Episode 65: Discussing MS Study with Lead Investigator Courtney Ellerbusch, DPT

Join us for an inspiring episode of our podcast as we delve into the recent published scientific article looking at the effect of the Neubie on functional recovery in MS patients. ‍Our special guest is the lead investigator on this study, Courtney Ellerbusch, PT, DPT, a distinguished physical therapist with 9 years of experience at Centura Health in Colorado. She shares her journey a career focused on neurological conditions such as MS, stroke, Parkinson’s, and neuromuscular movement disorders. ‍

Then, we explore her unique approach to treating MS patients with a Neubie treatment strategy. Her 4-part protocol, involving neuropathy relief, mobility and spasticity management, targeted muscle strengthening, and functional training, is a game-changer for patients with neurological challenges and forms the basis for the treatments she used in the study.‍ Finally, we discuss the objective data and compelling results of Courtney’s groundbreaking study, plus the inspiring stories and subjective experiences of the patients who participated, illustrating the transformative power of Courtney’s approach.

Whether you’re a healthcare professional seeking insights into cutting-edge therapy, a patient facing neurological challenges, or someone passionate about the intersection of science and human well-being, this episode offers invaluable insights that you won’t want to miss. ‍

Tune in now! Here is the link to the study we referenced in this episode: https://pubmed.ncbi.nlm.nih.gov/37465424/

Read the transcript:

Garrett Salpeter (00:06.243)

Welcome to this episode of the NeuFit Undercurrent Podcast. I have two people joining me today. Ramona Von Leyden is my cohost. She’s the PhD neuroscientist who runs our research and clinical education programs. And you may recognize her from previous episodes of our podcast, or if you’ve been through any of our certification trainings, she often is the model patient that we get to work on. So also our guest of honor is Courtney Ellerbush.

Courtney is a doctor of physical therapy working at Centura Health in Colorado. She’s been there for nine years, specializing in working with neurological patients. She works a lot with patients who have MS, stroke, Parkinson’s, and other neuromuscular movement disorders. She also is the PI, or the primary investigator, on the recent published study looking at the newbie and how it affects functional recovery in MS patients.

course we’d love to hear some of Courtney’s background and experience and also do a deeper dive into the study today. So Courtney, welcome.

Dr. Courtney Ellerbusch (01:11.67)

Hey, thank you so much. That’s awesome. I’m so excited to be here today with you guys. So thank you for having me. And I imagine I’ll go a little bit into my background, where I’m from and kind of how I got here, like you said. So I’m born and raised in Williamsburg, Virginia. And one of my first careers was as a personal trainer after college because I wasn’t quite sure what to do with that degree. So.

I knew I loved helping people, and so my first job was out there in Richmond, Virginia as a personal trainer and began to kind of get frustrated by what I didn’t know and trying to help people recover from pain. And I also began to kind of have some interesting conversations with folks that have kids that have learning disabilities, and I was invited into some really cool spaces. Like there was this house that was…

‍made for kids that have autism. And I came in as their personal trainer and I learned a lot from those kids and from that experience but also was so hungry to learn a lot more about the body and movement and movement as medicine. So I took a dive with few resources into going back to school, college at age 26 with…

‍very little resources and kind of sold whatever I had and went to part-time work and did pre-rec resit courses to apply to my doctorate of physical therapy program. And I found that those experiences of having to fight for a seat in the classroom and having to apply for student loans and find places to live and find times to study, find times to work to make it all work.

‍kind of prepared me for being at the place I am right now in my career and understanding what people are going through at some level when they have this kind of train wreck diagnosis or experience. Because it really just takes everything out from underneath your feet and if you don’t have an empathetic approach to that situation, it’s really hard for that patient to relate to you.

‍Dr. Courtney Ellerbusch (03:33.214)

So because of my experience and having to have done that fight for so long, at some level I understand the fight that these folks are in. But getting into PT school, my focus all along wasn’t just on kind of doing a certain job or being really refined in a certain skill set, but a desire to really apply what I was going to learn in graduate school.

‍meaningful enough way to really heal people. And I know we need adaptive equipment. I know we need to support people in their dysfunction. And there’s a very real and needed pathway for training and helping folks in that regard. But my personal call is to help heal people and to take a condition and see if we can reduce its impact in their life. So that’s where I’ve.

‍consistently focused and that’s a large reason why I feel called to help people with neurological diagnoses. Can we pause there? Edit that out. Let me talk to my dog just a second. Is that coming through? Okay. Oakley.

‍Garrett Salpeter (04:44.475)

Yes. Yeah. I’ll do it.

‍Yeah.

‍Dr. Courtney Ellerbusch (04:55.362)

Lay down. Let’s do P-Buds.

‍Garrett Salpeter (04:56.633)

I felt like talking to my dog for a second.

‍and pause.

‍Dr. Courtney Ellerbusch (05:06.898)

Okay, let’s edit that out. Okay, cool. But I said heal people, and so the next, I got my next, I’m ready to go. You guys ready? Okay, so I became a home health physical therapist in 2014, and about four years later in 2018, when I was working with a long time patient with multiple sclerosis, I discovered this guy named Trevor Wicken through kind of her experience in watching him online. I think you guys have heard of Trevor.

‍Garrett Salpeter (05:07.823)

Yeah, we can edit that out. That’s.

‍Dr. Courtney Ellerbusch (05:36.834)

He’s a good guy. Have you heard of Trevor? The MS gym based in Colorado? Yeah.

‍Garrett Salpeter (05:43.747)

Yeah, I’ve heard it last, Jim. I’m not familiar with Trevor’s story and everything too. So if there’s anything right there.

Dr. Courtney Ellerbusch (05:45.798)

Yeah, no, he’s a great guy. He’s local. He was actually recently on some talks that Dr. Terry Walls did. So didn’t know if you’d heard those. Anyway, I began to watch his videos and really get excited about how he was looking into the neurological system and using movement as medicine. So I took a risk and I reached out to him.

‍on social media and I invited him to surprise this patient with a visit and he was so excited and I was so excited that he said yes. And so we had about a two and a half hour breakout session where I was learning so much about his manual techniques and how he would see movement and adjust movement and see that person move better.

‍and the patient that I was working with was able to kind of do a better hip bridge for the first time in a long time, and it began this search for me on, okay, let’s know a lot more about mechanoreceptors because apparently they’re really important. And so I began to read as much as I could, and I found you guys, the newbie, soon after that, and was so excited about this machine that potentially could talk to

‍the mechanoreceptors because of my interest in neurological conditions. So wasn’t quite sure how to get my hands on a newbie, but just began just like I did in 2008, just to take steps towards a big goal and began to talk to folks that were in your company about a

‍the device and worked my way up to talking to you, Garrett, and you guys offered me the opportunity to do some research, clinical trial with your device. So it’s been a four and a half year. Can you believe it? Four and a half year. Ramona can, because I think you’ve seen how long these things take. I had no idea it was gonna take four and a half years, but it took that long to do the whole process of, okay, what’s our clinical question?

‍Dr. Courtney Ellerbusch (07:59.498)

are we asking the right questions? How do we measure the question? And then I need a partner neurologist, and so I had to develop those relationships. And then I went through the process of applying that research. Back up a little bit, I had to get Institutional Review Board approval, which took a while. There were just so many steps that led to eventually being able to actually do the research.

‍analyze the research, and then the whole process of publishing the research. And I’m so incredibly proud, and I’m thankful for so many folks who supported me along the way at the right time, including you guys at certain appropriate points. Really appreciate it. But honestly, I was talking to somebody recently, and I feel like we did this case series study, and it’s great, and we can see a little bit, and I’m so thankful, but it’s a little bit like being in the desert.

‍and you’re surrounded by all of these sand dunes and you wanna know more about the desert and what’s in it and how to help it and find water, but we dug a hole. And there’s a lot more work to be done here, a lot more to understand, but I’m really proud of the hole we were able to dig. And that hole, so to speak, has allowed me to continue to come to the table and conversation with people in really vulnerable situations.

‍I’m honestly, I’m a PT who’s in the trenches with folks that are facing really hard situations with really intense contracture.

‍Dr. Courtney Ellerbusch (09:40.962)

parts of their body that just aren’t going to move probably without significant intervention. And even with that, it would be difficult caregivers who are in burnout. And I’ve been able to kind of enter that conversation and say, well, we’re gonna do the best we can. We’re gonna support you guys where you’re at. And we may be able to go further than traditional PT because of some of these tools. And being in that situation with a device and a skillset,

‍and a protocol that I was able to develop has meant so much to me to be able to hold an empathetic space with my patients and for them and for their families.

‍Thank you so much and I’m excited to dig in more to the research itself.

‍Garrett Salpeter (10:30.499)

Yes, that’s awesome. Thank you for sharing that backstory. And it’s, you know, one sits down to read a scientific journal article, and you just see these objective measurements and methods and things like that. I think it’s cool to understand some of the motivation and the context, the narrative behind the study. And I really appreciate you sharing that and just want to acknowledge and say how grateful we are for the work that you’ve done to help advance the field forward. And

‍not just generally, but specifically for a population of people where there aren’t a lot of good options. And there’s, I would say, a hole here generally in physical therapy in ways to help these people restore function and regain quality of life. I think the work that you’ve done in this study is a great step forward. Like you said, we’re not out of the desert yet, but perhaps we’re finding some water somewhere and making progress.

‍Yeah, and Courtney, I think you spoke to it about the timeline and that’s, and how long it can take to get these things done. And I think that’s, that’s often the biggest challenge when explaining this to both other, you know, therapists as well as patients who are looking for those answers, who are running into these people who are dealing with a really difficult condition. And the reality is those little steps that you feel that hole you’ve dug, it’s the building block that we build on to, you know, go further with our research. But it does, it takes a long time.

‍And I think, you know, one thing we talked about for this podcast was kind of digging into that process and you’ve described it really well for your case series and that there’s all these things you have to do before you even start your research. But for our listeners who are obviously hearing and getting updates about what we’re doing with research, this is a good opportunity to kind of put it in the context of the greater research world. So ideally, you know, kind of the biggest possible option would be these like if you if you’re reading about

‍studies that are happening in these multi-site, huge hospital clinical trials, that’s like much further down the line, but that’s after you’ve built all those building blocks that show the reason why you need to pursue those, because those are quite expensive. So really the case series that you’ve done would be, in my mind, kind of the most important building block to have data that you need to build a much bigger study. So really when it comes to, especially in the clinical world, there’s

‍Dr. Courtney Ellerbusch (12:31.566)

Mm-hmm.

‍Dr. Courtney Ellerbusch (12:37.88)

Yes.

‍Garrett Salpeter (12:54.011)

basically three different kinds of studies you’ll see, one being your case study itself. So here Courtney has done seven different case studies and put them into a group, right? But each individual case study can, an individual case study can be published. And with those, of course, it’s one anecdotal case study and talking about the approach to therapy. And so the challenge there, the limitations of course, is that you can’t really do a ton of statistics on one case study.

‍You may have these objective measurements, you may have the changes that you’ve seen, but without putting in the context of a bigger group, you can’t say that this is really something that you could see across the board for anyone dealing with these conditions. So yours is kind of that next step, right? Like the case series where now you have at least a good group of people that, and as we dig into the research itself that you’ve done, you could do group analysis and look for statistical significance in…

‍all of the patients or at least a big enough percentage of the patients that it’s a significant change overall. That being said, that’s still limiting just because it is a smaller group. We like to call it our pilot data, right? But that would be the data you would build if you wanted to go for a bigger grant proposal or if you wanted to take this to a hospital system like you work with. Courtney is at Centura Health, so the work that you’ve already done.

‍Dr. Courtney Ellerbusch (14:03.928)

Mm-hmm.

‍Garrett Salpeter (14:19.803)

with the neurologist that we partnered with on this case series, you could build now a much bigger both institutional review board proposal but grant proposal to take to the hospital and say, hey, we’ve got data that says this is really worth digging into and showing how it could affect a greater community. Because those clinical trials, you’re ultimately looking for hundreds of subjects. And of course, that requires not just hundreds of subjects and the cost of treating hundreds of subjects.

‍Dr. Courtney Ellerbusch (14:39.723)

Right.

‍Garrett Salpeter (14:48.743)

but also time, and obviously you as one single practitioner, there’s no way that you could ever do 100 plus subjects. So that would be where you’d start bringing in different sites and other PTs that would be, you know, working on the same kind of process. So yours is really pivotal. It’s kind of like that turning point of, all right, we know that there’s some evidence that this can do, that can, this can help the spatial population.

‍Now we have some scientific evidence that’s statistically significant to say, okay, there’s a reason for us to expand on this so that we can go to something bigger and really then make that huge impact on the community. So that’s, you’re kind of like that turning point or I guess in the context of the sand, you’re like digging the hole and you’ve like, you just, the sand has started to get wet. Like you hit water, but it’s not the pool yet.

‍Dr. Courtney Ellerbusch (15:32.526)

Hahaha

‍Dr. Courtney Ellerbusch (15:37.715)

Yeah. Right. I like it. Good job, Ramona. Yeah, I’m bringing this.

‍Garrett Salpeter (15:45.703)

Try to bring it full circle. One other comment before we turn it back over to Courtney to just talk about the setup of the study. If you think about, okay, this is the initial pilot data that is a couple of years. I mean, this was four and a half years. Some of that was complicated by COVID. Say it normally would have taken two or three to get this done. Yeah, that would be more typical. Let’s say the stars aligned and it was that.

‍think about what even an ideal process would be. It’s a couple years to get that published, then that feeds into a larger study, which is a few more years, and then we’re talking four or five years, and then look about this filtering effect where at least in what I’ve read, it takes perhaps 15 years for what’s being published and being done in academic publications to actually filter into day-to-day clinical practice. So if we’re talking about…

‍I think there’s a conversation that we don’t have to get fully into here, but about the distinction between evidence-based and evidence-informed approaches and this realization that by the time things are published, there’s a lag, at least if not this filtering effect too. Just kind of understanding the steps and how long each of those take, I think, is an important takeaway for people to understand here. Yeah. I can put that a little bit in context in two ways.

‍It’s been a while since I’ve been on the podcast, but when I came on and introduced myself almost three years ago as I joined the team, my background had been more on the academic side and the preclinical research. And so when people would, when I would tell people what I, the area of focus of research I did, and they would say, oh, wow, that’s really interesting. When, you know, when are we going to be able to use that on people? And they’re like 10, 15 years, right? Cause that was even further back. That was just, you know, building the, the

‍the spoon to start getting, digging into the sand. So in the context of things, you know, kind of like any R&D really, like if you were outside of the scientific and academic world or outside of the clinical world, you could compare it to like car manufacturers, right? Like what we see on the market today, you know that they’re working on things that are, we’re not gonna see for 10 years, the advancements in the technology, that just the process of research just takes such a long time.

‍Garrett Salpeter (18:12.111)

So it can be both really exciting and also a little bit frustrating because you know you’ve got people who want answers and they want that opportunity to make changes. But there’s a process that it takes.

‍Dr. Courtney Ellerbusch (18:22.838)

Right, well, so great. Let’s, should we dig into the study a little bit? Yeah, yes, please do.

‍Garrett Salpeter (18:29.647)

Yes, I have a question about whether we want to desert this metaphor. Desert it. It might be time. But yes. The king of dad jokes, Garrett Salpeter. Thank you.

‍Dr. Courtney Ellerbusch (18:41.634)

Yeah, I get teased for mom jokes all the time. How old are your kids, Garrett? Yeah, I got 10 in, or almost 10, nine and seven. So man, the teasing gets worse, doesn’t it?

‍Garrett Salpeter (18:47.379)

12 and 8.

‍Garrett Salpeter (18:56.631)

I think this is last month is when my 12 year old stopped liking me. I think it was like a binary one day to the next sort of thing. Well it makes you feel better. Your teammates, I’ll tell you, your dad jokes have grown on me. Oh there we go. So we like you better.

‍

Dr. Courtney Ellerbusch (18:58.098)

Yeah. Yeah, okay.

‍Dr. Courtney Ellerbusch (19:07.921)

Okay.

‍Garrett Salpeter (19:16.271)

incentive to work more? I know that’s not… So we’ll go there. But let’s dive in this study now that we’ve teed up Courtney’s background and some of the motivation behind it and a little bit of the kind of nature of scientific inquiry and building evidence. So can you talk to us about the setup of this study and what the intervention, what the treatments look like? And then of course we’ll get into what happened. But can you just kind of frame it up for us here, please?

‍Dr. Courtney Ellerbusch (19:18.121)

Alright.

‍Dr. Courtney Ellerbusch (19:42.49)

Yeah, absolutely. So you can imagine trying to take this much information and education and bring it into this tiny little living space. So that’s where my head was at. And so I took a look at the information I had from Neubie on the protocol that you guys have developed with mapping and manual therapy. And I took a look at what I could do in home health realistically and kind

‍And maybe I should say three things together. So I put together home health requirements, restrictions, all that, the NeuFit method, and what I understand to my best ability about the multiple sclerosis pathophysiology, and what is needed to help somebody with significant impairment improve their mobility. Put those three things together.

‍And I developed a four-part protocol. And in that four-part protocol, I felt like there would be room for somebody who is in a wheelchair or power chair to experience that kind of intervention and make some kind of, potentially make some kind of progress or somebody who is ambulatory with a cane or walker or some similar kind of device.

‍So the four part protocol, if you do have the paper and are looking at the paper, I outlined in the back in the appendix and essentially it is, I’m gonna pull this up here because.

‍Garrett Salpeter (21:23.411)

And just for everybody listening, we will share a link to the paper to the PubMed listing in the show notes here. So we’ll have it for you.

‍Dr. Courtney Ellerbusch (21:30.494)

Okay, actually, if you maybe pause it for just a second, because I have things everywhere. And when I’m talking, I get like nervous. And I’m gonna pull up my four part protocol. I know what it is, but my brain kind of does this stress response when I’m talking. So yeah, I’m just normal, right?

‍Garrett Salpeter (21:53.072)

All good.

‍Dr. Courtney Ellerbusch (21:57.766)

I have it, no I have it, I know where it is, I just have these things everywhere. So my four part protocol, and it’s easier for me to not look at the camera, but do I need to look at the camera?

‍Garrett Salpeter (21:58.095)

You can use our infographic. It’s like a short.

‍Garrett Salpeter (22:11.559)

That’s fine if you’re reading from, yeah, that’s fine.

‍Dr. Courtney Ellerbusch (22:12.478)

Okay. And so the four part protocol includes…

‍Sorry.

‍Garrett Salpeter (22:26.643)

Pick it up again from the four-part protocol includes and we’ll just start wherever you want to start. Yeah, Courtney, it would be possible. You don’t have to be looking directly at the camera, but could we be back on your face? There we go. Cool. There we go. Yeah, you don’t have to, like, we’re going to see your eyes, but that’s helpful. Yeah.

‍Dr. Courtney Ellerbusch (22:28.011)

All right.

‍Dr. Courtney Ellerbusch (22:33.438)

Yeah, we’ll do this. I’m balancing on my, okay there we go.

‍Perfect, okay, so here’s my four part protocol. In understanding the impact of neuropathy with my subjects that experience any level of neuropathy, I had a foot bath protocol that I developed to support them in some kind of recovery or loosening of the body to allow them to participate further. The second part of the protocol was looking at.

‍

stretching combined with the electrical stimulation to move out of that extensor tone or flexor tone wherever it was, we would have them stretch in the opposing direction. Ideally, if they could stand, it would be against the floor because ground reaction force is a powerful part of our technique as PT’s and helping people to experience a deeper stretch when they’re standing in a closed chain position.

‍

it goes further. Then I used strengthening as much as we could against gravity or in the opposite direction of the spasticity. And in folks that had significant drop foot, I often would do that in combination with the foot bath because they’d be the most able to generate at least enough muscle contraction to say lift the great toe or

‍

initiate a little bit of movement, but we would find the right position for them to get their agonist muscle groups to fire and for them to get comfortable with moving out of a way that their body was pulling them into spasticity. Then the next part was taking those pieces of neuropathy treatment, stretching and agonist strengthening and applying it in functional training.

‍

Dr. Courtney Ellerbusch (24:34.506)

And this is where Dr. Gretchen Hawley really shines. Just a shout out to her and her deep dive into functional training. But I did the best I could with what I know of functional training to help people break down walking transfers and little bits of movements so that they could have the highest quality of movement with the least amount of compensation. So for our listeners, is there an understanding of what compensation is?

‍

what I’m talking about. Okay, okay.

‍

Garrett Salpeter (25:08.483)

Yeah, for sure. And also a shout out, you mentioned Dr. Gretchen Holly. She has been on the podcast and let’s see. I’m trying to look up what number she was. She episode 40 of the podcast. So

‍

Dr. Courtney Ellerbusch (25:11.784)

Yeah.

‍

Dr. Courtney Ellerbusch (25:21.514)

Okay, cool, yeah, so I love her work and I love her focus. And then the next part of the protocol, when I could fit it in, when there was time, and that was kind of a big if because of how much time each of these interventions take to set up, but when I was able to, I would do a master reset for clients because I know the power of that parasympathetic system.

‍

So I had my protocol in place, as far as what my intervention was. I had a neurologist queued up and they would go to see the neurologist first. They learned about the study from Dr. Siebert. They signed a consent form. And she did what’s called an EDSS. And I have to look up what that stands for. If you will edit that out. Do you, let me, let me queue, queue myself.

‍

Garrett Salpeter (26:15.891)

the I’m forgetting what the E is but it’s the disability scale and a disability score

‍

Dr. Courtney Ellerbusch (26:16.562)

Yeah, expanded.

‍

Dr. Courtney Ellerbusch (26:23.702)

Expanded, I’m gonna, can somebody Google that for me then I’ll just say it the right way. Expanded, expanded, disability.

‍

Garrett Salpeter (26:29.639)

Yeah, for sure.

‍

Garrett Salpeter (26:34.133)

You got it. Yeah, I got it. Everyone was looking at it. Yeah. It’s sweet.

‍

Garrett Salpeter (26:40.315)

It’s the Expanded Disability Status Scale.

‍

Dr. Courtney Ellerbusch (26:41.394)

Okay, I just want to say it right, cool. All right. So, Dr. Siebert would assess each client on the expanded disability status scale and then send them over to me if they met all the qualifications of inclusion criteria and exclusion criteria.

‍

Garrett Salpeter (27:06.617)

Courtney, I think it’s important as we discuss it, the level of disability that you required for this cohort, so they all had a similar level of disability, it had to be, I believe, on the ADSS higher than a six. What’s the difference?

‍

Dr. Courtney Ellerbusch (27:19.67)

Right, and so it’s very high level of disability. So they’re using, a six is they’re using a device and they are very limited in how far they can walk and they get tired at that distance. So what I said is if you can walk 150 feet, that’s as far as I want you to be walking for the study. And the reason why is because I work with home health and clients need to be home bound to qualify. So.

‍

I really can’t recruit clients that are community ambulators. They wouldn’t qualify for the study. So I needed to look at baseline, a very high level of disability and disease progression.

‍

Garrett Salpeter (28:05.707)

I think that also helps in terms of creating this pilot data and creating the preliminary data because if you have someone who has such a limited mobility, seeing changes in that is going to be much more profound and apparent than if you have someone who is basically ambulating somewhat normally.

‍

Dr. Courtney Ellerbusch (28:21.31)

Yeah, absolutely. I knew it would be a challenge, but it was, like you said, it’s a really important group that often, when you look at teaching and training that’s done for MS, they are kind of the forgotten group, the ones who have had enough disease progression to get into a chair. And if you talk to a lot of neurologists that specialize in multiple sclerosis, when patients reach

‍

threshold of a progressive MS diagnosis, they don’t know what to do for them.

‍

There are not a lot of good disease modifying treatment options. And the next step is really palliative care. And it’s a big cycle of they get handed off to the urologist, then they have a joint replacement that’s needed. And it’s just a very frustrating situation for everybody involved. So I thought even though it would be a little bit harder to demonstrate.

‍

big progress, I thought, well, what a great population to help and learn about and see if we can make a dent. So yeah, I totally agree. I was thankful for my group.

‍

Garrett Salpeter (29:37.779)

Yeah, anecdotally, we work with so many MS patients with the newbie that we have our own sort of group of patients that our support staff does regular calls with to support them in how they’re using the newbie for managing their symptoms. And I had the opportunity to speak with them just last week. And we went through the study and then talked a little about each of the patients and they, you know,

‍

several of the patients were like, wait, if I see someone on here who, you know, sounds similar to what I’m dealing with, like, this is really helpful, because then I can actually present this to, you know, a physician that I’m working with or a PT and say, okay, this person has similar symptoms. This is an approach we might try. So that really speaks to that importance of that population, Courtney.

‍

Dr. Courtney Ellerbusch (30:21.29)

Right, well thanks. So that was my four to five part protocol that I used. And again, in the paper, I do outline in one of my charts how all this works. So if you’re really deeply curious, you can see all of that in how I organized the study. And I did, there was only one time during the study that I saw two subjects at the same time. They did overlap, but most of the time,

‍

in the recruitment process as it was, I saw about one patient at a time, and I was able to focus. It took a lot of focus because in research, you’re measuring everything, and you’re recording everything, and there really isn’t room to miss something, because if you missed it then, you can’t go back and measure later. It’s not the right data time point. So I had to be really dialed in on what I was measuring, how I was measuring it.

‍

doing it the same way each time. And it was really cool, but really intense. And I have so much respect for anybody who’s done this process. So that is a little bit about how I did the research. What do I say? What are we doing next?

‍

Garrett Salpeter (31:41.195)

Yeah, so that’s a good way to understand the inclusion, exclusion criteria, who’s in the study, what the protocol was. So let’s then talk about the intervention here. So you had, it was seven patients, and let’s talk about how often you saw them, what the sessions looked like.

‍

Dr. Courtney Ellerbusch (31:58.046)

Okay, so the first session was what’s called, in my world, the Home Health PT, is called a start of care. And just so everybody here understands, a normal start of care visit takes 90 minutes because of all of the paperwork, the medication review, taking a look at the home and assessing the patient and a long conversation about their goals and a little bit of treatment. So I had to do that.

‍

combined with explaining that they are now a research subject and thanking them and teaching them about the newbie. So my start of care visit was two to two and a half hours long. And I didn’t touch them with a machine on that visit because I felt like it was overwhelming enough as it was. And in this population, the neurological system can only take so much. So I felt, and I made a judgment call, that introducing all of that.

‍

and putting something brand new on them that’s stimulating their body would just be so far and away too much. So I introduced the actual newbie on the second visit.

‍

Garrett Salpeter (33:08.448)

Did you do any of the functional testing, the pre-test on that first visit? Okay.

‍

Dr. Courtney Ellerbusch (33:10.558)

Oh yes, absolutely, yes. And I can pull out, I have all of the charts here. And so I did a manual muscle test of psoas, hamstring, rectus abdominis, quadratus lumborum, rectus femoris, all of the quad group, all of the glute group, hip ER and IR, adductors, tibialis anterior, posterior, fibulari, toe extension.

‍

And so it was quite a bit, it was quite a bit. And then I would measure range of motion of key joints. I did a modified Ashworth test with them, mostly in the sagittal plane, just for time’s sake and to keep it simpler. Sagittal plane is just front to back. Right, I looked at a lot of options for how to measure spasticity and it’s the most practical one. It’s not the perfect test.

‍Garrett Salpeter (34:00.568)

and Ashworth is looking at spasticity.

‍Dr. Courtney Ellerbusch (34:09.15)

but there is no perfect test for spasticity. It’s actually, it’s a big question. It’s a research question of its own. How do we measure spasticity correctly? But the modified Ashworth is kind of the best we can do. And when I was looking at studies, if it’s a PT-based study done by PTs, we’re using the modified Ashworth right now. Maybe in time we’ll develop something better, but that’s what I used. I did a timed up and go test when the client was ambulatory.

‍and a 25 foot walk test when the client was ambulatory. So everybody was tired. And actually in my car, I have a research kit. So I had this box and I went to Home Depot and I got a 25 foot rope, I got a 10 foot rope, I got a timer, I got these little frisbees to set up in the home and find space in the home to do these walking tests. So when I came in, you can imagine I have my

‍newbie in a rolling bag, my treatment backpack, my research box, my laptop, and all of the charting. It was just, I think so. I stayed working out, I stayed healthy, I haven’t had much pain, but yeah, it was a lot.

‍Garrett Salpeter (35:17.955)

I feel like we got a little stronger doing these exhibits.

‍Garrett Salpeter (35:27.323)

It’s a different way to use the new beat, the strength train.

‍Dr. Courtney Ellerbusch (35:29.782)

It was a brain workout and a body workout and the client was like, don’t worry, we’re not doing it all at once.

‍Garrett Salpeter (35:34.097)

Okay.

‍Garrett Salpeter (35:41.844)

So that was the initial visit and then talk to us about the subsequent treatments and then the points at which you retested.

‍Dr. Courtney Ellerbusch (35:41.922)

Right.

‍Dr. Courtney Ellerbusch (35:47.306)

Okay, so yes, then I had, let’s see, one, two, three, four, five, I had eight visits of kind of follow-up style visits. In the first of those eight visits, I did the mapping process with them, and I had a piece of paper designated for where I was gonna identify those four key locations, hot spots.

‍dead zones is what you guys used to call them. I’ve never liked that term because I wanna create life. But low sensory zones. Okay, yeah. Low sensation zones and areas that tended to increase spasm, spasticity, clonus. That’s a spot that I really would pay attention to. And then those gold spots where you have more motion.

‍Garrett Salpeter (36:25.607)

Would you?

‍Garrett Salpeter (36:29.23)

We’re good with that. Totally good with that. That was great, sir.

‍Dr. Courtney Ellerbusch (36:44.374)

So we identified all of those for the client, especially on the lower extremity, just because we were trying to move forward with mobility and walking. Arms and hands are wonderful, but they are a beast of their own. And it was outside of the scope of the study to do that for me.

‍So we did that and then based on those hotspots or areas of interest, and for me, I put Goldzone and areas that increase spasm and spasticity as the top of my tier to treat. Unless there was a whole lot of neuropathy, then I would be very interested in seeing if we could increase the sensation. So there is a little bit of a judgment call that we all make as clinicians and that I even made within the study on

‍how to approach somebody, what seems to be the most important part of here to help them move forward. And so once we identified those, I would set up electrodes or a foot bath around those areas. I typically used eight electrodes on any client that could handle it. I maxed out the capabilities of the machine to help them as much as I could. And we would go through a stretching process.

‍So my first two subjects were in chairs and had deficits in transfers. So they needed a lot of setup to make the transfer successful and the transfer itself was quite tiring. So once I would get them onto a bed surface, and by the way, I also bought my own like four inch mat to put on top of the bed. So it was the same surface.

‍If I was using somebody’s bed, I didn’t want the mattress to be different, so I used my own mat on the bed and I would clean it off afterwards, but they were on that same mat surface and I would do a lot of flexibility in supine. And for both of my first two subjects who were using chairs for mobility, rolling over into prone wasn’t easy at first. So most of the time I would be in supine on the back.

‍Dr. Courtney Ellerbusch (38:58.178)

getting to different joints that seemed to need stretching. After that, with the e-stim in place, we would go through as many exercises as we could to get against gravity. So I typically would start with tibialis anterior and helping them to get a little bit of ankle movement. And most of the time it was kind of.

‍passive range of motion, moving into active assist range of motion. And if we got a little bit of their own movement and active range of motion, we would celebrate that. But those muscles are highly fatigable. So after we got a little bit of motion, I’d move up into the quadriceps, hamstrings, hips, helping them to get a little bit stronger. And part of the really important protocol for me and doing all this was making sure that I did no harm. And I didn’t cause them to feel so

‍tired after I left that they couldn’t function the rest of the day, which is a very real reality in the population I work with. So I had a one to two or one to four work to rest ratio. So let’s say you lift up your ankle for three seconds, we would rest double to quadruple the time before we do the next rep through each of the exercises. So it’s quite time consuming, but the quality of movement is really maximized.

‍when you give those muscles time to repolarize. So that was a really important part of the protocol.

‍Garrett Salpeter (40:27.675)

Courtney, can you remind me, so you had 18 sessions total with these patients, how many was it a week? Because kind of with that same thing in mind that you didn’t want to, so three times a week, which is, that’s a lot. So that’s even more of a reason to really be careful within your sessions to give them adequate rest. And I think it’s noted in the outcomes that you did it right because almost every single session was done.

‍Dr. Courtney Ellerbusch (40:33.538)

Three.

‍Dr. Courtney Ellerbusch (40:37.162)

Yes.

‍Dr. Courtney Ellerbusch (40:42.411)

Right.

‍bright.

‍Dr. Courtney Ellerbusch (40:55.142)

Thanks, yeah. And then on the ninth visit, we did a reassessment. So I went right back into taking a look at the, if they were ambulatory, timed up and go, 25 foot walk test, we redid the modified Ashworth test, we did the manual muscle test and the range of motion test for each of these guys. And it’s interesting, we also did a subjective measure at the beginning and at the very end.

‍

And of course, it’s very natural when you’re working with folks in research or just as a normal patient, we’re, as a practitioner, we’re often seeking out their response. How are you feeling about this? What are your thoughts about this? And what I found is that in this group, their thoughts about how they were doing and how they were.

‍

doing were often not in alignment. So I had my first subject one was feeling rather negative about his progress and I was listening to that but we went ahead at visit nine as scheduled and did the reassessment and we were seeing that muscles were turning on that weren’t on before. The spasticity was measurably less in a lot of key places.

‍

And he was kind of saying, okay, well, this is big. I mean, objectively, I can’t argue with that. Like there is improvement here. And it helped open up his eyes and kind of say, okay, well, I’m gonna just try to reframe my experience with working with this because you can imagine most of these folks have tried so many types of therapies, medications.

‍

alternative treatments and disappointment comes along with the territory. And so there’s almost a preparation for how disappointed should I prepare to be. But when you show them objectively like your glute med, it used to not even fire and now we’re at least getting contraction and slight movement when we set you up in the right way. And they can’t argue with that and it feels really

‍Dr. Courtney Ellerbusch (43:17.934)

powerfully encouraging. So that, I was, yeah, and so, and that’s where we are. When you have a high level of disability and you’re just barely turning something on or you’re feeling something for the first time, it’s a super cool space to be in. But you really have to help that individual find where the progress is happening because there’s so many things that are also yelling in their ear and their mind about what’s wrong.

‍Garrett Salpeter (43:22.823)

That’s awesome.

‍Dr. Courtney Ellerbusch (43:47.454)

So, visit 10 through eight, 10 through 17, we did more follow-up treatments with the same protocol that I outlined again and again and again. And I tried to push them up to walk a little bit further when it was possible, push the number of reps they could do or reduce the amount of rest between repetitions when that was possible. And then on visit 18,

‍We reassessed everything including the subjective measurements and recorded all that data. And then I went home and I’d stay up late that night or the next night because there were so much data that I had that I had to make sure that I had in the right place and I had down accurately. So I would get all that data loaded up into my laptop and neatly tucked away in.

‍like one of these folders, subject five. There we go, that’s safe to show. Yeah. So, and then, so that’s a bit about how the study was run, and we did that time seven. Sometimes I was able to get subjects back to back, and other times there seemed to be a little bit of a pause.

‍Garrett Salpeter (44:52.29)

there.

‍Dr. Courtney Ellerbusch (45:09.914)

Maybe it was COVID and people being a little bit wary about participating, or the neurologists being a little worried about having them participate. I don’t know exactly, but eventually we got to seven subjects. It did take a year, but I was able to study seven people the same way. Two of my subjects were non-ambulatory and remained non-ambulatory, but were able to initiate standing with quite a bit of help.

‍for the first time in years. And four of the subjects were ambulatory. And in some cases we saw dramatic difference in gait speed. And in some cases we didn’t. And in the cases that we didn’t, I was looking really intensely at kind of the big picture for them. And a lot of times that psychological

‍or social component was a really, really big part of that. Kind of a side note and a little bit of a rabbit hole. Our field in physical therapy right now is looking at whether or not we should solely practice in the biomechanical model because there’s a very real component and voice that we need to have in the psychological model and the social model.

‍

And if we, for example, help somebody’s with their patellofemoral syndrome have less pain and get stronger, but they go back to an abusive relationship, I’m pretty confident that patellofemoral syndrome is gonna come right back in addition to something else. So if we don’t have an awareness and we’re not trauma-informed, psychologically-informed, socially-informed in our practice, we’re only gonna go so far.

‍Garrett Salpeter (46:54.387)

Mm-hmm.

‍Dr. Courtney Ellerbusch (47:04.862)

And I think none of these subjects were in abusive relationships, thankfully. But they’re all facing a high level of disability and the burden on the caregiver and their life is something that’s to note. I mean, each one of them was trying to navigate how much they could thrive without having their caregiver being burnt out.

‍Right.

‍Garrett Salpeter (47:36.551)

Right. Yeah. Well, there’s another example of where these objective measurements that, you know, even if they’re feeling down about it for you to be able to say, no, look how far you have improved, gives them that mental fortitude to be like, okay, I can keep working at this and I will be able to thrive, you know, at least partially without my caregiver. And that also probably, you know, helps with the caregiver burnout to say like, okay, well, I’m doing all this work, but we are making progress.

‍Dr. Courtney Ellerbusch (48:02.11)

Right, right, and some of that caregiver burnout is not gonna be relieved by your gluten-aid firing, no matter how much it fires. It’s great. That’s a whole nother political and social situation, conversation on kind of the limited support that we offer in our country for folks with disabilities.

‍Garrett Salpeter (48:12.92)

No, of course not! We can only hope!

‍Garrett Salpeter (48:26.663)

Yeah. Well, at the very least, I’m glad you call that out. We talk about this biopsychosocial model of pain and the metaphor of the threat bucket and how different things that we think wouldn’t physically hurt can cause pain, whether it be job dissatisfaction or being in an abusive relationship like you said, stuff like that. So I’m glad you called that out.

‍In terms of the, any other comment on that, or can we talk about kind of the results at large? I mean, very briefly, I was going to say, I think this also, you know, just in the context speaks to what we’ve seen and why we’ve kind of continued to grow in the neuro world as a company and as a team is that we, you know, initially had people coming to us with neuro conditions where they felt like there was no hope. And to even be able to see things that objectively there, it’s making a difference, whether it’s a sensation that they haven’t had in a long time, or what

‍whether it’s a movement or a firing of a muscle that they haven’t been able to fire in a long time, even if it’s not, you know, earth shattering, it can mean the world to someone who hasn’t had that experience in a very long time.

‍Dr. Courtney Ellerbusch (49:29.138)

Yes, it can be that piece like you said earlier, it’s like that case study piece, it’s like where does it fit for me? Like I’ve done this thing, but you saying that has helped even just in the moment of understanding where it builds. And so for that person and that caregiver, it might be enough of a spark to say, okay, it’s worth continuing to invest in this kind of thing because even though things will be hard for a while,

‍like this feels encouraging to us and let’s keep going. And probably those are the clients that are able to continue to see those results.

‍Dr. Courtney Ellerbusch (50:11.969)

Yes.

‍Garrett Salpeter (50:12.083)

And then speaking of results, we don’t have to go through all subject one through seven, everyone’s muscle testing and modified Ashworth scores and EDSS. But what can we share in terms of results here? You’ve already touched on it a little bit, but what can we share to kind of wrap that up and help people understand the outcome?

‍Dr. Courtney Ellerbusch (50:19.228)

Yeah.

‍Dr. Courtney Ellerbusch (50:31.822)

Okay, absolutely. Yeah. So I’m gonna, I’m looking over here because I have, I’m gonna turn this around so you guys can laugh and if anybody watching can laugh. This is how I put my poster up. I found a way to hang it on my cabinets. Yeah.

‍Garrett Salpeter (50:51.187)

That’s awesome. I love that. It’s like an expanded version of like putting your child’s report card on the refrigerator. And just for reference, for reference, everybody, Courtney is presenting this study as a, it’s a poster presentation at the Colorado Physical Therapy Association, right? The state annual state meeting.

‍Dr. Courtney Ellerbusch (50:56.018)

Yeah, it’s…

‍Dr. Courtney Ellerbusch (51:07.698)

The APTA Colorado Conference, which happened on September 29th. Yes, I stood with this poster and had some good conversations last weekend. So, yeah. And hopefully we can do we can do more good things in the future and it won’t take 10 to 15 years. Yes. So the results for manual muscle testing.

‍Garrett Salpeter (51:28.011)

Amen. Amen to that. Trying, trying.

‍Dr. Courtney Ellerbusch (51:37.002)

were promising in a few places. Now I’m gonna talk about these results, but let me back up a little bit and say, there were just seven subjects and I’m gonna share some things that sound good, but these are seven subjects and I really wanna be cautious and humble and say, wow, this is good and I think it trends well and it definitely speaks to the need for more research. We need to be really humble in our findings.

‍because it is so small and the power that we have to speak with is limited. I hope our microphone gets bigger, but right now it is a little bit of a small microphone.

‍Yeah. And so what we found was especially at the tibialis anterior group, or I should say lower leg group. In the lower leg group, we saw a combination of things that I thought was cool. We saw the plantar flexors, the muscles that point the ankle down. We saw a trend in six out of seven subjects that improved at the reassessment.

‍Garrett Salpeter (52:17.755)

That’s fair. Totally fair.

‍Dr. Courtney Ellerbusch (52:45.894)

and also at the final assessment. Simultaneously, we saw that tibialis anterior muscle, which opposes it, that lifts that ankle, that improved in six out of seven subjects. I did spend, in the way that I approach these clients on each and every one on all seven, I really highlighted ankles in spasticity reduction, and I found spasticity in just about everybody’s

‍ankles at the plantar flexors and I highlighted anti-gravity strength of the tibialis anterior in my treatment and it showed up in the results of improving that ability to lift the ankles at least a half to a full manual muscle test and it reduced plantar flexor spasticity in 71.4 percent of the subjects which is six out of seven.

‍Garrett Salpeter (53:43.155)

Just to be clear, when you say the strength increased by half or a full, you’re talking about a half point or a full point on the five point manual muscle testing scale that’s fairly standard in physical therapy, just to clarify that.

‍Dr. Courtney Ellerbusch (53:50.424)

Yes.

‍Right, so, and there are, there’s different ways people do that, the way I use that, it was one plus, two minus, two, two plus.

‍three, three plus, right? And so that’s outlined in the study, but yes, that’s kind of the formulary that I used.

‍Garrett Salpeter (54:19.375)

And just for reference, you know, like zero is no contraction, five is you can full fully lift the limb against gravity and also against external resistance. And then as you go down from five, it would be lifting the limb, but can’t resisting and, you know, can’t handle external resistance. And then from there, it would be down to like a trace contraction, but not enough to move the limb against gravity. So it’s that, that sort of thing, just to frame it up, people were not familiar.

‍Dr. Courtney Ellerbusch (54:41.326)

Yes, absolutely. And in the ankles, it’s really interesting when you’re looking at getting your ankle to lift for the swing phase of gait. That is the hardest place to help somebody with their ankle dorsiflexion. Because when you stand up and you have some spasticity, when you stand, your spasticity is gonna be, are you okay? Pause.

‍Garrett Salpeter (55:11.108)

Good. Pause for one second. We don’t, I don’t see your camera. Did your camera go off or?

‍Dr. Courtney Ellerbusch (55:14.778)

Um, there it is, I don’t know. Okay. So when, the easiest time to help elicit dorsiflexion is when you are what we call breaking up tone and you’re bending at the hip and you’re bending at the knee and that allows the client to move their ankle the most. When you stand, you’re gonna find if you’ve got spasticity in your quadriceps and your plantar flexors.

‍Garrett Salpeter (55:18.395)

There we go. Oh, there it is. No. OK.

‍Dr. Courtney Ellerbusch (55:42.638)

That’s when it’s at the maximum because the body’s like, oh my gosh, I don’t want to fall. I’m going to kick in the quads and kick down the toes. So it’s very difficult for these clients to get ankle dorsiflexion with walking. In all of my subjects, I was not able to correct drop foot in that functional way.

We were at times very intermittently able to slightly lift the ankle and maybe clear the floor a little bit, but it didn’t really normalize the walking. But because of the strength that they had developed and other places in core and hips, their walking speed often became faster.

‍Dr. Courtney Ellerbusch (56:28.371)

What other results?

‍Garrett Salpeter (56:35.143)

So you talked about, I mean, walking speed faster. So that speaks to the, you know, timed up and go. You mentioned the two who were in wheelchairs were able with assistance to initiate standing.

‍Dr. Courtney Ellerbusch (56:39.054)

Great.

‍Garrett Salpeter (56:51.575)

Ashworth scale, it sounds like we’re seeing improvement. Can you talk in more detail on the spasticity and what you found there?

‍Dr. Courtney Ellerbusch (56:57.014)

Yes, let me pull up that chart so I can speak to it while I’m looking at it. And so when I look at this chart, and I’ll just switch over my camera so you guys can see what I’m looking at. Maybe I can’t, I’ll just do this. So when I look, this is what I’m looking at. When I look at this chart, I have a category for clients who are worse, or measurements that were worse, measurements that were the same, and measurements that were improved.

‍And because I only have seven subjects, when it’s 57.1% improved or 57.1% same or worse, it’s hard to really know. Maybe it was how I tested. Maybe it was the time of day. Maybe it was a stress response. Maybe it was a particularly good day. So there’s so many variables. So I really highlighted on the fact that when I had a 71.4% response, six out of seven subjects,

‍I feel that’s the most, that should be where I talk the most because that potentially speaks the most to where the results were. And so it’s that ankle plantar flexion change that I saw just about across the board that was improved in subjects for spasticity. And in some cases, there may be a little bit of improvement in hip extension, knee flexion spasticity.

‍But really where I saw the most tangible results that we can speak to, it’s that plantar flexion spasticity change. You guys are aware that in MS spasticity changes throughout the day with amount of sleep, hydration, temperature. I did the study over a course of a year. So some clients were in winter, some were in summer. All of those.

‍Garrett Salpeter (58:35.95)

Awesome.

‍Dr. Courtney Ellerbusch (58:52.235)

have a big impact on how the spasticity presents.

‍Garrett Salpeter (58:58.043)

Mm-hmm. Yes, a good insight there and a caveat, like you said, we wanna be humble because of the number of subjects and the statistical power, and then also these. Each one is a case study and each one had some, you know, you were consistent in how you performed the tests and the interventions, but each one had these different circumstances. So all of that is duly noted. And.

‍

Dr. Courtney Ellerbusch (59:21.33)

And being a case study, I think I’ll highlight subject six. Great, great guy. And his walking speed was the most dramatic improvement. We both were shocked. When I first measured him, because of the amount of drop foot that he had at the first test and how much his foot was sliding and the weakness in his leg, his timed up and go.

‍

took 54.75 seconds. And for those who don’t know, what timed up and go is when you stand up from a chair, you walk 10 feet, you turn around, you walk back, you sit down. The test starts when you stand and stops when you sit. And normal, low fall risk subjects that are in the community, what is normal, but your average person that’s maybe young and healthy, they’re doing that in

‍

eight seconds. He took 54.75 seconds to do that. At the final assessment, he improved to 16.81 seconds. So he’s not normal, but holy cow, he improved huge. We were both just shocked at that. And so his ankle picked up just enough to clear the floor. His hips were so much stronger.

‍Garrett Salpeter (01:00:37.491)

Thank you.

‍Dr. Courtney Ellerbusch (01:00:47.358)

and he’s a hard worker, so he’s doing his best for the research and for us, so that was great. The other really cool thing for him was that 25-foot walk test. And so for my subjects, 25 feet is enough distance to really challenge their muscular system and make them pretty tired. And if you’re gonna see a gait impairment, you’re definitely gonna see it within that 25-foot space. And his first…

‍25 foot walk test took 36.88 seconds to go 25 feet. When I measured him at the final assessment, he did it in 12.15 seconds. Yeah, it was great, it was great.

‍Garrett Salpeter (01:01:28.239)

Wow, fabulous. According, can I ask, right, this is all, of course, in the context of this protocol, prior to using the newbie, had you worked with subjects in a similar fashion, basically going through similar exercises, but without the newbie, and seeing or not seeing changes and improvements?

‍Dr. Courtney Ellerbusch (01:01:50.474)

I did not, it’s hard, it’s really hard. It’s a great question, I love the question, but.

‍Dr. Courtney Ellerbusch (01:01:58.246)

No, no, I think the answer is no. I had done some ideas around flexibility, manual therapy to get into the mechanoreceptors, strengthening, and of course they got a little bit better and we worked really hard around all of the parameters to make them better, but nothing that dramatic for sure.

‍Garrett Salpeter (01:02:24.935)

Great. Okay. I mean, essentially that’s really right. Although obviously as a case series, every single participant in your subject in your case series received this treatment with the newbie, but in the greater context, we wanna say, are we making a difference compared to what they would average be able to improve with 18 sessions without the newbie?

‍Dr. Courtney Ellerbusch (01:02:46.378)

Yes, and also in all of these subjects, I wish I had quadrupled the time. Cause I, I think that they would agree. If we, if we would have had quadrupled the time, the results would have been much better and more likely to hold. We use this term carryover in physical therapy. And that means that

‍Garrett Salpeter (01:02:57.155)

Sure, of course. Yeah. There is a sweet spot with research and try to find a way to do that.

‍Dr. Courtney Ellerbusch (01:03:15.314)

what I do in the moment may look good, but what about at 5 p.m. that night, and then after a night of sleep when they wake up, or coming home from work, what happens then, did it last, or do they go right back to their prior state? And so when you have a neurological condition that’s already demyelinated in the central nervous system, and also the peripheral nervous system.

‍Garrett Salpeter (01:03:28.211)

Sure.

‍Dr. Courtney Ellerbusch (01:03:45.79)

and you’re trying to move in a new way, and you’re only doing it for six weeks, it’s really hard to see that carryover. And so I think one of the weaknesses of the study, based in the fact that it was very small, it was me, we didn’t have capacity to do really a robust followup or a formalized followup to see how they’re doing now. So I really can’t speak to their carryover.

‍Garrett Salpeter (01:04:18.351)

And one comment on that, if we’re seeing positive trends in these first six weeks and 18 sessions, that’s good. And in an ideal and hopefully more common, more typical setting, the patients, if they’re seeing that progress are going to continue. And we have some of these really amazing stories, like in my book, I talked about Wendy, this woman who had MS was in a wheelchair.

‍and over a period of time regained the ability to walk, walked her son down the aisle at his wedding. She also was able to get rid of the need to have a full-time caregiver at home. She was able to get her driver’s license back, all these stories. But that was over two years of consistent work. She’s using the machine. So to see the direction people are going and the trajectory here, I think is the value. But we’re not saying…

‍18 sessions over six weeks is the treatment, right? We’re saying we’re doing this pilot, like Ramona said, it’s the sweet spot here. We wanna have it be long enough to possibly see some changes, but it’s not a full intervention, and perhaps a more robust study would go even longer. Yeah, I think one thing that the six week time point tends to be a really common one for us in our studies, and in a lot of clinical studies, because it’s long enough that you can see continued progressive change.

‍Dr. Courtney Ellerbusch (01:05:26.232)

Right.

‍Garrett Salpeter (01:05:39.035)

But it’s also long enough where you can say, it’s not something that’s just anecdotal for that session. And yeah, ideally, after your six-week protocol, if you could go back to 12 weeks and remeasure them and see if those changes had lasted, that’s great. But yeah, we want to find kind of the sweet spot to get statistically significant results as quickly as we can. But you have to do it for long enough to actually start to see that consistent change in order to get those results.

‍Dr. Courtney Ellerbusch (01:06:06.894)

Totally, but I was gonna mention one follow-up conversation. I did reach out to some of the subjects and I talked to subject three. Is my camera failing again? There we go, okay. So subject three had depression. He owned the fact that he was depressed, but did not want any medication for his depression. That was his preference with he and his doctor. But throughout the visits, I talked to him about how,

‍Garrett Salpeter (01:06:20.987)

It just turned back on now.

‍Dr. Courtney Ellerbusch (01:06:36.834)

The depression does touch on everything that goes on with your health. And if there is an avenue of treatment that you would accept, I think it would make a difference in your movement and your health. So that was my consistent message throughout to try to be encouraging without being heavy handed. And actually in our last final assessment visit, our measurements looked worse in many of the categories for function.

‍but they looked better in strength and spasticity. And so I was in this paradox of why the heck is he stronger in these key glute muscles, quad muscles, hamstrings, tibialis anterior, everything’s working better, but when I get him up to walk, his walking speed is slower. And during that session, he didn’t let me talk. He was in a very bad head space. He didn’t wanna have a conversation.

‍

He just wanted me to do my job and he was gonna do his job and have it be over as soon as possible. So I respected that and I did that. And that was that. So I called him like a year and a half later to check on him and he said, Courtney, you changed my life. And I was like, what? I was like, we didn’t even talk.

‍He was like, yeah, no, but I realized the power of electrical stimulation and I was recognizing like before and after, like my body felt the best it’s felt in a long time, I just couldn’t see it. And I decided to do something about my mental health and I started to live for other people in my life that meant something to me. And I’m going to PT two times a week, things are still hard but I’m using my BioNest which is electrical therapy for tibialis anterior foot drop.

‍I’m using it more consistently, I’m doing PT, I’m getting my head in a better place, I’m eating right, and I’m gonna keep moving forward. That was just awesome. Like I didn’t expect that. I thought he might not even talk to me on the phone because he was not in a good head space, but I’m just so glad that I was able to call him and get that story.

‍Garrett Salpeter (01:08:54.115)

That’s fabulous. Yeah, that’s incredible. I’m glad you shared that too, because I would look at subject three and think, oh, he didn’t respond as well. But then that, you know, hearing that, wow, that’s amazing. Well, this also speaks to the reason why we really need to look at this, the social and psychological side, because yeah, sometimes you may not see it in that physical measurement, but it’s made the difference that it needed to change someone’s life and trajectory. Yeah.

‍Dr. Courtney Ellerbusch (01:09:18.798)

Absolutely and maybe perhaps because his headspace wasn’t good even though his body was stronger. He was Predicting the outcome wouldn’t be good and his body didn’t line up and he didn’t walk his best that headspace Matters so much and we are just beginning to understand it But I don’t think we can separate the psychological the social and the physical. I think they’re really all one

‍But how do we do that as PT? What if one person’s behind a curtain talking to them about their social life and getting the community around them? And the other PT is behind the other curtain, getting into their head space as much as we can and helping them to make good choices. And the other one is doing some manual therapy work, really dialed in. Which one is doing physical therapy? Right? We kind of all are, but we have to figure out what our norms are.

‍Garrett Salpeter (01:10:17.487)

Yeah, I think that’s a good uplifting message, you know, as we draw to a close in this conversation. And I think, you know, both with this study and with that line of thinking, you are a force for good helping to move the profession forward in a way where it can be even more impactful. And I just, you know, again, wanted to thank you and acknowledge you Courtney for excellent work there. And also…

‍

give you and Ramona an opportunity, if there’s any last thoughts or anything else that we feel like we need to share before we come to a close here.

‍Dr. Courtney Ellerbusch (01:10:50.75)

Thank you guys so much for this time and for believing in this project through the hills and valleys and changes and partnerships and how long it took. Really appreciate that support.

‍Garrett Salpeter (01:11:06.007)

Yeah, no Courtney, we’re really pleased with the outcome and just thrilled that you were able to, you know, really weather the storm of the sheer amount of time and effort that it takes to do a study and to do it alone is no minor feat. You really should be quite proud of yourself. That’s, you know, most people, if they’re doing a study alone, they’re doing their doctorate, he says, right? So, you know, for you to take that initiative and that challenge on is, it speaks to how much you care about the community you work with.

‍Dr. Courtney Ellerbusch (01:11:23.694)

Yes.

‍Garrett Salpeter (01:11:34.667)

And I hope that you, you know, getting those responses from people that you followed up with has really made it all worth it.

‍Dr. Courtney Ellerbusch (01:11:39.818)

Yeah, totally. Hey, thanks you guys. Keep doing good things out there in Austin and beyond. Yeah. All right.

‍Garrett Salpeter (01:11:47.143)

Thank you. Same to you in Colorado. And thank you everybody for tuning into this episode of the NeuFit Undercurrent. And a huge thank you to Courtney and my co-host Ramona. Thank you all. Bye bye.

‍Dr. Courtney Ellerbusch (01:11:57.454)

All right, bye bye.