Elder Care on the Air - Rehabologym

Overcoming Adversity: The Power of Specialized Rehabilitation

In this episode of Eldercare on the Air, host Michael Amoruso welcomes a truly inspiring guest, Avrielle Rykman Peltz of Rehabologym. Aviel played a life-changing role in the recovery journey of former guest Laura Fallon, who went from marketing robotic rehabilitation services to becoming a patient in need of them after a spinal cord injury.

Together, they discuss the transformative impact of specialized rehabilitation techniques, the challenges of navigating insurance for critical medical equipment, and the power of compassionate care. Aviel’s generosity and expertise helped Laura regain independence, highlighting the importance of having the right team in your corner during life’s toughest moments.

Tune in to hear this incredible story of resilience, innovation, and the unwavering support that makes a difference in rehabilitation and eldercare

Transcript

SPEAKER_02 0:00

You've lived well, you've worked hard to make your place in this world. Your dignity and security are earned and well deserved. Or maybe you have a loved one who needs you more than ever. Well, we can help you help them plan life better. Amaruso and Amaruso.

SPEAKER_04 0:27

Welcome to Eldercare on the Air, a weekly radio show with guests in the fields of eldercare, special needs, financial services, independent living, and yes, people just like you. Where we will empower you to make sound choices when you're faced with an eldercare or special needs crisis. My name is Michael Amoruso, an elder law and special needs attorney with Amoruso& Amoruso in Rybrook, New York, which services clients in New York, Connecticut, and Massachusetts. You're at our new home, 107.1 The Peak. But I do encourage you to go onto our website, eldercareontheair.com. That's eldercareontheair.com. Click on the radio show tab you see. and just simply download the episode you'd like to listen to. You see, this show is designed to arm you with the knowledge and tools that you need to make sound choices to help you or a loved one age in place. If you have any questions or would like to hear topics on future episodes of Eldercare on the Air, please send us an email at info at eldercareontheair.com. That's info at eldercareontheair.com. In this episode, we are now going to take a deep dive into a very specialized area of rehabilitation. Now, for those of you that follow our show, you may remember I recently had on a very special guest by the name of Laura Fallon. You know, Laura's been on our show twice. The first time, she was marketing robotic rehabilitation services, and... Merely two, three months later, she found herself with a spinal cord injury, needing those exact same services. And that leads me to my guest today, who is Avriel Reichman-Peltz of Rehabology. And what's so special about Avriel is she was a true angel for Laura. So I thought it would be wonderful to have her on this show to really talk about the type of therapeutic techniques that she utilizes and how it helped Laura and how it can help you. So, Abriel, thank you for joining our show today.

SPEAKER_01 3:07

Hi, Michael. Thank you for having me. It's a pleasure. And I'm not the angel. Laura is the angel. And it's my honor to work with her as well as many other people in Laura's shoes.

SPEAKER_04 3:19

Well... She would say differently. You are her angel. And let me tell you, you have a heart of gold. I can just see that from the brief conversations that we've had.

SPEAKER_01 3:27

Thank you.

SPEAKER_04 3:28

And Laura's a fighter.

SPEAKER_01 3:31

She is.

SPEAKER_04 3:32

But she would not have been where she is today without the team, that you're a big part of that team.

SPEAKER_01 3:37

Thank you.

SPEAKER_04 3:38

And for those of you that haven't listened to that show, I encourage you to go onto our website at eldercareintheair.com. Listen to it, because towards the end of the show, you'll realize that Laura's insurance company would not cover a required quadriplegic wheelchair that she needed, and Avriel just happened to have one donated in her clinic, and she, the goodness of her heart, gave it to Laura.

SPEAKER_01 4:03

Thank you. It was meant to be. The powers were working in our favor, and luckily... Fortunately and unfortunately, because again, I would never want anyone to have to go through this journey. But we were blessed by having someone donate a wheelchair to us. One of my former clients who was moving to a new apartment and her current motorized wheelchair did not fit into the doorways, which is a very common problem with a lot of our clients is that their home may not be conducive to what they need. You know, for instance, when Laura got out of the hospital, she had to sell her longtime home of many, many years because it was not wheelchair accessible. So luckily, my client, again, their new home was not wheelchair accessible. So they said, we need to donate it to your facility. We want you to have it. So I was using it for therapeutic purposes to teach people how to transfer or move from a motorized wheelchair onto a bed or onto the toilet just for practice purposes but also to show them if they did need a motorized wheelchair at home what that would look like and how to train them so luckily we had that tool in our clinic and when Laura really needed it because unfortunately insurance insurances they don't cover what our clients need and deserve which is upsetting because her insurance company would not cover the proper wheelchair for her being someone who does not have arm or hand function nor leg function, where she could not self-propel a manual wheelchair. That was the only thing that she would be able to be entitled to. And luckily, we were able to get her that motorized wheelchair. And we had the vendor come and customize it to Laura's needs to make sure it was a good fit for her. And thankfully, she's still using it today.

SPEAKER_04 5:59

Well, as you all can hear, Arielle has got a heart of gold.

SPEAKER_01 6:02

Thank you.

SPEAKER_04 6:03

So let's tell the audience, how did you get involved in this industry? I mean, you have a long history. Tell

SPEAKER_01 6:09

us. I do. So in a nutshell, I was a dance and drama major my whole life. I actually was in college for... dance and drama. I was in the entertainment industry. And in my junior year of college, my father, who was 47 years old at the time and I was 20, had a massive brain hemorrhage. And I ended up taking a year off of college to take care of my father. And that's when I learned about the world of neurological recovery through multiple ICUs, hospitals, acute care hospitals, then acute rehab and subacute rehab and outpatient rehab. And we were met with a lot of challenges as a family. And from that experience, I decided to shift my professional career from the entertainment world into the medical world. And I wanted to become an occupational therapist. So I ended up going back to college and graduated with an undergraduate degree from SUNY Purchase. Woo-hoo, Westchester! In psychology. And then I graduated from NYU. I got my master's degree in occupational therapy. And luckily, when I was at NYU, we are... So part of our curriculum is occupational therapists. We are well-rounded and educate in both physical disabilities... but also mental health. So we have a tiered responsibility to work with anyone with any type of mental illness because what an occupational therapist job is, what people don't understand, is that we're really life skills

SPEAKER_03 7:49

therapists. Yes, that's

SPEAKER_01 7:51

right. We can't help with someone getting a job. We can do basket weaving because those are the notions that OT is really just for fine motor coordination. But really what occupational therapy is is Allowing someone to be as independent as possible, no matter what their physical or mental health limitations are, to get them to be independent with any daily life skill, such as dressing, driving, laundry, cooking, going to the bathroom. So anything that you need to do in life that you have a limitation of, that is our job to get you better with.

SPEAKER_04 8:27

So you got this degree.

SPEAKER_01 8:29

So I got this degree. What did you do with it? And then I ended up having two amazing internships, one at New York Presbyterian in my mental health. I was offered a full-time position there. And then my second was at Burke Rehabilitation Hospital in White Plains, New York. And I was offered a full-time job there as well as a scholarship. So I ended up staying in my true passion, which was neurological recovery. And I started working at Burke in September of 2001, the week right before the Well, actually, the week after the World Trade Center hit, I was at Burke. So I actually took care of all of the World Trade Center survivors at Burke at that time. And I worked my way up. I worked on every single unit at Burke. Orthopedic, pulmonary, burn, stroke, traumatic brain injury, and spinal cord injury. But my true passion was always... neurological recovery. So I worked my way up as a senior therapist there very early in my career. And then in 2006, I was very lucky that Dr. Bruce Volpe, who is a lead neurologist at Burke, asked if I would leave Burke Rehab Hospital to jump ship and start and work with him in his robotics research lab. which is part of the Weill Cornell Medical System. So even though the Burke Neurological Institute is on Burke campus, it's still under the umbrella of Weill Cornell. So I ended up traveling nationally and internationally, learning and researching the top methods for stroke recovery, spinal cord recovery, and neuromuscular degenerative conditions using cutting-edge technologies and robotics. So fast forward, that was in 2006. And then because of my history working with research robotics and seeing how many people benefited from using this technology, I begged the hospital, please, can we open up a fee-for-service clinic? And they would say, why? And I said, because I'm so tired of turning so many people away that could benefit from the research that we do because they don't qualify for research projects.

UNKNOWN 10:44

Right.

SPEAKER_01 10:44

So with research, there's very strict criteria. So a lot of the research that we would do, they would say, you have to have one single stroke that affected your right side of the body. So if someone would come in and they had a stroke and it happened to be on the left side, you know, right side of the brain or affected the left side of the body, I would say, sorry, sorry. you don't qualify for the study and I would have to turn people away. And that's how research works. So I wanted to use research proven methods to help people. But for a long time, people would say, oh, it's not ethical to charge for research. So fast forward in about 2010, we had some new leadership and my colleague, Dr. Dylan Edwards, who's now at Moss Rehab Center in the Philadelphia area, said, you know, what do you want to do? And I said, I want to open up a research-based center for everyone to help as many people as possible. So after two years of convincing leadership there, I was able to open up a small clinic using two robots with one assistant. And it went from one little clinic and two robots to three clinics throughout the hospital and over 30 employees under me working and doing many wonderful things. And then fast forward to 2019, where we did have a wonderful clinic called the Restorative Neurology Clinic that was a fee-for-service clinic based on research-proven methods. In 2019, some things were changing at the hospital, and I learned that they were looking to close my clinic, and I was more in an executive role, and I really... wanted to focus on my passion. You're more hands-on. I wanted to be hands-on. As much as I loved the executive part of overseeing different laboratories and different centers, my passion really was to help as many people as possible. And if I didn't have that opportunity to continue to work hands-on with my clients, I was going to be broken myself. So luckily my family said, you know what? If you want to make a change, we're willing to work with you. Let's just start your dream and let's jump ship and let's see if we can open up this amazing clinic. So we rallied together. So this is a family-owned business. It's called Rehabilitium. We're located in Tarrytown, New York. And my husband and I run more of the front of the house. We do all the clinical and client services. And my brother-in-law, and my sister, Leanna and Alex Saro. Oh

SPEAKER_04 13:21

my goodness, you have the whole family

SPEAKER_01 13:22

there. Yeah, the whole vishpacha we say in our culture. But yes, so they run more of the business end and helped with backing the business end to get our clinic up and running. So we were able to secure a really nice space and we opened our doors on January 6th of 2020. Oh

SPEAKER_04 13:44

my goodness, that's timing.

SPEAKER_01 13:45

Yeah, and then six weeks later we had to close for COVID and we were closed for several months because what we do is so hands-on. So we provide physical therapy services, occupational therapy services, speech therapy services, and we have health and wellness programs for conditioning to keep people healthy. So I always say we're like IHOP. IHOP specializes in pancakes, but they serve waffles and eggs. We specialize in all neurological conditions, but we see every condition. from age five and up. So we work with pediatrics, we work with teens, we work with adults, and we work with the elderly population. So it was a struggle back when COVID hit because a lot of our clients do come nationally and internationally, not only from the tri-state area because of the specialties that we do. And because of that, we really had to rebuild and really start from scratch, even though we were starting from scratch at that time.

SPEAKER_04 14:51

Avery, we're going to take a quick commercial break. But when we come back, I want to dive deep now into what this robotic therapy is and how it benefits people.

SPEAKER_01 14:59

Okay, sounds good.

SPEAKER_04 15:00

Sounds good.

SPEAKER_01 15:01

Yeah, ready for it.

SPEAKER_04 15:03

Wonderful. If you missed any part of this episode, just log on to our website at eldercareontheair.com and we'll be back in a few moments.

SPEAKER_00 15:10

Amoruso and Amoruso LLP advises clients on how to obtain public benefits, including Medicaid, and more importantly, how to protect and preserve their assets, whether they be modest or significant. Find Amoruso and Amoruso online at eldercareontheair.com. Amoruso and Amoruso, a 107.1 The Peak Ask the Expert partner.

SPEAKER_02 15:31

Amoruso and Amoruso Empowering you to care for the ones you love.

SPEAKER_04 15:40

Welcome back to Eldercare on the Air. I'm Michael Amoruso, and I'm so happy to be here with Avriel Reichman-Peltz, who is one of the owners of, right, one of the owners?

SPEAKER_01 15:50

I'm a co-owner, and I'm a clinical director.

SPEAKER_04 15:53

Of Rehabilogym.

SPEAKER_01 15:54

Yes.

SPEAKER_04 15:55

I got it right.

SPEAKER_01 15:55

You did, Rehabilogym.

SPEAKER_04 15:57

There you go. All right, beautiful. So before we took our quick break, Arielle was telling us how she got involved in the OT, occupational therapy industry, focusing on robotics. Now we're going to take a deep dive into exactly what she does at her clinic. So go ahead, Gabrielle, tell us about this.

SPEAKER_01 16:20

Sure. So, you know, we specialize in neurological conditions. So stroke, spinal cord injury, brain injury, all neurodegenerative conditions, ALS, Parkinson's disease, multiple sclerosis, rare genetic conditions, as well as a lot of brain and spinal cancers. So we have special programs for people tri-state wise, but also we have intensive programs for those out of town folks that could come to us on a two to four week basis. We do neurological assessments with a neurologist and then we do head to toe baseline evaluations in all disciplines and set up a comprehensive care plan for our clients. And we also have, we can help with lodging and transportation resources. We have a hotel right next to our clinic for ease of movement. So then clients can come in for three to four hours of intensive therapy a day and then we put them on the right path. But regarding neurological recovery, you were asking me earlier offline about, well, what does it mean when you have a neurological injury or illness and how does the body heal? So I'm going to use my famous three analogies I like to use. So when someone heals after a stroke or a traumatic brain injury or a spinal cord injury, you heal like a tree grows. So typically the legs, and this is more for brain injury or stroke, you hear like a tree grow. So the trunk is usually the strongest, meaning your legs usually are stronger than your arms. So just like a tree grows, the trunk is the strongest part. So legs up to your torso. But then, just like branches on a tree grow, those branches represent your arm recovery. And the leaves are usually the last to come back, which represents your hand function. So if you want to understand the etiology or the physiology behind a neurological condition, nerves in your body that come from your brain or spinal cord speak to your muscles. So imagine that you have electrical wires that are going from your brain or your spinal cord out to your arms and legs. And imagine if those electrical wires are short-circuited by someone taking a pitcher of water and pouring water all over those electrical wires. What will happen is everything will spark up and not work properly. So imagine if you were to plug in a plug to a light bulb. Imagine that long cord is that electrical wire and that light bulb is your muscle. So maybe if you plug in that wet cord, you plug it in and it zaps out and you won't get that light working. So imagine the healing is taking a towel and drying off that water from that wire. So as that dries off, you might see a little buzz of light and then it dims again. And then a little buzz of light and dims. So just like that electrical wire, that's how nerves speak to muscles in your body. So the way that the body regenerates... It's all about nerve regeneration

SPEAKER_03 19:27

and

SPEAKER_01 19:28

getting those nerves, those nerve impulses to move quickly to speak to that muscle to move. So I'm going to use my third analogy. So imagine if you're driving and all of a sudden you see a big roadblock. There's a car accident and the police put up a roadblock and they say, you cannot come down this road. But in the in terms of your body ever again. So once those nerves are damaged from a stroke or a spinal cord injury, as an example, those nerves are damaged for life. Okay. But just as in a car accident, when they put up those roadblocks, they usually give you a detour. And they say, hey... This is a roadblock. You cannot come down this road, but we will give you a detour to be able to get to your final destination in a different way. It might take a little longer, but you can finally get there. The same thing happens in your body. Your nerves actually regenerate and rewire new connections and make detours to get to those muscles. And that is called neuroplasticity.

SPEAKER_03 20:32

But

SPEAKER_01 20:33

the only way that neuroplasticity or nerve healing can happen is through repetitious movement.

SPEAKER_04 20:39

So that's where the robotics comes in.

SPEAKER_01 20:41

Correct. So repetitious movement means like I can be sleeping and someone can move my arm back and forth a hundred times. But if I'm sleeping and someone is moving my arm for me, it's just helping my joint stay loose. I as a person have to volitionally look and attempt the motion myself. So that is the only way that your nerves will regenerate. It's not if someone else does the work for you. You have to think about the motion do the motion, and then get that nerve impulse to drive that arm, hand, or leg, or whatever body part you need to move.

SPEAKER_04 21:18

So your brain has to be engaged to start this process.

SPEAKER_01 21:22

Correct. So by vision, by feel, whatever your senses are, you need to volitionally attempt and initiate the movements yourself.

SPEAKER_03 21:31

Okay.

SPEAKER_01 21:32

What the robots provide, and when I say robotics, I want you to imagine, so someone like Laura is using something called her XONR device, which is an exoskeleton. So imagine Iron Man or C-3PO from Star Wars for my older generation, which I'm part of. So imagine a robot exoskeleton around your body, and it is doing objective measures and interventional capabilities of everything. assisting with movement again. For the upper limb or the arm or the hand, if someone is paralyzed by a spinal cord injury, brain injury, or weakness from any neurodegenerative condition, imagine instead of those big arcade games from the 1980s, like just using that joystick with your hand, imagine your arm or your hand set up in an arm trough or a big apparatus. And as you visually look at a screen, like a video gaming screen, you have to react to what you're seeing on the screen by using your arm or your hand or even your leg as the joystick to operate that arcade machine. And so what we do is, just like a ruler doesn't lie, robotics take objective measures. for evaluations and for interventional capabilities. We are able to track positive and negative change in our patients over time. So mainstream therapy, or even when a doctor goes to see you, they say, hey, Mike, put your arm out. Let me push your arm down. And they're testing your strength. But I'm a woman and I might push your arm down and I might say, oh, Mike, your arm is, I'm scoring it as a three strength. But if I have Arnold Schwarzenegger or Sylvester Stallone come and he's evaluating, one of those guys are evaluating you, and he says, hey, Mike, let me push down your arm. Arnold Schwarzenegger is a lot stronger than I am. And if he pushes you down, he may say, ah, Mike is a weakling. He's only a one.

SPEAKER_04 23:38

So there's no consistency.

SPEAKER_01 23:39

Correct. So even though there's objective numeric scales in the medical world to test strength and change in people with neurological conditions, Just like rulers don't lie, you measure something, it's eight inches, eight inches, that's it. With a robot, because of the technology, we're able to measure physiologically what's happening inside of the body to say how many steps are you taking in X amount of minutes? How high are you able to lift that knee on one side of the body? How much movement are we able to see in your fingertips this week? How much strength are you able to squeeze? And we take objective measures that we can look at as a benchmark to say, hey, You had a stroke. You want to get better. We can measure that positive change.

SPEAKER_04 24:23

And I guess that the same level of consistency, since you're using a robotic device, would also apply in moving the arm in the actual therapeutic exercise.

SPEAKER_01 24:34

Correct. So robots do not get tired.

SPEAKER_04 24:36

Yeah.

SPEAKER_01 24:36

So through research, what we find is what makes a difference in neurological recovery are over 1,000 repetitions per treatment session, typically over a course of three months, three times a week for three months of over 1,000 repetitions Right. Before they do robotic therapy, they might not be able to lift their elbow to do something as simple as put deodorant under their armpit. But then three months after using repetitious movement, using robotics, they're able to lift that arm again. So imagine a professional athlete. The only way that neuroplasticity can occur is by muscle memory, doing something over and over and over again, just like a professional athlete has to do something over and over. So does a person healing from a neurological condition? Me as a human, I get tired. So if I were to say, hey, Mike, let me move your arm 1,000 movements in this session, I'm going to get tired, you're going to get tired, and the quality of the movement might change. It's

SPEAKER_04 25:42

inconsistent.

SPEAKER_01 25:42

It's inconsistent. But if I hook you up to that machine and say, hey, Mike, move your arm, but the robot only helps you when you need the help. So you initiate the movement. And if it's an actuator-driven robot, it'll detect, oh, Mike is having trouble moving. Let me take over the motion. But you still have to think about the motion and move to help that nerve impulse get to the muscle. Same with our walking devices. So the exoskeletal device that we use, Laura has to stand in it. But the robot will only move when Laura initiates herself to take a step. And then if she can't do that whole step, then the robot will take over and help. But it's the therapist, it's just look at robotics as a tool in the therapist toolbox to expedite healing for people with neurological conditions to get better quicker. And that's how

SPEAKER_04 26:32

the nerves find the detour around the roadblock.

SPEAKER_01 26:35

Correct.

SPEAKER_04 26:36

Interesting.

SPEAKER_01 26:37

Yes.

SPEAKER_04 26:38

Who's your ideal client?

SPEAKER_01 26:40

My ideal client is anyone and everyone who needs any type of therapy for any condition. Whether it's orthopedic, whether it's pulmonary related, whether it's neurological related, we are there for you. We do not believe in plateaus. We believe that everyone has the capacity and the opportunity to get better no matter what their issues are. We never turn anybody away. And our ideal client is anyone that needs the top of the top best therapy that they need and deserve. We just really, we have very high expectations of From a therapy perspective that we want, you know, just like I was in everyone's shoes that comes into our clinic. I was a caregiver of someone for over 28 years with a neurological condition that needed and deserved top notch care that never really got what he needed because insurance didn't cover it. So our ideal client is anyone that needs and wants the best of the best therapies and resources for their condition. We are considered an out-of-network provider. So what that means is clients do pay out-of-pocket. for our services, but we work very closely with our clients. They could pay by the session, they could pay by the week, they could pay by the month. Our services range anywhere from$50 up to$350. It depends on what their ailments are, it depends what program, it depends how many therapists are assigned to them, but every client gets at least one-on-one individual attention with a primary therapist for at least one hour in every service. For our exoskeletal program or walking programs, we usually have two therapists working with each client. But we do provide detailed invoices and receipts with CPT codes. So if someone does have out-of-network benefits, great. I usually recommend contact your insurance provider and say, hey, what are my out-of-network benefits?

SPEAKER_04 28:37

And you can give them the forms to submit to their insurance to hopefully get reimbursed.

SPEAKER_01 28:41

Correct. But again, we have no, unfortunately, we have no control over what insurance

SPEAKER_04 28:47

reimbursement

SPEAKER_01 28:48

but we will do everything in our power to give you the detailed receipts or invoices or claim forms that you need to hopefully get reimbursed, but we can't guarantee it.

SPEAKER_04 29:00

How do they get in touch with you?

SPEAKER_01 29:02

They can call us directly at 914-603-8600. They can go to our website, www.rehabologym.com, R-E-H-A-B.com, O-L-O-G-Y-M dot com or they can email info I-N-F-O at Rehabologym dot com and you can also check us out on Facebook, LinkedIn and Instagram or check out Mike's show and go to his website and you can find us.

SPEAKER_04 29:32

Excellent. Well, Avriel, thank you so much for everything you did for Laura.

SPEAKER_01 29:36

My pleasure. She's a pleasure. It's really my honor.

SPEAKER_04 29:39

And thank you for being on our show today. I think we're going to have her back because I may want to cover this with sports with you one

SPEAKER_01 29:45

day. Oh, that'd be awesome. And we also have our home subscription programs and stuff that we didn't talk about that we can deploy different technologies and devices to people's homes if they can't come to the clinic on a regular basis.

SPEAKER_04 29:58

Excellent. And if you've missed any part of this episode, just log on to our website at eldercareontheair.com. That's eldercareontheair.com. And you'll find every else show there. Listen to it and take advantage of our services. Repetition is key when it comes to recovery. I'll talk to you all next

SPEAKER_02 30:14

week. Amoruso

SPEAKER_00 30:18

and Amoruso, a 107.1 The Peak, ask the expert partner. Visit eldercareontheair.com for more details.

SPEAKER_02 30:38

Amoruso and Amoruso empowering you to

SPEAKER_03 30:43

care for the ones