← 4D: Deep Dive into Degenerative Diseases - ANPT
4D: Deep Dive into Degenerative Diseases - ANPT
DDSIG: Bonus Episode- CSM 2025 Platform Award: Amplifying walking activity in Parkinson’s Disease through autonomous music-based rhythmic auditory stimulation – with Franchino Porciuncula
00:37:37
In this episode, host Ken Vinacco interviews Franchino Porciuncula, the winner of the DDSIG platform award at CSM 2025 in Houston, TX. They discuss his research related to utilizing closed-loop, music-based rhythmic auditory stimulation (RAS) with peop...
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- [00:00]
A
This is for informational and educational purposes only. It should not be used as a substitute for clinical decision making. Welcome to 4D Deep Dive into Degenerative Diseases, gaining insights through casual and amusing clinical conversations welcome to 4D podcast brought to you by the Degenerative Diseases Special Interest Group of the Academy of Neurologic Physical Therapy, a component of the apta. I'm Ken Vanoca, a physical therapist in the Outpatient Neuro Clinic at Brown University Health and on the Podcast Committee of the DD sig. I'm excited to be here tonight with Franchino Procyncola, Research Assistant professor at Boston University, to talk about his platform presentation Amplifying Real World Walking and Parkinson's Disease through Autonomous Music Based Rhythmic Auditory Stimulation Randomized Control Trial, which won the DD SIG Platform Award at this year's CSM in Houston. Welcome Francino. Feel free to tell us a little bit more about yourself and your role at Boston University.
- [01:08]
B
Hi Ken, thanks for inviting me to this podcast. I'm really honored to be talking to you today and to be sharing our research with the NEUROSIG and to talk more about our research here at Boston University. My role at Boston University I'm a Research Assistant professor. I'm involved in different studies that look at ways on how we can optimize and improve rehabilitation, specifically looking at gait in Parkinson's disease and in stroke. One of our studies is this particular clinical trial looking at increasing or amplifying physical activity in people who have Parkinson's disease through this novel approach using an autonomous closed loop music based digital gait intervention, which is essentially an autonomous rhythmic auditory stimulation device that integrates the person's stepping performance with music cues. So this is really novel. So in a nutshell, basically we wanted to understand the effectiveness of this intervention in people with Parkinson's disease. We had performed prior feasibility studies looking at safety and initial proof of concept of this approach in people with Parkinson's disease and we found favorable and encouraging results on the improvement of physical activity based on steps, amount and intensity. And the next step for us was to understand or at least have an initial understanding of the effectiveness of this approach. Basically comparing this new approach against something which doesn't use cueing, which was moderately brisk walking without cueing and that was our active control. This was an eight week study that looked at the intervention and we basically found encouraging and promising results looking at three primary outcomes, real world walking activity based on step intensity, step amount and gait variability. Generally what we found was favorable outcomes on those metrics in Favor of the experimental group, which I can talk more about as we talk about the study.
- [03:28]
A
That'd be great. And I think it could be helpful, too. Like, that was such a great background, and it seems like there's been a lot of research leading up to this project, too, maybe in, like, smaller groups of people with pd. But it could be helpful, too, for our listeners to understand, like, what is this rhythmic auditory stimulation and a closed loop approach versus maybe what's an open loop approach and how those may differ.
- [03:53]
B
Yeah, that's a great question. So perhaps many clinicians, especially folks who are working with neurological populations, have, at some point in their careers, have tapped into using rhythmic auditory cues to help with setting patterns, whether it's in stroke or Parkinson's or other populations. Essentially, the concept of rhythmic auditory stimulation is that we are pairing auditory cues with motor behavior. In this case, it's stepping. And what has been shown in the literature over the past several decades, this is not a new thing. People know that this has been in existence for a long time. Rhythmic auditory stimulation is capable of improving immediately improving gait quality. People take longer steps, People walk faster. And we think that is advantageous for increasing intensity and amount of walking in people with Parkinson's disease. Pretty.
- [04:51]
A
That immediate effect that it can have.
- [04:53]
B
Yeah, yeah. So these are immediate effects, again, with a caveat of having the right parameters for rhythmic auditory stimulation. You can't just present any type of cue, regardless of what the person's doing. It is scaled somehow to the person's walking tempo or walking cadence and then modulated accordingly. So the traditional rhythmic auditory simulation approach is the open loop approach, which essentially utilizes fixed cues or manually adjusted cues. And these cues are independent from what the person's doing. So there's no connection between the cues and the user or the patient or the participant. In case of our study, therefore, a therapist or someone who's trained to monitor and assess the person's walking would need to do manual adjustments if there were no manual adjustments. If it's kind of like fixed cues all throughout, there is a chance for an accumulation of errors, which eventually would lead to gate destabilization. So it is necessary to have some sort of, like, a monitoring or assessment of whether these cues are appropriate for a particular cadence or for a particular gate pattern.
- [06:08]
A
And, like, maybe at a particular time, too. Yeah.
- [06:12]
B
Yep.
- [06:12]
A
Someone, let's say you calculate their cadence. Like, you get a. Could be a metronome. Right. Or a music set at that beat, and you set them off on their walking program. And then I don't know, maybe their cadence improves to the point where it needs to be faster. It actually, it just happened to a patient of mine just two hours ago. Came in, her cadence at baseline was like 100 to 105 beats a minute. She had gone and like started her walking program. She was doing fantastic and like going out four or five times a week, 30 minutes. And I asked her, this is now three weeks or four weeks after she started her program. Like, oh, are you still using the queuing? Are you still using the music? She's like, no, I, I got sick of it. I was, I was actually, it wasn't working for me. I was like walking faster than the beat. Oh, let's, let's change things up. Let's increase your cadence. Yeah. And now she's, she's off and running again. She said like, you know, gave her the new playlist and a new set, beats a minute and she's off. But that variability or that specificity, you know, would be so great if that's autonomous, which maybe you could speak a little bit more to get it approach.
- [07:25]
B
That is such a great example. I just wanted to add regarding open loop for, for that very example that you provided is that you can't easily take this open loop approach out of the clinic because of the dynamic nature of walking. Things are so dynamic at a stride by stride level on a day to day basis. Even within a session, it changes. There's the element of the environment where things change. There's fluctuating pedestrian traffic if you're trying to walk outside. And then there's unevenness on the ground which affects one's gait. And then there's the individual variations within a task, whether there's a fluctuation in medication or fatigue even. And then over time, as you have said, perhaps people are getting better, which is a good thing. But the cues also have to be updated as they are getting better or the other way. So it's very dynamic even across days or even months of how cues are being used. And that brings me to kind of like the advantages of a client closed loop approach or an autonomous closed loop approach. Closed loop basically refers to the type of control where the steps or the person's performance is being taken into account by how cues are being delivered to the person. And typically how this is being used or implemented is that there is usually some sort of like a sensing component to the system, whether they're wearable sensors or some sort of like pressure sensors which allows the system that provides the keys, whether it's a metronome or music to understand how the person's walking. What this allows is that the person then is able to have more flexibility in their program. The system is not going to be progressing them at higher tempos if they're not ready yet. Right. And the algorithm is going to determine where they are in their cadence and then scale either higher or lower, depending on what is needed to be done. So I think that that's kind of like very high level advantages of a close loop approach.
- [09:38]
A
Yeah, yeah, yeah. It sounds like it's, it's more adaptable to the individual patient because sounds like there are sensors that the patient wears that would provide this information on their gait variability and characteristics, where this algorithm would adapt to it.
- [09:56]
B
That's right, Yep. And I think that is what determines the viability of this approach to be taken outside of clinical settings and for it to be sustained as part of a long term walking program. There is high potential. We haven't, we haven't examined yet, but I think that is our next step. I don't want to get ahead of like the future directions, but I think that that is where this is headed to.
- [10:20]
A
Yeah, that's great. So for your particular study here, like what was the population of people with Parkinson's? Like what, what did that look like and tell us maybe a bit more about sort of the methodology of your study?
- [10:35]
B
Yeah. So our population, our sample included people who are middle age, older adult people with PD and they are in a mild to moderate stages of the disease. I would say the population or our sample is more on the higher level side of things in terms of like their gait speed and their six minute walk test. However, we still have a spread, so.
- [11:02]
A
Like lower disease severity and not quite newly diagnosed Parkinson's, but higher ability walking in the community still. And these individuals did not have freezing of gait, is that correct?
- [11:19]
B
Yeah. So one of our exclusion criteria, just based on where this clinical trial is in our stages of investigation, this is kind of like the first time we're, we're doing this randomized controlled trial. So we excluded those who had moderate to severe freezing of gait, but we had some participants who had mild freezing of gait, maybe a couple of them.
- [11:40]
A
Very interesting. Yeah. Did you find that there? And this is on a participant by participant level. But did those individuals with any mild freezing of gait respond differently to the intervention?
- [11:53]
B
It's very interesting. So anecdotally, as we talk to participants when they come back in for their assessments, for those couple of participants who experience mild Freezing of gait. They found some benefits. Their perception was more of, like, they were able to use the cues to overcome episodes when they felt like the freezing of GATE was going to come on. So we didn't have any specific instructions on how to use cues against freezing of gate, but these were things that they found while they were engaging in the program, which we think is very promising. And it kind of like lines up with how we think freezing of GATE can be mitigated. But this requires more investigation to understand how people are using these closed loop autonomous cues to counter freezing of gate. But it's. Yeah, it's a potential application.
- [12:43]
A
It would be so interesting to see the applicability of that for people who freeze.
- [12:49]
B
Yes, absolutely.
- [12:51]
A
But it seemed like, yes, this population was more active. And did you measure that? Like, was this. These people, did they take more steps at baseline compared to other people with. With pd? Like, what were their baseline activity levels?
- [13:05]
B
Yeah, I would say so. We quantified their step activity at baseline, but on average they were greater than 8,000. About 8,000 to 9,000 steps on average, which is higher than what we would typically expect. And I think this goes with the population that such an exercise intervention is attracting, especially in our region. In the Boston area, everyone's so educated and informed about Parkinson management, which is a good thing. But what that tells us is that I think this is very encouraging, right, to be able to generalize or increase the generalizability of our results. Understanding different presentations, different baseline characteristics would be important. But even if they were walking at these relatively higher amounts of steps per day, if we would look at the intensity of their daily stepping, which is perhaps a more meaningful metric to understand intentional walking, they had very minimal levels of sustained moderate intensity walking. So the way we define moderate intensity walking in our study, consistent with other studies too, are steps taken at 100 steps per minute or greater. And they had very minimal minutes at moderate intensity walking, which again tells us that they may have lots of steps, but those are being done at lower intensities. So there's an opportunity for us to. If they have that capacity to do more steps, they can further optimize the benefits of walking by walking at higher intensities, which they were not doing before the intervention.
- [14:48]
A
Right. Which is really the ultimate goal of an intervention like this. And what we know to be so effective for people with Parkinson S disease is the continuous, maybe moderate to high intensity walking versus just the accumulation of daily steps through, like, chores or household or community activities, where they're just accumulating those Steps, but not that sustained aerobic effort.
- [15:12]
B
That's right, yeah.
- [15:14]
A
So you started to dive into a little bit of the details about the methodology of the study and how there is a intervention group and a control group. But could you explain a little bit more about those two groups and how the study was designed?
- [15:30]
B
Yeah. So this is our randomized control trial. So basically, when they came in for their first assessment, they were randomized to either what we call the AMP PD group, which is kind of like a shorthand for amplifying physical activity in Parkinson's. They were the group who received the digital gait intervention, the closed loop rhythmic auditory stimulation. And then the other folks were randomized to an active control group, which was moderately brisk walking. For the AMPD group, they were asked to walk five times a week, 30 minutes each session, for six weeks using this device. So they were asked to do the program independently. So this was done out in a community. There were no instructions as to do it at a particular time, et cetera. So they made those decisions on their own on how it fit in their schedule. We gave them a paper log to record their walking sessions for us to understand whether they were adhering or not adhering so well with a program at the very end. And they also received a phone call from the physical therapist for the first six weeks of the intervention. The purpose of the phone call was to just basically check in how they're doing with the program if they had any questions about the device. And that was basically it.
- [16:52]
A
Yeah, that was a question I had, like, yeah. Was there follow up throughout the intervention or were they just told, walk for six weeks? Here's the rhythmic auditory stimulation. Go for it. But seems like there was that follow up.
- [17:06]
B
There was a phone call which is kind of like just a touch point. There was no explicit behavioral intent for those phone calls, but basically just kind of like checking in if they had any questions about the program and to monitor whether there were any adverse events.
- [17:21]
A
Right. Were they instructed to do over ground walking, or were some individuals able to go on the treadmill?
- [17:27]
B
Yes. Great question. So when we gave them the device, gave them instructions on how to use it so they can use it independently. So there are specific instructions related to the device, essentially walking on relatively or generally flat ground or flat surface in order to get more accurate sensor recording. It doesn't work so well on uneven ground or on, like a slope or a hill. So we advise participants to find a suitable location around the neighborhood or something that's accessible or easy enough for them to get into. But Our participants primarily walked out in the neighborhood. So there were. And we also gave them safety instructions like avoid areas with heavy pedestrian traffic, dogs, etc. Just to minimize any.
- [18:19]
A
I'm always curious about and cautious about with my patients is like, yes, I'd love you to listen to music and love to walk to the beat, but make sure you can like know where traffic is. Make sure you can hear things around you.
- [18:32]
B
Make sure, yeah.
- [18:34]
A
And does that maybe impact the effectiveness of this rhythmic auditory stimulation? Meaning like if there's potentially background noise or things that are distractors.
- [18:47]
B
So the headphones for this device, they're bone conducting headphones. So they essentially it's intentional because they wanted the manufacturer Med Rhythms wanted to ensure that people had spatial awareness of what's going on, like environmental awareness. So that's one point. And then regarding distractions, we think that the mechanism behind auditory motor instrument is not necessarily maybe the first couple of steps. You would have to think about your steps and the music. But eventually it becomes kind of like less cognitive driven. So people are not really paying attention. So they kind of like use the music as an external reference and it kind of like stays on the background and then they do their walking. At least that's how you would understand it. Maybe there would be some elements of periodic shifting in attention depending on situation, but depending on context, whether they're crossing the road or whatever. But I think in general the cues are being used as an external reference and it's less cognitive driven.
- [19:58]
A
I've always wondered if you remove the intervention completely after you've delivered it, is there some carryover session without the cue?
- [20:09]
B
Immediate carryover, yes. Studies have shown that there's immediate carryover like in a matter of minutes after. And we see this in our other studies in the lab where we look at single session effects of RAs. So there's that and then within days there is still some carryover. And this is what we have shown in our study. Our post assessment on gait variability was done without cues and we saw a reduction in variability during uncued walking. However, regarding the true durability of effects, like if, let's say we did like a washout or if we waited like a month or so without the intervention, without the closed loop approach, we're not too positive that we would be seeing much of a durability effect. Maybe there's going to be a mixed response. But what we know in Parkinson's disease, this is a degenerative disorder that is the basis of the motor difficulties, are dopaminergic Loss. So if we stop the intervention, I don't think we would expect a strong persistence of these effects. Which, what that tells us is that we have to have ongoing interventions across the stages of the disease.
- [21:34]
A
Right, right. So true. And such a good thing to point out the, you know, the skill that goes into treating these individuals throughout their, their diagnosis and as it progresses, but not to go too far away from the overall study design. So the seems like the intervention group had this for six weeks. They were instructed to walk five times a week for 30 minutes. The brisk walking group was instructed to walk the same amount.
- [22:02]
B
That's correct. Yeah, same amount without rhythmic auditory stimulation or listening to music. So basically, brisk walking on their own.
- [22:11]
A
Were they followed up in a similar way?
- [22:15]
B
Yes. So they got the same frequency of follow ups with phone calls from the physical therapist. They used the diary or the study log, the, the paper log to track their walking session. So the same thing. The only difference was the, the device.
- [22:32]
A
So, you know, what, what were the results? What happened?
- [22:37]
B
Yeah, so, so our primary outcomes were step intensity, step amount and gait variability. Step intensity. We examined their real world stepping intensity based on moderate intensity minutes. So we found a significant difference between groups after the six week and after the eight week end point, we found significantly higher moderate intensity minutes in favor of the NPD group over the active control group. And then when we look at differences per group, we found significant increases again with moderate intensity for the MPD group while they were doing the intervention and after the intervention. However, when we took away the intervention, the device, it went back to baseline, which again kind of like it goes back to the point of durability. If you take away the intervention, they are unable to sustain the, the activity because this intervention is what is allowing them to tap into latent capacities. The moderate intensity minutes were on average above 30 minutes per session. And if we extrapolate that across a week, that would be meeting or that would be satisfying public health recommendations of 150 minutes per week. So that was very encouraging to know that people are able to do this if you give them the right tools to do their walking.
- [24:06]
A
Right.
- [24:07]
B
In contrast, the active control did not have significant increases in their moderate intensity walking at any time point in intervention.
- [24:17]
A
Right. That, I mean, that's really encouraging for the intervention and that they accumulated those minutes of walking and that at that intensity too, we know can be such an important factor management of symptoms in this disease.
- [24:35]
B
Yes, absolutely.
- [24:37]
A
And did people like the intervention? Did they enjoy using it?
- [24:42]
B
Yeah. So we did a post study exit survey. What Came out of that were themes that were related to enjoyment, structure, gait improvements. They felt like they were walking better when they were walking with the closed loop approach. And they also had some insight on things that can be improved in the system which we would expect for, for such an intervention.
- [25:09]
A
Yeah. And they continued to use it even after they were told they didn't have to walk with it anymore. Is that right? Did I?
- [25:17]
B
That's right. Yep. So after it's a six week structured intervention period, we told them we're done with a study, you'll get to keep the device. If you want to continue using using the device, you are free to do so basically kind of like do whatever feels right for you in the next couple of weeks. And we said the same thing for the active control group. We found good to excellent adherence rates. At the follow up, the MPD group had slightly better adherence, maybe about 80% compared to the active control. But to answer your question, yes, they continued using the device.
- [25:57]
A
Yeah, that's also encouraging because you know, that's, you know, part of the, the challenge that can happen when treating people with Parkinson's disease is maintaining that level of activity.
- [26:10]
B
Yeah.
- [26:10]
A
The various non motor reasons and yes, humans.
- [26:15]
B
Yep, yep. One of the things that we didn't talk about habits, but this is kind of like grounded on habit formation. We wanted something to be habitual routine and how can we, how can we establish those behaviors? And we measured habit through a self reported outcome measure and both groups demonstrated or reported at least improved habits at the end of eight weeks. So that's encouraging.
- [26:44]
A
Oh, that's great. Yeah. Could people choose any music they wanted with this intervention too? And do you think that autonomy to choose also helped them adhere?
- [26:56]
B
Yes, that's a great question. They were able to choose the genre of music. We had at least five selections. There's oldies, there's classic rock, there's country, there's Motown. So basically these songs are curated based on the therapeutic value of the song and beat salience. So they can't just kind of like choose any song that they like. It's prescreened for that reason. But they had this autonomy to kind of like have their preferences be acknowledged during their day training. And I think music matters, you know, it has cultural significance, it has, it triggers enjoyment, happiness and all of that. And if these things are helpful from, from a non motor standpoint, we think it would just further optimize the effect of the intervention, both motor and non motor and ultimately adherence. If you're not liking the music, who wants to be walking or dancing to music that they don't like. It's the same concept in this approach.
- [27:52]
A
Right. Oh, I found that to be so powerful when you can find someone's favorite artist or song actually matches their cadence.
- [28:01]
B
Yes.
- [28:02]
A
A match made in heaven. Yep.
- [28:05]
B
And I think what's super cool with this element of music is that, well, other groups have looked at music, but it's not popular or familiar music. The music that was used in this device was popular, familiar music. There's a partnership with Universal Music Group which gives the company or the maker of the device access to a wide range of music choices, which is key to making sure that one identifies with a type of music. So I just wanted to acknowledge that feature.
- [28:40]
A
So, you know, where do you envision this going now? Like what is your, your next project that you're lining up? Or where do you see this sort of autonomous closed loop rhythmic auditory stimulation helping people with Parkinson s?
- [28:54]
B
I'm just going to preface it by acknowledging some of the gaps in in practice. Right. Parkinson's disease is a complex condition that includes motor and non motor. And if we think about the motor aspect alone, there's gait slowness, there's poor gait quality which impacts and then the loss of walking automaticity, impacts gait variability, arithmeticity, and combined together, it has a cascading effect on real world walking activity, amount and intensity of walking. And those elements are important in optimizing outcomes. But there isn't any intervention out there that can target these array of gait deficits in Parkinson's. And we feel that this has potential. But in order for us to fully understand its effectiveness on a range of presentations, we have to do a bigger trial, a pivotal trial. So this is a large randomized controlled trial. We would need to open up our inclusion criteria to include people who have more severe difficulties, definitely greater than where we started in this particular trial, and then understanding what the effects of the intervention are when extended beyond the short period of six or eight weeks. This eight weeks is more of like a trial just for us to get an initial signal. But our original intent is for us to understand the effectiveness and the sustainability of such intervention for long term routine use in daily life. So we would need to test it out for longer intervention periods, at least six months. That that's been kind of like typical for other clinical trials. So I think that's where we're headed.
- [30:39]
A
No, that's really exciting for the clinician. Now who wants to implement this type of rhythmic auditory stimulation? What can they do?
- [30:50]
B
Yes. So again There is a gap with open loop approach, but not to say that you can't use open loop approach. Now there's more appreciation of advantages of a close loop approach. So this particular device by Man Rhythms has just received a Class 2 FDA status basically for prescription type of device. So there's, there's that avenue and for the rest of the research community, it basically demonstrates that there is a lot of potential in developing technologies that utilize closed loop approach independent of the device that we are specifically studying right now.
- [31:32]
A
Right. That's exciting about the FDA approval. And is that for. I know In Tandem was like Med Rhythms intervention for individuals post stroke, but now is it get that Class 2 FDA approval for individuals with Parkinson's disease.
- [31:50]
B
That's right. Yeah. So this was pretty recent. The In Tandem has an algorithm that is specific for stroke. The device that we used has an algorithm that's specific to Parkinson's that received its FDA Class 2 designation maybe a couple of weeks ago, which is really promising.
- [32:08]
A
That's great. Should we have any disclosures in this podcast? Is that.
- [32:13]
B
Yeah, I don't have any financial conflicts of interest related to the device, so I just want to put it out there. We ultimately want these devices or these ideas that are born in the lab to be taken out of the clinic and to be used by patients, whether it's an approach or an actual technology. So really encouraging to be to have this available.
- [32:38]
A
Right. Well, I think everything that you've just said now should really excite clinicians. I know it excites me to want to go in and implement this sort of training or intervention with my patients. But I do want to ask you, and I want to give you really the opportunity to thank any of your collaborators on the project because we know it does take a team. So is there anyone that you'd like to recognize?
- [33:03]
B
Yeah, this work has been just. I've been so lucky to be working with just fantastic people at Boston University. Specifically Terry Ellis, who is a wealth of knowledge in Parkinson's and in clinical trials and technology. The research physical therapists Nick Wendell and Theresa Baker, they were the blinded assessors and contributed a lot to the design of the study. Jenna Zajak, she was a PhD student back then, but she was key in, in the design of the study and also implemented. She was the interventionist, Lua Wad. I would also want to thank the support of the funding agency, the National Institutes of Health, NIA and the support from Med Rhythms for providing us access to the devices. So thank you to this great team.
- [33:59]
A
Cool. And of Course. You know, Nick, pinch hit for you at csm.
- [34:03]
B
Oh, absolutely. Yeah. How can I forget? I want to thank Nick Wendell for stepping in last minute to present in behalf of my CSM talk. I got sick. If people didn't know, I got the flu a couple of days before the presentation. And Nick Wendell was just Superman, saved the day, and he did a fantastic job presenting. So thank you, Nick Wendell.
- [34:28]
A
And I thought it was kind of great, though, that you'd still get to present your findings here and hopefully all the great work you did. So we're so happy.
- [34:37]
B
I appreciate the opportunity.
- [34:40]
A
Last question, though. I have for you is really a tradition that we have here on the DD SIG, where we ask each of our guests what they like to do outside of work.
- [34:50]
B
I practice yoga. That's what I do for taming the crazy brain. I need some meditation and yoga. That's what I do on my downtime.
- [35:02]
A
It's great. Well, you. Yeah, fulfilling the typical physical activity, exercise sort of answer that folks usually give.
- [35:12]
B
So I. I try.
- [35:14]
A
Yeah. That's great. Well, really appreciate you coming on tonight, Francino, and speaking to the great work, and you're a fantastic platform, which, again, congratulations and really excited to see where this goes.
- [35:29]
B
Thanks so much, Ken. It's been a pleasure.
- [35:31]
A
Thanks for joining us and special thanks to our guest today, Francino Porcincol. This podcast was produced and edited by the AMPT Degenerative Diseases Special Interest Group podcast team. For more information on this SIG and the AMPT, visit www.neuropt.org. our podcast team includes Sarah Zoller, Christina Burke, Marm Padgett, Jeff Schmidt, Shannon Brown, Skylar Ross, and I'm Ken Vanako. Thanks to Jimmy McKay for providing music and please share this episode with a colleague. Today, the Academy of Neurologic Physical Therapy and its collaborators disclaims any liability to any party for any loss or damage by errors or omissions in this publication. The views or opinions expressed are those of the individual creators and do not necessarily represent the position of the Academy of Neurologic Physical Therapy. So I started recording. I wasn't sure I was gonna capture some bloopers. Ken's in charge. Oh, no. That's a scary thing.
- [36:43]
B
She's a miniature schnauzer slash mini Aussie. So she's kind of like a blue. A blue schnauzer.
- [36:55]
A
Is that Lily? Wait, wait. Yep. We need to say hello.
- [37:01]
B
She wants to say hi.
- [37:03]
A
Oh, You're in Boston on Monday. I'll give you a wave wherever you are.
- [37:13]
B
Oh, you're running Are you running?
- [37:15]
A
Yeah.
- [37:16]
B
Oh, wow.
- [37:18]
A
If I get beat by Paul Revere, you know, no hard feelings.
- [37:24]
B
Call. Sorry. My. My light just turned off here.
- [37:28]
A
Mood lighting.
- [37:32]
B
Interesting. I wasn't expecting this question.