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What if freezing of gait isn't a late-stage problem at all, but something already taking shape at the moment of a Parkinson's diagnosis? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with Becky Farley, PhD, MS, PT, founder of Parkinson Wellness Recovery (PWR!), and Jennifer Bazan-Wigle, PT, DPT, CEEAA, physical therapist at the PWR!Gym in Tucson, Arizona, about what the PWR! team learned while building their World Parkinson Congress poster on personalized freezing of gait interventions for freezers and non-freezers. Becky explains how digging into the underlying mechanisms convinced her that gait and balance must be targeted seriously from diagnosis. Those mechanisms include interference and loss of automaticity, perceptual processing dysfunction, abnormal coupling of posture and gait, and executive dysfunction. She also explains why she now adds psychological stress to that list and why stress management, medication optimization, and aerobic intensity form the foundation for building resilience. Jen describes how the PWR! team flags higher-risk patients early, how they run consecutive-day freezing intensives each month within an insurance-based model, and why group classes may be key to holding onto those gains. Claire shares how her team at Rogue screens for freezing using 360-degree turns and step counts during gait speed testing, and why anxious movers often resist the very classes that would help them most. The conversation also covers a new standardized freezing of gait assessment now in validation, a large South Korean cohort linking earlier rehab referral to lower mortality, and why the ability to control rhythm, including moving slower than comfortable, may be an underused screen and treatment target. Resources mentioned in the episode, including an image of the poster and Becky's reference list, are linked below. https://www.pwr4life.org/fog/ Freezing of Gait (FOG) Poster, FOG Assessment & Video examples, FOG Mechanisms w/ Video Examples FOG Resources from WPC for our FOG posters This includes a page of NEW FOG relevant REFS and LINKS. https://www.pwr4life.org/floortransfers/   References: Gülke E, Lewis SJG. What is new in Freezing of Gait?. J Neurol. 2026;273(4):222. Published 2026 Mar 21. doi:10.1007/s00415-026-13765-6 Gilat M, Nonnekes J, Factor SA, et al. An updated definition of freezing of gait. Nat Rev Neurol. 2026;22(3):172-181. doi:10.1038/s41582-025-01179-3 Tosserams A, Fasano A, Gilat M, et al. Management of freezing of gait - mechanism-based practical recommendations. Nat Rev Neurol. 2025;21(6):327-344. doi:10.1038/s41582-025-01079-6 Gaveel TJ, Postma EM, Bloem BR, et al. The SENSS (Stress, Exercise, Nutrition, Sleep, Self-management) study: study protocol for a randomized controlled trial to evaluate an integrated, personalized and stepped care lifestyle approach for people with Parkinson's disease. Front Neurol. 2026;17:1752073. Published 2026 Mar 3. doi:10.3389/fneur.2026.1752073 Goltz F, van der Heide A, Helmich RC. Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?. J Parkinsons Dis. 2024;14(s1):S147-S158. doi:10.3233/JPD-230211 Johansson ME, Toni I, Bloem BR, Helmich RC. Parkinson's disease progression is shaped by longitudinal changes in cerebral compensation. Brain. 2026;149(1):194-208. doi:10.1093/brain/awaf302 Lindholm B, Hagell P, Odin P, et al. Balance and gait disorders in de novo Parkinson's disease: support for early rehabilitation. J Neurol. 2024;272(1):11. Published 2024 Dec 12. doi:10.1007/s00415-024-12804-4 Tosserams A, Bloem BR, Ehgoetz Martens KA, et al. Modulating arousal to overcome gait impairments in Parkinson's disease: how the noradrenergic system may act as a double-edged sword. Transl Neurodegener. 2023;12(1):15. Published 2023 Mar 26. doi:10.1186/s40035-023-00347-z Tosserams A, Fasano A, Gilat M, et al. Management of freezing of gait - mechanism-based practical recommendations. Nat Rev Neurol. 2025;21(6):327-344. doi:10.1038/s41582-025-01079-6 Yoon, S.Y., Chang, SY., Heo, SJ. et al. Timing of rehabilitation therapy initiation and all-cause mortality in parkinson's disease: nationwide cohort study. npj Parkinsons Dis. (2026). https://doi.org/10.1038/s41531-026- 01495-5 Zhang M, Zhang Y, Zhang Z, et al. Effects of mindfulness-based exercise on Parkinson's disease and Alzheimer's disease: a systematic review and meta-analysis. Front Neurol. 2 Parkinson's Weekly with Dr. Bas. Bloem – Podcast EP 36 – Think Gut: Why Parkinson's Medication Sometimes Stops Working nosilverbullet4pd The Brain's Backup Plan: The Power of Neuroplasicity in Parkinson's with Dr. Rick Helmich https://youtu.be/UHXxEz88_s4?si=zHJXako9ao2LUlI5 Parkiknson's Disease: Managing Stress with Parkinson's Disease with Dr. Rick Helmich https://youtu.be/jZDnSyr1qAU?si=IUBbWqmYZaYVP6PB

What does it take to get a piece of high-performance sports tech out of the soccer world and into the living rooms of people with Parkinson's? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with Christoph Dressel, founder and CEO of Mimofit about the reaction-based light-pod system his team built after clinical trials in Spain showed real gains in dual-task performance, gait speed, and reaction time for people with Parkinson's. Christoph walks through the surprising finding that reaction-speed improvements only showed up once a timeout was added to force time-pressure. Plus he shares how Mimofit's coach-versus-home-use model differs from other tools on the market, how the devices are built rugged enough to step on yet simple enough for everyone, why they market direct to consumer, the newer symbol- and number-based cognitive games rolling out through app updates, the affordability as well as HSA/FSA eligibility, and his partnership with Rock Steady Boxing — plus an open invitation for coaches and clinicians to shape which games get built next. Linkedin: https://www.linkedin.com/company/mimo-fit/ Instagram: https://www.instagram.com/mimofit.parkinsons/ Facebook: https://www.facebook.com/people/Mimofit/61572605414962/ Email: [email protected]

What if the key to helping a patient with Parkinson's find their voice again isn't more repetition, but movement? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with Jessica Ackerman, MS, CCC-SLP, RYT, speech-language pathologist and founder of Speak Steady, about why the classic Parkinson's presentation so often goes untreated, and how a technique born out of a pandemic-era Zoom yoga class became a clinically validated, self-paced communication program. Jessica walks through the neuroplasticity and motor-learning principles behind pairing each spoken word with a movement, how posture and breath mechanics directly power vocal loudness, where Speak Steady differs from voice-isolated approaches like LSVT LOUD, and why so few people with Parkinson's ever make it into speech therapy in the first place given long wait times and a national shortage of SLPs. The conversation also touches on early, easy-to-miss signs of swallowing difficulty and how PTs and OTs can use Speak Steady as a low-lift referral option for patients who may never see a speech therapist otherwise. Speak Steady: www.jessicaackerman.com Link to Speak Steady: The Parkinson's Voice Reset : www.jessicaackerman.com Info flyer Speak Steady: https://drive.google.com/open?id=1bigUtWvw6taGpgc2d2jglYQfVHkI-pVz Instagram: https://www.instagram.com/breathespeakmove/

Have you ever worked with a stroke survivor or patient with spinal cord injury who had swollen limbs and not been sure what to actually do about it? Maybe you tried something, maybe you didn't because you didn't realize you should.  In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Rachel Walker, PT, DPT, GCS, CLWT, CBIS about why edema is so common — and so consequential — in the neuro population. Rachel walks through why unmanaged edema leads to pain, joint contracture, and long-term functional loss; how to run a full assessment (girth measurements, skin and lymphedema staging, and a bedside ABI to rule out arterial insufficiency before compressing); and what actually gets patients to stick with their compression, from donning aids to garment length and brand selection. Whether edema management has felt like an afterthought in your practice or you're looking to sharpen your clinical reasoning around it, this conversation gives you a clear, practical framework to start using right away.

Why do two patients with what looks like the same stroke on paper walk out of rehab so differently — and why does a home exercise program built on ankle pumps and heel slides so often fail the people who need it most? In this episode, host Erin Gallardo, PT, DPT, NCS, talks with returning guest Dr. Jennifaye V. Brown, PT, MSPT, PhD, NCS, CAPS, a four-time ten-year board-certified neurologic clinical specialist and author of Brace Yourself: Everything You Need to Know About AFOs After Stroke, about why going back to foundational neuroanatomy — knowing exactly where a lesion sits, how large it is, and how edema and brain shift distort the initial picture — is the difference between generic protocols and precision rehab. Dr. Brown walks through how she uses movement observation and cranial nerve testing to localize lesions when imaging isn't available, why upper versus lower motor neuron signs (and even mixed presentations) change her clinical reasoning, and how she builds five-exercise home programs tailored to a specific synergy pattern, flexion contracture, or cerebellar presentation rather than handing out the same generic list to every client. The conversation also digs into intensity: why so many stroke survivors aren't actually reaching the high-intensity thresholds the neuroplasticity research calls for, how Dr. Brown uses culturally relevant, music-paced activities and a color-coded RPE scale to get clients there, and why she separates muscle strengthening from muscle endurance in her programming. She previews a case study she'll present in an upcoming NeuroSpark webinar and makes the case for how clinicians can build self-efficacy rather than aim to see patients forever by using neuroanatomy.   Order ebook (Flipbook or PDF): jvbneuropt.com/book Website: jvbneuropt.com LinkedIn: https://www.linkedin.com/in/jennifaye-brown-pt-mspt-phd-ncs-caps/ YouTube: https://www.youtube.com/channel/UC-0M-apffkZl4vqjAqomd8g Email: [email protected] Get Dr. Jennifaye Brown's 90 minute AFO FITT-CORRECT: A Plan to Improve Foot Drop Webinar Just $29.99

What tasks do you keep doing in your business that you secretly hate? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with returning guest and favorite NeuroBiz coach Emily Duval Ledger about the reflective milestones of her 20-year entrepreneurial journey — from leaving her full-time job, to closing her brick-and-mortar gym during COVID, to running a leaner, more sustainable solo practice today. The conversation moves through the martyrdom trap so many clinician-business-owners fall into, how to actually trust a virtual assistant or new hire with work you've always done yourself, and the emotional nuance of transitioning long-term one-on-one clients to other team members without them feeling abandoned. Emily closes with a challenge born out of a personal practice of pausing before volunteering for anything: identify at least two things you can fire yourself from, and notice how much better you get at the few things you keep. Listeners will feel seen and inspired to take a new path toward freedom in your business rather than working a job you'd never sign up for if it weren't your own business.

What if the biggest gains in your patients' outcomes came from four small, free shifts you could start using tomorrow? In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Jamie Haines, PT, DScPT, NCS, who recently left a long career as an associate professor at Central Michigan University for mobile concierge PT in Florida, where she treats patients with a wide range of neurologic conditions in their own environments. Jamie and Erin preview the "amplify your practice" framework, covering aerobic priming to get the nervous system ready to learn, rhythmic auditory stimulation and music-based cueing, the OPTIMAL theory of motor learning (autonomy, enhanced expectancies, and external focus), overground training. Learn how tapping into a patient's identity can be the difference-maker in adherence. You'll also hear that overground training is NOT simply walking overground. You'll take away specific examples of how to incorporate these evidence-based boosts to enhance recovery in your patient sessions.   Register for the free webinar live on September 10 HERE Join NeuroSpark during our next opening September 14–17 at www.joinneurospark.com

How much hand function can come back after a neurologic injury, and how do you know whether to remediate or compensate? On this episode, host Erin Gallardo, PT, DPT, NCS, talks with Jenna Barber, MOT, OTR/L, BCPR, an occupational therapist who specializes in neurorehabilitation across acute care, inpatient, and outpatient settings. In the show you'll learn how to assess fine motor deficits through activity analysis and standardized testing, the difference between remediation and compensation and when to use either. We'll also discuss favorite tools like FES, focal vibration, and rocker knives, how to keep the non-dominant hand and shoulder involved even when it's not the primary focus, and discuss emerging tech including MusicGlove, Vivistim, Bioxtreme, VR, and other devices and their place in rehab. Follow Jenna for tips, tricks and giveaways at @Neuro_OTPT_Nerds on Instagram

In this episode, host Erin Gallardo, PT, DPT, NCS, talks with returning guest Rose Tilton, OTR/L, OTD, an occupational therapist at Marquette University's Neuro Recovery Clinic, and new guest Dr. Yi-Kai Lo, PhD, CEO and co-founder of ANEUVO, about transcutaneous spinal stimulation (TSS) for people with spinal cord injury. Rose shares how she discovered TSS through her own research, became a clinical trial site investigator at Marquette, and now uses ANEUVO's ExaStim® device — a multi-channel electrode array system that can be individually programmed and timed to match specific functional movements — alongside other TSS devices on the market, including ONWARD Medical's ARC-EX. Dr. Lo walks through the engineering behind ExaStim, how the device is positioned and calibrated for each patient, and the proposed mechanism of amplifying descending brain signals to the spinal cord. Together they cover who's actually a good candidate (spoiler: it's hard to predict), what a typical treatment session looks like from aerobic priming through hand-strengthening work, and real patient outcomes ranging from improved grip and transfers to unexpected anecdotal gains, like bowel and bladder function for some. Dr. Lo also shares results from ANEUVO's ASPIRE clinical trial and home-use study, including a newly designated CPT code that will make TSS billing possible starting January 2027. Whether you're new to TSS or already using it in your practice, this conversation is full of practical, clinically grounded insight into where this intervention is headed. ANEUVO website: aneuvo.com Contact ANEUVO here: [email protected] Dr. Lo LinkedIn: https://www.linkedin.com/in/yi-kai-lo-53531977/ Dr. Lo Google Scholar: https://scholar.google.com/citations?user=cqiyyYgAAAAJ&hl=en ANEUVO LinkedIn: https://www.linkedin.com/company/aneuvo 276: Clinical Use of Spinal Stimulation for SCI Rehab with Rose Tilton, OTR/L, OTD

What if the biggest threat to your practice's growth isn't your marketing budget, but the way your team handles the very first phone call? Getting the phone to ring is necessary, but never sufficient. In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Daniel A. "Danny" Bobrow, MBA — creator of The Art of First Impressions™ and The Persuasion Blueprint, and President of AIM Dental Marketing — about the three pillars of persuasive communication: caring, connection, and collaboration. Danny reframes the moments clinicians tend to fumble, like the "do you take my insurance?" question that quietly hands control of the call to the caller, and "expert override," the well-meaning habit of finishing a patient's sentence that costs you the connection you were trying to build. For neuro clinicians, the throughline lands close to home: therapeutic alliance measurably improves outcomes, and small shifts keep the nervous system out of threat mode so real behavior change can happen. Whether you're fielding first calls in a cash-based practice or trying to get a patient to actually do their home program, it's a practical masterclass in influence as an act of caring rather than coercion. Learn more about Danny's work at dannybobrow.com. Support Danny's foundation at: https://www.climbforacause.org Www.Facebook.com/danielabobrow Www.Linkedin.com/In/Danny Bobrow

What do you do when the most evidence-based intervention you have is also the one your patient is "not allowed" to receive? Constraint-induced movement therapy has decades of research behind it, yet its exclusion criteria — especially around cognitive impairment — rule out a huge share of the stroke survivors clinicians actually see. In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with neuro OT Briana Elson, MS, OTR/L, BCPR, CBIS, about her decision to try modified CIMT with an 86-year-old stroke patient who had significant cognitive impairment and underlying dementia — a textbook exclusion — and why his profile, a left-handed man whose affected side was his dominant hand, made forced use feel natural and salient rather than confusing. Briana walks through how she built the protocol around safety and supervision in inpatient rehab: getting a physician order for the constraint mitt, educating and enlisting his wife, keeping a consistent daily schedule, breaking the three-to-six hours into non-consecutive blocks, and removing the mitt before late-day sundowning. She shares the outcomes that surprised even her skeptics — meeting the minimal detectable change on the Box and Block Test and a standardized motor scale within roughly thirteen days, plus real gains in grooming and feeding independence — alongside the honest caveats, including that his cognition never improved and that real-world delivery never looks as clean as the published article. It's a practical, encouraging conversation about reading the research, respecting its limits, and giving more patients a shot at an intervention they're usually told they can't have.

What happens to your neuro patients after they leave your care, and who's in their corner when the discharge falls apart? In this episode, host Erin Gallardo, PT, DPT, NCS, sits down with Kimberlie Williams-Feth, BSW, founder of Healthcare Survival Kit and a former hospital social work discharge planner who became an independent patient advocate after living the system's failures firsthand. When her husband's routine spinal fusion led to unexpected paralysis, Kimberlie navigated unsafe discharges, a "ghost network" of providers who didn't actually offer neuro care, and the months it took to find neuro PT and OT all while working full time and holding her family together. She shares the green/yellow/red scripting framework she teaches families, why a rushed discharge can leave patients financially liable the moment they say "no," and the three deceptively simple questions every clinician should ask: what did life look like before, what can you do now, and what are your goals. For neuro PTs, OTs, assistants, and students, this is a candid look at the holes in the system clinicians can't fill alone and the advocates who exist to fill them. Find an advocate by state or diagnosis at GNAnow.org (Greater National Advocates). www.healthcaresurvivalkit.com https://www.linkedin.com/in/kimberlie-williams-feth/ https://www.tiktok.com/@healthcaresurvival https://www.facebook.com/healthcaresurvivalkit/ https://www.instagram.com/healthcaresurvivalkit/ Greater National Advocates: https://gnanow.org

What if a patient who is years — even decades — out from their stroke could still make meaningful gains in their affected arm? In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Mason Hearn, PT, DPT, NCS, about Vivistim, the FDA-approved paired vagus nerve stimulation system for chronic ischemic stroke, and why the "paired" piece — stimulation delivered in the same moment as intensive, task-specific therapy — is what makes it work. Mason breaks down the triple-blinded RCT behind the device, why patients an average of three years post-stroke saw two to three times greater improvement on the Fugl-Meyer, and how the real-world results coming out of clinics are landing even higher. This episode gets into what the protocol actually asks of patients (90-minute sessions, three times a week, 300–500 reps), how at-home "swiping" turns everyday tasks like getting dressed or cutting into a baked potato into neuroplasticity-building practice, who is and isn't a candidate, and how therapists can think about screening and advocacy without feeling like they're "referring someone for surgery." It's a hopeful, practical conversation about giving chronic stroke survivors real agency over the next stage of recovery and the clinicians who can open that door for them. Learn more at: Vivistim.com https://www.vivistimacademy.com/ Here is the safety profile: http://www.Vivistim.com/safety

What happens to a family when "wellness" stops meaning saunas and cold plunges and starts meaning keeping the lights on? In this episode, host Erin Gallardo, PT, DPT, NCS, talks with Russell Meyerowitz, founder of the Parkinson's Wellness Fund, about how the needs of families living with Parkinson's have shifted from health-and-wellness support toward urgent emergency relief — and what that means for the clinicians who serve them. Russell shares why his organization issues no-judgment relief grants for everything from walkers and ramps to groceries and utility bills, why they're now fielding two to three applications every 24 hours, and how those years on the front lines led to the launch of Raya Health, a subscription-based care-coordination platform that keeps a family's medications, appointments, documents, and clinical notes in one shared place. He and Erin dig into the continuity-of-care gaps neuro clinicians see every day, why care coordination is crucial, and the forthcoming "Ask Raya" feature for surfacing medication and exercise trends over time. It's a warm, candid conversation about being proactive instead of reactive — and about having a stranger in your corner when Parkinson's makes life feel like survival. Links mentioned:  Parkinson's Wellness Fund — parkinsonswellnessfund.org Raya Health — raya-health.com Instagram: Parkinson's Wellness Fund and Raya Health HQ Use this promo code for 100% free access to Raya Health! RAYALOVESNEURO

Are the heart rate formulas we've been using actually working for our patients with Parkinson's? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, discuss with Cielita Lopez-Lennon, PT, PhD candidate in Rehabilitation Science at the University of Utah, her recently published research on refining maximal heart rate estimation for people with Parkinson's disease. The conversation digs into why standard formulas like 220 minus age systematically overestimate max heart rate for people with autonomic dysfunction, what chronotropic incompetence actually means in practice, and how Claire has been applying — and adapting — the research findings in real time at Rogue. If you're prescribing high intensity exercise to your neuro patients, this episode will change how you think about whether they're actually hitting the dose. www.linkedin.com/in/cielita Research article: Refining Maximal Heart Rate Estimation to Enhance Exercise Recommendations for Persons With Parkinson Disease — https://www.archives-pmr.org/article/S0003-9993(25)00626-4/fulltext Listen to the previously recorded episode where Claire shares the rationale and the formula she created (which you get access to!) Episode 302: https://www.neurocollaborative.com/blog/applying-a-new-calculation-for-max-heart-rate-in-pd