Neuro-IFRAH®. Game Changing Therapy
In my experience as a mother that has observed countless hours of therapy, there are generally two kinds of rehabilitative therapy; one is so common that most therapists fall under the category of it, and the other is so rare that most people don't even know it exists. It's important to understand this early on because the difference between them may look slight at first glance, but further down the road, the results you get are vastly different.
The first category generally believes that, once someone has a stroke with considerable damage, they will have permanent, lifelong, debilitating and noticeable deficits.
When you believe this, you treat differently than if you believed that someone could regain normal function. The key word here, for us looking on, is "normal", because there are lots of results to be had in rehabilitation that fall under the heading of 'functional' that are not what you would call 'normal function'. You definitely are looking for 'normal function'.
The brain relearns how to do something through practice. If a therapist's definition for 'functional' is just having a patient be able to get from point A to point B, then that patient will likely be practicing ambulating in ways that do not lead to walking like they used to. Relearning to move in the way you used to before your brain was damaged happens because a therapist has methodically helped your body relearn certain movements in certain sequences that make moving normally possible.
Extremely early in my daughter's outpatient rehab, fate brought an amazing kind of therapy into our awareness. She had just come out of inpatient rehab where the goal is to get stroke survivors as independent as possible in the shortest period of time. Watching Sophie try to ambulate in any way she could was painful, and it also happened to be practiced a lot. By the time we were ready for outpatient rehab, we came across therapists that were trained in Neuro-IFRAH, founded by Waleed Al-Oboudi in San Diego, California. Neuro-IFRAH® methods are implemented with the intention of getting as much normal function as possible, and not a day goes by that I am not so grateful for finding this method and the therapists that administer it.
Mr. Al-Oboudi has helped countless stroke and TBI survivors all over the world return to their lives. He is the therapist that takes patients that everyone else has told to give up hope. Today, my daughter who was given the prognosis of possibly never walking again, and certainly not without a cane, walks so beautifully on her own that strangers don't know she had a stroke. This is entirely because of Mr. Al-Oboudi and his Neuro-IFRAH® trained therapists.
To whom it may concern:
I am writing this letter in support of the Neuro-IFRAH approach. I have over 20 years’ experience in rehabilitation management. I have worked for both an established large healthcare organization as well as helped with the start-up of another post-acute organization. Early on, I was tasked with the challenge to find educational opportunities to bring to our rehabilitation clinicians that would impact their patient’s care and outcomes. I began extensive research of the many treatment techniques and therapies and education that was at that time available. I came upon a gentleman named Waleed Al- Oboudi. We met and I came to know him quite well as an experienced clinician who had a unique, whole-person approach to the treatment and management of the adult population who had suffered a stroke, brain injury or other neurological insult. I invited him to teach in my own facility and observed his hands-on training and treatment of patients during his classes and knew that was the experience I wanted for our clinicians.
At that time, we contracted specifically with Mr. Al-Oboudi to teach for our organization and saw the immediate return on our investment with an increase in functional outcomes for our stroke/brain injury patients, increased discharge to community and better job satisfaction from our employees, who now had the skill set to treat this challenging patient population. What literally occurred was the therapists returned from the training and stated their approach to their patients would be different. In addition, patients wanted to stay with those clinicians. It was amazing. We began a plan to develop an instructorship program within that organization which was very successful. It should be noted that several of those instructors still teach for my current company today.
As stated above, I was once again tasked with with the opportunity to form an educational department with another organization approximately 13 years ago. I knew immediately to contact Mr. Al-Oboudi to develop our educational programming. I have recruited 3 Neuro-IFRAH instructors for my current organization. They teach and treat our patients. For the last 10 years, we have offered ongoing Neuro-IFRAH classes for all of our therapy and Nursing staff to promote this dynamic treatment approach in our settings.
It has thus been my experience that this approach has proven to be superior and unmatched in the 20+ years that I have been in healthcare leadership. At this time, over 75% of our PTs and OTs are Neuro-IFRAH trained and we have over 50 clinicians who are Neuro-IFRAH certified. I believe this approach has unmatched concepts that have set the standard of excellence for the care of the neurologically involved patient.
By far, the Neuro-Ifrah® approach has been unmatched in the rehabilitation approaches we have been exposed to.
In 2009 my life changed when I received a call that while traveling my husband had experienced a right hemisphere stroke. After 10 days in a neuro-intensive care center at one of the leading hospitals in the country, my husband was transferred to a rehabilitation unit where he spent 12 weeks. On discharge, the physical therapist told me that my husband would likely need a custom wheelchair and would not be a functional ambulator. He was severely affected by the stroke leaving him with left hemiplegia, left inattention, and a left homonymous hemianopsia. He was sent home unable to shave, bath, toilet, and transfer or dress himself. All aspects of his care required maximum assistance. We were given very little encouragement.
As a couple, my husband and I were determined that his quality of life could be improved. My husband’s determination drove us to research all and any treatment options and approaches for stroke recovery. We tried many of these. Some we were not eligible for due to my husband’s severe limitations. With the approaches we were able to try, we did not see noticeable changes or improvement. Then we were introduced to Waleed Al-Abdouli and the NeuroIFRAH approach.
My husband has received treatment sessions directly from Waleed at his center in La Jolla as well as follow up sessions from individuals trained and certified in this approach. I have been able to watch sessions and see the results in our daily lives. My husband is now walking short distances and is able to enjoy outings without the need of a wheelchair. His improved mobility allows him to participate in his own self-care with minimal assistance or supervision. As a caregiver, this has been a major improvement that has made a positive impact in my own physical health and well-being.
Our physicians, general practitioner, and neurologist, have all been amazed at the progress made after initiating the Neuro IFRAH sessions. My husband’s general practitioner, a top Vanderbilt University Medical School graduate, was new to us after his stroke. On his first visit to this new physician he was in a wheelchair with severe physical limitations. This physician has since commented that she would never have thought my husband would functionally be where he is now. On a third year post stroke visit to our neurologist (another Vanderbilt physician), I was asked what was new. I explained to her that my husband was now able to flex his knee. She pulled the medical chart to review her assessment notes and then in disbelief tested his knee herself! She had adopted the belief that no one improves after 1 year. My husband, through the use of Neuro IFRAH, has challenged that notion with her and other physicians.
But we are not finished! My husband continues to make progress with ankle dorsiflexion and toe extension movements emerging. His arm is still not functional but there is active muscle movement ---just like we initially witnessed in his leg! We continue to see how these small gains make significant impacts in our lives together but more importantly in his life. I contribute ALL of his gains to the Neuro IFRAH approach and to the encouragement and insight of Waleed. All through these years Waleed has masterfully worked with my husband. And in the background, Waleed would work with me showing me the possibilities for further recovery, while maintaining a realistic view of outcomes. Waleed clearly told us that my husband could make improvement but did so acknowledging that there may still be limitations with the very fine skilled movements.
As an occupational therapist with 35 years of experience across many different settings and populations, I had to challenge my training and knowledge in the traditional rehabilitation protocols and methods. Going to outpatient therapy for a 45 minute session of OT and a 45 minute session of PT seemed like a great deal of effort with very little return. The compensatory approaches many times only encouraged abnormal movement. As a therapist I have seen the long-term impact on joints and movement when this is how a client is taught to “get by”. This seemed to be illogical in a healthcare environment where health, prevention, quality of life, and participation are stated as high values. I felt that there had to be a way to improve the motor return in quality.
Before we started Neuro IFRAH, I witnessed therapists struggling with what to do with my husband due to his low functioning level, lack of movement and muscle activation, and the therapists’ inability to know how to create an environment that allows success. I have continually been amazed at how skillful the Neuro IFRAH therapists are at analyzing movement and identifying how to set up conditions for success, how to build these successes into bigger successes, and eventually how this all translates into function. And all the while, they are astutely attuned to my husband’s emotional and psychological well-being.
The holistic approach used by Neuro IFRAH has shown my husband and myself that while this is a journey (not a quick fix) there is hope and more recovery is possible. We have seen it in our own journey but we have also witnessed this with other clients being treated. It is not a magic pill. It involves hard work and commitment on the part of the individual and their family as well as on the part of the treating therapist. By far, the Neuro IFRAH approach has been unmatched in the rehabilitation approaches we have been exposed to. We are thankful for having had the opportunity to work with Waleed. As an occupational therapist, I am proud to call Waleed a colleague.
From Chaos to Order
"One day my daughter Kelly called and with some interesting news. She knew a doctor who, in turn, knew a renowned rehabilitation therapist in the Los Angeles area who might be able to help my advance on the road to recovery. Waleed Al-Oboudi was his name, and he specialized in working with stroke victims and with people who had suffered brain injuries. Although he did not generally take patients directly—instead spending his time training other physical therapists in his sought-after approach—Oboudi became interested in my case and said he would like to work with me. However, he would only be able to do so for one week because of previous commitments—and he would need authorization from my physicians.
I called Dr. Dozier to get his opinion on the safety of my traveling by air and to secure from him to authorization to see Al-Oboudi. “It’s a short flight from Reno to Los Angeles and the cabin is pressurized,” he said. “Nonetheless, the cautious approach would be not to do it. But I know you’re going to do it whatever I say, so if you feel you’re up to it, go ahead. Omer I just ask that you keep in touch with me by phone during the time you’re in Southern California, starting with the moment your plane lands.” I assured him that I would.
I had done fine on the drive to Tahoe and I felt that I could handle the plane ride as well. So I informed my new physical therapists office at the Lake that I would be leaving for a week and the receptionist there helped me make the travel arrangements. George drove me from the Lake down to the Reno airport on the scheduled day and I boarded the plane for LAX. The flight was uneventful, and when I arrived in Los Angeles I was picked up by my good friend Bill Raffin, whose office in Manhattan Beach was only a short distance from Al-Oboudi’s office in Redondo Beach.
Al-Oboudi’s facility, like a fun house for kids, was lined with mirrors and filled with colored balls, bands, low-to-the-floor trampolines, tubes, and tunnels. Though a child would have been at home there, much of the equipment was new to me, including the bosu, a rubber half-ball meant to create an unstable standing surface and thus to challenge one’s ability to balance.
Al-Oboudi immediately started by asking me to step up onto the wobbly bosu surface. The flat surface of the bosu was face-down on the ground, which meant I’d have to step on the ball side, which was soft, unsteady rubber. Balance was still difficult for me when “walking” on regular or soft surfaces, so this would be a challenge. But wasn’t that why I was there? To get better, I had to keep challenging myself and to have others challenge me.
As I stepped up onto the soft rounded half-ball, I pitched forward and then backward, before falling off to the side. This happened time after time until I managed to attain some degree of balance while standing on the bosu. Even then it was like standing on the edge of a boat without any rails in choppy water.
As time passed, Waleed and I make small talk and got to know each other. He was a highly educated Iraqi-American with dark hair, olive skin, and a light accent. He had practiced physical, occupational, and rehabilitative therapy for many years in North America and Europe, and though we did not discuss it I suspect that he emigrated from Iraq around the time that Saddam Hussein’s Baath party came to power.
As that first day progressed, Oboudi ran me through one exercise after another. Although these exercises would have been simple for me several months before, under the changed circumstances they were incredibly challenging.
Eventually I was able to stand on the bosu, however unsteadily. Oboudi then began to toss balls to me while I stood there wavering back and forth on the unstable surface. He also had me stretch taught, relatively thick exercise bands with my weakened and still quasi-lifeless arm and hand and then navigate on all fours through tunnels. I tried to walk on a tube that twisted and turned beneath the weight of my body.
Whenever I attained some degree of stability in a given exercise, Oboudi would change things, always pushing me to the next level. He’d put light weights in my hand and ask me to do the same activity I’d finally managed to do without weight, or he’d have me transfer a skill to an increasingly unsteady surface. There was constant emphasis on balance.
With each exercise, I could tell that I was growing steadier, stronger, and more confident. When I had arrived in Southern California to work with Oboudi, I had regained about half of my lost weight. Quite quickly during our work that week, I could sense my muscles and tone starting to come back.
“Muscle memory is and extraordinary thing,” Oboudi explained. “You were in good shape for much of your life, Omer, and your muscle memory from that time will be of immense help during your recovery process. You are already beginning to gain weight and definition. I can see it. What we’ve got to do is really emphasize that. It can be done, but if you don’t work hard to redevelop those muscles, they will be lost to you forever.”
Thus, I learned from Oboudi that it’s not just the brain that has memory—other parts of the body have memory too. Before the aneurysm, my muscles were accustomed to a certain environment, and they strived to get back there again. With some help, I believed they could and would.
One day early on, Oboudi took me out onto a tennis court. He put a racquet in my right hand, and I did my best to grasp it. “Okay,” Oboudi said as he walked to the other side of the net, “I’m going to throw a tennis ball underhand over the net and show you approximately where it’s going to go. Watch where it lands and how high it bounces.” I did.
“Now, this time, when I throw it over the net, try to hit it back to me,” he said. The first time I tried, I missed. “That’s alright—that’s what I expected.” Oboudi said.
He continued to throw gentle underhand tosses to me. On the third one, I softly and clumsily hit it back. “Okay, I want you to just keep hitting it right there,” Oboudi said, and he continued to throw thirty or forty more balls to my new “sweet” spot.
“Wow, you’re really doing well, Omer,” Oboudi finally said. “But you want to know something? That’s not life. Right now you know pretty much where the ball is going to land, how high the ball is going to bounce, and what you need to do to get the ball back to me. If we keep this up much longer, you will be slamming those balls back to me. You could probably do so while eating a ham sandwich. But that’s not life—whether it’s tennis, business, or personal relationships. Life isn’t easy and it certainly isn’t predictable. In fact, it’s chaotic. So what we’re going to do is come out here again tomorrow. But the ball is not always going to go to the same side of you. It may go over your head, drop in front of you, or land on the other side of you. You might swat and miss; you might fall down. But you must start the practice of reacting to the unexpected.”
“By God, Oboudi is right—life is chaos,” I thought. I could do the same thing over and over again but that was not going to help me a whole hell of a lot. I needed a body that once again could respond to uncertainty—a body that could handle not knowing what was coming next.
So Oboudi and I worked from nine to five each day that week, and with each and every task that we did, I would be forced to progress from certainty to chaos. That was life after all: messy, untidy, and uncertain. Although I had always known that, Oboudi’s emphasis on it as an integral part of my therapy had a pronounced effect on everything I was there after to do during my road to recovery.
Without question, therein would lie one of the secrets to any long-term recovery I might make from my brain aneurysm and stroke. I had to train for chaos. I would have to push past every comfort zone and expose my body to uncertainty in order to trigger my muscle memory and rebuild my physical capacity. Before I could succeed, I had to face extreme vulnerability even if at the risk of falling and suffering injury.
By this stage of my life I was certainly no stranger to pushing beyond limits so I was primed and ready for Oboudi’s wisdom. Just as I had been willing to fall out of bed when I first tried to walk, I would now go back to Tahoe and enlist my physical therapists and friends in putting me to the test of chaos in every activity in which I engaged. We would start one place and often end up at another altogether unexpected place. I would take my body to new places until they felt old and familiar again.
As we said goodbye, Oboudi shared these parting words with me: “Your recovery is now up to you, Omer. If you don’t remain determined whatever minor progress we’ve made this week, you will lose rather quickly. But if you remain determined, you will get there—I’m convinced of it.”
To this day, I consider Waleed Al-Oboudi not just a friend, but and angel."
Excerpt FromRains, Omer. Back to the Summit: How One Man Defied Death & Paralysis to Again Lead a FullLife of Service to Others. New York: Morgan James, 2012. 211-214. Print.
Get Busy Living or Get Busy Dying or, Italy
"The week with Waleed was extremely beneficial. It made inpatient therapy look like kindergarten playtime. It was hard. The physical exertion often had me sweating through my clothes. Yet by the end of the week, I was pretty much free of my dependence on the walker. Waleed even had me fitted for a new brace that was more of a walking boot. It corrected my ankle weakness and almost had me walking “normally” again. Of course, normality comes at a steep price sometimes, and the brace itself cost well over $1,000. The whole week of therapy cost several times that. But thanks to our fund-raiser, we didn’t have to worry about affording this medical necessity. While we were working with Waleed, another couple was there, usually working with another therapist on the other side of the room. This older couple, from Texas, made me think of the couple that Christie had come across online, Tyra and Steve, the ones who lost their battle with a brain tumor. The ones who never got the chance to do the one thing they so desperately wanted to do together if he ever got better: travel."
Excerpt from Bishop, Bryan. Shrinkage: manhood, marriage, and the tumor that tried to kill me. New York: StMartins Press, 2014. 308-309. Print.
I am writing this memo to describe the impact of the therapies that our son, Dewey has received from the Neuro-Ifrah® Clinic
I am writing this memo to describe the impact of the therapies that our son, Dewey has received from the Neuro-IFRAH Clinic and Education Institute in Foster City, CA
Dewey was hit by a Muni-Trolley in November 2007 at the age of 36. He sustained a skull fracture, traumatic brain injury and intra cranial hemorrhage. As a result he was in a coma for almost a month in San Francisco General Hospital. He has been suffering from speech impairment (aphasia, reading, writing), short-term memory loss, double vision and paralysis of right arm and leg. Physicians projected very little improvement from his functioning level at 6-12 months after the accident. They said it would be reasonable to expect 10-15% of further improvement at the most with rehabilitation effort.
However, a small miracle has happened since he started to get the therapies at the Neuro-IFRAH Clinic since August 2014, even though he has a long way to go to achieve independent living.
Dewey accompanied by his wife, Grace went to Neuro-IFRAH Clinic in San Diego two or three times in 2008 for a one week treatment program, then stopped any further treatment. He had continued to get physical/occupational and speech therapies in this San Francisco Bay area until last August. His condition improved very little during the past seven years in spite of 6-9 hours per week of other sources of therapies. When we learned that a branch of the Neuro-IFRAH Clinic was opened in Foster City last August, Dewey started going there to get therapies on more regular bases. He has been getting 4-8 hours therapies each week as the schedule allowed. To our disbelief, he is able to walk in a normal pair of shoes without the ankle/leg support in a modified shoe for his right foot since last month. This is a huge relief for him. He has also started to read, probably not as well or as fast as he likes but has made a big improvement from not being able to read restaurant menus and street signs. He is very motivated to do the recommended exercises at home and works hard to improve. With the encouragement and positive reinforcement of the staff at Neuro-IFRAH, he now has hope and faith in that he will improve to the level of being independent. He is planning to regain his driver's license by help from the driver rehabilitation services.
I believe the success of the clinic is largely due to its philosophy and approach as well as the devotion of the well-trained staff members. They try to treat patients from the "whole person" perspective. Not only do they work on a patient's physical condition but also psycho-emotional well-being as well. They are supportive and encouraging to their patients so that hopes and dreams to recover are instilled in their patients. The staffs' dedication and hard work toward patients' recovery is truly admirable.
I wish all institutions with occupational/physical therapy programs for the neurologically impaired people would offer a course/clinical training like the Neuro-IFRAH Clinics and Education Center.
Acquiring a traumatic brain injury, rendering her unable to move her left side.
Our daughter Katherine Gray was in a severe car accident May 20, 2009. Acquiring a traumatic brain injury, rendering her unable to move her left side.
Subsequently we had taken her to various physical therapist and occupational therapist. Being that our daughter was so young, and wanting to offer her every opportunity to heal and regain the use of her left side and be able to walk, we had been to several therapist with no results and as one doctor commented “we had unrealistic expectations.”
Upon our first visit to see Waleed Al-Oboudi at Neuro- IFRAH, we saw first hand that our daughters situation was absolutely not ‘hopeless’ but full of hope and healing.We saw our daughter’s hand and wrist move, her legs moving on the first visit.
Our daughter has been attending the clinic periodically for almost a year now, and she is walking assisted, and commencing to take steps on her own. Her left hand and arm are responding, and in the midst of recovery.
Reiterating, she had seen others with no results, but since she has been attending the Neuro-IFRAH clinic her progress is phenomenal, since she is recovering, her confidence has increased and most of all her hope of living an independent life is actually going to become a reality.
We cannot overstate our appreciation, respect, and happiness Waleed’s work has affected our daughter’s life.
To all of our friends who have carried us through the past year with your prayers
To all of our friends who have carried us through the past year with your prayers, I wanted to send a FINAL update as promised. June 11th marked the year anniversary of Sarah’s accident. She went to California at the end of May to work with an eminent therapist, Waleed Al-Oboudi who specializes in neurological disorders. Sarah’s wonderful therapist, Megan, trained under him and teaches for him in various places. She felt that he could help her restore those last few things she was having problems with, such as her left arm. She had a great session with him. He taught her to run, juggle(!) and such. She was very pleased with the results she had working with him. Mike and I came and observed the last day of therapy. My favorite recollection about the whole experience was his final words to her after 4 days of working together. He said, “Sarah, you have all of your range of motion back, and everything you need to make a full recovery. What you need to do is turn the page on this accident and go on with your life.” Wow. How wonderful to hear that at the year anniversary of the accident.