Topic: Health & Wellness

Hearing plays a major role in how we interact in the world around us. Talking with friends and family, listening to music, and hearing oncoming traffic are just a few examples of how hearing is deeply integrated into our day-to-day living experiences. But, despite its importance, 1 in 4 Americans is already showing signs of hearing loss (1). So you heard it here first (just maybe not as loud as you should have) — hearing loss is on the rise.

Hearing loss is becoming near-endemic in its numbers, as more people every year are slowly losing their ability to hear as well as they used to. The most frustrating part about this rise in hearing loss is that, unlike many other injuries, noise-related hearing loss is both impossible to repair and completely preventable. While education about the importance of protecting our hearing is more common today, it appears that compliance with wearing the needed protective equipment is lower than it should be. According to a recent survey, roughly 70% of people who are regularly exposed to loud and damaging noise levels do not wear any form of personal protective equipment (2).

As the prevalence of hearing loss continues to rise around the world, we need to find ways to integrate safe hearing practices into our regular living routines. Hearing loss is steadily climbing the list of chronic health conditions, and without intervention, hearing loss will become a health problem of global proportions.

Our noisy world is to blame

As our society becomes more advanced and modernized, the amount of noise that we are exposed to on a daily basis has increased. From densely packed cities with loud ambient noise to loud personalized headphones to blast your favourite song directly into your ears, we are exposed to a ton of loud sounds every single day.

Sound volume is measured in a unit called the decibel. The lower the decibel level, the safer prolonged exposure to that noise is for the health of your ears. Some common examples of sounds and their decibel levels are (5):

• 0 – 60 decibels — Whispering, a watch ticking, refrigerator noises, and normal volumes of human conversation. These levels of noise are not considered dangerous and are not likely to cause hearing loss.
• 70 – 85 decibels — A running washing machine or dishwasher, city traffic from inside a car. These levels may cause irritation and annoyance.
• 85 – 110 decibels — A lawnmower, motorcycle, live sporting events, and using headphones at maximum volume. These levels will result in hearing loss after as little as five minutes of exposure.
• 110 – 150+ decibels — Shouting into the ear, standing next to sirens, and fireworks. These levels cause ear pain and damage immediately.

Noise exposure is the primary contributor to preventable hearing loss. Our daily exposure to sound pollution has gotten so loud that we aren’t even able to properly identify the amount of damage it is causing. Because of this, the World Health Organization (WHO) has identified environmental noise as an underestimated threat to our overall health and wellness (3).

Our lack of understanding surrounding the true extent of harm that environmental noises have on our health can be seen in the rate of acceleration of hearing loss in many countries around the world. In the 10 year span between 2008 and 2018, the twelve most populated countries in the world have all trended upwards in the number of people experiencing hearing loss (4).

Important Hearing Loss Statistics:

• Due to the increased exposure to loud noises and the rise in the use of personalized headphones, nearly 50% of all people aged 12-35 (roughly 1.1 billion young people) are currently at risk of developing hearing loss (6).
• Profound hearing loss leading to disability is also on the rise around the world. While around 400,000 people were living with disabling hearing caused by preventable noise exposure in 2015, the number is estimated to skyrocket to over one million by the year 2050 (4).
• Men aged 20-69 have almost twice the risk of developing hearing loss when compared to women in the same age group (7).
• About 53% of adults living with hearing loss caused by noise exposure report that they have no on-the-job exposure, indicating that we truly do not understand the extent of harmful sound pollution we are exposed to on a daily basis (8).

Noise degrades our hearing by damaging small hairs inside our ears

Being able to hear sounds is not as simple as it may seem. Hearing a single tone involves collecting the sound waves through the outer ear, passing the vibrations through small specialized bones and hairs in the inner ear, and then sending that signal to the brain to be recognized and interpreted.

So how does exposure to loud sound cause damage to this system in the first place?

The primary culprit for the progression of hearing loss is the bending and breaking of our sound receptor hairs within our inner ear. When we are born, we have over 16000 tiny hairs within our ears that are responsible for detecting and transmitting sound waves to our brain to decode. Just like the blades of grass beneath our feet, these tiny hairs bend and move when sound waves interact with them. In short bursts of loud noise, the hairs can bend and bounce back into their normal position. But, when a person is exposed to long durations of loud noise, the hairs can remain bent or even break, resulting in hearing loss (8). Every hair that is damaged and unable to pass sound information onto the brain results in more profound hearing loss that is unable to be repaired.

It starts in the workplace

It is important to understand the true magnitude that even a change of 5 decibels can have on the safety of a given working environment. The decibel, which we discussed earlier, is actually measured on a logarithmic, or nonlinear, scale, meaning the marks on the scale are based on orders of magnitude. In this way, a noise level of 95 decibels is actually significantly louder than even 90, and so on and so on.

The official American government stance on sound exposure in the workplace follows guidelines from the National Institute of Occupational Health and Safety (9). Following their recommendations, they suggest that workers should not be exposed to sound volumes any louder than 85 decibels (roughly as loud as a lawnmower) from the duration of an eight-hour shift without hearing protection.

But it is important to recognize that 85 decibels are not necessarily the sound level that hearing loss begins. In a study conducted in 1974 by the Environmental Protection Agency, it was found that sound levels of 70 decibels or less were ideal for preventing noise exposure hearing loss (10). Because of this, the National Institute of Health now recommends a daily maximum volume in the workplace to be no more than 75 decibels (11).

So as you can see, daily exposure to sound pollution at work is a serious problem that many of us aren’t even aware of. And as a result, occupational noise exposure is the second most common risk factor in the workplace, behind workplace injuries.

It is also important to note that the duration of sound exposure is not always the primary culprit for hearing loss in the workplace. The permissible exposure limits of incredibly loud sounds (of 115 decibels or more) indicate that these sounds can cause significant damage to your hearing, even after exposure for a very short period of time (12). Because of this, it is highly advised that people working in loud environments wear hearing protection to prevent hearing damage from sudden loud noises.

Modern life is damaging our ears

The comforts of modern living are having a negative impact on the health of our overall hearing. Densely packed cities, increased traffic, and loud construction noises are all contributing factors to the loud and damaging environmental noise of city living. In a recent study, it was found that city living and hearing loss have a 64% positive correlation, indicating that where you live does have an impact on your risk for developing hearing loss (13).

In this study, 50 cities were analyzed to understand the impact of sound level and the number of people living with hearing loss (13):

• Of the 50 cities, Delhi was found to be one of the worst cities for sound pollution, alongside Guangzhou, Cairo, Paris, and Beijing. It was found that people living in Delhi recorded the highest average of hearing loss, with most people studied having a hearing level equivalent to someone almost 20 years older than their age.
• The cities ranked for the least sound pollution were Zurich, Vienna, Oslo, Munich, and Stockholm. Vienna had the lowest rates of hearing loss in their population, but still experienced a loss of hearing equivalent to someone 10 years older than their age.

Seeing these numbers, it is quite staggering to understand the impact that city living has on someone’s hearing health. People living in large cities are regularly exposed (against their will) to noise above 85 decibels from sources like traffic, subways, industrial activity, and airports, and that’s enough to cause significant hearing loss over time.

In addition to loud ambient noises, modern living has also brought additional sources of noise that we have grown accustomed to. Festival and headphone culture have widely taken off over the past decade, allowing people to be exposed to loud music and sound on a more regular basis. From 2003 – 2013, the rate of annual attendance to large (and loud) music festivals has increased by over 10 million people (14). Attendance at these events without proper hearing protection can cause significant hearing loss over just one single weekend event.

And what about listening to music or podcasts all the time on earbuds, the ubiquitous symbol of millennials? While regular use of headphones can be safe if used at an acceptable sound level, blasting music on high volumes directly into your ears can have a significant impact on your hearing. When cranked to their top volume smartphone can emit up to 100 decibels of sound, which can cause significant damage after only 15 minutes of exposure (15).

Hearing naturally gets worse as we get older

Alongside noise exposure, it is normal for our hearing to worsen with age. Over time, our hearing loss increased from 7% at ages 20-29 to as much as 68% by ages 60-69 (8). But, as you can imagine, it is difficult to determine what extent of hearing loss is from age-related causes (also known as presbycusis), and hearing loss that comes from noise exposure.

It’s More than Just a Loss of Hearing

For many of us, it is very easy to think of hearing loss as a minor inconvenience rather than a large-scale problem. While many of us would likely prefer to keep our hearing, the idea of progressively losing the ability to hear sounds may not cause a 911 emergency level of anxiety and worry. But, it is super important to understand that hearing loss impacts many other areas of our health and lifestyle.

At the individual level, the burden of hearing loss over a lifetime can be very substantial, and can even be exacerbated by negative societal attitudes and prejudice towards affected people. In general, hearing loss has a more profound impact on our day to day lives than we truly realize. Adverse consequences on interpersonal communication, challenges to psychosocial well-being, poorer quality of life, and a possible loss of economic independence are all examples of the large-scale impacts of hearing loss over time.

In children, early-onset hearing loss and exposure to noise pollution can lead to poorer speech and language development. These delays can have a significant impact on the child’s future, as they can set the child on a trajectory of sub-optimal educational and career-based achievements.

In adults, hearing loss also comes with a multitude of negative lifestyle and health impacts. Adults living with hearing loss are more likely to experience social isolation and stigmatization, abuse, psychiatric disturbance, and depression. They are also more likely to have difficulties maintaining relationships with partners, friends, and children, and can even experience restrictions on their options for careers.

Even more shockingly, a recent study found that adults suffering from noise exposure hearing loss were more likely to experience a decline in their social, psychological, and cognitive functioning at an early age (1). Individuals with hearing loss can experience as much as a 30-40% acceleration in cognitive decline when compared to those without hearing loss (16). This acceleration has a dramatic impact on quality of life, financial stability, and individual independence at an even earlier age than many expect.

So as we can see, hearing loss is a serious chronic health condition that impacts billions of people around the world. As a society, we need to make a shift in how we understand, educate, and protect ourselves and others from the dangers of persistent sound pollution and short term exposures to loud noises.

Sources

1. Vital Signs: Noise-Induced Hearing Loss Among Adults — United States 2011–2012 (CDC)
2. Hearing Protection, Dr. Lewandowski’s Infinity Hearing
3. Data and Statistics (World Health Organization)
4. Hearing loss is on the rise! (World Health Organization)
5. What noises cause hearing loss? (CDC)
6. New WHO-ITU standard aims to prevent hearing loss among 1.1 billion young people (World Health Organization)
7. Quick Statistics About Hearing (National Institute on Deafness and Other Communication Disorders)
8. Too Loud! For Too Long! (CDC)
9. The National Institute for Occupational Safety and Health (CDC)
10. EPA Identifies Noise Levels Affecting Health and Welfare (Environmental Protection Agency)
11. Noise-Induced Hearing Loss (National Institute on Deafness and Other Communication Disorders)
12. Permissible Exposure Limits (Occupational Safety and Health Administration)
13. Worldwide Hearing Index 2017 (MIMI)
14. Attendance at popular music concerts in the United States from 2003 to 2013 (Statista)
15. Make Listening Safe (World Health Organization)
16. Untreated hearing loss can accelerate cognitive decline (Starkey)

Original article: Say What? Hearing Loss is on the Rise (HealthMatch)

Physiatry, also called Physical Medicine and rehabilitation or PM&R, is the medical specialty which maximizes function. Function can also be thought of as human performance. The types of patients seen by physiatrists vary widely ranging from musculoskeletal injuries in athletes to back pain to neurological rehabilitation caring for persons with stroke, traumatic brain and spinal cord injury, cerebral palsy, and multiple sclerosis, among other diagnoses.

There are three factors that make physiatry unique among medical specialties: the result of our interventions are always measured by performance, we work in healthcare teams, and our medical training includes extensive training in both neurology and musculoskeletal medicine. We are holistic in our approach to treatment, always considering our patients within the context of their own unique lives. Treatments include rehabilitation therapies like physical therapy, oral medications and injected medications.

Rehab physicians work very closely with a variety of other rehabilitation professionals like physical and occupational therapists, speech language pathologists, neuropsychologists, therapeutic recreation specialists, nurses and social workers, among others. These rehab professionals provide non-medical treatments like exercise, bracing, psychological support, and more. Because they spend so much time with our patients, rehab therapists often bring challenges and limitations to the attention of the physiatrist and also are in the best position to assess any changes seen as a result of a given treatment.

Rehabilitation medicine treats a huge number of symptoms in persons with neurological and musculoskeletal disease, from children to the elderly. Pain, weakness, decreased balance, visual deficits, cognitive (or thinking) problems and communication deficits are just a few. All rehabilitation professionals are interested in minimizing these symptoms, but also how they affect a person’s performance in walking and mobility, self-care, communication, recreational activities and return to school or work.

There are two broad approaches used in rehabilitation medicine. Remediation strives to eliminate a bothersome symptom to the greatest degree possible using exercise, bracing, medication, and other treatments. Sometimes a particular symptom cannot be fully treated and, in that case, the strategy of compensation is used. Compensation explores how a person can use remaining strengths – physical or mental – to accomplish a given task.

The length of a rehabilitation treatment varies enormously, ranging from a single session (for example, some types of dizziness resolve after a single treatment with an occupational or physical therapist!) or many months after more severe neurological injuries or disease. In general, patients see a rehabilitation medicine physician every 4-8 weeks while receiving active treatment. Therapy sessions typically last between 30-60 minutes and occur a few times a week. Insurance coverage of rehabilitation services varies widely and some patients need to check their individual carrier before finding a provider.

In neurological rehabilitation, more severe initial injuries or diseases tend to have longer recoveries and more difficulties. Some patients will see a full recovery after a stroke or traumatic brain injury, but many will have residual weakness, decreased balance or difficulty in communicating. One of the most difficult challenges is helping a patient and their family deal with the reality that the odds of getting “back to normal” may be quite low. Because things happen that I cannot explain or predict, it is rare that I would completely rule-out further improvement. Sometimes the goal is “hope for the best and prepare for the worst.”

Different & Able editor Erin here, writing to share some strategies that I’ve found helpful for dealing with my anxiety about Covid19. A little background: I’ve had anxiety for as long as I can remember. Two decades of therapy have helped me gain some insight into practical strategies that work to control it. Usually I don’t need to implement these strategies daily in order to feel well. When I was younger and my anxiety was less under control they were crucial, but now they’ve become so ingrained that I don’t really need to think about them consciously. That said, I realized early that Covid19 was going to be a huge mental health challenge, and since the beginning of the pandemic I’ve reintroduced them. It’s helped a lot. Here are some things you can try if you feel like you’re spinning with anxiety right now.

1. Look to the future, but not too far in the future.

If you’re feeling depression right now, which for so many of us is a cousin of anxiety, I get it. One way I’ve been hedging against getting bogged down by depression is to plan ahead, but not too far ahead. By that I mean, I am planning out my days and the coming weeks carefully, but not looking further into the future than that. For instance, like so many people, I don’t know how Covid19 will affect me professionally. I won’t know that for a few months, at least. So now is not the time to focus on that part of my future, since I have so little information and can’t do anything about it. Instead, I’m focusing on the day ahead of me and the week to come. How will I feed my family this week? What meals will I make to utilize everything in the pantry and avoid trips to the store? These are the questions I’m trying to answer, instead of wondering where we’ll all be in a year.

2. Plan your days carefully.

Each morning I’ve taken 20 minutes or so to plan my day in a detailed manner. It has been extremely helpful.

I write it in pencil so that I can change it as the day goes on. If I make a change, I add it. I’m not hard on myself about whether I stick exactly to the schedule, but I do make sure to record any changes. This helps me feel in control. I make sure to add daily exercise like walking my dog, and meditation, as well as dedicated time with friends and family. (I enjoy taking a lunch break from work with my husband, and watching Love Is Blind in the evenings over FaceTime with friends!)

3. Adjust your perspective

A common experience for those with anxiety disorders is to catastrophize. We tend to exaggerate the consequences of small actions, and are liable to think that they condemn us to a certain future. This is not true! There is very little in life that you can’t revise. Remember that if you’re alive and well, and surrounded by people you love (both digitally and IRL), you are very, very lucky. If you don’t lose a loved one or get sick yourself in Covid19, you are very, very lucky. All the other stuff is just detail at this point. So don’t allow yourself to catastrophize right now.

Talk back to your own mind when you hear yourself say things like, “this is going to ruin all my chances” or “I’ll never become x now!” Tell yourself: “I am healthy, I have a safe place to live, and people who love me. If I have those things, I can survive.”

4. Stay updated, but don’t overdo it.

Don’t stare at your phone all day. It won’t help. Add a time to read the news into your daily schedule and stick to it. Give yourself half an hour in the morning and half an hour in the evening to catch up, and then cut yourself off.

5. Be kind to yourself.

This is not the time to add pressure. I’ve been hearing a lot of people saying things like, “what are you going to do with your pandemic time?” This makes me anxious. I’m not going to put any extra pressure on myself now–not going to try a new exercise regimen, not going to try to learn a new hobby unless it’s seriously easy and I enjoy it, and not going to expect myself to excel. This is a time to stick to routine and do your best, not to overdo it. Even if you can do a lot with this time, doing so may exhaust you and leave you too tired to stick to routine the next day. Take it from a former over-achiever: slow and steady is the way to go right now.

6. Do things for other people that make you feel good.

Anxiety tends to make us selfish. I say that not as a value judgement, just as an observation: for me, at least, anxiety gets me stuck in my own mind, my own feelings, and my own experiences. One good way to trick your brain into forgetting your own anxiety is to do things for other people who are more in need than yourself. I’ve been sewing masks for doctors in need, as well as checking in on my elderly neighbors to see if they need supplies that they can’t get. This helps me a) put my own problems in perspective, b) stay busy doing something that makes me feel good and c) feel some agency over a situation in which I have little control.

Editor’s Note: The following ideas are adapted from “Soul-utions for People Who Stutter – Stuttering Therapy” by Phil and Uri Schneider, in Stuttering: Inspiring Stories and Professional Wisdom, 2012. These ideas offer a soulful frame for understanding stuttering and its treatment (both in terms of the “BODY” aspects of stuttering and the “SOUL” aspects of stuttering).

In the spirit of the proverbial saying, “There is nothing new under the sun,” this post will remind us what we already know about the most universal and deepest truths about stuttering, and helping people who stutter.

Let’s be clear, helping a PWS (person with stuttering) is more than working on mechanics. Rather, the purpose of our work is to liberate and enrich the human experience through increased freedom and power of speech. Our work, therefore, is a dynamic process: working from the outside-in and the inside-out, planting values and building great communicators by drawing out the intrinsic greatness within each person.

BODY:

Stuttering is a neurologic, physical condition which generates unpredictable, involuntary, intermittent interruptions in the automatic, effortless, seamless transition from one sound to the next (or from silence to sound). The frequency and intensity of these interruptions vary widely from moment to moment. We know enough to know that they are not simply caused by emotional or cognitive variables. We also know enough to say stuttering is multifactorial and can be exacerbated by any number of triggers, including but not limited to: speech intensity, speech rate, fatigue, emotional arousal, hormonal changes, language complexity, and social-emotional circumstances. The speaker can have a clear flow of thought and motor planning, and still experience interruptions.

Consider the typical speech motor system, which could be likened to an intricate ballet performed in super-fast speed (vocal folds the size of your pinky fingernail move hundreds of times per second!). As is true in dance, each articulatory posture in speech needs to transition with flow from the one which precedes it while, at the same time preparing for the posture which follows. The physical aspect of stuttering introduces unpredictable disruptions to this intricate ballet – even though the speaker “knows” the dance well and may have performed it tens of thousands of times before, without a single glitch. The person who stutters, knows what they want to say, and may have said the words fluently before. But stuttering is the experience of unintentional interruptions to that regular flow of speech. There are three different types of disfluencies – “hesitations”, “repetitions” and “prolongations”. Any person who stutters, may have one or more of these disfluencies which characterize their personal stuttering condition. These terms – “hesitations”, “repetitions” and “prolongations” – are descriptions of the surface behaviors which are the observable representation of the physical aspect of stuttering. The traditional assessments use percentage of syllable stuttered (%SS) as a surface measure of the physical behaviors of stuttering. But these terms and assessments only relate to the physical, “body” aspect of stuttering. When working with a person who stutters, we need to tune-in to things that cannot be seen, heard or measured by outside observations. For the experience which cannot be seen or heard, is as real, and if not as challenging, even more so, than the moment of interrupted speech may be.

BODY MEETS SOUL:

To understand the personal human experience with stuttering, one must consider the impact of these physical interruptions on communication and self-image.

These unpredictable and undesired physical interruptions can press upon the speaker’s desire to express himself and reduce his desire to freely connect with others. Over time, this condition can even lead people to avoid speech communication altogether, stifling social, academic and vocational development and opportunities. If this happens, the person who stutters loses more than their fluency.

Their soul becomes sore. They may lose faith in the pursuit of their life dreams, and damage their sense of purpose and sense of self. Stuttering can make us feel hopeless and helpless: out of control of our both bodies and our lives. When we feel robbed of our sense of inner dignity and self-determination, we can develop feelings of shame and humiliation. Interestingly, unlike other speech disorders (like articulation), stuttering can be exacerbated by increased drive to be heard. In fact, if you don’t talk, you can’t stutter. Ironically, stuttering affects those who commit to communicating and sharing their inner thoughts, feeling and ideas with the world! Peculiarly so, people who stutter usually do not stutter in speech which is not genuine communication.

Now, let’s consider how speech communication, stuttering and speech therapy are really the intersection of meta-physical (soul) elements and physical (body) mechanisms. The physical mechanism of speech communication includes movements, airflow, sounds, words and grammatical structures. But we must not forget that these physical elements coalesce to serve a special, meta-physical (“soulful”) purpose. Universally, speech communication is a means to understanding, which opens the door for compassion, which leads to relationships and connection. Speech communication is the song of soulful communication; a gift endowed to mankind above and beyond all other creatures on this planet. Through our speech communication, we fulfill our inner drive to express our personal thoughts, feelings, needs and desires, and feel connected to others through a two way symphony of sound and expression. When we speak-out our thoughts and feelings through our voice breath, in exchange with other people, we really build shared-bridges of meaning, between ourselves, our inner experiences and those of others’.

TREATMENT APPROACH:

Now, as we understand the experience of being a person who stutters as an integration of “body” and “soul,” then speech therapy must also take a body and soul approach. The “body” of therapy focuses on the physical mechanics of speech production and the exercises designed to enhance the ease of speech and reduce the frequency and severity of interruptions. This includes physical training needed to break old behavior patterns and establish new ones. It’s significant to note that the physical aspects of therapy have been the primary (sometimes exclusive) focus of our professional tradition, but it is certainly not the only part, and probably not the most meaningful part of the healing process.

After all, we must also address the underlying, meta-physical “soul” aspects of why we communicate and what we think and feel about our speech, about ourselves as communicators, our self-worth and most of all, our true purpose in the world. In reality, these soul-ful elements define the purpose for the work and which motivate, direct, and drive the hard work needed to modify physical mechanisms.

Other “soul-utions” include more general dimensions of “determination” and “persistence.” Determination helps to prevent delays in follow-through. Delays in taking action can lead to a loss of enthusiasm. Quick follow through helps to capture the focused clarity and energy needed for success. Persistence is needed to make ongoing sacrifices in the present based on the anticipation of meaningful rewards in the future. “Determination” and “persistence” help a person stay on course in spite of pressure to fall back into the status quo.

CLOSING THOUGHTS:

Our experience continues to demonstrate that our role in working with the PWS is so much more than treating the physical aspect of stuttering. In fact, if we treat only the superficial symptoms of stuttering, we risk doing harm. We must look at the body and the soul of the issue, in the same way we must look at the people who seek our help. They are not bodies or client files. Each one is an entire world of dreams, interests, pain and loss and their inner soul is looking to restore its shine. We must be focused on helping people; we must focus on helping people transcend their stuttering through wholistic understanding, care, acceptance and of course, speech strategies. If we treat people in this way, giving credence and attention to both their physical and non-physical realities, then we can be partners in the exciting and ongoing process of real recovery.

To learn more about Uri and Phil Schneider’s work and services, visit: Schneider Speech

Stacey Rhodes, LCSW is a psychotherapist in New York City. She has obtained her Master’s of Social Work from NYU’s school of Social Work. She helps her patients with a wide range of issues, such as anxiety, obsessive-compulsive disorder, phobias, depression, life changes, grief, dating, and other relationships.

Stacey also has experience working with parents to help them face challenges and family matters. Working within the Mt. Sinai Health System, Stacey used trauma-focused therapy while working with children and adolescents. She also believes in a collaborative approach, working with family, schools, mental health professionals, and other providers as needed.

According to the Center for CBT in NYC’s website, “Stacey believes in and sees the best in her clients and acknowledges how hard they are working to manage a hard situation. Stacey provides a warm, caring, and non-judgmental space for her clients and welcomes a client’s collaboration in sessions. Stacey believes that therapy is a joint effort between client and therapist. She has found great joy in being able to be an additional support and cheerleader for her clients and join them in their life’s journey.”

Different & Able’s president and founder had the honor of interviewing Stacey. In the interview they talk about important and relevant mental health issues.

Summer brings longer days, more social activity, and for many people with neurological conditions, a noticeable shift in how the body and brain function. In the summer, fatigue can arrive earlier and symptoms that were manageable in cooler months may become harder to predict. This means cognitive effort increases, which changes how you need to approach each day.

Heat has documented, measurable effects on the nervous system, and those effects are significantly more pronounced in people whose nervous systems are already managing a condition. Understanding what is actually happening, and why, is the first step toward navigating summer in a way that works for you.

Why Heat Affects the Nervous System

The nervous system is exquisitely sensitive to temperature. Nerve conduction, the process by which electrical signals travel along nerve fibers, depends on precise electrochemical conditions. When body temperature rises, those conditions shift, and in a healthy nervous system, the body compensates efficiently. In a nervous system affected by injury or disease, that compensation is significantly harder.

This is most well-documented in multiple sclerosis (MS), where it is known as Uhthoff’s phenomenon. In MS, demyelination, the loss of the protective myelin sheath around nerve fibers, already slows and disrupts nerve conduction. Research has shown that even a rise in core body temperature of as little as 0.5 degrees Celsius can be enough to slow or block conduction in demyelinated nerves, causing symptoms to temporarily worsen. Up to 80 percent of people with MS experience this effect. Importantly, it is not a relapse or a sign of disease progression. It is a temporary physiological response that typically resolves as the body cools.

The implications extend beyond MS. People with traumatic brain injury, stroke, Parkinson’s disease, chronic migraine, and other neurological conditions also report increased symptom burden in heat, through related but distinct mechanisms. After brain injury, for example, the brain’s ability to regulate temperature and manage the physiological demands of heat exposure may itself be impaired. In migraine sufferers, heat is a well-recognized trigger. In Parkinson’s disease, autonomic dysfunction can affect the body’s ability to thermoregulate effectively.

Across these conditions, the common thread is that heat adds physiological demand to a system that is already managing more than its typical share.

What This Can Feel Like

Heat effects on neurological symptoms are not always immediate, which makes them easy to underestimate. Internal body temperature can rise gradually over the course of a day, and the effects may not show up until hours later. By that point, significant depletion may already have occurred.

Some things the community commonly reports noticing in summer:

• Fatigue that seems disproportionate to activity level
• Brain fog that feels heavier or arrives earlier in the day
• Existing symptoms that temporarily worsen but improve as the body cools
• Mood changes: irritability, or emotional sensitivity that tracks with heat exposure
• Greater difficulty with balance, coordination, or motor function
• Headaches that follow time outdoors or in warm indoor spaces
• Sleep disruption on hot nights, which then compounds the following day

None of these mean something has gone wrong with the condition itself. They mean the nervous system is responding to a physiological stressor, and the response makes complete sense given the underlying biology.

Keeping Cool as a Strategy

The research on cooling strategies for neurological conditions is genuinely encouraging. Because the effects of heat are physiological, cooling is a legitimate and effective form of symptom management, not just a comfort measure. Here are approaches that tend to make a real difference:

Before You Head Out

• Pre-cool your body before going into heat: a cold shower, cold drinks, or a cooling vest worn before exposure can delay the onset of heat effects.
• Check the heat index, not just the temperature. High humidity significantly reduces the body’s ability to cool itself, which means a humid 80 degree day can feel much harder than a dry 90 degree day.
• Plan outdoor activity for the morning when possible. Air quality and temperature are typically better earlier in the day.
• Know your baseline for the day before committing to plans.

While You Are Out

• Carry cold water and drink it regularly, not just when thirsty.
• Cooling towels, neck wraps, or small fans are portable and genuinely effective at reducing perceived heat load.
• Identify shade or air-conditioned spaces in advance and use them proactively rather than waiting until symptoms worsen.
• Noise-canceling headphones can reduce the sensory load of busy outdoor environments, which frees up more capacity for the heat itself.
• Check in with yourself at regular intervals rather than waiting for a clear signal that things have gone too far.

After Heat Exposure

• Build in explicit recovery time after time in the heat, treating it as part of the outing.
• Cold drinks, air conditioning, and rest are not indulgences after a hot day. They are recovery strategies.
• A fan pointed at the body, cooling sheets, or a cold pack on the neck can help bring body temperature down enough to improve sleep quality on hot nights.

Humidity, Air Quality, and Other Summer Factors

Heat gets most of the attention, but it is not the only summer variable worth knowing about. Humidity reduces the body’s ability to cool through sweating, which means high-humidity days can produce heat effects even when the temperature feels manageable. Many people find that tracking humidity alongside temperature gives them a more accurate picture of how a day might feel.

Air quality is worth checking on high-heat days. Poor air quality increases respiratory demand and inflammation, both of which can affect neurological symptoms. Most weather apps now include air quality data alongside temperature, and on days when both are high, reducing outdoor exposure tends to be worth it.

Planning Summer Around Your Nervous System

Understanding the relationship between heat and neurological symptoms makes it possible to plan more effectively rather than simply reacting. Summer participation is absolutely possible for people with neurological conditions. It often simply requires more intentional planning than it might for someone whose nervous system is not affected by temperature. That planning is not a limitation; it is what makes genuine participation possible.

In a fast-paced world where we have a million things on our minds and our to-do lists, it can be easy to miss the small, meaningful moments in life. These moments serve as reminders that life is full of love, human connection, and things to be grateful for. The little things, a kind word, laughing with friends, or enjoying a hot cup of coffee may not erase hardships, but they can help ease our anxiety, depression, and increase our overall well-being.

Gratitude is a mindset; it is more than saying “thank you” and being polite. Practicing gratitude helps us notice the good in everyday things, even when life gets tough. For many people, especially those living with disabilities, chronic illness, or neurological differences, gratitude can be a very useful grounding tool.

What Gratitude Really Means

Gratitude is defined as “the appreciation of what is valuable and meaningful to oneself, and a general state of thankfulness or appreciation.” This means gratitude is the ability to recognize good things, big or small, and to connect them with a sense of appreciation. What we appreciate in life differs from person to person, but many times humans tend to overlook the small things. Taking a hot shower, enjoying the fresh air, reading a good book, are all small, daily things we do that are sometimes taken for granted. By stopping and appreciating these daily things we have a gratitude mindset.

But gratitude does not mean pretending everything is perfect. It’s about balance, acknowledging that we do have daily difficulties, but we also have moments of peace that coexist alongside them.

Examples of Everyday Gratitude Might Include

• Appreciating a supportive message
• Noticing your body for what it can do
• Feeling thankful for a friend who listens
• Recognizing small wins (finishing a task, showing up, getting through the day)
• Practicing self-care

What Is Toxic Positivity

It’s important to note that gratitude does not mean we ignore our negative feelings. That is what toxic positivity is, which can be harmful to practice and hurt the people we care for. Toxic positivity pressures us to stay positive no matter what the circumstances. It preaches that any situation can be looked at in a positive light, which is not always true. Gratitude makes space for complex situations. Humans are complex and we are allowed to say this situation is really hard or unfair, but we can still be grateful for the things and people who help us get through the hard times. The distinction between toxic positivity and gratitude matters, especially in communities where people may face daily physical, social, or emotional challenges. Gratitude doesn’t dismiss pain; it acknowledges resilience.

Why Gratitude Matters

Research consistently shows that gratitude supports mental health, relationships, and overall well-being. People who practice gratitude regularly tend to report:

• Greater happiness and life satisfaction
• Improved sleep
• Lower stress levels
• Stronger social bonds
• Higher empathy
• A deeper sense of purpose

By choosing to notice what’s good, even in small ways, we change our mindset and allow for more positive moments in between the harder ones. We do not use gratitude to minimize our pain, but to highlight the positive in our everyday lives.

Planning to become pregnant and start a family can and should be an exciting time for women. However, women with disabilities (WWD) can face additional challenges and hurdles. As we’ve discussed in our previous articles, The Challenge of Becoming Pregnant and Overcoming Physical Barriers, finding doctors who are experienced with WWD or who have accessible equipment can be challenging. Many physicians are not adequately trained to work with WWD, as “Ob-Gyn physicians…are aware of the special healthcare needs of WWD, but only 17% report receiving any training…and 92% endorse a need for more knowledge resources specific to pregnancy.” (Signore, 2022). Further, some doctors hold incorrect assumptions that WWD are less likely to conceive and that their infertility rates are higher than they actually are, creating harmful misconceptions about infertility. Navigating the societal stigma, isolation, and internalized doubts about motherhood can be overwhelming. Addressing these barriers through counseling and peer support is critical.

WWD can be empowered and should be proactive in their medical care when planning to become pregnant. By doing research and staying up to date and informed about their care and medical advances, WWD can improve their chances for a healthy pregnancy and delivery. Build your team. By discussing your plans with the doctors that you already work with, e.g. PCP, Ob-Gyn, OT, PT, and registered dietitian, you can design a customized plan of care to meet your needs.

Pregnancy for women with disabilities can involve unique risks, such as complications during delivery or preexisting conditions. “While most pregnancies in women with disabilities (WWD) have favorable outcomes, there are increased risks of perinatal complications including preterm birth and low birth weight infants.” (Signore, 2022). Another important consideration is medication. “The main risk fetuses are exposed to during pregnancy … is exposure to drugs and therapies. In fact, people with disabilities often take medications that cannot be suspended and whose effects over pregnancy are not known. Careful medication administration should be carried on before and during pregnancy to ensure the minimum risk possible for both mother and baby.” (D’Angelo 2020). Having a doctor who knows how to assess and manage these risks is important for the well-being of both the mother and the infant. Unfortunately, systemic issues, like the lack of proper medical coding, can make it more difficult for providers to know what specific care a patient requires.

Specialized care can effectively manage risks associated with pregnancy for WWD. Nutritional counseling is also an important part of the prenatal care process. For example, taking the recommended dosage of folic acid is a strong preventative measure for spina bifida. Other nutrients, such as iron, calcium, vitamin D, DHA, and iodine are also important for growth and development. Dietitians and other healthcare professionals can work with women to create a practical nutrition plan to ensure that they’re getting the necessary nutrients to promote healthy fetal development.

Pregnancy planning can feel overwhelming, but working with the right team of professionals who understand how to manage the associated risks can increase chances for a healthy pregnancy. By staying informed and advocating for themselves, WWD can be empowered in their medical care when preparing for pregnancy.

If you or someone you know is a WWD and has had a successful pregnancy and would like to share their story, please email us at info@differentandable.org. We’d love to hear from you.

References & Resources

Special thanks to:

• Director Connie Lam, NYU Langone Orthopedic Hospital
• Initiative for Women with Disabilities
• Elly and Steve Hammerman Health & Wellness Center

References:

• Becker, H., Andrews, E., Walker, L. O., & Phillips, C. S. (2021). Health and well-being among women with physical disabilities after childbirth: An exploratory study. Women’s Health Issues, 31(2), 140-147. https://doi.org/10.1016/j.whi.2020.10.007
• Byrnes, L., & Hickey, M. (2016). Perinatal care for women with disabilities: Clinical Considerations. The Journal for Nurse Practitioners. Article (PDF)
• D’Angelo A, Ceccanti M, Fiore M, Petrella C, Greco A, Porrari R, Gencarelli S, Ralli M, Vitali M, Ferraguti G, Galeoto G, Valente D, Framarino Dei Malatesta M, Messina MP. Pregnancy in women with physical and intellectual disability: psychiatric implications. Riv Psichiatr. 2020 Nov-Dec;55(6):331-336. doi: 10.1708/3503.34890. PMID: 33349725.
• National Council on Disability. (2019). Quality-Adjusted Life Years and the Devaluation of Life with Disability: Part of the Bioethics and Disability Series. Washington, DC: National Council on Disability. ncd.gov
• National Council on Disability. (2012). Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children. Washington, DC: National Council on Disability. ncd.gov
• Powell, R. M., Mitra, M., Smeltzer, S. C., Long-Bellil, L. M., Smith, L. D., Rosenthal, E., & Iezzoni, L. I. (2019). Adaptive parenting strategies used by mothers with physical disabilities caring for infants and toddlers. Health & Social Care in the Community, 27(4), 889-898. https://doi.org/10.1111/hsc.12706
• Signore, C. (2022). Pregnancy in women with disabilities: Past, present and future. Paediatric and Perinatal Epidemiology, 36(6), 769-770. https://doi.org/10.1111/ppe.12897
• Access Board: Medical diagnostic equipment standards
• New York Times: These Doctors Admit They Don’t Want Patients with Disabilities
• Women’s eNews: The Doctor Won’t See You Now: Why Do Barriers to Healthcare for Women with Disabilities Persist?
• March of Dimes: Vitamins and other nutrients during pregnancy

Spinal health is extremely important to your overall health. At the most basic level, our spine consists of bones that help us stand tall. But inside the column of vertebrae runs the spinal cord, which is an electric living extension of your brain.

How the Spine and Nervous System Work Together

Your spine is made up of 33 different vertebrae. Vertebrae are bones that are neatly stacked on top of each other; ligaments and muscle hold the vertebrae in place and allow them to move. Inside the spine is your spinal cord, which is made up of nerves that connect your brain to the rest of your body. Together, your brain and spinal cord make up your central nervous system, the command center for every thought, movement, and feeling. The spinal cord can be thought of as a superhighway of information. Messages travel up and down constantly, telling your body what to do and processing sensory information.

The spinal cord carries two different signals:

• Sensory signals (sensations such as pain and temperature) travel up to your brain.
• Motor signals (that tell your muscles to move) travel down from your brain.

This two-way connection allows you to move, breathe, and react throughout the day. Since your spinal cord is vital for basic movements, any injury can have a profound effect on the body.

Spinal Cord Injuries and Conditions

There are many spinal conditions, many of which have neurological roots or effects.

1. Spinal Cord Injury (SCI)

Spinal cord injuries are often caused by car accidents, falls, or sports injuries. Traumatic SCI happens when the spinal cord is bruised or severed. Depending on where it occurs, it can lead to paralysis (paraplegia or quadriplegia), loss of sensation, or changes in breathing and bladder control. Even partial injuries can affect balance, mobility, and independence. Ongoing rehabilitation and adaptive technologies are helping people regain function whenever possible.

2. Herniated or Bulging Disc

The soft discs between your vertebrae can rupture or slip out of place, pressing on nearby nerves, which is a herniated or bulging disc. This often causes shooting pain, tingling, or weakness, especially in the arms or legs. Early physical therapy, posture changes, and core strengthening can prevent long-term nerve damage.

3. Spinal Stenosis

Over time, as we age, the spinal canal can narrow, often from arthritis or bone overgrowth, which can squeeze the spinal cord and nerve roots, also known as spinal stenosis. Symptoms include numbness, cramping, and balance issues, especially when walking. It’s most common in older adults and can often be managed with therapy, injections, or surgery if symptoms are severe.

4. Transverse Myelitis

Transverse myelitis is an inflammatory condition that damages the spinal cord and is often linked to immune disorders or infections. It can cause sudden weakness, paralysis, or loss of bladder/bowel control. Treatment focuses on reducing inflammation and supporting recovery through rehab.

5. Degenerative Disc Disease

As we age, the discs that cushion our spines naturally wear down and cause degenerative disc disease. For some people, this leads to chronic pain, stiffness, and nerve irritation. Movement, hydration, and good posture can help in preserving spinal health. The body sends signals early, such as numbness, burning, or sudden weakness. Listening to your body can make all the difference.

Caring for Your Neuro-Spine Connection

Spine care isn’t just about avoiding pain. It’s about protecting your body’s communication system. There are several things you can incorporate into your daily routine that can help improve and maintain your spinal cord health.

• Exercise: Gentle stretching, walking, or yoga keeps your spine flexible.
• Strengthen your core: A strong core supports proper alignment.
• Check your posture: Especially when sitting or using screens.
• Stay hydrated: Your discs depend on fluid to cushion movement.
• Sleep smart: Use a supportive mattress, keep your neck aligned, and pay attention to your sleep posture.
• Listen to your body: If you notice tingling, weakness, or numbness, don’t wait to get checked.

Looking Forward

• Exoskeletons: Wearable robotic suits help people with paralysis stand, walk, or climb stairs. They’re being used in rehabilitation clinics and, increasingly, at home.
• Smart Wheelchairs: Modern wheelchairs now use sensors, voice control, and eye-tracking to make mobility more accessible and fluid. Some can navigate obstacles automatically or adjust for terrain.
• Brain-Computer Interfaces (BCI): BCI technology allows the brain to communicate directly with computers or robotic limbs. For people with severe spinal cord injuries, this can mean regaining control of movement or assistive devices through thought alone.
• Neurostimulators: Implanted devices send electrical signals to stimulate the spinal cord, which can help reduce chronic pain and, in some cases, restore partial movement and sensation.

For many years, it was assumed that individuals with intellectual and developmental disabilities (IDD) rarely experienced suicidal ideations and behaviors. Unfortunately, however, recent research has shown otherwise. In fact, young adults with IDD report suicidal ideation and behaviors at higher rates than their peers without disabilities (Fields et al., 2025). These findings challenge outdated assumptions, and emphasize the need for suicide prevention efforts that include people with disabilities, utilizing strategies that are accessible to the individual.

If you or someone you know is in crisis, call or text the 988 Suicide & Crisis Lifeline at 988.

This truth is heavy, but acknowledging this reality is an essential step towards prevention. A widely used mnemonic for recognizing potential warning signs is IS PATH WARM:

• Ideation
• Substance abuse
• Purposelessness
• Anger
• Trapped
• Hopelessness
• Withdrawal
• Anxiety
• Recklessness
• Mood change

While it is important to look for these signs, it is also vital to note that signs of suicidal ideation in individuals with IDD may not be displayed as traditional verbal cues. The signs can also appear through shifts in body language, gestures, and posture. For individuals with IDD, changes in behavior, routines, or emotional expression can be signs that something is “off.” Caregivers, peers, and professionals should remain attentive to sudden changes and trust their instincts if they think something is wrong.

Suicide prevention is never one-size-fits-all. The CDC outlines broad strategies for suicide prevention, such as creating protective environments, teaching coping and problem-solving skills, improving access to care, and reducing risk factors. While these provide a foundation, prevention efforts for individuals with IDD also require adaptation, aiming to build support systems that are accessible and purposeful.

For Caregivers

Caregivers are often the first to notice when something is different. Because of this, it’s crucial for caregivers to have the proper training and support to act swiftly and with compassion.

Ask the hard questions – After noticing warning signs of suicidal ideation, ask the individual how they’re feeling. Caregivers can use alternative communication strategies, adapting questions to fit the communication needs of the individual.

Safety planning – Safety planning is a brief intervention designed to help individuals work through a suicidal crisis by creating a step-by-step plan to lower the risk of engaging in suicidal behavior and taking action steps towards regulating themselves (Stanley et al., 2018). The Stanley-Brown safety plan utilizes six key steps:

1. Warning signs – intervene before it becomes a crisis.
2. Internal coping strategies – identify techniques that can be used to manage stress or distress before it escalates.
3. Use people and social settings to provide distractions.
4. Reach out to friends, family or caretakers that can provide support during a crisis.
5. Contact professionals or agencies who can provide support during a crisis.
6. Making the environment safe – Reduce or remove items that can be used for physical harm.

For Individuals with IDD

Empowering individuals themselves is central to prevention. This can look like:

Practicing self-advocacy – Asking for help isn’t easy, but it is vital. Educating individuals with IDD on suicide and suicidal ideation enables them to recognize warning signs and know when and how to ask for help.

Developing internal coping strategies – Internal coping strategies are techniques that individuals can use to manage any escalation of suicidal thoughts or behaviors. They can include breathing exercises, distraction (hobbies, music, TV), physical activities, creative activities, or cognitive reframing.

Building a “circle of support” – No one should go through things alone. Identifying a trusted group of people gives individuals a clear list of who they can reach out to when things begin to feel overwhelming.

Suicide prevention for individuals with IDD is not only possible, it is essential. With awareness, adaptation, and strong support networks, warning signs can be recognized early and responded to with compassion. By reducing stigma, expanding access to resources, and equipping both caregivers and individuals with practical tools, suicide prevention for people with IDD becomes more effective. Mental health matters for everyone and no one should struggle alone.

If you or someone you know is in crisis, call or text the 988 Suicide & Crisis Lifeline at 988.

Resources

• American Journal of Preventive Medicine article
• CDC: Suicide Prevention
• Relias: Disability and Suicide