Henry Hoffman, licensed Occupational Therapist and Co-founder of Saebo Inc., always believed there was no such thing as "plateauing" in stroke and traumatic brain injury recovery. When survivors stop seeing progress in their recovery journey, they're often told that they've "plateaued" and have no choice but to accept this reality. If you ask Hoffman, he'll tell you this – "It's not the patient that plateaus, it's their treatment options that do." It's why he co-founded his company Saebo (a medical device company focused on stroke and TBI rehab) on the mantra "No Plateau in Sight." So, how exactly can survivors keep pushing to overcome the fate of plateau? Hoffman is on a mission to speak to anyone and everyone out there defying the norm in neuro-rehab. This is the No Plateau Podcast – the podcast for stroke and brain injury survivors, their caregivers, and the therapists helping them to break boundaries in their recovery journey.
No Plateau Podcast
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Henry Hoffman, licensed Occupational Therapist and Co-founder of Saebo Inc., always believed there was no such thing as "plateauing" in stroke and traumatic brain injury recovery. When survivors stop seeing progress in their recovery journey, they're often told that they've "plateaued" and have no choice but to accept this reality. If you ask Hoffman, he'll tell you this – "It's not the patient that plateaus, it's their treatment options that do." It's why he co-founded his company Saebo (a medical device company focused on stroke and TBI rehab) on the mantra "No Plateau in Sight." So, how exactly can survivors keep pushing to overcome the fate of plateau? Hoffman is on a mission to speak to anyone and everyone out there defying the norm in neuro-rehab. This is the No Plateau Podcast – the podcast for stroke and brain injury survivors, their caregivers, and the therapists helping them to break boundaries in their recovery journey.
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Publishing Since
7/11/2022
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Recent Episodes
April 13, 2026
Cryoneurolysis: The Next Frontier in Spasticity Treatment
In this episode of the No Plateau podcast, host Henry Hoffman sits down with physiatrist and researcher Dr. Paul Winston to talk about cryoneurolysis, an emerging treatment that is gaining attention in neurorehabilitation. Dr. Winston breaks down how this minimally invasive technique works and why it is generating excitement among clinicians treating spasticity. Using a probe that delivers extremely cold temperatures, around −88°C, through gases like nitrous oxide, clinicians create a small “ice ball” around targeted peripheral nerves. This controlled freezing temporarily interrupts the nerve signals that drive muscle overactivity. The key advantage is that the nerve’s structure stays intact, allowing it to regenerate over time and creating a valuable window for rehabilitation and functional recovery. Henry and Dr. Winston also explore how cryoneurolysis compares with more familiar treatments like botulinum toxin injections, nerve blocks, and surgical approaches. While some treatments chemically block or damage nerve signaling, cryoneurolysis uses a physical process that allows nerves to recover gradually. Dr. Winston shares stories that will stick with you, the husband grasping his wife's hand for the first time in years, the 12-year-old boy applying his own deodorant, the patient who threw away his AFO and now runs through the neighborhood. These aren't just clinical successes; they're reminders of why we do this work. The conversation also highlights how collaboration between physicians, occupational therapists, and physical therapists can help patients make the most of this recovery window. Listen to the full episode to learn how cryoneurolysis may reshape the future of spasticity treatment and what it could mean for your clinical practice or rehabilitation journey. In This Episode Podcast disclaimer (00:09) Introduction to Dr. Paul Winston (01:21) From dance to rehab (02:44) How cryoneurolysis differs from cryotherapy (05:35) How cryoneurolysis became part of Dr. Winston’s practice (09:11) The first cryoneurolysis patient: eureka moment that changed everything (13:13) Anatomy of a nerve: what actually happens during cryo (16:28) Using ultrasound and electrical stimulation to target nerves (23:30) Sensory vs motor nerves in cryoneurolysis treatment (25:58) What spasticity really is beyond textbook definitions (30:02) Comparing common spasticity interventions: Botox, phenol, and cryoneurolysis (33:44) Choosing cryo vs Botox (38:35) Toxin vs cryo: comparing mechanisms and applications (39:26) How Botox works (41:33) Contraindications and potential side effects of cryoneurolysis (43:21) How therapists should use cryoneurolysis in rehab (50:01) Real patient outcomes and functional improvements (56:01) The future of cryoneurolysis in rehabilitation (01:00:53) Understanding reducible deformity vs contracture (01:05:38) Where clinicians can learn more about cryoneurolysis (01:07:56) Our Guest Dr. Paul Winston, MD Dr. Paul Winston is a Canadian physiatrist and Clinical Associate Professor at the University of British Columbia specializing in neurological rehabilitation and spasticity management. Originally trained as a dancer at Canada’s National Ballet School, he brings a unique perspective on movement to rehabilitation medicine. He is widely recognized for advancing cryoneurolysis and is a co-founder of the Canadian Advances in Neuro Orthopedics for Spasticity Consortium. His work focuses on improving movement and quality of life for people living with neurological disabilities. Resources & Links Dr. Paul Winston on LinkedIn Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn
February 23, 2026
Spasticity Without the Plateau: Science, Access, and the Path Forward
In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors. Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale. The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix. The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well. In This Episode Introduction to the No Plateau Podcast (00:00) Meet Dr. Monica Verdusco Gutierrez (00:59) Understanding spasticity: Definitions and misconceptions (02:59) Assessing spasticity: Tools and techniques (08:35) Treatment options for spasticity (12:38) Neurolysis: Phenol, alcohol, and cryo (16:23) The importance of functional goals in spasticity management (22:43) Introducing the AAPM&R consensus guidance (24:39) Getting feedback from patients and therapists (28:37) Botox and other toxin treatments (29:07) Exploring cryotherapy for spasticity (29:57) Disparities in access to spasticity care (31:10) Cost efficiency in spasticity management (36:56) Caregiver challenges in managing spasticity (42:14) Communication between therapists and physicians (44:47) Future directions in spasticity management (51:20) Conclusion and final thoughts (54:51) Our Guest Monica Verduzco-Gutierrez, MD Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine. Resources & Links AAPM&R Consensus Guidance on Spasticity Assessment and Management (2024) UT Health San Antonio – Department of Rehabilitation Medicine Monica Verduzco-Gutierrez on LinkedIn Monica Verduzco-Gutierrez UT Health Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn Saebo’s Stroke Caregiver Support Group Saebo’s Stroke Survivor Support Group Stroke Guidelines 2023
January 25, 2026
Neurorehab Lessons Every New Grad Needs to Know
In this episode of the No Plateau Podcast, host Henry Hoffman sits down with occupational therapist, researcher, and educator Annie McCluskey to unpack the neurorehab lessons she wishes she had known as a new grad. With over 30 years of experience in stroke and brain injury rehabilitation, Annie brings a refreshingly honest perspective on how practice has evolved and where clinicians still get stuck. They dive into big topics like becoming a true movement scientist early on, why repetition, intensity, and high dose practice matter from day one, and how fear once held therapists back from pushing patients hard enough. Why were we so cautious for so long? And what does the evidence actually say now? Annie challenges outdated habits like excessive hands on facilitation, routine splinting, and low rep sessions, advocating instead for task specific, meaningful practice that patients can carry beyond therapy hours. The conversation also explores courage, having the confidence to question tradition, de implement ineffective treatments, and speak up in clinical settings. What should new grads stop doing immediately? And how can they collaborate more deeply with stroke survivors rather than prescribing one size fits all programs? This episode is a must listen for students, new grads, and seasoned clinicians ready to rethink how neurorehab is delivered and how much better it could be. In This Episode Introduction to Annie McCluskey (00:00) The Birth of Stroke Ed (03:03) Lesson 1: Becoming a Movement Scientist (06:12) Lesson 2: Repetition, Intensity, and High Dose Practice (12:42) Lesson 3: Being Courageous in Clinical Decisions (25:34) Introduction to Bo Bath Therapy (27:57) Task-Specific Training vs. Bo Bath (28:49) Challenges in Therapy Approaches (29:48) The Evolution of Strength Training (31:05) Hands-On Therapy and Its Limitations (34:46) The Importance of Hand Function (36:51) Collaborative Rehabilitation Planning (40:38) Advice for New OT Graduates (44:23) Resources and Courses for Therapists (49:01) Conclusion and Final Thoughts (51:27) Our Guest Annie McCluskey, OT, PhD Annie McCluskey is an occupational therapist, researcher, and educator with over 30 years of experience in stroke and brain injury rehabilitation across Australia, the UK, and internationally. She has published more than 70 peer-reviewed journal articles, contributed to multiple book chapters, and secured over $4 million in competitive research funding. Annie is the co-developer and director of StrokeEd, an education platform dedicated to translating evidence-based neurorehabilitation research into everyday clinical practice. Resources & Links StrokeEd Website StrokeEd Free Lecture Series StrokeEd Online Workshops & MOOCs Annie McCluskey on LinkedIn Henry Hoffman on LinkedIn Saebo On YouTube On Instagram On LinkedIn Saebo’s Stroke Caregiver Support Group Saebo’s Stroke Survivor Support Group Stroke Guidelines 2023
28 total episodes available
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This podcast updates bi-weekly.
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This podcast is available on 8 platforms including Apple Podcasts, Spotify, and more. You can also use the RSS feed directly.
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