Stroke Recovery and Rehabilitation by Richard Harvey MD, Joel Stein MD , Carolee Winstein Phd PT, George Wittenberg MD PhD, Richard Zorowitz MD
The sixth episode of CIONIC’s podcast Superpowering the Human Body, features a conversation with Dr. Richard Zorowitz, Chief Medical Informatics Officer and attending physician at MedStar National Rehabilitation Hospital and professor of Clinical Rehabilitation Medicine at Georgetown University School of Medicine, in Washington D.C.
As chair of the Rehabilitation and Recovery Committee at the American Stroke Association Stroke Council and a longtime researcher/clinician, Dr. Zorowitz brings a unique and holistic view of stroke and stroke motor recovery. He advocates for and builds individualized care goals through a global lens focused on the specific patient in order to provide the best chance of maximizing patient recovery after a stroke.
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The full transcript is below, edited for readability.
Jeremiah: Hi, my name is Jeremiah Robison, Founder and CEO of Cionic. We build bionic clothing that can analyze and augment human movement, enabling the body to move with more freedom and control. Welcome to another episode of our podcast Superpowering the Human Body where we explore the science and technology of human ability and augmentation.
Today on the show, I’m joined by Dr. Richard Zorowitz, Chief Medical Informatics Officer and attending physician at MedStar National Rehabilitation Hospital and professor of Clinical Rehabilitation Medicine at Georgetown University School of Medicine. Both in Washington D.C.
Doctor Zorowitz, thanks for joining us today. You have an impressive set of credentials and career. I’m just going to read through a few of them for our audience and then we’ll jump into questions.
Doctor Zorowitz has been researching stroke rehabilitation outcomes in dysphagia, spasticity and hemiplegic shoulder. He has published articles in peer-reviewed journals and written chapters about stroke rehabilitation in international papers and books. He has participated on consensus panels of the Joint Commission for Primary Stroke Centers and the Commission on Accreditation of Rehab Facilities in the stroke specialty program. He is a chair of Rehabilitation and Recovery Committee at the American Stroke Association Stroke Council and also serves as a member of the Innovative Practices and Payment Models Committee of the American Academy of Physical Medicine and Rehab. Wow. That’s a whole lot of contribution to this world…and thank you for joining us today.
Zorowitz: And thanks for inviting me. I really appreciate your invitation.
Jeremiah: So you’re board-certified physical medicine and rehabilitation doctor, as well as an accomplished doctor in spinal cord injury medicine and brain injury medicine. That must bring a unique and holistic view of stroke and stroke motor recovery. Can you speak a little bit about how all those disciplines interplay in your practice.
Zorowitz: So let me start by telling you that in physical medicine rehab, we describe ourselves sort of as “functional and quality of life doctors.” I mean, we’re here to try to get patients as functional and as independent as possible, whether it has to do with things that I do…brain injury; spinal cord injury and stroke, as well as my other colleagues which sometimes deal with some of the more musculoskeletal things that we see, but the thing that really brings us all together is the whole idea of function and trying to build quality of life.
So we are a very holistic specialty and the reason why is, one because we don’t really focus on one body system. I mean, we’re not a gastroenterologist or a nephrologist. I mean we really deal with the entire person. When we do that, we’re dealing first with the physical aspects of it: trying to get people as functional as possible with walking, or bathing, feeding and grooming themselves. But in addition to that we deal with language and cognitive aspects and how that plays into function as well. So that can be patients who have speech problems such as Aphasia or Apraxia or the cognitive issues like memory and attention in executive functioning. So we have to look at all that stuff and try to put that all together.
In addition to that, we also look at the psychological aspects of disability. Many patients who have strokes or spinal cord injuries or brain injuries, can become depressed. They can become anxious. So we have to look at these issues and bring in the resources to be able to deal with these patients as well. Then finally, we need to deal with the psychosocial thing. Because it’s not just the patient that we’re dealing with. We’re dealing with everybody around the patient and especially with stroke or some of these other things…we have to worry about caregivers because if a caregiver can’t advocate for themselves, it’s going to be very hard for them to take care of the patient and If the caregiver can’t care for the patient, they’re both going to languish. And so put that all together, you know, it’s a very very complicated but integrated way of practicing medicine, but it is truly holistic in that we really have to look at the whole person and what goes on around that person.
Jeremiah: Absolutely. You talk in your research and some of your published works about “early access and comprehensive personalized care.” Can you describe both of those components, and what the best practice for creating a personalized rehabilitation program for a stroke survivor?
Zorowitz: So for a stroke survivor, we try to get rehab going as early as possible. I’m not going to go into all the literature…but suffice to say that we really start with rehab really after the first 24 hours. I really love to say that the neurologist gets the first 24 hours, and we get the rest of their lives. So you really want to try to start doing rehab in the acute care hospital, which is really getting the patient out of bed, and getting them mobilized.
But another very important aspect of this is trying to evaluate that patient and make decisions on how and where are the best places to take care of those patients? And so an evaluation is really very key and that again is the physical aspects of it, the psychological, and it’s the cognitive and language. As well as the psychosocial, because the patient who is not going to have the support to be able to go home…may not be able to go home eventually. So we have to really look at those things very carefully. At the same time, we want to make sure that patients get the appropriate care that they need. So by doing a really comprehensive evaluation, we can make sure that they can either go to an acute rehab or to a skilled nursing facility, or whether they can go directly home and have home care or outpatient. That’s really very important because there is some literature that actually suggests that patients do slip through the cracks and may actually be discharged home when they probably could have benefited from some sort of an in-patient type of setting.
In terms of the treatment…the treatment also has to be somewhat individualized. Which is a good thing because basically, as I love to say when you’ve seen one stroke or a brain injury or spinal cord injury…you’ve seen one of those. Everybody is different and has to be treated individually. So the idea of making sure that those problems are identified and that those are reated appropriately with the therapist that you need is going to be really key to maximizing that person’s outcome. The interesting part of all of this is that the literature really suggests that one treatment is not necessarily better than the other. Which in reality is a good thing because of the fact that you know, we can choose things just like you choose off a Chinese menu…is my analogy. You can choose from column A and column B, and get a program together with the idea that you want to get that patient to engage in what they’re doing and then do lots of it, because by doing that, it is going to help reorganize the brain and get that brain to work as efficiently and as maximally as they possibly can.
So by getting the evaluation, getting the individualized treatment plan…and then, by getting that initialized plan in action really makes a huge difference and that will allow the patient to ultimately get to their maximum level of function.
Jeremiah: I love that you use the phrase about meeting one stroke patient, we say the same thing when we meet one child, like my daughter with a diagnosis of cerebral palsy, is one child with cerebral palsy and everybody is unique and individual. And for her, that engagement…finding different ways in which she engages in her treatment..she does dance for instance because it’s something she really loves. It doesn’t feel like therapy, but it has amazing therapeutic benefits and is increasing her strength, balance, and range of motion. So finding things that really engage the person is just so key.
Zorowitz: Absolutely, and I think even on the in-patient side…we make use of recreational therapists who can take things like dance, music…you know, playing board games… and you can actually take all those things and when you break them down, you can actually break them down into functional activities — whether it’s cognitive or physical — that will allow that patient, you know, hopefully to flourish over time.
Jeremiah: You talk about the psychological aspects of stroke and brain injury and one of my questions is what are some of the misconceptions that people have? Either people who have just had a stroke, or people who surround them in the community about stroke survivors and what’s possible.
Zorowitz: I think probably the misconception is that you can’t maintain what you have, or can’t get better. I mean the literature has really suggested that over months or even years there is the potential…and I really emphasize the idea that it is potential…because I’ll be very realistic not everybody necessarily does get better, but the idea that with hard work, after that stroke they can maximize and hopefully build on whatever skills that they are learning, over a period of time, to be able to maximize their function.
Some other misconceptions, especially in terms of like Aphasia for example…language is really probably a big thing. Most people will maybe talk to a patient who’s aphasic, they may talk loud and it’s not a matter of they can’t hear, it’s just that they have a problem processing. And so sometimes you do have to talk a little bit more slowly or repeat yourself and really engage with that person to make sure that they’re understanding. So that’s another aspect of things that we have to look at as well. And the other thing too is that when we can, some families may decide “okay, this patient really can’t do a lot. So we’re going to do everything for them.” And you know, the idea of rehab is to try to get the patient as independent as they possibly can be. So really the concept really is going to be me: meet them halfway. Let them do what they can do, and then if they really, really, really cannot do something. That’s when you jump in and help them complete that activity.
Jeremiah: Yeah, and there is a disability advocate who said the best approach that she had heard was “how can I help you do the thing you’re already doing.” I want to recognize that you are already doing this, and if I can be helpful…great. If I can’t, you know, if it’s better that I’m not…just that acknowledgement is key.
Zorowitz: Right. And I think the idea for us is that we’re here to be cheerleaders. You don’t want to be critical because that patient really may not be able to do the kinds of things…but you try to cheer them on to get them to do what they can be able to do and then help them out along the way.
Jeremiah: I was thinking of one other misconception that I’ve seen within disability…that oftentimes there is an assumption that with a physical difference and a physical impairment, there is also a cognitive impairment. We’ve seen this with our daughter who is… highly verbal and very engaged. They were surprised when they see her in a walker or using her canes that she doesn’t have a cognitive impairment that goes along with that.
Zorowitz: Certainly that’s another thing, but then you have the other side, and that is for some of the patients who do have cognitive impairments…a lot of people will sort of call that the invisible impairment because you look at that person and they’ll say “oh they look perfectly normal,” but you know if they’re not remembering, or if they’re if they can’t pay attention to things that’s major major problem. And sometimes people don’t acknowledge that and can’t really help patients with some of those things. So those are things that we have to be aware of as well.
Jeremiah: You talked earlier about meeting patients halfway, and I guess it’s on everybody’s mind with the pandemic. I think it has been very challenging for people with disabilities, as well as driving some awareness of the inability for us to go and see and do things with our friends, that may actually be the reality for people who have a disability all the time. Do you think there are some silver linings to what has happened with the pandemic, whether it is a shift of working and accommodations for telemedicine and virtual healthcare?
Zorowitz: Yes I mean there’s good things and there’s been bad things. We’ve heard somebody talk a couple of months ago about simple things like being able to get out to the community and go shopping. So I’m going to talk a little bit of negative then you know, and then I will answer that. For example, we had one person, who spoke to us about the idea of not being able to go out and go shopping and suddenly having to be dependent upon the community to get stuff into the house and how difficult that actually was. Especially when that person was capable to some degree of getting out to the community, suddenly has to depend on the community to help them out. So, you know, as those things get going, I think that’s a nice thing.
On the other hand, to get to some of the positive things that you asked about; I think in terms of work, the silver lining I think has been this whole shift of being able to work from home. Some of my patients have told me how nice it actually has been, to not have to worry about the commute, and if they are dependent on Metro access here in the DC area, which is our disability ride…and then basically, not having to worry about having to make those appointments and get that stuff because they can do it at home and they can work.
I think where some people are going crazy, some people are very, very thankful that they can actually stay home, and I think the advantage to that for those patients is that they at least have the ability, one to work remotely and number two to have really the accommodations because literally whatever they have at home, which is their accommodations…they can make use of rather than again having to ask for that kind of stuff at work.
If they need for example say speech-to-text software or text-to-speech software for that matter…they can have that stuff because usually that stuff is going to be right there in their own setting. So I think there are some nice things that have happened and my patients have sked me, when we start getting back into reality, can I get a letter from you to be able to continue doing this. I’m certainly willing to support all that stuff so we can keep our patients as productive as they can be.
Jeremiah: I had read a somewhat depressing stat that since the ADA was passed several decades ago the percentage of the disabled that are still in the workforce has not significantly increased, and my hope is that with this virtualization of work and the ability to work from anywhere…that that you really start to see a shift, because work is so important to people.
Our contribution to society is often how we value ourselves, so the ability to increase that percentage I think would be a huge huge win out of what has been a really struggling time for everyone.
Zorowitz: I totally agree with that. But I think at the same time, making sure that accommodations that can be approved and applied by ADA is very important. I mean up to this point, we’ve had plenty of issues of patients whose employers have not always been very cooperative in terms of doing that. So I’m hoping that maybe going forward, doing more telework will help to maybe solve some of those problems.
Jeremiah: Let’s shift gears a second and talk about caregivers. You mentioned early in this conversation the socioeconomic and the psychological burden on caregivers. What can we do better to account for that…to support those people and give them the assets they need to care for what’s often their family and friends?
Zorowitz: So caregiving is probably one of the most difficult things that needs to be addressed. I think in terms of how it’s accounted for…it’s hard. I mean very seriously, it’s hard…because how do you account for it? The number of hours that someone may have to go into. It’s not like you punch your clock in and from 9 o’clock and then at 5 you can punch your clock out. Usually, it is a 24-hour seven-day-a-week endeavor, and sometimes a very significant one. I mean if you can imagine, a stroke survivor…I had a guy in today who is at least a couple hundred pounds and his wife takes care of him. So being able to have to transfer, and lift 200 pounds every time you have to do something like that, is a major thing and it puts caregivers at risk. So not only is it the hours, but also the physical demands.
The problem is of course, there is no job description for a caregiver. I mean, it’s really everything as directed or as needed and that’s really what you have to do. So in terms of being able to support…we start a lot, right from the get-go. When patients come into acute rehab, we will really talk from the social work standpoint in terms of what’s going on, and who’s at home to help you. Or do you have the financial resources if you need to hire somebody. So sometimes that’s a major effort because families may have to really come together, so you get several people. As I said early on, if a caregiver cannot advocate for themselves, you know, they’re in trouble and the patient’s going to be in trouble. We try to make sure that you get as much help as possible, and in-patient rehab…I mean, we’ll talk about that. We will talk about doing family training because again, that’s a very key aspect to make sure whoever is going to be involved with caring for that patient can really do the job.
If we find that is not the case, we may make the recommendation that going home may not be the best thing right now, and maybe going to a different facility where you can get care provided for you is going to be a better way to go. The other ways that we can do this is following up outpatient visits and checking in with the caregiver to make sure that everything is going well. Another aspect of this is support groups. That’s really key, because support groups allow caregivers to talk with other caregivers, one, if nothing else to commiserate with one another
so they have that kind of emotional support, but also it’s a good way for caregivers then to sort of throw out ideas and figure out, what works and what doesn’t work. Finally, the other thing is what financial resources that there may be, out in the community and in social work at least on the in-patient rehab side is very important. They can help potentially identify, resources for those patients and caregivers to use to be able to provide the care. So that ultimately a patient does not end up in a nursing home in the long run, and can remain out in the community.
Jeremiah: I think that idea.. the support groups…not just as places where people can take care of their own mental wellness with others and share the experience…but the collaboration and the idea to share what’s working. PM&R (physical medicine and rehabilitation), physical therapists, occupational therapists are almost a front line, but your family and your caregiver and your care team extends all the way to your home, and will see you every day and they’re really a wonderful advocate and resource for new ideas.
Zorowitz: Yes, and I what I find because I do go talk with our support groups periodically and I find it amazing because these are people who are not shy. They have questions and they are going to ask. You try to provide the information that they need, and give them the best reality that you can and it’s really a lot of fun to do that.
Jeremiah: Let’s talk a little bit about new innovations within the care space. Cionic is a company focused on providing technology for both the analysis of movement as well as the augmentation of movement. We know that stroke is still occurring at about 800,000 new cases per year, but that we have a decreased mortality rate, so people are living post-stroke longer. What are the innovations that have helped to enable higher quality of life and what things are on the horizon that you’re excited about mainstreaming into the care plans?
Zorowitz: I’m going to backtrack just a teeny bit, because in terms of some of the things on the acute care side…I’ve been very lucky over the years…when TPA first came out, now thrombectomy. Now tweaking all these things to decide how far out we can actually do these things that can help patients. The interesting part is that, you’re absolutely correct…there is decreased mortality. The problem, I guess which unfortunately keeps us in business, is the fact that you’ve shifted people who may not necessarily live through this entire thing…and may now live with a disability…and so we have to deal with all that.
There is a lot of stuff, outside of conventional therapies, that have been in development. There’s a lot of technological stuff, a lot of non-technological stuff, we have things like mental imagery, mirror therapy, bilateral arm therapy, constraint induced movement therapy for the lower extremity. You have body weight support treadmill training and things along those lines. So a lot of that stuff is there, and at most maybe uses a treadmill and harness, but a lot of it really is just good old fashioned therapy with the therapist and the patient.
With the technological things that have come about…I mean it’s fascinating to look at virtual reality. There’s been a lot of research there. Robotics: both upper and lower limb machinery that’s being done and then stuff like you’ve been working with in terms of being able to potentially use brain computer interfaces, BCI.
You have all these wonderful technological advances that are being made and it’s going to be interesting. I think the whole idea with something like bringing brain computer interfaces is really trying to see how you can bypass the damage and actually get function again. As opposed to trying to get the brain to reorganize itself and but you’re still limited as to what you know, what function you know, the brain actually actually has.
Jeremiah: We talked about some of these new innovations and something that I’ve been incredibly passionate about, for even longer than I’ve been working in this space, is data-driven healthcare. We know the amount of data that we’re starting to be able to generate on humans and the human body — especially as integration of sensors into clothing and devices that we carry around in our pocket, it becomes a deluge of data and the idea of how do you turn that data into action? What are some of the data that you use within your practice? What data do you wish you had more access to to be able to better help these patients?
Zorowitz: Well, a lot of what we do is really in terms of functional data, so I think the the first and foremost on the in-patient side, to this point we’ve been using a measure called the Functional Independence Measure (FIM) with Medicare/Medicaid, moving on to we’re now using the care tool, which is going to be more of a tool…instead of in-patient rehab, it’s supposed to measure function across the continuum of in-patient care, so into skilled nursing facilities and things along those lines.
I’ll be very frank on the outpatient side, which is really where things are probably more important for keeping patients out in the community, the kind of data that we have is not really great. And that’s because the question of “what is function?” and function is many, many, many different things. And so how do you measure that? I think it’s really a matter of you what do you really want to measure? It could be as simple as time not spent being in a nursing home or being at home, for example. Or, if it’s for walking, it can be walking speed, or walking distance, but these are finite very specific kinds of measures. There are other measures that are probably a lot more global, such as: how satisfied are you? Quality of life kinds of things.
So, from the functional standpoint when we’re doing research, sometimes it’s really difficult to figure out the most appropriate types of measures. I think one of the things in stroke has been spasticity and trying to correlate changes in spasticity with things like botulinum toxins or intrathecal baclofen or medications even: how do you translate that into function?
We may have one measure, but even that one measure of the disability assessment scale, looks at four different types of functions, which includes pain, it may include range of motion, different types of impairment measures. Again not great…but that’s the best we have. So, there’s still a lot of work. The idea of being able to measure these things ultimately becomes a tool box with good validated measures overall that are standardized, and can be really used across the board.That’s not necessarily that easy and there are tons of them out there. Which ones do you specifically use? Tough choice to make sometimes.
With the kinds of things that Cionic is working on, that’s sort of the Big Data kind of thing…If you’re looking at trying to look at brain waves and decode these things to try to translate it in the movement. That’s a huge amount of data because that’s getting readings from different parts of the brain, and then being able to figure out how do they work in movement? And however big those data sets are, they are absolutely tremendous so we have that kind of data that we have to work with as well.
Jeremiah: Yeah, and I think there are a couple different elements as I think about the opportunity around data, one of them being if you can democratize it in a de-identified and safe way so that people who are really into the data science of it and the research can identify those specific biomarkers or specific functions that can be modulated.
Cionic has been largely focused on the peripheral nervous system and the interaction of muscle firings and being able to measure spasticity in real-time…both as a cause…and the kinematic output as an effect.
An answer which came from our experience of taking my daughter Sofia to a gait lab and having her strapped up with all of the sensors…which took about an hour to set up and she did like five steps across the force plates and five steps back. Then we get a report and then you never saw any data on that again. Yes, it did inform the care plan at that one moment. But our question was “what if I could have that data all of the time,” and then what if the data isn’t just used in an analysis standpoint, but also used to power neural augmentation.
By combining that with functional electrical stimulation, which is what we do to make a closed loop system for a neural prosthesis. It can actually react to the environment she is in, say if she goes to school outside the lab and there are people and furniture around. Just the context of it all is so different. And I really wanted to see if we could do something about understanding humans as they are out in the community…as they are in context of their daily lives. Then not only just have the data for information…as you know I spent a lot of time in the “data as information” standpoint, but use that to power something that was actually helping them in real time.
Zorowitz: So the Big Data from there is really correlating what goes on out in the periphery with what goes on centrally and trying to make some sense out of all of it, which is a big order to fill.
Jeremiah: It’s cool because I do believe that neurology and understanding of the human brain is really coming into its own now and there are some amazing companies working on it. We just saw this week the news from Neuralink, with the monkey playing pong with its brain and their sort of similar mission, which is that eventually this type of technology can be applicable to all humans, but let’s start with the people who need it most. Neuralink is focused on spinal cord injury and the PCI interface into machines. Have you looked at their stuff and have interest in where they are going and applicability to the communities you’re working with?
Zorowitz: It’s interesting stuff. I mean just to say this is really a step in the right direction. The good news is that these kinds of interfaces have actually been around for about 20 years. So from that standpoint nothing new, although the technology has really gotten a lot smaller. And then the one thing that they’ve done here is they’ve used more Bluetooth technology to make this wireless, which is probably why everything we saw before was people connected up to wires, which isn’t practical in the long run.
But I do think it’s very cool that they’ve been able to get to this point, where it’s working at least now with animals and hopefully eventually with humans. I totally agree with you. The low-hanging fruit will be with spinal cord injury because at least there is a normal brain to work with and that’s going to be the easiest thing to work with to start. Really the Holy Grail is going to be figuring how…if at all possible…to work with brain injury patients who don’t have everything available to them, and in addition, their brains may not be as static.
One of the things we saw in grand rounds a couple years ago at the Applied Physics laboratory at Hopkins where they’re doing neural prosthesis, they had someone who could actually control a neural prosthesis just using their mind. But the issue they said was that for some of these things…trying to get everything in sync so that it will work properly is a major task. Hopefully artificial intelligence will help put that all together in the future. It’s a really interesting, but very difficult question to answer.
Jeremiah: I do think that there’s been some exciting innovations in control systems and machine learning algorithms and the productization of all of that. I started my career working in machine learning in the late 90s and we used to have to build all these things by hand.
You were building these hand-tuned models and now that we have all this infrastructure to just take care of you…what you have to do is go get all the well labeled data and you can turn a crank.
I think what drove a lot of that recently in complex systems around autonomous vehicles and those systems, and there’s only one company that I’ve seen that’s doing real true sort of end-to-end AI…and all the rest of them are doing a lot of machine-learned verticalized systems with a lot of checks and balances. You talk about speed and speed of coordination and think about an often taken for granted skill of walking. How many muscles groups are being fired in coordination with one another? That’s Cionic’s main area of focus is on gait…and you’re really trying to coordinate a bunch of systems together in milliseconds…right? Milliseconds of time.
I do think that we have an opportunity…and I am hopeful as I see more and more companies taking on human scale and clinical innovation…that they’re embracing the research community and working with them to bring the best of both worlds together. Because not often happened prior to this, where you have true research getting commercialized with true industrialization skill sets bringing those together as a challenge always.
Zorowitz: I totally agree. Absolutely. And that’s where universities or the National Institutes of Health can come together with industry to help move these things forward.
Jeremiah: One of the things that we’ve been trying to do with our system is not just build a single product…but build a platform and in that process we’ve been engaging with different universities to try and take some of their research and invention and bring it out. Because one of the big challenges that they all say — and I’m sure the folks that you were talking to in neural prosthesis said the same thing — you spend so much time just building the hardware. And if everyone is rebuilding the same hardware, you’re not getting that scale, and the same sort of scale that came from cloud data centers, I think will now allow us to democratize access to the human body. What innovations can be inspired there?
Zorowitz: Yes, and ultimately be able to use…as I like to call it…the original equipment as opposed to having to deal with the prosthesis. That will be an amazing thing if we can accomplish it.
Jeremiah: Outside of their very personal connection to brain injury that is cerebral palsy, just the idea that with a lightweight soft exoskeleton or a sensor enabled garment and the stimulation enabled garment…you can take advantage of existing musculoskeletal strength. And it is about coordinating those pathways and, as you said, if we bypass the damage or read on one side and write on the other…there’s an opportunity to hopefully in a very low footprint be able to give greater mobility and freedom.
Zorowitz: And that’s one of the other Holy Grails that I think you’re working on so well: Trying to make this stuff so that patients who have weakness to begin with can actually wear and tolerate these things to a greater degree than they can now.
Jeremiah: Sometimes it feels like it’s just a million small things. Right? As you said, BCI has been around for a long time and the innovation that’s happening now: one is, being able to pack a lot into a small space of miniaturization — the power of speed to do these rapid iterations on small time scales, and then it’s all these little things that go from something that can work once to something that works on a wide swath of all of these individuals. Giving them an opportunity to engage in different ways into their own rehab which we said at the beginning was such a key and critical advantage as we move forward into it.
Zorowitz: And I think with these things will serve really two purposes. One, the functional purpose is certainly very important…and that’s more in the compensatory realm… the other is the facilitation realm of what can you do with these things that actually might help improve function of the patient themselves.
Jeremiah: We have talked about sort of this continuum of abilities.I say I’ll never be as smart as Stephen Hawking or as fast as Usain Bolt…that we’re all on this continuum. Now, there’s very binary words like disability, which I think short sell the complexity and the nuance and what those people are highly abled to do. And so, if we think of the aspirational — of being able to move everybody up that continuum — where comes the point when someone thinks “well, I’m going to use the same technology” as maybe as the Neuralink case for spinal cord injury patients… “I’m going to use it because it gives me a function that’s beyond existing human capabilities.” Not just replacing something that has been taken away. But exceeding human potential which I think inspires us to also push further.
Zorowitz: So it really can serve a couple of purposes for the disabled community as well as hopefully, you know, maybe the abled community in the future. But I guess we will have to see where this takes us.
Jeremiah: Absolutely. I wanted to ask justas a last question back to resources for those who have recently suffered a stroke and those caregivers. Where would you point them? Where should they go look for more information on best practices and new forms of care?
Zorowitz: From the work I’ve done with others, the American Stroke Association website, which is on the platform stoke.org is a great place to start. We have a lot of professional, as well as lay people resources out there. There is a stroke warm line. So if any stroke survivors need help, there is a number they can call to talk to somebody and help and hopefully get some of the help that they need.
If you have a local rehab hospital nearby, chances are there’s a stroke support group that’s associated with it. And that’s often a good place to be able to get together with other stroke survivors as well as caregivers for that emotional support education.
I think those are probably the two best places to start, and there are some national websites out there for stroke support groups.
Jeremiah: Fantastic, thank you so much for this conversation. It was really a lot of fun, hitting a lot of topics and thank you for all of the work that you are doing in this space to further the quality of care for stroke survivors and other brain injuries. Thank you so much.
Zorowitz: Thank you, it was a lot of fun. And again, thanks for inviting me.
Jeremiah: That’s all for this episode of Superpowering the Human Body. Thank you for listening. You can subscribe to our podcast on Soundcloud or YouTube. Until next time.
