Krystina Miller, PT, DPT works with patients who have complex neurological diagnoses. After several years working in an inpatient setting, she opened her own practice in the Metro Detroit area and started using the Neubie shortly thereafter. Initially, she incorporated it as an adjunct to help her neuro patients with other pains and injuries, especially the ones who had shoulder problems from operating their manual wheelchairs. As she was helping them with their pain, she saw ways that she could use it to help with the actual neurological impairments as well. She shares stories of helping spinal cord injury patients restore sensation, improve autonomic function to help blood pressure and reduce swelling in the legs, and dramatically reduce spasticity to improve function.
[Garrett salpeter] 0:50
Welcome to this episode of the undercurrent podcast. I am very excited to have Christina Miller, DPT joining us today, Christina has a practice in the Detroit metro area. Thank you so much for being here, Christina.
[Krystina Miller] 1:03
Thank you for having me, Garrett. I’m excited to be here.
[Garrett salpeter] 1:05
All right. Well, I’m, I’m really looking forward to this conversation, because you’ve been using the newbie for what little over a year now? Or? Almost two, almost two.
[Garrett salpeter] 1:16
Wow. Yeah. Seems that way. Awesome. Awesome.
[Garrett salpeter] 1:22
And can you tell us about a little bit about your physical therapy practice just so people can kind of understand, you know, the type of work that that you’re doing?
[Krystina Miller] 1:31
Yeah, absolutely. So my physical therapy background is mostly in the rehab setting inpatient rehab. And about three years ago, I jumped out on my own to start an outpatient practice for people with neurologic issues. So I work primarily with people with neurologic diagnoses, specifically spinal cord injury.
[Krystina Miller] 1:55
And I started out in the community travelling to clients, to gyms and community areas, and opened up a physical location in June, in Macomb Township in Metro Detroit. And the focus of the practice has always been kind of a high intensity rehab, fitness environment.
[Krystina Miller] 2:19
So looking at taking clients on at any stage in their recovery. So whether they were initially or recently discharged from hospital setting, or whether they had been in the community for a number of years, meeting them where they were with their rehab needs. But then the goal is to progress them to a state where they have more independence in the control of their rehab and moving into fitness in a gym, that they had access to accessible equipment and fitness trainers that are familiar with their condition and can help continue to progress.
[Garrett salpeter] 2:56
That’s, that’s awesome. I love your vision and intention with that. And I’m so excited that we were able to connect and work together so that you can start using the newbie in that practice. I’m interested before us before we talk a little more about that, you know, some of the experiences you’ve had with it.
[Garrett salpeter] 3:17
What would you say generally, is the differences or is there any contrast between the work that you were doing before and the inpatient and outpatient pretty newbie versus now that you’re using it? How that how is is that changed either your approach or different elements of your practice? What differences that made for you.
[Krystina Miller] 3:38
So I’ve always treated a range of patients in terms of their diagnoses, their abilities, and where they are in the rehab process. So especially early on, a lot of the focus is more on the day to day functional stuff. So getting people back to being able to transfer being able to take care of themselves, a lot of cases learning how to walk again. And all of these patients have some form of pain, whether it’s joint pain, musculoskeletal pain, a lot of times nerve pain. And those issues from a physical therapy perspective almost always ended up on the backburner, or they were not the primary goals because there were always more pressing issues.
[Krystina Miller] 4:23
And especially with nerve pain, it was something that from a physical therapy perspective, we would find ourselves chasing with not a lot of positive results using different modalities, but still no long term effects. And so when finding the newbie I actually heard about it on a podcast and you guys were talking a lot about avoiding surgery or accelerating the healing process after surgery.
[Krystina Miller] 4:52
And the joint of particular interest in me was actually the shoulder because I see a lot of people with shoulder pain from long term wheelchair use I also see people who are on the fence about doing shoulder surgery because they rely so heavily on their arms. So the limitations after surgery would not allow them to be independent. And we’ve always been looking for ways to avoid going down that road for them.
[Krystina Miller] 5:20
And then at the time, interestingly, that I had listened to the podcast, I had a patient who is an adaptive Ironman athlete, primary wheelchair user that is his mode of mobility. And he was having a lot of shoulder pain issues that were affecting his performance was using manual techniques using traditional Easttown he’d got some relief, but then would go out and train and would be in pain again. So the newbie has allowed me to spend, honestly very little time actually focusing on the shoulder or focusing on back pain, neck pain, and actually get some results that holds and still focus on the other activities that we’re traditionally focusing on. So it’s allowed me to be, in my mind more effective as a therapist for this population.
[Garrett salpeter] 6:15
That’s awesome. I really liked that perspective, where there is obviously a whole range of, of different, you know, things that you want to help these patients with. And so being able to, to focus on that more typical, you know, physical therapy work, while at the same time not being so distracted from the, you know, the functional goals that you have, for they’re more closely related to their neuro diagnosis. I think that’s, that’s awesome. And since you since you’ve added the newbie, I know you’ve worked with a wide range of patients we’ve gotten interact over some of them, what are the what are the main either, you know, success stories or the cases where you feel like new fit has been able to how adding that in has really been able to benefit your patients there what kind of stands out in your mind.
[Krystina Miller] 7:08
So one of the first patients that I use the newbie with who was gracious enough to allow me to experiment and explore. She has an incomplete level spinal cord injury, so she’s C 67. Asian be for anybody that’s, that’s familiar with that scoring. But she beyond about T two T three, she’s never had any muscle activation, voluntary muscle activation. She uses a manual wheelchair for primary mobility. And she’s been in therapy since her accident. So now we’re going on, I want to say three years or right she’s right around the three year mark after her injury, and no sensation below the level of her injury. She had been working on for quite a period of time being able to tolerate standing she does have a standing frame at home.
[Krystina Miller] 8:06
And that activity has been limited by orthostatic hypotension. And a lot of times she ends up with some increased swelling in her lower extremities because of the inhibited Miss return. And I was seeing her home, initially twice a week. And I started bringing the newbie with me and we started just with the scanning process looking for different areas that we might be able to to run with and have an effect. Within a couple of months we were finding that when I would put the pads on one of them some more approximately so we do cervical spine or mid thoracic and had a matching hotspot in her lower extremities.
[Krystina Miller] 8:50
She was actually getting some new sensations where she’d be able to feel the stem in her glutes and lateral thigh and into her feet and her toes. And that was something she hadn’t experienced before. She was never able to really feel the stem when it was on her legs. Traditional Eastham and the newbie and then she started to get when the stimulus off she was getting more sensation in her feet. So when her caregivers were putting her socks on socks and shoes on the morning, she could actually feel that and then we were gaining some motion so she had spent some time in the rehab setting using the RTI stim bike so it coordinates traditional alternating current stem with muscle contractions for motion to propel a cycle and it does have a Motor Assist.
[Krystina Miller] 9:42
I’ve used that on her myself and she never got more than a twitch of a muscle and it’d be like a twitch of the quad. It lasts for a couple of minutes and then it would fatigue out we wouldn’t see anything for the rest of a 15 or 20 minute liking session with the newbie it Took us initially, very high settings to be able to get a full range of motion contraction of something like ankle dorsiflexion, or knee extension.
[Krystina Miller] 10:11
And over time, we were seeing that the level of stem that we needed to get a contraction was significantly lower about 50%, lower over a couple of months. And then she was able to actually repeat more repetitions of the same movements, we were gaining some muscle endurance. And then she started to have having some breakthrough where we I could leave the stem on continuously, and she could actually work through the stem and perform ankle dorsiflexion and plantar flexion.
[Krystina Miller] 10:40
So it was obvious that she was getting some control, she was working outside of the function of the machine. She doesn’t have movement yet off the machine where she can actually get full range ankle dorsiflexion and plantar flexion. But just the improvement in that I feel was carrying over into her standing frame performance. So she was increasing her endurance in the standing frame, we actually stopped getting swelling in her legs, we were able to stop using compression stockings to control fluid build up, so she doesn’t wear them anymore at all. And with just elevating her legs once or twice during the day, she’s keeping the swelling out of her extremities. So that for her was a big improvement because she had been wanting to ditch the compression stockings for quite a while they’re not very attractive in the summertime. So she’s able to wear her cute shoes and not have to wear her compression stockings.
[Garrett salpeter] 11:39
That’s awesome. I love hearing that. I mean, obviously some sensation coming back, you know, some function, some functional improvements, in some strength, some endurance still still progress to be made. But that’s certainly exciting to me to hear this swelling because that speaks to autonomic function and, you know, blood vessel tone and dilation and constriction of blood vessels.
[Garrett salpeter] 12:03
And that often, I think, precedes higher levels of functional recovery. Did that affect her or you mentioned she had orthostatic hypotension, which is if anyone doesn’t recognise that term, that means like, if you go from lying down or seated up to standing, you can get lightheaded because the blood kind of goes down into your legs. And so you need you need to have your autonomic nervous system or automatic nervous system constricted blood vessels so the blood stays higher up in your body. There’s enough in your brain you don’t get lightheaded did that did that change at all for her.
[Krystina Miller] 12:34
So we seem to be making progress for quite a while she was able to stay in her standing for him for about 30 minutes at a time without taking rest breaks and without any issues and blood pressure. And then she had some setbacks and wasn’t tolerating it at all for a while. She ended up working with a cardiologist because I was actually concerned and taking her vitals not only would her blood pressure drop, but her heart rate, which we would normally expect to elevate to try and compensate for that low blood pressure would elevate initially, and then within 30 seconds, it would drop off and she’d literally tank down into the 40s Oh, wow. She wasn’t feeling well, she’d get nauseous. So beyond the lightheaded, orthostatic hypotension.
[Krystina Miller] 13:16
And the cardiologist was running some tests, they really, were not finding anything that could help much with they had put her on a medication to help elevate her blood pressure didn’t seem to have a lot of effect. But then after taking the course on micro current, I started exploring some options to stimulate the sympathetic Plexus for her. So she’s actually the one that I had spoken with you about setting that up? Oh, yeah, we did two sessions with that for the micro current. Nothing else has changed in her fluid consumption in her medications, in anything that we did preparatory to stand. And she’s now back up to like 10 or 15 minutes without symptoms were before we were lucky to get two or three minutes, for her heart rate seems to be staying up. So she’s blood pressure, still dropping a little bit, but not to orthostatic ranges. And she’s maintaining a heart rate between like 90 and 110. While she’s up in the glider, and she seems to feel fine, or up in the standing firm, sorry. So it seems to have done some something and she’s happy to be back up there again. So
[Garrett salpeter] 14:28
Oh my gosh, that’s fabulous. I didn’t even realise that was the person and when we when we talked about that, but just for context for everybody so that when Christina mentions the microcurrent that’s something that we had recently had our first level two course, where we reviewed some different new methods that we’ve been working on as part of our ongoing innovation in our efforts to continue to be able to help wider ranges of patients with different types of issues, diagnoses and I’m so that’s awesome that two sessions on that made such a big difference. Fabulous. Thank you so much for sharing.
[Krystina Miller] 15:04
Yeah, absolutely. I was shocked. And she was she was willing to try it because she didn’t have to do anything different. I mean, we put it on and ran it for about 10 or 15 minutes. And it didn’t seem to have much of an effect the first time we did it, but we did it right before she got up. And then the second time we did it, it was like a light switch flipped and she was back in business so
[Garrett salpeter] 15:27
Fabulous. Wow. That’s really some of the autonomics is as cool as the functional improvements are. Sometimes these autonomic changes are even more interesting or exciting.
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[Garrett salpeter] 16:14
Any other any other stories or cases that that stand out in your mind?
[Krystina Miller] 16:21
Yeah, so one of the other big effects that I have found with my spinal cord injury population, and using the newbie is spasticity management. So a lot of my clients end up with flexure tone or extensor pattern spasticity that actually interferes with their mobility, a lot of times masks muscle weakness, so it even makes it difficult to work on strengthening exercises when people have incomplete levels. And I have a gentleman, I’m trying to think if he’s almost five years, probably five or more years out from his injury.
[Krystina Miller] 17:00
And he works through it, but he’s actually had a lot of low back and mid back pain and tightness that comes from abdominal and back muscle chronic spasticity. So I suspect that some of it is probably arthritis related below the level of his injury in the spine and the hips, because we do have confirmation on X rays of that. But then prolong positioning in the wheelchair, his posture is locked in to this posterior pelvic tilt with compression from prolonged sitting. And when we get him out of the wheelchair, his legs bounce his a dominance fight him moving that he’s actually a fall risk. And then when we have done some standing and utilising gait training devices, we often have to stand and then wait for some of that to relax before we can get moving.
[Krystina Miller] 17:59
And then he’s limited because his arms get fatigued because it’s fighting that to move. And we’ve used the newbie to help relax some of that specificity and then actually tap into strengthening of his abdominals. We’ve had a couple of sessions recently where he gets out of his chair and he’s actually really surprised he sits and waits for it, he’s surprised that he’s not pulled in one direction or the other, we get to standing. I don’t I’m afraid to say anything because sometimes I think it’s going to, you know, cause the specificity to kick in. But he’ll get up and we’ll just get moving and he’ll do more walking than he’s done in the past simply because he’s not fighting this tone. His abdominals are getting stronger with using the new beat helped happen to some strengthening and it’s made a lot of his functional activities easier. Improved his band, his setting balance as well. So that’s been huge and his level of injury just for references, the T four T five area so it’s higher thoracic, he doesn’t have based on the level of its injury, he doesn’t have access to most of his abdominal muscles.
[Garrett salpeter] 19:09
That’s fabulous. Thank you so much for sharing. I know that spasticity is a is a big deal for patients with many types of neuro diagnoses. So that’s really awesome to hear that.
[Krystina Miller] 19:22
And then with him this is kind of a side note and has nothing to do with this spinal cord injury specifically but he had an injury to one of his feet. He wasn’t sure what he did to it, but it blew up like a balloon. It was black and blue actually went and got some X rays. It wasn’t broken, but the doctor told him not to do any standing or walking until that was cleared up. So it became a focus of ours because walking was such a focus of our treatment that he wanted to get back on his feet. And I did the micro current with him.
[Krystina Miller] 19:53
I didn’t believe it myself. I actually had to take my forehead thermometer to take a test temperature, because that leg was about what was it when we measured about five degrees, five or six degrees warmer than the opposite side, which was one sign that it was doing something. And within two visits or three visits, the swelling was gone, he barely had any black and blue left. So within I think we waited about a week, a week or week and a half, and he was back on his feet. So it was kind of cool.
[Garrett salpeter] 20:29
So for anyone in Michigan who would like physical therapy care, or anyone listening who may be interested in just learning more about you and your practice and some of the work that you’re doing, what’s the best place for people to look you up? Is it website, social media?
[Krystina Miller] 20:46
Either or website or social media we’re active on both respond pretty quickly to website inquiries. So the business is called matrix health and fitness. So it stands for maximising abilities through research based exercise. So it’s m a TRX, health, and fitness.com. And we are on Instagram at mat X health dot fitness, and our Facebook pages linked to that as well.
[Garrett salpeter] 21:18
Awesome. And we’ll put those links up. For anyone who’s watching or listening. We’ll put that up in the in the notes here as well. Perfect. Thank you so much, Christina, for joining us. It’s been a true pleasure to get to work with you and interact over the past couple of years. I Gosh, it has been about two years. Yeah. And just to see the work that you’re doing really is inspirational, to me to our team, and to everyone in our community of practitioners. And thank you for helping to lead the charge.
[Krystina Miller] 21:49
Well, and I appreciate you guys so much, Garrett, new fit has been great. And you guys have been a wonderful support. I know when we started out. Like I said, my initial goal was to better treat shoulder injuries. And you guys have definitely delivered on that. But you have supported me through exploring the neural population, especially with Laura’s help and addition to the team. She’s been been great input there. And we’ve appreciated everything we’ve been able to do for our patients because of you guys. Thank you.
[Garrett salpeter] 22:20
Fabulous. So it’s our pleasure. And let’s keep it going. Keep up the great work go in here. All right. Thank you everyone who tuned in and listen to this episode of the undercurrent podcast, and we’ll see you next time.
[Garrett salpeter] 22:33
Thank you so much for listening to the undercurrent podcast. If you enjoyed this episode, please consider leaving a review and be sure to subscribe to stay up to date as we release future episodes.
