.com/company/saebo-inc] * Saebo’s Stroke Caregiver Support Group [https://www.facebook.com/groups/423786023009376] * Saebo’s Stroke Survivor Support Group [https://www.facebook.com/groups/SaeboStrokeSupport] * Stroke Guidelines 2023 [https://www.ahajournals.org/doi/10.1161/STR.0000000000000436#:~:text=The%20%E2%80%9C2023%20Guideline%20for%20the,diagnose%2C%20and%20manage%20patients%20with]

Neurorehab Lessons Every New Grad Needs to Know

In this episode of the No Plateau Podcast, host Henry Hoffman sits down with occupational therapist, researcher, and educator Annie McCluskey to unpack the neurorehab lessons she wishes she had known as a new grad. With over 30 years of experience in stroke and brain injury rehabilitation, Annie brings a refreshingly honest perspective on how practice has evolved and where clinicians still get stuck. They dive into big topics like becoming a true movement scientist early on, why repetition, intensity, and high dose practice matter from day one, and how fear once held therapists back from pushing patients hard enough. Why were we so cautious for so long? And what does the evidence actually say now? Annie challenges outdated habits like excessive hands on facilitation, routine splinting, and low rep sessions, advocating instead for task specific, meaningful practice that patients can carry beyond therapy hours. The conversation also explores courage, having the confidence to question tradition, de implement ineffective treatments, and speak up in clinical settings. What should new grads stop doing immediately? And how can they collaborate more deeply with stroke survivors rather than prescribing one size fits all programs? This episode is a must listen for students, new grads, and seasoned clinicians ready to rethink how neurorehab is delivered and how much better it could be. In This Episode * Introduction to Annie McCluskey (00:00) * The Birth of Stroke Ed (03:03) * Lesson 1: Becoming a Movement Scientist (06:12) * Lesson 2: Repetition, Intensity, and High Dose Practice (12:42) * Lesson 3: Being Courageous in Clinical Decisions (25:34) * Introduction to Bo Bath Therapy (27:57) * Task-Specific Training vs. Bo Bath (28:49) * Challenges in Therapy Approaches (29:48) * The Evolution of Strength Training (31:05) * Hands-On Therapy and Its Limitations (34:46) * The Importance of Hand Function (36:51) * Collaborative Rehabilitation Planning (40:38) * Advice for New OT Graduates (44:23) * Resources and Courses for Therapists (49:01) * Conclusion and Final Thoughts (51:27) Our Guest Annie McCluskey, OT, PhD Annie McCluskey is an occupational therapist, researcher, and educator with over 30 years of experience in stroke and brain injury rehabilitation across Australia, the UK, and internationally. She has published more than 70 peer-reviewed journal articles, contributed to multiple book chapters, and secured over $4 million in competitive research funding. Annie is the co-developer and director of StrokeEd, an education platform dedicated to translating evidence-based neurorehabilitation research into everyday clinical practice. Resources & Links * StrokeEd Website [https://strokeed.com/] * StrokeEd Free Lecture Series [https://strokeed.com/lectures/] * StrokeEd Online Workshops & MOOCs [https://strokeed.com/mooc/] * Annie McCluskey on LinkedIn [http://linkedin.com/in/annie-mccluskey-22ab9b58?originalSubdomain=au] * Henry Hoffman on LinkedIn [https://www.linkedin.com/in/henry-hoffman-01a09312/] * Saebo [https://www.saebo.com/?utm_source=podcast&utm_medium=saebo-podcast&utm_campaign=no-plateau-podcast] * On YouTube [https://www.youtube.com/user/SaeboInc] * On Instagram [https://www.instagram.com/saeboinc/] * On LinkedIn [https://www.linkedin.com/company/saebo-inc] * Saebo’s Stroke Caregiver Support Group [https://www.facebook.com/groups/423786023009376] * Saebo’s Stroke Survivor Support Group [https://www.facebook.com/groups/SaeboStrokeSupport] * Stroke Guidelines 2023 [https://www.ahajournals.org/doi/10.1161/STR.0000000000000436#:~:text=The%20%E2%80%9C2023%20Guideline%20for%20the,diagnose%2C%20and%20manage%20patients%20with]

Restoring Movement vs. Adapting to Loss: Choosing the Right Path in Stroke Care with Amber Walter and Caitlin Wright

In this episode of the No Plateau Podcast, Henry Hoffman sits down with Amber Walter, Clinical Science Director, and Caitlin Wright, Occupational Therapy Advisor at Sheltering Arms Institute, to dig into one of the biggest debates in stroke rehab: should therapy focus on restoring movement, or teaching patients to adapt with compensatory strategies? But on the other hand, if therapy leans too much on compensation, are we robbing the brain of its chance to truly recover? Amber and Caitlin share how Sheltering Arms has taken a bold stance by committing to a neuro-restorative model of care, one built on intensity, technology, and outcome-driven practice. They talk about the science of neuroplasticity, the dangers of defaulting to one-handed strategies, and why therapists need to start planting seeds of recovery early, even for patients with the most severe deficits. Throughout the conversation, you’ll hear why high-repetition, evidence-based therapy matters, how technology extends what therapists can do, and why the future of stroke rehab depends on longer, more intensive sessions that focus on restoration, not just adaptation. In This Episode * Introduction to Caitlin Wright and Amber Walter (00:00) * The Importance of Neuroplasticity in Stroke Recovery (05:23) * Challenges in Current Stroke Rehabilitation Practices (07:25) * Sheltering Arms Institute: A New Approach (12:46) * Implementing Restorative Therapy at Sheltering Arms (15:05) * Technology and Evidence-Based Practices in Therapy (20:30) * Evaluating and Treating Stroke Patients (24:13) * Therapist Fatigue and Technology in Patient Recovery (31:44) * Critical Components for Severe Impairment Recovery (32:34) * Balancing ADLs and Intensive Therapy (35:31) * Historical Perspective on Rehabilitation (37:25) * Innovative Approaches in Modern Rehabilitation (38:35) * Case Study: Remarkable Patient Recovery (44:18) * Implementing Evidence-Based Practices (55:38) * Closing Thoughts and Recommendations (56:04) Our Guests Amber Walter, PT, DPT, NCS, is the Clinical Science Director at Sheltering Arms Institute in Richmond, VA. She oversees multiple therapy disciplines and specializes in translating research into everyday practice to improve outcomes for stroke and brain injury survivors. Caitlin Wright, MOT, OTR/L, is an Occupational Therapy Advisor at Sheltering Arms Institute. She is board-certified in physical rehabilitation and a certified brain injury specialist, with expertise in implementing neuro-restorative strategies to maximize recovery potential. Resources & Links * Sheltering Arms Institute Website [https://shelteringarmsinstitute.com/] * Amber Walter on LinkedIn [https://www.linkedin.com/in/amber-walter-28618aa5/] * Caitlin Wright on LinkedIn [https://www.linkedin.com/in/caitlin-wright-otd-atc-845729160/] * Henry Hoffman on LinkedIn [https://www.linkedin.com/in/henry-hoffman-01a09312/] * Saebo [https://www.saebo.com/?utm_source=podcast&utm_medium=saebo-podcast&utm_campaign=no-plateau-podcast] * On YouTube [https://www.youtube.com/user/SaeboInc] * On Instagram [https://www.instagram.com/saeboinc/] * On LinkedIn [https://www.linkedin.com/company/saebo-inc] * Saebo’s Stroke Caregiver Support Group [https://www.facebook.com/groups/423786023009376] * Saebo’s Stroke Survivor Support Group [https://www.facebook.com/groups/SaeboStrokeSupport] * Stroke Guidelines 2023 [https://www.ahajournals.org/doi/10.1161/STR.0000000000000436#:~:text=The%20%E2%80%9C2023%20Guideline%20for%20the,diagnose%2C%20and%20manage%20patients%20with]

Unlocking Hope for Vivistim Therapy: Bridging the Gap from “Not Yet” to “Approved” with Amanda Saylor

In this episode of the No Plateau Podcast, host Henry Hoffman is joined by Amanda Saylor, an occupational therapist specializing in neurological rehabilitation, to discuss Vivistim Therapy, a groundbreaking treatment for chronic stroke survivors with upper limb deficits. Vivistim combines vagus nerve stimulation (VNS) with intensive therapy to enhance neuroplasticity and improve arm and hand function. Amanda shares her experience implementing Vivistim in her clinic, the science behind the treatment, and how it can be integrated into stroke rehabilitation. "Vivistim is basically vagus nerve stimulation paired with therapy. It has to be—it cannot be one without the other."– Amanda Saylor This episode highlights the importance of combining innovative technology like Vivistim with evidence-based practices to push the boundaries of stroke recovery. For therapists and patients alike, Vivistim offers a new avenue for hope and progress in the journey toward recovery. "The success of Vivistim is only as good as the therapist that's going to be doing it. It’s the tool, but it’s the person behind the tool that makes the difference." – Henry Hoffman As Amanda and Henry discuss, the future of stroke rehabilitation lies in longer, more intensive therapy sessions and the integration of neurotechnology to enhance neuroplasticity. "Patients need more time in therapy. We know they need more repetitions, and they can't always get those on their own." – Amanda Saylor In This Episode * Introducing Vivistim Therapy (00:39) * Meet Amanda Saylor: Professional Background (01:17) * Understanding Neuroplasticity and Stroke Rehabilitation (02:58) * The Role of Task-Specific Training in Recovery (04:21) * Challenges and Innovations in Stroke Therapy (05:59) * Diving into Vivistim Therapy (06:54) * Clinical Trials and Outcomes of Vivistim (18:40) * Insurance and Reimbursement for Vivistim (26:19) * Navigating FDA Approval and Reimbursement (30:18) * Identifying Ideal Candidates for Vivistim (30:49) * Accessing Vivistim Treatment (33:32) * Training and Implementation for Therapists (35:10) * Case Studies: Success Stories and Strategies (37:38) * Future Directions and Recommendations (54:06) * Conclusion and Contact Information (57:56) Our Guest Amanda Saylor, MOT, OTR/L, is an occupational therapist with over eight years of experience specializing in neurological and orthopedic rehabilitation. She works at AdventHealth in Orlando, Florida, and is a consultant for MicroTransponder, the company behind Vivistim. Amanda is passionate about stroke rehabilitation and shares treatment ideas and tips on her Instagram page, @neuro_ots, with her colleague Becca Carr. Resources & Links * Advent Health Website [https://www.adventhealth.com/] * Vivistim Website [https://www.vivistim.com/] * Amanda Saylor on LinkedIn [https://www.linkedin.com/in/amanda-saylor] * Amanda Saylor’s Instagram [https://www.instagram.com/neuro_ots/] * * Henry Hoffman on LinkedIn [https://www.linkedin.com/in/henry-hoffman-01a09312/] * Saebo [https://www.saebo.com/?utm_source=podcast&utm_medium=saebo-podcast&utm_campaign=no-plateau-podcast] * On YouTube [https://www.youtube.com/user/SaeboInc] * On Instagram [https://www.instagram.com/saeboinc/] * On LinkedIn [https://www.linkedin.com/company/saebo-inc] * Saebo’s Stroke Caregiver Support Group [https://www.facebook.com/groups/423786023009376] * Saebo’s Stroke Survivor Support Group [https://www.facebook.com/groups/SaeboStrokeSupport] * Stroke Guidelines 2023 [https://www.ahajournals.org/doi/10.1161/STR.0000000000000436#:~:text=The%20%E2%80%9C2023%20Guideline%20for%20the,diagnose%2C%20and%20manage%20patients%20with]

The Educators’ Role in Translating Evidence into Practice with Jessica Schmidt

Are you or someone you know working towards recovery and looking for effective ways to break through barriers? In the world of rehabilitation, evidence-based practices are making a significant impact, especially within the field of occupational therapy. "We really have to take the time as educators to be willing to modify our courses, stay up to date on evidence, and make sure that we're using the best resources that are the most up to date." (17:45) - Jessica In today’s episode of the No Plateau Podcast, we delve into the integration of evidence-based practice in occupational therapy education and clinical settings from our own perspectives. We tackle the challenges of translating research into practice, including the delay between discovery and implementation and the hurdles we clinicians encounter in keeping abreast of new information. We cover the initiatives we're taking at Concordia University to improve evidence translation, the significance of clinical practice guidelines, and the role we play as fieldwork educators. We also engage in the debate over whether to focus on ADLs or neuroplasticity post-stroke and discuss the use of assessments like the Fugl-Meyer. We recommend the ViaTherapy app as a tool for evidence-based stroke rehabilitation, sharing our insights and experiences with it. "You can't get your arm and hand back if it's seven months, nine months, two years later; you missed a window. So focus on what matters the most, which is neuroplasticity." (24:25) - Henry In This Episode * The need for evidence-based learning (00:00:32) * Challenges in implementing evidence-based practice (00:05:27) * Strategies for speeding up evidence translation in education (00:11:11) * Dealing with outdated practices (00:22:20) * Adaptive techniques and neuroplasticity (00:24:21) * Barriers in implementing evidence-based strategies (00:31:22) * Accessing clinical practice guidelines (00:37:58) * Impairment-based outcome measures (00:45:12) * ViaTherapy App and free resources (00:49:32) Our Guest Jessica Schmidt, OTR/L is an assistant professor of occupational therapy at Concordia University of Wisconsin. She earned her master's from the University of Wisconsin-Milwaukee, and her post-professional doctorate in occupational therapy from Rocky Mountain University School of Health Professions. She is a member of ACRM, AOTA, and WOTA. In clinical practice, Jessica specialized in treating adult neurological patients in acute care and inpatient rehabilitation settings. She is passionate about evidence-based practice, helping translate research into the clinic, and preventing healthcare worker burnout. Resources & Links * Henry Hoffman on LinkedIn [https://www.linkedin.com/in/henry-hoffman-01a09312/] * Jessica Schmidt on LinkedIn [https://www.linkedin.com/in/jessica-schmidt-ms-otd-75b7a3137/] * * Saebo [https://www.saebo.com/?utm_source=podcast&utm_medium=saebo-podcast&utm_campaign=no-plateau-podcast] * On YouTube [https://www.youtube.com/user/SaeboInc] * On Instagram [https://www.instagram.com/saeboinc/] * On LinkedIn [https://www.linkedin.com/company/saebo-inc] * Saebo’s Stroke Caregiver Support Group [https://www.facebook.com/groups/423786023009376] * Saebo’s Stroke Survivor Support Group [https://www.facebook.com/groups/SaeboStrokeSupport]