Brain Injury Recovery at Home: Making Everyday Life Part of Rehabilitation | E78

Dr. Ayla Wolf DAOM: 00:00 My guest today is Dr. Christopher Gaskins, a cognitive motor neuroscientist and neurological occupational therapist who has spent more than 15 years helping people recover from brain injury, concussion, and stroke. His career has taken him from working with wounded warriors and veterans at Walter Reed to earning a PhD in neuroscience and cognitive science and founding his own neurorehabilitation practice, Neurosuite. What I especially appreciated about Dr. Gaskins is his ability to bridge the gap between what we know about the brain and what actually helps people function better in everyday life, as his job takes him directly into people's homes to help them figure out how to navigate life a little bit better. Please enjoy my conversation with Dr. Gaskins. Welcome to Life After Impact, the concussion recovery podcast. I'm Dr. Ayla Wolfe, and I'll be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information. Whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr. Ayla Wolf DAOM: 01:30 Dr. Christopher Gaskins, welcome to Life After Impact. How are you? Dr. Christopher Gaskins: 01:35 Great, great. Thanks for having me. Dr. Ayla Wolf DAOM: 01:37 You are welcome. You are a PhD, a cognitive motor neuroscientist. Explain what that is. Dr. Christopher Gaskins: 01:46 So obviously, it's the blend of examining cognition and motor function, but really being able to understand the level of concentration and attention that's attributed to being able to complete a motor action. So the best way to think about it is, you know, think about it like if you're tying your shoe, you're probably eliciting very, hopefully very low mental effort of workload because he's been doing it since he's been like a little person, you know, like a young person. Um, but then if I gave you more challenging tasks, like trying to crochet or maybe trying to code, you have no idea how to do it, you know, you're resulted more of um, you know, a cognitive, you know, workload because you're not as familiar with that motor, you know, sequence. Um, so it's really just being able to understand the allocation of cognitive resources that we need to be able to complete everyday movements. Grab in a cup or something even as complicated as you know, typing, typing a dissertation. Dr. Ayla Wolf DAOM: 02:49 Yeah. I guess one of the analogies I sometimes think about is like when you have way too many apps running on your phone, and then your phone starts acting weird, and you're like, I'm just gonna shut all these down, and then uh see if we can reset it, and then does it work better? I think sometimes we don't recognize that that's how our brain works as it's running all these simultaneous programs. And uh you throw a brain injury on top of that, and all of a sudden it's hard to run all those programs at the same time. Dr. Christopher Gaskins: 03:19 Yeah, exactly. Dr. Ayla Wolf DAOM: 03:21 Okay. So you are a neurological occupational therapist, an educator, an entrepreneur. Uh you have a background working with the military as well and advising them. I'd love to hear more about your background and kind of how you ended up in in this place where you are now. Dr. Christopher Gaskins: 03:39 Yeah, sure things. So at the University of South Carolina, I did an internship at a rehab hospital called HellSelf. Now it's called Encompass. And during that time, often, you know, although I was working as an assistant or a therapy aide, I would have to work with individuals living with stroke and brain injury and other neurological uh conditions. And a lot of times my uh superiors, the PT and OT that I kind of worked for and supported, they would kind of be surprised and say, Well, Chris, how did you kind of get them moving or how did you get them engaged or talking? And I realized I had like an affinity for, you know, working with those that have, you know, brain injury. So, you know, as I got through school and as I became an occupational therapist, I just tried to kind of steer my career while working at Walter Reed uh National Military Medical Center to really support those with brain injury. And I started out working on the inpatient TBI unit where I was the primary um OT there, working with those individuals that have, you know, been exposed to blasts, you know, while in conflict, um, you know, even gunshot wounds, uh, traumatic injuries or accidents. And we will do everything from managing your schedule on your phone to going out in the community or even learning how to go on a date again, or even learning how to get on the on the metro. Um, and that's really, you know, where my affinity for working with those limited brain injuries just really blossomed. Um, but at the same time, some of those experiences that I had were challenging in that I became frustrated because some people did not respond as well to therapy as I hoped they would. And it kind of sent me down a path to better understand the brain, uh, hence me obtaining a PhD in neuroscience and cognitive science. Um, but now with my company Neural Suite, it's really about just bringing all those experiences together collectively as a scientist and occupational therapist, and still continuing the mission to help those living with brain injury. Dr. Ayla Wolf DAOM: 05:41 Yeah, that's amazing. And it sounds like from your website, you use a lot of different therapies, whether it's virtual reality, um you've got a lot of tech in your office that you use, but then you also really help people to not just work with them in the office, but to really translate that into what is happening in their house, what is happening at work, how can how can they make shifts that make their life easier? Um, so why don't you talk a little bit about kind of what your work looks like in office and then how you help translate that out of the office? Dr. Christopher Gaskins: 06:12 Yeah. Well, we believe that the home is a therapy gym. So while again, we do, you know, love leveraging technology when appropriate and different therapeutic tools, but the most salient and important tools, you know, to our patients are indeed the things that they operate and and use, use every day. So most of our work, I mean, well, really up until just a week ago, 100% of our work has been done in the home and in the community. Uh, we just got a brick and mortar uh literary just early on this week. So my gosh, congrats. Yeah, thanks. We'll be offering in clinic and in homework. But yeah, we believe a lot of the magic happens in the home because it's salient. Uh, and that's a principle of neuroplasticity that you hear me mention a lot, but it's meaningful to the client. So our typical day, you know, usually will involve, you know, uh a commute to our clients' homes, uh, usually, you know, hopefully no more than 30-minute commute uh throughout the Washington, uh, Maryland, and uh Virginia area. And, you know, a lot of times we're instead of leveraging like a lot of therapy tools, we're using the mug in the home. That's the favorite mug. We're, you know, help them stand up from their favorite, you know, chair, going to their bathroom, understanding what their bathroom or what their bedroom looks like in case they need to provide, you know, modifications. Um, so I feel like it provides a simpler approach, but you know, equally a more meaningful approach because we're working, you know, directly in their environment. And then two, we're able to see things that the traditional clinic therapists, you know, wouldn't see. We're able to observe the cleanliness of the home or you know, the amount of clutter, which might indicate, you know, depression or disorganization. Um, you know, we're able to observe the interactions in the home environment where they're really comfortable, uh, because people might act a lot differently being like in a clinic versus being in their, you know, in their home to say. And we're also able to even observe like even the car or the vehicle in which, you know, that they uh, you know, leave the home, or even just, you know, going out into their garden. So it's uh it's a very unique model, but it has, you know, to me, significant value because you really are understand the person a lot more through the restition, you know, of the of the home. Dr. Ayla Wolf DAOM: 08:39 And are you finding that when you go into people's houses that you're identifying certain obstacles that kind of immediately need to be taken care of that could be dangerous? Dr. Christopher Gaskins: 08:49 Yeah. Yes. So a lot of things. Um mainly the bathroom is often a target area or area of interest. So a lot of times uh people might have mobility issues and it might be a tub shower combination as opposed to like a walk-in shower. Um so we have to immediately be able to identify modifications or a depth of equipment that they can use, like a tub transfer bench or a handheld shower. Um so we notice that immediately. And then two, we also notice, again, clutter. So thinking about the cognitive aspect, you know, of a brain injury, organization can be challenging. How to organize the mail and identify the bills need to be paid versus like the junk mail. Um, you know, have how to have a consistent routine there. Even how to understand for proper nutrition how are you going to eat. Um, if you go into the fridge and things are scattered, food that's spoiled, spoiled is not being thrown away in time. It creates visual clutter, which then creates mental clutter, and you know, the performance is impacted, and then you may not get the proper nutrition. So, yeah, those are just kind of a couple examples of things that we immediately kind of look for that we, you know, that we ready to kind of adjust um as you need to best help our clients. Dr. Ayla Wolf DAOM: 10:06 Yeah. Dr. Ayla Wolf DAOM: 10:06 And I think one of the things that we don't always think about as clutter is our digital clutter. And now that so much is on phones and computers, like I know that was something I really struggled with. I I process so much information in my my three different companies that I own that it's like I've had to get really, really good at having better organizational systems on my computer, but I still know, okay, I know I saved that file somewhere, but I can't find it. And also passwords are the bane of my existence. So are you also helping people with the the digital clutter and just their digital lives? Dr. Christopher Gaskins: 10:43 I yes, I actually really enjoy this part. Yes, we do. So a lot of times, one we want to determine right away are you a digital phone person or you prefer a written methodology? And a lot of clients actually prefer to use their calendar. They like still the kinesthetic effect of handwriting and how that helps them reconnect with the tasks that they're trying to remember or do. Um, but given technology, you know, our young younger brain injury clients and older, they do like to use their their phones. So we're mainly identifying the primary apps of interest. Calendar management is almost always the first thing. So using the in-stock calendar app, like on the iPhone or even like the Android. Second thing, we understand the importance of engaging the caregiver, the husband, the wife, you know, the the child, the mother, the father, when possible. So we then are looking to say, okay, is this a share calendar? How are you communicating these schedule changes to your loved one who also shares responsibility and making sure you remember those appointments? Um, so we do that immediately. And then also we make sure that the calendar is not being overused. So you want to use it for events, but maybe for reminders of day-to-day things like remembering to brush your teeth or you know, remembering to uh, you know, walk them 10,000 steps a day, the calendar might not be best fit for that. So then we'll look at a reminders app to couple with that. And then depending upon the client, but we can use different things. So, for example, we worked with a brain injury client uh last fall, and his big task was to be able to prepare a meal for his family, to get into the routine of going grocery shopping and preparing a meal. So, what we did with the reminders app in his iPhone is that we created a grocery list, one that he can easily check off in real time as he's in the grocery store. But then instead of just making a generic reminder, like we didn't just want to say, okay, iPhone, remind us of the grocery store list at five o'clock. We had like a geotag to like his favorite grocery store. So that when he got within a certain proximity to like this uh, what was it, mom's organic, I think. Then we we had like a geotag for that grocery store so that that reminder will automatically come up on the phone when he's in that area. Um yeah, and it turned out to be very successful. He was able to go to the grocery store, get the items that he needed, and then that next session he was able to prepare the meal, you know, for his family successfully. Um so yeah, we're big into looking at the technology and trying to simplify it first before we start adding on. Dr. Ayla Wolf DAOM: 13:40 Sure. Yeah, yeah. Because technology can be such a great source of frustration, but it can also be amazingly helpful if you can set it up the right way. unknown: 13:50 Totally. Dr. Ayla Wolf DAOM: 13:51 Yeah, that's awesome that you're you know getting giving people like that really, really concrete practical help to just make their days go easier. Because sometimes we do get into habits where uh, or maybe we don't have a routine of putting our keys in the same spot every day. And then it's like every day, okay, where are my keys? Um, and so those little things like that that can just add stress to your life if you don't create those systems. Dr. Christopher Gaskins: 14:17 Yeah. And another thing with the current times, uh AI has definitely come into the forefront. And clients were experiencing and testing and trying to use AI, you know, more and more. Um, so also we spend time educating clients on responsible use of AI, whether that be ChatGPT, Claude, Gemini, whatever they prefer to use. And then use that as uh, you know, memory assistant to help them organize their thoughts, but teaching them how to even organize chats within the AI so that you know they can return to prior work that they've done and not rehashing or restarting a conversation every time. And, you know, most recently we successfully use, you know, Chat GPT as well as some other uh functions to help a client refine their resume. Um, and then proper put it on on a you know professional looking letterhead and be able to send that out to potential employers. Um yeah, so yeah, again, we're constantly you know trying to simplify the technology and then response be kind of layering different apps to kind of help people do what they need to do. Dr. Ayla Wolf DAOM: 15:25 Yeah, I have a a friend of a friend who is developing an app that's specifically meant to use when people go to their doctor so that they can kind of record the conversation and then it can organize it and and using AI can kind of explain what just happened at that doctor's appointment as well, and then they can save it. And I think that I mean, things like that for some people, I think would be game changers, especially if you know you have poor memory. I can't tell you how many times I hand people instructions or appointments and they call me back and they say, I lost the piece of paper you gave me. It happens like every week. And so to be able to have an app on your phone that records everything the doctor said and then explains it to you, it sounds like a phenomenal tool. Dr. Christopher Gaskins: 16:12 Yeah, there's a need for it. Uh yeah, you're just bringing back memories to experiences with past clients. But yeah, there's a client I was working with um again last fall. Uh she's living with Parkinson's disease, and that's literally what we did. I mean, I think we spent like a whole week trying to find an app that would do just what you described. So, yes, your friend needs to get that app out. Dr. Ayla Wolf DAOM: 16:33 Yeah. I'll get you the name of it. I'm pretty sure it's already launched. Dr. Christopher Gaskins: 16:38 Nice. Dr. Ayla Wolf DAOM: 16:39 Yeah, yeah. Dr. Ayla Wolf DAOM: 16:41 And then what was your role as a military health subject matter expert um on the brain injury initiatives that they were working on? Dr. Christopher Gaskins: 16:50 Yes, that was a very interesting experience. Because it allowed me to kind of peep beyond the veil and see the other side to my healthcare, military health. And it was unique such that my first years working as occupational therapist from 2011 and 2017, you know, I was working for um, you know, a certain military facility um or practice. And then for me to come back as, you know, a military health consultant, I was supporting that same client, which was ironic, because you know, that same client I worked for as occupational therapist. Now I'm coming back as a consultant from the business aspect. But particularly my experience there was supporting um a group of uh wounded warriors and then also civilians uh that had a unique type of of injury or brain injury, and really just being able to contribute to structuring that program um so that get so that those people could be, you know, service properly so that they so that they could get the help that they needed. Um so a lot of my day-to-day there would consist of helping to one better understand the pain points within the workflows of that organization. How can we develop metrics to be able to track the how well that that program was performing? So being able to capture like how many clients you know might be seen within a time frame, try to quantify the amount of casework or management that would have to occur to make sure the clients got the proper care. Um and even just to even encourage communication between different military treatment facilities so that they can best help, you know, this this unique population. Um so it was a great a great experience. Again, you know, I was able to see on the other side from the business aspect, from a you know, kind of like a bird's eye view, from a more systematic viewpoint on how we can structure systems to be operate more efficiently to best help those with brain injury. It made me really, really passionate about it. Uh yeah, because I think there's always opportunity to make things a little simpler for our patients and easier and more accessible. Dr. Ayla Wolf DAOM: 19:08 And obviously with brain injuries, everybody's symptom profile is completely different. How how individualized is the therapy at a place like Walter Reed? Dr. Christopher Gaskins: 19:20 Yeah, yeah, most definitely. Amazing care there. Um, yeah, I mean, contrary, I really didn't see a lot of experiences where care was kind of uh, you know, the same for various individuals. It was always highly customized. And I think that speaks to the organization of the program, but also just speaks to, you know, the professionalism of the therapist. Just learning to be what we call client-centered. And, you know, like you said, every brain injury is not the same, everyone looks a little bit different. And interventions that we would use also look a little bit different. Um, again, ranging from grocery store outings to meal preparations. I mean, even one client I, you know, helped take him out in the community to get him prepared to take his wife, you know, on a date because he kind of lost that ability to kind of socialize, just like his brain injury. Um Yeah, we I mean we did all kind of things, but yeah, it was highly, highly customized. And um, you know, I kind of brought that into my company at Neural Suite. And kind of shedding this notion that, okay, to maybe see more people, you have to develop a you know, program that everybody gets the same treatment to like, no, there's some things we can standardize, but you know, always like let's think about what's most important to the client. Like I always tell my clients during our evaluation, I kind of preface them to what I'm about to say. But I was kind of saying like, okay, now we're getting to the most important part of the evaluation, and then I kind of pause for a second, and they're kind of looking like, what are you gonna say next? And I say, now tell me your hobbies, tell me your interests, tell me your goals. And like more times than one, there's a pause, unfortunately. Because it's hard for them to really think about, well, oh my god, like what do I like to do? Because for so long I've been focused on what I have to do to get better. Um, but our philosophy at Neural Sweet is that we we use like your hobbies and your interests as uh impetus, like as a as a tool to help you address these executive function challenges or these memory challenges. So yeah, I would definitely say we highly customize. Dr. Ayla Wolf DAOM: 21:28 Yeah, yeah. You've got kind of a a framework, but within that framework, a lot of wiggle room to to focus on individual people. And I imagine with the the veterans, you so many of them probably had other injuries as well, not just uh TBI, but on top of that, simultaneous other injuries that also needed to be kind of rehabbed at the same time. Dr. Christopher Gaskins: 21:50 Yes. Yeah. So I think we will see uh accompanying like brachial plexus injuries, um, a lot of polytraumatic injuries. Injuries, so orthopedic injuries coupled with, you know, nervous system injuries, um, amputations, um, you name it. And then also we think about the mental health aspect, depression, anxiety, you know, PTSD. So yeah, we're we're trying to be very acutely aware of all those different things and concerning and considering how that impacts the care. Mm-hmm. Dr. Ayla Wolf DAOM: 22:22 Yeah. And from what research I have read on blast injuries, it really sounds like that's uh a very unique type of brain injury in in in the fact that it is much more widespread in how it kind of impacts the brain. Did you find that the people suffering from blast injuries had a much harder time recovering? Or was did you were there certain things that you did differently in that population of people that were more effective or helpful? Dr. Christopher Gaskins: 22:52 Yeah, that's a good question. I will say, yeah, I think we did we did tend to find, I don't know if I'll say those clients more challenging, more challenging things to work on. But I'll just say, like to your point, because the blasts, you know, can affect the brain from a more of a diffuse perspective. It's not focal. Um, yeah, we would see more, more diverse symptomology. So again, you know, the impulsivity or or frustration, um, coupled with, you know, sometimes even hemiparesis. Um, so like a partial, you know, paralysis like of the limb or of the side of the body. Um vision is another is another big one. Um yeah, so we would see. So I think, yeah, to answer your question, I think we we will have to employ more strategies, not just based in a neuromuscular viewpoint. Um thinking about trying to repair like the the neuromotor dysfunction, but oftentimes we also have to, again, rely upon like a social psychosocial framework as well, as well as sometimes like just a pure what we call biomechanical frame of reference. So just really, you know, because these polytramatic injuries thinking about, you know, really trying to improve the range of motion to be able to do, you know, meaningful functional things. Dr. Ayla Wolf DAOM: 24:21 Did you guys have hyperbaric oxygen therapy at Walter Reed? Dr. Christopher Gaskins: 24:26 Yes, we did. Yep, yep. But OTs didn't, we didn't necessarily work um, you know, with those that were in the hyperbaric chamber. But yes. Dr. Ayla Wolf DAOM: 24:35 But it was one of the therapies being offered. Yeah, that's awesome. Are there any um stories that stand out to you? Dr. Christopher Gaskins: 24:43 Yeah, no, there's several. Uh there's several. I'm just trying to think of the the best one to say and then make it appropriate for the podcast. Uh yeah, I I think, I mean, the things I remember I mean several cases. Um but you know, I think about an individual that, you know, had a brain injury and he'd been essentially shot in the head. Um and then he, you know, he lost his his vision or his perception of of vision. But then it affected his personality, I mean, tremendously, almost like a Phineas Phineas Cage story. Um and just what we call the flat affect, like the challenge in just being able to smile or make appropriate facial expressions or just show like emotion was extremely challenging. And at the same time, observing like the pull away from the family and the and the young daughter. And as an OT, I'm just trying to think, you know, what can we do like to help him express more, you know, to be able to preserve like his family relationships. Um, that was that was particularly challenging. Um, and that's a gentleman where we literally did like a community reintegration activity to kind of prepare him for taking his wife on a date. Um But that that was yeah, that was you know transformed to me like as a as a young as a young therapist. Um also think about you know, also a lot about a young, well not so young, but uh a fairly young mother. Um and her husband, you know, was in the army. But her, she just really loved the role of being like a a wife and and a mother. And then, you know, since she she she suffered a brain injury, I'm trying to remember, I think her some of her blood vessels uh ruptured, like in her inner brain, and just you know, very, you know, traumatic, serious, like anoxic like brain injury. And yeah, just just work with her a lot and a lot of strides and great things were were done and made, from her being able to uh sing, Dr. Christopher Gaskins: 27:04 you know, you know, as a way of expressing herself, to, you know, her being able to go to like a grocery store. We went to like Cheesecake Factory, where I'm training her on how to like, you know, use like a scooter to go through the community. Um, or even just make eye contact because the vision was impacted, just be able to hold and sustain eye contact with a loved one. Um that that was very touching and affected me. But also as a therapist, it frustrated me some because I felt like, you know, we couldn't, I wish we could have done, done more. Um really her story was really part of the reason why I decided to go back and get you know my PhD. Um yeah, so I mean I have to thank her a lot. And I mean, fortunately, like she's still here with us. We you know, we still communicate and and you know, I get Christmas cards every year from them. Um but yeah, definitely uh changed, changed my life just as much as I hopefully changed theirs. Dr. Ayla Wolf DAOM: 27:57 Well, I mean, such a different relationship, I imagine you form with people when you're actually in their homes helping them to adapt their home and you really get to know a side of people that most clinicians don't when you're right there beside them, figuring out their bathroom and their kitchen and their living room and yeah, I agree. Dr. Christopher Gaskins: 28:20 It allows for opportunity to be um very transparent and you know, kind of peeking behind the veil. And um a lot of clients are excited about it, but then once we get in there, get in there, we really start seeing things. Sometimes they can even be, or the caregiver can even be like a little protective, so to say, or a little uh defensive, even if I can if I can say, because I mean we're really, I mean, you're exposed, like really seeing like everything and how we can you know best support. Um so yeah, I definitely think it's uh it's an intimate um setting, and it's just a really opportunity just to see, you know, the full person and seeing just how their environment is is tied, you know, to who they are as a person. Dr. Ayla Wolf DAOM: 29:04 Yeah. And on top of making changes in the home or on the phone, um, are you actually then also doing rehab sessions in the home with active therapies and kind of what does the actual uh uh neuro rehab part of it look like? Dr. Christopher Gaskins: 29:21 Yeah, yeah, very heavily. Uh depends upon the the diagnosis, but for somebody that might have like neuromuscular impairment, so you know, because they're brain injury, they might have what we call spasticity. So just kind of like this overreactive, you know, brain condition, you know, that that really just causes like essentially like hyperactivity, like of the electrolectrical signals being sent downstream to like the limbs. And sometimes that can result in what we call spasticity. And the arm, it might look like you know, the elbow kind of flexing, the wrist flexing, you know, the forearm pronating, hand flex. But with that, yeah, there are a lot of things that we do, a lot of sometimes um what we call task-specific training, which is a fancy term, but again, it just ties back to this idea of doing things that are meaningful to you, but they have to be functional. So if you're working on self-feeding, I'm not gonna waste time and give you um, I don't know, like a popsicle stick for you to work on, bring it to your mouth. It's like, no, let's get let's get like a real fork, you know, let's get like a real spoon and let's get some reps in on this. Like, let's get, you know, several reps. Um and just in my approach, I attend a couple TAS-specific training with tactile cues, so gently touching the body in various places to elicit or support certain movement that we want to facilitate. Um, then if needed, which I think a lot of times OTs can probably do a better job of being aware of, but understanding the musculature and that, you know, if somebody is tense, if somebody has plasticity, they're gonna have, you know, musc muscular and um restrictions. And sometimes you have to release those those trigger points, release that tension to be able to improve the range of motion. So always couple, you know, my tax-specific training with that. Um, and then a lot of good old what we call activities a day live-in training. Um, how many times can we get your shirt on? Can we reduce the time it takes to get your shirt on? Uh for those high-level clients, cooking. If, you know, if it's a little bit more challenging, maybe just let me see, you made some oatmeal. But if you're kind of up there and we can challenge you a little bit more, let's see a three-course meal even. Or let's see at least uh a breakfast. Like just a couple weeks ago, I made breakfast with uh, you know, one of my clients and educated her on safety. You know, don't put the plastic spatula, don't leave it on the um pot for too long because it's hot and it could melt. Like, I mean, very critical, important things. Um, and then lastly, you know, technology when appropriate. Um, so there are various like robotic, you know, devices that can help people learn to use their limbs again. Um, electrical stimulation. Uh, so for that impair signal signal that the brain attempts to send downstream to the arm and the hand, you know, we can use electrical stimulation that can facilitate hand movement or arm movement. Um, that can be very good for the brain. Um, even you know, vagus nerve um stimulation. Uh, there's a device called uh the Vivostem, in which clients get an implanted um uh vagus nerve stimulator. And as a therapist, we're actually able to control the amount of stimulations that they get during the session. And every time we're administering that stimulation, you know, they're getting a burst of those good neurotransmitters like acetylcholine and norepinephrine that can facilitate neuroplasticity. Um so yeah, our sessions are very dynamic in the home. Yeah, and we're definitely doing a lot of you know different ways of neuromuscular rehab or cognitive rehab, as we say. Dr. Ayla Wolf DAOM: 33:13 Yeah, yeah. You're kind of a one-stop shop with the OT and the hands-on work all combined. That's incredible. Dr. Ayla Wolf DAOM: 33:23 What do you see changing in the future when we look at what technology is out there? Um, what are you excited about? Dr. Christopher Gaskins: 33:31 Yeah, I feel like there has to be more interventions or technology that is uh directly either trying to understand the signal that the brain is trying to send, um, and then be able to map that signal and you know, into like uh an action. So, like what I mean by that is, you know, because somebody suffered impairment, if they're trying to elicit hand movement, and if we look at the brain, you know, that that neural activity might not be coming from, you know, the typical area that we expect, like in a motor cortex, you know, um, it might come from somewhere else, or it just might be a different pattern just due to the injury. And I think the ability to be able to characterize that pattern, we can now understand the client's intended movement or intended goal. And then if that intended movement can be packaged and sent to like a robotic arm or robotic hand device, you know, I think that can be beneficial for one, helping the client just better engage in motor learning and facilitate neuroplasticity, but also most importantly, just helping them do meaningful things. And I think technology is already heading that way with a lot of brand computer interface, you know, devices, like the Ipsy Hand, uh, for example, does something similar. But that's kind of where I would like to see things go. Um and I would like to see it be done if possible in a way that's still cost-effective for the client. Or it needs to be a clear pathway that the client can actually or assurance will pay or cover the device. I think that's critical. Yeah, yeah, absolutely. Yeah, I think it's important to be advocates for our brain injury survivors. And I think kind of going back to this idea of my PhD, which focused on this concept of mental workload, like everything you know we try to do, want to lessen the mental effort to do things to have a desirable outcome. And I think that you know, that really applies for the healthcare system. Um, unfortunately, there are a lot of stuff. Dr. Ayla Wolf DAOM: 35:42 You mean it's not easy to navigate? Dr. Christopher Gaskins: 35:44 Man, listen. Oh my goodness. It's unreasonably challenging. And the patients suffer. And that's, I mean, because we're boots on the ground, I see that, I see that firsthand. And it really matters. Timing matters. I think things need to be looked at in a way if if we can strip down, we can still protect the patient, but if we can strip down unnecessary policies, um workflows that are any data with a lot of fluff or redundancies are not needed. I think healthcare as a whole, ranging from insurance companies, you know, to those that make, you know, the laws, to even down to the policies of the healthcare companies. We constantly need to take a look at at this. Um and I think too, like, I think we need to listen more to our patients and their experiences, understanding the logistical headache that they have to go through to get care or be able to get proper resources. And again, going back to this note of mental workload, you know, some may not even have the emotional gusto or, you know, the kind of ability to sustain being put on hold for 20 minutes because you want to get a prior off so that you can get the proper care you need. Or they might not have the ability to be able to uh complete a client intake form for this facility. But now because facility A and facility B don't communicate, when I go to facility B, I have to do this all over again. Or even just capture your history. If I had a traumatic event, I don't want to keep on telling it over and over and over. It matters. But this is an easy problem to solve by just simple. I won't say simple, but we can communicate better. Things can be, you know, in the technology world, agnostic, things can be better kind of interconnected. Um, so at least for neurosweed, like we continue to push and make it things safe but simple. Um, but I just really hope that yeah, we can have the impact to kind of push some change amongst the whole healthcare system for those of them with brain injury because um I think that's something that we're overlooking. I mean, I'll just say that. So yeah. Dr. Ayla Wolf DAOM: 38:00 Yeah, yeah. No, absolutely. You bring up a a really good point. And I think we've all had the experience of even like going to the dentist and saying, why do I have to write my name and my date of birth and sign like six pieces of paper? Dr. Christopher Gaskins: 38:13 Right, right. Yeah. It matters, yeah. Dr. Ayla Wolf DAOM: 38:17 Yeah, yeah, yeah, it does. It it does. Dr. Ayla Wolf DAOM: 38:20 Oh my gosh. Well, I will include all of your contact information. Um, you said you just opened a brick and mortar as well. Um what is that gonna look like? Are you transitioning more than to doing that, or are you just expanding your team to be able to offer all of the services in-home and I'm excited, yeah. Dr. Christopher Gaskins: 38:41 Um, one thing, so mobile will still be the main mode of care, delivery of care, mobile practice. So we'll still travel into the client's home. So we I wanted the brick and mortar um because I do want to be able to create programs and standardized systems and therapy protocols. And, you know, I thought that can be best done in like a central location. And then additionally, you know, because I'm a neuroscientist, my passion with starting neural suite was to one provide the neural the neural rehab. We we treat our clients. But then that was always meant to build like a research and development portion of the company. So the brick and mortar location is the the beginning of that essentially. Um so the long-term goal there is to again be able to use that that space and be able to begin to craft studies uh so that we can, you know, that we can do research and begin to collect data and do studies that can again affect affect policy and affect um better care. So we hope to be able to develop rehab products, you know, and protocols that can push uh the care for brain injury survivors, push that forward. So those are the main aims. Yeah, I'm excited. Dr. Ayla Wolf DAOM: 40:03 Awesome. Awesome. No small tasks. So I wish you all the best. I know research sometimes feels like it moves slower than we want it to. Dr. Christopher Gaskins: 40:14 Yeah. That's another discussion that can the same rule applies of uh safe and simple. I think there's a way to make it simpler and a little faster. But yeah, I digress. Dr. Ayla Wolf DAOM: 40:25 Awesome, awesome. Cool. Well, I will definitely stay in touch and uh would love to hear what you what you're doing down the road here. Dr. Christopher Gaskins: 40:32 Thank you, thank you. Dr. Ayla Wolf DAOM: 40:34 Yeah. What is your um your website just so people can go there if they want to learn more? Dr. Christopher Gaskins: 40:40 Yeah, sure thing. Uh neurosuite.rehab. So neuro by neurological and suite, like a suite of rooms.rehab. Perfect. Dr. Ayla Wolf DAOM: 40:51 All right. Awesome. Dr. Gaskins, have a good rest of your day and long weekend. Dr. Christopher Gaskins: 40:56 Great. Thank you so much. Dr. Ayla Wolf DAOM: 41:01 Medical disclaimer. This video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis, or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.