In this Talk Dizzy to Me episode, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT sit down with Dr. Mike Studer, DPT, MHS, NCS, CEEAA, CWT, CSST, CSRP, CBFP, FAPTA to unpack neuroplasticity—what it is, how it works, and how to apply it in vestibular rehabilitation. We cover dual tasking, prediction error, fear-avoidant vs. fear-adapted movement, motivational interviewing, and patient-directed dosage using the OPTIMAL theory of motor learning. Mike shares practical clinic and real-life examples (driving, grocery stores, cooking), mic-drop lines you’ll quote to patients, and how to talk to insurers using objective measures.
If busy visuals or movement bother you, consider listening on Apple Podcasts/Spotify.
Neuroplasticity = learning. It’s not just more pathways; it’s stronger, faster, better-fed pathways that consolidate during sleep.
Dose the meaningful. Intensity, repetitions, salience, and task specificity drive consolidation (“put a post-it on that memory”).
Exposure works. Habituation/adaptation creates prediction error (“that wasn’t as bad as I expected”), reinforcing change via dopamine.
Fear shows up in movement. Beyond fear-avoidant behavior, watch for fear-adapted movement (reduced head turns, co-contraction, slow/over-intentional strategies).
Dual tasking is two goals, not ‘think-and-move’ toward one goal. Use cognitive+motor or visual+motor loads that are personally salient.
Autonomy accelerates progress. Let patients choose dosage (keep, dial down, or push), using motivational interviewing and OPTIMAL theory.
No expiration date. Neuroplastic change remains possible well beyond 1 year—set expectations and use objective measures to justify care.
Connect with Mike
Email: mike@mikestuder.com
Website: mikestuder.com
Instagram: @MikeStuderDPT
Book: The Brain That Chooses Itself
Time Stamps03:29 Neuroplasticity defined 05:21 Core principles: intensity, repetitions, salience, task specificity, sleep consolidation09:35 Zooming into vestibular rehab10:06 VR as proof of neuroplasticity; predictive processing 11:32 Habituation/adaptation as exposure-based therapy; links to pain & psychology13:32 Fear, expectations, and patient education14:28 Therapeutic alliance: precision starts with the person17:42 Treating fear: exposure-response prevention & prediction error (dopamine wins)20:05 Dosage variables + motivational interviewing + OPTIMAL theory21:27 Threat perception, amygdala, and “roadblocking” fear pathways24:13 Fear-avoidant vs. fear-adapted movement (new concept in progress)26:11 Cognitive load, exhaustion, and dual-task intolerance29:32 Building alliance between sessions (check-ins)30:00 What dual tasking is (and isn’t): two separate goals31:32 Clinic examples: cognitive+motor; visual+motor with busy backgrounds34:51 Real life: driving with kids, grocery stores, cooking; task switching vs. dual tasking38:40 Overtraining in clinic to empower life outside39:10 Progression: patient-controlled dosage (autonomy)43:27 Neuroplasticity at any age; caveats for degenerative conditions45:26 “Road crew at night” metaphor; why sleep matters47:13 The “1-year” myth; talking to insurers with objective measures49:27 Mic-drop lines
Hosted by:
🎤 Dr. Abbie Ross, PT, NCS
🎤 Dr. Danielle Tolman, PT
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