Wisdom Shared with Carole Blueweiss

A Mother Shares Her Journey Parenting a Newborn Diagnosed with a Stroke

Episode Summary

Eleven years ago Mara Yale’s daughter, Mia, had a stroke at birth. In this episode, we hear how Mara’s research, advocacy, self-education, and curiosity informed her approach to parenting and contributed to her daughter’s remarkable recovery. Mara shares considerations that apply across the board for all kids, regardless of age, diagnosis, severity of injury, or track in development as well as information on both the unconventional and conventional therapies she chose for Mia.

Episode Notes


Website: www.marayale.com
Facebook Page: www.facebook.com/yalemaram
Instagram: @maramyale
Blog: www.marazoemia.net


Research in the Rehabilitation Games and Virtual Reality Laboratory at Northeastern University focuses on the sustainable, evidence-based integration of virtual reality (VR) and active video games into rehabilitation practice for children with neuromotor impairments such as cerebral palsy. 

Website: www.web.northeastern.edu/regamevrlab
Facebook: www.facebook.com/regamevrlab

Audio from ReGame-VR lab interviews produced by Benjamin Bertsch and Adam Fischer.


I-ACQUIRE: www.nihstrokenet.org/i-acquire/family-resources
I-ACQUIRE clinical trial for constraint induced movement therapy: www.clinicaltrials.gov/ct2/show/NCT03910075
Cerebral Palsy Soccer: www.cpsoccer.us
Hand in Hand Parenting: www.handinhandparenting.org
The Reading Promise: www.makeareadingpromise.com
Dr. Karen Pape: www.karenpapemd.com
Children's Hemiplegia and Stroke Association (CHASA): www.chasa.org
International Alliance for Pediatric Stroke: www.iapediatricstroke.org
Sheryl Field, Field Center for Integrated Development: www.thefieldcenter.org
Feldenkrais: www.feldenkrais.com
Somatic Experiencing: www.traumahealing.org/about-us

Episode Transcription

[00:00:00] Carole Blueweiss: Welcome to Wisdom Shared, where parents are the experts. [sound of pogo stick] When was the last time you saw a child on a pogo stick? Do you even know what a pogo stick is? How about jumping on a pogo stick using one hand? 

[00:00:22] Mia Yale: One hand! 

[00:00:26] Carole Blueweiss: Try it. It's not so easy. That was Mia. At birth, 11 years ago, she experienced a stroke. I met her mother, Mara Yale, a single parent, serendipitously. After exchanging an email or two, I decided to invite her to join me on Wisdom Shared, and she said yes. I wanted parents, teachers, and healthcare workers to listen and hear her story, her journey with her daughters, a journey filled with inspiration, hope, and love. 

[00:01:02] Many considerations come up in this podcast and they apply to all children across the board, regardless of age, diagnosis, severity of injury, or their track in development. I ask Mara about her approach to parenting, why she chose the specific conventional and unconventional therapies for Mia.

[00:01:24] We learned how Mara advocated to get the best care for Mia and how she came to her decisions. There's so many choices out there, and not just therapy, but parenting decisions as well. A little bit about Mia's mom, Mara Yale. She has devoted her life to helping children and adults facing neurological difficulties and pain.

[00:01:44] She herself suffered a shoulder injury while playing Division One ice hockey in college. The one thing that helped her the most was the Feldenkrais method. So she decided to get trained, and after that training finished, her younger daughter was born and was diagnosed with a middle cerebral artery stroke. With her scientific inquiry fostered by her PhD in geophysics and a career in software engineering, Mara researched what was available and effective, and she also found ways to fill in the gaps. 

[00:02:19] In addition to being a guild certified Feldenkrais practitioner, she's trained in somatic experiencing and Hand in Hand Parenting. She lives with her daughters Zoe and Mia in the Boston area. Let's begin with Mia's own words, explaining why she loves to play ice hockey. And from there Mara shares her parenting wisdom with us all. 

[00:02:41] Mia Yale: What I like about hockey is that it's like different 'cause not, well, not a lot of girls do it and like, I like to be different. 

[00:02:57] Carole Blueweiss: What was it like for you when you found out that Mia had a stroke? 

[00:03:03] Mara Yale: Mia was born at full term. She was 40 weeks, five days. She had excellent Apgar scores at birth. She was born by cesarean after a full 27-hour labor. Everything seemed fine. Then at 48 hours old, she had jerky leg movements, which I didn't think much of. Babies have jerky leg movements. Hers happened to be in the right side. I'm a single mother, so I was alone in the hospital with her.

[00:03:32] My toddler was at home with other family members. In the middle of the night, the hospital pediatrician came in and told me that my baby was having seizure activity. So there I was up in the middle of the night standing two days after a major surgery for the cesarean. And then they told me that they needed to transfer her to a larger hospital, to Massachusetts General Hospital. And it was during that 36 hours that I received the call that she had been diagnosed with a stroke. 

[00:04:04] Carole Blueweiss: People don't understand that strokes can happen to children or to babies, and I think that's important also to explain. 

[00:04:15] Mara Yale: At the time, I'd never heard of babies having strokes. It's actually less rare than one might think. One in somewhere between 2,500 and 4,000 babies have strokes. 

[00:04:30] Carole Blueweiss: Wow. And what happened after that? Yeah, tell me a little bit about your process. 

[00:04:35] Mara Yale: Emotionally, I think I was in shock. I was still a patient at one hospital and I had a baby at another hospital and I had a 2.5-year-old at home. So I was not sure how to proceed. I was exhausted. And the next morning at 5:00 AM, I got up and they gave me a pass, like a get out of the hospital pass, to go visit my baby. So I went by taxi and she was in the NICU for another 10 days, in the neonatal intensive care unit, while they tweaked the anti-seizure medications to get to a dose that was gonna keep the seizures under control.

[00:05:15] And for her, the seizures were a symptom of the stroke. So she has not had seizures since that time. And I actually think the seizures were a blessing because they got us the diagnosis at three days of age, of this left middle cerebral artery stroke.

[00:05:34] Carole Blueweiss: Oh my God. So you went home. And tell me a little bit about how you processed. And practically speaking, you have a toddler at home and you bring home a newborn baby. What happened next? 

[00:05:48] Mara Yale: Eventually, I went home and she stayed in the hospital and then I was also not advised to drive at first, so I had friends and colleagues who were arranging meal trains and driving trains. So I got rides to and from the hospital each day and I would be with my baby Mia for six hours a day to reestablish breastfeeding, to have time to talk to the medical team there.

[00:06:15] And then at home, I was parenting my toddler in the mornings and evenings, and I also had to hire a nanny on the spot for two weeks. I like to say that at the beginning, I was balancing the fear of the unknown because I never had heard of stroke. Once I heard the diagnosis and talked to the neurologist, I understood there could be near complete recovery, but there also could be deficits in motor function and in language development. Those were the primary areas that we were concerned with and I really didn't know. 

[00:06:51] And so there's this like cloud of uncertainty and fear. And then I also held out a lot of hope, and the hope came from my prior apprenticeship and formal training in the Feldenkrais Method, which is an approach to, I like to think of it as applied neuroplasticity.

[00:07:10] So it's a way of learning through movement that can help us when we have injuries or illness or stroke with a path toward recovery. And I had discovered that in my twenties for a shoulder injury and had been a two-decade long passion by the time I had Mia. So I had all of this direct experience of improving my own wellbeing, and almost from the beginning, I started to apply those concepts in parenting her.

[00:07:39] Carole Blueweiss: That's great. And then so how did you actually get her some work with the Feldenkrais Method? Did you yourself work with her or did you find a practitioner? 

[00:07:48] Mara Yale: There's two kinds of work that I think of when I think of applying Feldenkrais principles to parenting her that pervaded every aspect of our lives. In addition, she had hands-on lessons initially from Sheryl Field, who works in New York and New Jersey, and later from other practitioners. But really a lot of - now that she's 11 and my older daughter Zoe is 13 - I feel like I'm taking ownership of a lot of what I did was setting up conditions for learning in daily life, from infancy through toddlerhood and up to age 11 now.

[00:08:30] Carole Blueweiss: So when you say there's the two types, the actual practical hands on, and then there's the way that you are using the principles of the Feldenkrais Method. Can you explain that a little bit more? 

[00:08:41] Mara Yale: Yeah. Hands-on lessons typically happen in an intensive series of one or two lessons a day for three to five days in a row. And maybe there's a specific goal that's held loosely, like the child's not yet crawling and you wanna see if they can get somewhere in the direction of crawling. Or in the case of Mia, early on, she was extending or arching her back a lot and a lot more than she was flexing or bending forward. And so there seemed to be an imbalance in how she was using the muscles of her trunk.

[00:09:21] And I thought if we address that with some hands-on Feldenkrais lessons that she would be able to emerge with motor skills better like rolling and eventually creeping and crawling. In terms of being at home, some of it is things I did and some things I didn't do. So one example is I didn't force milestones.

[00:09:45] I gave her a huge apprenticeship with the floor, with bare legs, bare feet. She spent just a lot of time on the floor in all different positions. On her back, on her side, on her belly, when she could get herself there. I didn't put her in sitting very much until she could get into and out of sitting. So sitting is like a transitional place.

[00:10:10] It's not a sessile place where a child is placed and then they can use their hands, but they don't, they're stuck. If they're placed in sitting and the trunk may seem like they can hold themselves up, but if they can't get into and out of it, then they don't really own that position and I think they haven't earned the right to be there in sitting. Surely for feeding and other things, she would be in sitting, but not for play time. So she had baskets of books on the floor, a really floor-based environment in the early infancy. 

[00:10:44] Carole Blueweiss: That's really good to hear because so many parents just want their kids to rush to the next developmental milestone. Sometimes it's not the best thing to do. So that's interesting that you said it's what you didn't do more than what you did do. Going forward from there, as she developed, did she have physical therapy? 

[00:11:03] Mara Yale: Mia qualified because of her stroke for early intervention from one month of age onward until she was three years old. And through that she had developmental evaluation and she initially received physical therapy, which later transitioned to occupational therapy around one year of age because she largely met her gross motor milestones in her first year of life.

[00:11:29] We always had excellent occupational therapists. The physical therapist around one year of age, I liked a lot, but there was one moment where we had conflict in terms of what she wanted to recommend as the course of treatment versus what I wanted to do. And Feldenkrais wasn't able to illuminate what to do either.

[00:11:51] So I, it was really a place where there was no expert telling me the right path, and we had to figure it out. Mia was walking by the time she was 12 months old, and as she became upright more and more, the tonus and spasticity in her right arm increased, so she was turning her right wrist inward and her hand was tightly fisted on the right side. And the recommendation from the physical therapist was to brace the hand, to essentially pull her thumb out and open up her hand.

[00:12:31] And I knew from my Feldenkrais experience that if we pull on tight muscles, they actually get tighter against the brace. And so intuitively I didn't wanna do that. And that led me on a whole research quest. I have a background as a scientist. I found the community of families that have children who've had stroke at birth or soon thereafter.

[00:12:59] And constraint-induced movement therapy was a therapy that I didn't know anything about. And because of my scientific background, I was not inhibited and I went and read the literature. There wasn't very much on using constraint therapy with children, but I just decided to start experimenting. So we went on vacation and I bought an ace bandage at the drug store and wrapped up her left hand and covered it with a sock and just let her play with her right hand and eat with her right hand.

[00:13:34] And later we got support from an outpatient occupational therapist who was trained in constraint therapy at Spalding Rehab Hospital, so we'd go for a visit every three months, and it was more like a consult. She'd give us new things to try. 

[00:13:53] From 12 months to 2-and-a-half years, it was part of our daily routine. She'd put on the brace as part of getting dressed for the day, and I'd send her to daycare in that setup, and she would eat breakfast at home with her right hand and play. I taught the daycare providers how to set up sensory rich activities that she could do with her right hand, playing in shaving cream or finger painting, those kinds of things. She'd have morning snack and then when it was time for them to go outside to play, they'd take off the brace. 

[00:14:27] Later, I really left it up to her. The brace at that time was a Benik splint that had a hard palm. So she could put it on and take it off when she wanted, and it was in her bedroom. It was like one of her toys. So sometimes she would play with constraint therapy, but it wasn't every day at that point. And then she forgot about it for a while. 

[00:14:51] Carole Blueweiss: Yeah, that's really interesting. Did you continue with the constraint therapy once she was able to take off that brace? 

[00:14:57] Mara Yale: At two and a half, Mia could then undo the Velcro on the constraint therapy brace, and I decided if she could undo Velcro with her right hand, that she was ready to choose when to wear the brace and when not to wear the brace. And the brace was on her unaffected arm, on her left arm, to give her more time to practice with her right arm. 

[00:15:22] Carole Blueweiss: The first thing that comes to mind is how ironic is that you had one professional say you need a brace on the affected side. And then what ended up happening is she had the therapy with the brace on the other side. And it must be confusing to parents. You were very proactive and you figured out which one resonated with you. But for many parents out there, I can see that a lot of it is luck. Like who you end up coming in contact with in terms of how you end up treating or managing rehab or therapy. 

[00:15:56] Mara Yale: When Mia was about six or seven, she rediscovered her constraint therapy brace and started wanting to do it again herself. And at that time, I was able to find a camp so she could do it socially with a group of other children, and it was run by a local therapy center.

[00:16:15] Carole Blueweiss: If it was approved by insurance, would the setup be that therapists would still have those three weeks paid for at a more local level and the child would have this intensive constraint therapy?

[00:16:29] Mara Yale: There's a phase three clinical trial for constraint induced movement therapy in infants age eight months to 36 months. That's underway now at 12 sites around the country. And the goal is to understand the efficacy of this treatment. And what's the appropriate dosing? Three hours a day or six hours a day? And for four weeks, there's this intensive therapy available to families that want to participate in the clinical trial.

[00:17:00] Once there is a blinded controlled research study demonstrating the efficacy of therapies at a sufficient scale, then there's justification for engaging with the insurance companies to say usual and customary care is subpar to something else. So obviously we need to wait till the research plays out and see what happens.

[00:17:27] But more and more parents are asking for this kind of therapy, and right now it's quite elitist because you can only get it if you can afford to pay for it or if you, like me, are willing to take on the task of experimenting on your own. 

[00:17:45] Carole Blueweiss: That's fantastic to get that science, that research out there to show the validity of this kind of work. One question that I have is, did Mia ever choose, I can't imagine that she would actually put it on just for fun when she could, but it sounds like she did sometimes? 

[00:18:01] Mara Yale: Yeah, she did because she chose the color. The first one was this ace bandage that I bought at the drug store, but then we went to an orthotist who made her one that was hot pink and then she grew older and I think around age two she chose a lime green. So she had this lime green thing in her bedroom and it was not something that a big deal out of. So when she was in private, she'd sometimes put it on and play. Almost like a challenge for herself. 

[00:18:33] Carole Blueweiss: Oh, that's so interesting. And the children's minds is so different. She didn't have that judgment that she's, it's just play. It's fascinating. But it took you to put that in front of her and to give her that attitude as opposed to saying, you must wear this, where she might have said no way to letting her decide that was something she wanted to do.

[00:18:52] Mara Yale: I just made it part of getting dressed and it wasn't associated with the therapist that she was resisting seeing. It was just part of what we did as a family getting dressed. And actually Zoe, who's Mia's older sister, she was four at the time, and she would ask a lot of questions about why Mia needed that splint and what the purpose was.

[00:19:18] And so I actually used that as an opportunity to find language to talk to both of them. So I was answering Zoe's questions. She was very verbal and had a lot of questions, and I wanted to answer her questions in ways that I was totally comfortable with Mia hearing. So play and being very neutral about oh, Mia's putting the splint on Lefty so she can practice with writing. So it was just matter of fact and neutral and there wasn't a lot of fuss made out of it. 

[00:19:52] And I think that really set the tone for Mia owning her own developmental experience. For me as a parent, I think it was super helpful to have had Zoe as my first child and then Mia come along because I was not just wondering what's typical for development versus what's related to the stroke. I had a frame of reference. 

[00:20:17] Carole Blueweiss: Yes. Fantastic. And then tell me a little bit more about their relationship. 

[00:20:21] Mara Yale: They're siblings now, and there's sometimes conflict and there's sometimes cooperation. It's up and down, and that's been true through the years, but overall, I would say that Zoe has motivated Mia a great deal by just being two and a half years older, and so Mia would wanna keep up. And then they just played with each other, which was really remarkable, as I think it is for any parent, to see siblings emerge with their own independent relationships, generating ideas for how to play together.

[00:20:59] Carole Blueweiss: You have some fantastic video of Mia on the Monkey Bars. A nickname for her or, I know there's a Monkey Mia story? [sounds of play]

[00:21:12] Mara Yale: Early on, a lot of the physical therapists and occupational therapists start with gross motor activities, and they want to encourage weight bearing through both arms. And for toddlers, there's a fair number of ways to do that, like wheelbarrow walking or crawling through tunnels, but at a certain point, kids wanna be upright.

[00:21:38] And then there's also an advantage for kids who've had a stroke to reaching, so to doing activities on a vertical surface. Because if you raise your hand, so it's facing the wall in front of you, for example, a thumb falls away and is in a useful position to actually grasp. Whereas if you're in other positions, the thumb might be tucked and fisted.

[00:22:04] So I was always on the lookout for offering Mia things to do on the wall or on an easel or reaching and swinging. So we actually, this was a serendipitous thing. We had this baby hammock that someone had given us for Zoe when she was a baby. And when Mia was a baby, Zoe discovered that she could swing from it with her two arms, the frame that was like a freestanding frame for this baby hammock. 

[00:22:34] And Zoe taught me that she could swing from it. And so that silly thing, which was just this metal tubing to support the hammock, stayed in my bedroom probably for six or seven years, and both girls learned to hold themselves up with their arms and eventually to flip over inside, and it was something that was, again, just part of daily life.

[00:23:00] They would mess around on that before bedtime or after bath. And fewer and fewer playgrounds have monkey bars now because of liability reasons. But the playground at my girl's preschool did have monkey bars, and the playground at our park in our neighborhood also has monkey bars. So Mia just kept working at the monkey bars, and I think it was assisted by this little thing we had in the bedroom and then she, by age four, had mastered the monkey bars, which really was remarkable for me and very supportive. 

[00:23:35] So I'm a big fan of swinging or hanging in addition to weight bearing or pushing through the arms as a way to promote growth and integration through the whole skeleton, because you have to coordinate the whole self to organize, to swing from monkey bar to monkey bar.

[00:23:55] Carole Blueweiss: And at this point, was she getting traditional therapy? 

[00:23:58] Mara Yale: At age four, she was in the period where she was getting half an hour a week of occupational therapy at the public preschool. So Friday mornings 8-8:30 was her occupational therapy session. So a lot of what I was doing was, again, trying to integrate it into what she was getting during the day at preschool and what I could do with her in the evenings and weekends. 

[00:24:26] Carole Blueweiss: For example, the monkey bars, is that something that was extra?

[00:24:30] Mara Yale: It was play and it was really driven by her and probably driven by her seeing her older sister master the monkey bars. So she, again, she wanted to do it. And maybe in the beginning, I'm sure in the beginning it started with, in Feldenkrais, we talk about successive approximation. So doing things as well as you can right now and then gradually getting better with each successive time that you try something. So I'm sure it started with her just wanting to reach up and hold the bars in my arms, I'd hold her. 

[00:25:05] But over the course of it, in the videos that you referenced, she learned how to fall and she learned how to trust her ability to fall from monkey bars that are six feet off the ground. So her feet weren't six feet off the ground, her feet were two feet off the ground. But I think a lot of parents are fearful, especially when a child's had an early brain injury about falls and how, is my kid gonna get hurt? Is their brain at risk for another injury if they fall? 

[00:25:38] And I actually think it's super important to let kids learn how to fall. So this is another thing I didn't do when she was a toddler, is I didn't hold her hands when she was an early walker. I just let her fall and if the floor was too hard, I moved her to a floor that was softer or I put rugs down and she really was not afraid of falling. And so I think as a result, she's been very confident in taking little risks. And the risks get bigger as she gets bigger. 

[00:26:13] Carole Blueweiss: That's really interesting. I'm glad you brought that up. I have right here ready to ask you about that. I think it's brilliant. You have a blog and in your blog you document a lot of her development and it's just really interesting to read. And one of your blogs talks about the importance of letting her fall and you say, no able-bodied child has ever learned to walk without a lot of falls. And I think that's really important to hear. 

[00:26:39] Mara Yale: The blog you're referencing also is in connection to the correspondence I had with Dr. Karen Pape, who was a Canadian neonatologist, and she said that she used to study children in one way by looking at their bruises on their legs to see if they were living a natural childhood. And a natural childhood includes bumps and scrapes and bruises. And in the absence of those, she was worried. She was worried that the child was sheltered or overly protected and not experiencing those bumps and bruises that actually build resiliency.

[00:27:20] Carole Blueweiss: Yeah. Fantastic point. Really good to hear because as a mother you, there's a part of you that wants to protect your child, but then there's the reality that the child really actually needs to experience failure in order to learn. Is Mia now with sports and activity, what's going on with her right now? 

[00:27:39] Mara Yale: Mia is 11 years old and she's a competitive athlete. She has an identity as an athlete. She plays ice hockey goalie. I think she would say that's her favorite sport and her favorite position. She also plays soccer and she's, she plays in soccer she plays in goal as well, but she also plays on the field. And there's a story about Mia becoming a goalie. So I played ice hockey growing up all the way through college, and I now coach both of my daughters in ice hockey. So it was natural for me to expose them to hockey. And we started early with hockey when they were six and four years old.

[00:28:21] So Mia was four and a half when she started skating. Actually the year before, she started skating when she was three, but in full hockey equipment when she was four and a half. And her skating initially was very affected by her hemiplegia, so she on a scooter or a bike or running, you could see no issues, no gait issues, no asymmetries in how she used her lower extremities, but when we put her on skates, which is a more challenging task, she was able to figure out how to push and stride through her left leg much more quickly than her right leg. 

[00:29:04] Each skate has an inner edge and an outer edge, much like skis. And the way that she skated, her right skate was always on its outer edge, whereas a typical skating stride, you would be pushing off the inner edge. And it wasn't until we found a figure skating coach who looked at her skating and actually said, oh, there's a skate shop that can help you. And we went to this one particular skate shop in Wilmington, Massachusetts, and they adjusted the angle between the skate blade and the skate boot. They put shims on the inside of the bracket between the blade and the boot, just to slightly tweak the angle and put her on the inside edge of that skate. And then instead of her skating across the ice at a 45-degree angle, she was able to skate straight. So that was the first hurdle with skating at age four or five. [hockey sounds]

[00:30:08] And then in the early hockey, everyone plays every position, including goalie, and she just kept asking to play goalie week after week. And there were, there was equipment for the kids to try. Because her stroke affected the right side of her body, she's very dominantly left handed. And most of the goalie equipment for these young children was for the opposite handedness.

[00:30:38] And I think she was six at the time and now she's 11 and she's playing at a competitive level. She just loves it. And in terms of built-in therapy, she has to get dressed in all of this equipment several times a week. And I watch her kind of in awe. Because it's a big deal in the community of pediatric stroke survivors for children to learn to tie their shoes.

[00:31:05] So not only is she independently lacing and tying her skates tightly enough to skate, she is putting on the all these pads and buckles and equipment efficiently enough to get out on the ice on time with her teammates. 

[00:31:21] Carole Blueweiss: Wow, that's hard for anybody. Adults, too. 

[00:31:25] Mara Yale: So I'm a huge fan of intrinsic motivation. So like when Mia put the splint on as part of her play for therapy, when she is playing sports, it's something that's really driven by her and by her love of sports, and she doesn't think of it as therapy. She thinks of it as play and it has social benefits, and she's enjoying being with all of her peers.

[00:31:57] Carole Blueweiss: Fantastic. And then at some point, you met somebody who was doing research with virtual reality and Mia became a subject for that. Can you talk a little bit about that? 

[00:32:10] Mara Yale: Sure. So there's a physical therapist who's at Northeastern University. Her name's Danielle Levac, and she has a ReGame lab. It's a virtual reality lab that's focused on rehabilitation. And so she was recruiting children to participate in this clinical trial where you get all dressed up in a virtual reality headset and you're playing a game.

[00:32:39] It's like a video game, so it's perfect for Mia, who's a digital native. The task involved pointing at various objects that she was seeing in the field of view and seeing how she shifted her balance to do that both with her, I believe with both hands. 

[00:33:00] Carole Blueweiss: Can you tell me a little bit more about that study? Did it, do you know any of the results yet on how that's gonna be used in the future? 

[00:33:08] Mara Yale: That study is still underway. There was a validation between the virtual reality task and then a physical setup. So what they're trying to demonstrate is can there be training or learning in the virtual reality context that then carries over.

[00:33:25] Male Voice: You went to the VR lab yesterday for the first time? 

[00:33:28] Mia Yale: Yes. 

[00:33:29] Male Voice: Tell me about that. Tell me about the experience. How did it, were you nervous? Was it, oh, this is really exciting 'cause of technology?

[00:33:36] Mia Yale: I was pretty excited. Well, especially because like, that was my first time in VR goggles and like it was really cool, all that technology.

[00:33:54] Male Voice: Yeah. Describe to me, what did you have to do? 

[00:33:57] Mia Yale: We put on the VR goggles and it was this environment where it was nature. So there were these rectangular targets and with one white dot in the middle, and I was wearing this glove on my left hand, my non-affected side. I had to move to find, 'cause if the target was red, I wasn't close to finding it. The goal was to get the target to be green and then to sit and break through reality. By making the target go green, you had to move around and see which position made it green, and then you had to stay in that position and with the glove and virtual reality, touch the target with the pointer finger. 

[00:34:49] Male Voice: Was it tough?

[00:34:50] Mia Yale: It was pretty tough.

[00:34:53] Mara Yale: Yeah, that it's a fun way to interact. The kids think they're playing a game. It's high tech, and then actually then there may be some carryover. And Danielle's even experimenting with mailing virtual reality headsets to children to try. Danielle is also interested in measuring things that are not just physical development, but also tolerance for frustration and other cognitive and psychological measures about how we learn.

[00:35:25] Carole Blueweiss: That's great. So at a time like this, it would be just fantastic for these kids who are missing their therapies to have this opportunity to have targeted therapy at home. And that ties in a lot of how the Feldenkrais, they're very focused on the idea of learning. So it's nice to see the two very separate professions merge on this idea and to have the research. That's very exciting. 

[00:35:51] Mara Yale: So just connecting back to your comment about the convergence of PT or this PT research with Feldenkrais, as well as with research that I'm conducting with the neurologist who I collaborate with at Mass General Hospital. It's all based on modern neuroscience, right? So there's a big focus on neuroplasticity and how we learn and how neuroplasticity is actually most fluid at the youngest ages, maybe zero to three or zero to five, and then there's another big developmental window in the teenage years.

[00:36:25] But we can really learn at any age. So when you talk about a convergence, I think there is a convergence, but I think it's more that everyone's recognizing the implications of neuroplasticity in these respective fields. Feldenkrais was way ahead of his time in recognizing that. And he didn't use the word neuroplasticity, but he understood these principles and ways of learning.

[00:36:49] Carole Blueweiss: Now, I know you've also done some other very interesting certifications, or, I don't know if that's the right word, you can correct me, but this the Hand in Hand, how has that played into your life and what made you be involved with that work? And what is it? 

[00:37:03] Mara Yale: In terms of non-movement based practices that I've added to my repertoire as a parent and now as a practitioner, there are two that I have taken on. Early on, when my kids were about four and two, it became increasingly challenging for me to figure out how to navigate parenting in ways that felt authentic to me. Like I wanted the home to be peaceful and not have my kids fighting all the time. And Zoe, my 4-year-old, was pretty intense.

[00:37:37] She was very verbal and needed a lot of socialization and I was struggling. And I heard about special time. And then I started researching special time, and I think it's used in various contexts, but one place where it's used is within this framework called Hand in Hand Parenting, which is also based in neuroscience, and it's the subtitle of Hand in Hand Parenting is Parenting Through Connection.

[00:38:04] The premise is that if our children and we as adults and as parents feel heard and listened to, then our behavior will reflect that. And that children's behavior is actually a direct reflection of how well regulated they are and how well understood they feel. 

[00:38:25] Carole Blueweiss: Which changes something in the brain on their learning switch, right? Like how that's part of that neuroplasticity that's targeting the brain as opposed to this very strict sort of from outward to inward. It's more from inward to outward, which is just makes so much sense.

[00:38:41] Mara Yale: So, with this child that I'm thinking of, there are stressors. He's also a stroke survivor, so there's stressors of being a preschooler in a preschool with children who are typically functioning. And so there's this always trying to keep up and I think that the stuttering was a manifestation of that. So the traditional way to address a stutter is to go to speech therapy. Any kind of therapy is then getting in the child's head as something's wrong with my speech. And the advantage of doing it through play is he didn't think we were working on his speech. He thought we were having fun, and it just happened to help his speech. 

[00:39:27] So another modality that I'm adding to my repertoire in the past, I'd say five years, is called somatic experiencing. And it's really about how trauma gets stored in our system. And how it can get processed and released. And trauma can be for these children, it can be medical trauma, it can be chronic stress of going to being driven around from therapy to therapy, many each week. Or it can be parents who are very stressed about decisions about their child who has special needs.

[00:40:06] So there are many different ways it can manifest. I actually got into the work for my own personal needs. I was experiencing a period of burnout at my software engineering job that I'd been at for nearly 20 years, and so I sought some somatic counseling or therapy for myself to work through my decision making about whether to stay or to go and how to survive staying in a way that still left my nervous system intact.

[00:40:39] I was quickly able to see how to use some of these strategies that I was learning for myself with my own children and now with other children that I'm working with in my private practice. And so I'm nearly complete with the three year training program in somatic experiencing. I'll complete it by the end of this year.

[00:40:57] Somatic experiencing was pioneered by Peter Levine, and he's a biophysiologist who understood how the thwarted fight-flight-freeze responses get stuck in our nervous system, and there's a variety of ways of being with others that allow us to revisit those, not necessarily revisiting every trauma or every stressor in our lives, but like peeling layers of an onion to uncover what's the true essence of each person and how they can move forward and get unstuck in their lives.

[00:41:38] Carole Blueweiss: I understand that you started this somatic experience and with your own self after trying to figure out about your profession and your job and those feelings that ensued. How do you see this kind of work helping somebody who's had a child that the whole traumatic experience of, that you went through and others go through learning about their child's differences? Is that something that you think is properly recognized, that the trauma and how does that affect them as a mother going forward? Since you have that background? 

[00:42:07] Mara Yale: Yeah, for mothers and for fathers and grandparents and whatever caregivers are in the picture, I don't think trauma's recognized, and it's something I've been trying to educate the medical teams that I'm in interfacing with. I think it's really under-recognized and for me, the way I would experience it initially, many of Mia's appointments, her follow-up appointments, were at the same time of year. So she was born in June, late June, so it was hot and humid. And every time I would go into Boston, so I live outside of Boston, I'd go into Boston and it'd be this hot, humid weather and I'd be trying to figure out how to navigate and how to park and manage the stroller and everything.

[00:42:53] And there was this weather trigger and I'd be like immediately back in that time of when she was in the NICU. And so for me there was like a recognition oh, that's maybe a little bit of PTSD from that time. And it took many years, even after she was doing the monkey bars and she was doing okay in school.

[00:43:16] It took many years for me to name that and own it. And compared to many families that I've met, her medical trauma was less involved than it is for many. So I just think it's really critical to destigmatize it, to name it, and to offer support. And one of the key ways to offer support is connection with community. I mean, it can be community of a like-minded diagnosis. Or a similar diagnosis, or it can be local community that's broader in the range of diagnoses, but might be more resourceful for local resources in your local geographic area. And I found both of those super helpful. 

[00:44:00] Carole Blueweiss: And would you say that some of these parents don't even realize because doctors don't necessarily talk about it and the medical profession doesn't recognize it, that that can carry on unrecognized, unconsciously, and affect parents and and grandparents. And had they somehow gotten access to some help, that less stress? 

[00:44:23] Mara Yale: Yeah, a lot of what I learned from the Hand in Hand Parenting is about epigenetics. And if we as parents take care of ourselves and our stressors, then we're gonna be better regulated in our nervous systems. And we will be less likely to snap when our children invariably push our buttons. We'll have more equanimity, more ability to be resilient. And that models resilience for our children and models regulation. And really, children can't learn if they're not in a place, in a zone of regulation.

[00:45:00] So I think it's crucial 


[00:45:02] Mara Yale: for the parents to take care of themselves and it's self care that goes beyond a day spa or a night out. Something that actually has to happen at the nervous system level for parents in connection with others so they don't feel so isolated and that the stigma is removed completely. 

[00:45:23] Carole Blueweiss: What is some advice that you can think of that you think is so important for parents to keep in mind? 

[00:45:29] Mara Yale: For parents and other caregivers, I think it's essential to recognize that this journey is long. It's a marathon, it's not a sprint. There's not gonna be one silver bullet. As a scientist, I come at it from an observational science point of view, so you might try one thing and see if it works or it doesn't work, and tweak it and try the next thing.

[00:45:52] It's not a hard science. Nobody's gonna be able to tell you do X, Y, and Z, and your child will land on the moon. It's very organic and you have to be in it for the long haul. And to be in it for the long haul, the first thing is to figure out how to love and enjoy your children as they are right now. And that all of this focus on rehab has to be integrated with the kind of family life that you envision, and maybe you have to modify the kind of family life that you envisioned before you had your child with special needs, but you still have values.

[00:46:32] For me, reading has been a core part of family life from the beginning, and I've kept that going all the way through, and that's something that, you know, is accessible regardless of level of ability. So I just think that the finding other things that matter to you as a family and keeping them going as the primary drivers for how you're gonna structure your family life are crucial.

[00:47:01] And if that's hard to do, to recognize that it's okay to ask for help and there may be a process of grieving for the diagnosis or the struggles that your child's having, and to feel free to get that help that you need and support and that those issues can emerge at different points along this long journey.

[00:47:22] Carole Blueweiss: In your experience, what has helped you the most? 

[00:47:27] Mara Yale: What's helped me the most is a combination of community, all different kinds of community, and then also trusting my own expertise as the expert on my children and being their best advocate. So all the experts that we see are consultants, in my view, and I'm the one who's directing the show. So it took me a long time to get to that place, and part of the journey to get there included hearing that and seeing it modeled by parents of children who are a little bit further along. 

[00:48:05] Carole Blueweiss: So would you, I hear that a lot from parents, as saying that they came to the really important conclusion that you need to really trust yourself and that the instinct in the beginning is to look to the professionals and the experts, and then you come to realize that no one has the answer, necessarily. And the reason I started this podcast to begin with is because parents have so much knowledge, and I believe the parent is the expert when it comes to their own child. The idea of really trusting yourself, is there a way to fast track that or do you feel like you have to go through that whole process of talking to all these experts and doing all the research and then you come to trusting yourself?

[00:48:45] Mara Yale: So that's an interesting question about how the trust in yourself emerges. So I think there's absolutely a learning curve. Like I said, I had no idea that babies could have strokes. So there's a whole lot that follows on if a baby can have a stroke, what does that mean for their physical, cognitive, social, emotional development?

[00:49:06] So there's so many aspects of that I had to learn, but you're with your child way more than any practitioner that you see once a week for 20 minutes or 30 minutes for a therapy session, or even if it's an intensive that you do over a period of time, you're still with your child. And you care more than anyone else, right?

[00:49:33] Like you're invested in the outcome of your child and maximizing their potential. And the potential could be quality of life. It's not some specific ideal of how they're gonna be, but you're the most invested in how your life's gonna be as a family and how your child's life is gonna be. So I think it's a process.

[00:49:56] What I think we could do to support parents earlier is to offer more forums for them to meet each other. So I've started to do that. I've been involved through Mass General Hospital in creating two workshops for families with children who've had stroke, and it's really remarkable to see the parents come together and there's just this hunger for communicating with each other, especially with parents with children of similar ages. And it has a different quality to the online communities, which are also important, but have the distance associated with being virtual. 

[00:50:35] Carole Blueweiss: And so would you consider that a support group? Does that fall under that umbrella or is it a different category?

[00:50:40] Mara Yale: Yeah, so the workshops are not yet a support group because they've been one-time events. I've personally run my first parent support group this past spring, and I anticipate running more of those. So really providing some education at the same time that parents get to hear each other's stories and tell their own story. I think that it's really different to tell a story about a child who's had a stroke or other brain injury to other parents who also get it than it is to tell that story within an extended family context or at the grocery store, if somebody wants to know why your kid is wearing a brace. 

[00:51:24] So extending on the theme of community, there are in-person events, CHASA, which is the Children's Hemiplegia and Stroke Association. It's the largest organization for supporting families who've had children with stroke or hemiplegia from other causes.

[00:51:42] I knew that they hosted in-person events, but again, like logistically for me with young children, I couldn't go to these in-person retreats. They were in the south in the summer. I didn't wanna take my vacation time to go there. I didn't really get it. In 2016, they announced that the retreat was gonna be in Lexington, Kentucky, and that's close enough that I could drive there.

[00:52:05] It was a two or three day road trip to get there, but I drove there with my two children. And we went again to another retreat in Texas in 2018 that was close to where I have some family members. And at both retreats, there were opportunities for the children to interact in the swimming pool, at breakfast, at dinner, bowling. There were bowling outings and ice cream outings. 

[00:52:31] What parents and caregivers can get online in terms of community and support is remarkable, but children get something from other children like them and like their siblings by being together. And we even interacted with horses on one of those outings and got to hear panels of young adults answer questions about what their life was like growing up and what they would encourage parents of younger children to do and not to do. And all of that really helped me get it, the value of understanding and identifying and connecting with community. 

[00:53:09] Carole Blueweiss: Fantastic. And I just wanted you to just touch on, I was trying to find the number of books you've read together. I think that's just a remarkable activity you do with your kids. I can't find the number, but it's a big number. Can you talk about what you do with reading and how that helped you during this Covid time even? 

[00:53:27] Mara Yale: Yeah, so we read aloud together. My mother was an elementary school librarian, so I grew up reading a lot and naturally wanted to pass that on to my children. And when Zoe was in kindergarten, I read a book, a memoir called The Reading Promise of a daughter who had read with her father more than 3000 days in a row from fourth grade through her senior year of high school. And Zoe at five said, I wanna beat that number. And I think we're close, if not there, because we started when she was in kindergarten and she's in eighth grade now.

[00:54:05] But it's not about the competition anymore. It's really about, especially with teen and preteen daughters, it's about maintaining connection. And for Zoe, it's still about reading, although it's a negotiation what we read. We seem to have gravitated now to nonfiction because if it's fiction or memoir and it's too engaging, she'll take it and read it on her own.

[00:54:30] So it has to be something we can read together slowly, a page at a time, over months. Mia favors poetry right now. Sometimes she prefers to play games or watch documentaries. So there's this sense of each of them individualizing that time together for connection. 

[00:54:49] Carole Blueweiss: Fantastic. For both your girls, they're two and a half years apart with very different, I'm sure, personalities and obviously experiences. What do you wish for them going forward like in high school and going forward to college? 

[00:55:04] Mara Yale: Right now, both of my daughters are in middle school. Zoe's in eighth grade and Mia is in sixth grade and I really hope that they continue on their own unique paths and they're already there. So they've chosen different middle schools. Zoe is continuing at the bilingual middle school that's an extension of the bilingual elementary school they both went to. Mia chose a charter school that has an expeditionary learning model, and I think she chose it 'cause it's smaller and feels a little bit more contained for her, which is a good fit. 

[00:55:40] They have different interests. Zoe's super talkative and verbal, and Mia's quieter, and she's really great at figuring things out. So she loves anything mechanical. Building projects and technology. So I don't know the specific directions that they'll go in, but I will continue to foster their love of learning. Keep them in sports as long as I can because they think it's good for physical and social development. And really encourage them to follow their own dreams.

[00:56:14] Carole Blueweiss: Is there anything you'd like to say that we haven't talked about? 

[00:56:18] Mara Yale: There is one thing that I'd like to say, which is two years ago or two and a half years ago, I took the very brave step of leaving my software engineering job of nearly 20 years as a single mother to reinvent myself. And a lot of that journey is based on my experiences parenting Mia in her remarkable recovery. And I've become really passionate about supporting other parents and other families because I believe that the outcome that I've had with Mia being as functional as she is in all aspects of her life is not an accident. And it's something that can be taught and be supported if we can figure out how to give that support to families, especially in the early years after a stroke diagnosis or other early brain injury.

[00:57:11] So I'm really dedicated to that and it's a deep core passion that's driving that. I'm super excited to see how that can really help others and set the bar higher than it's set by the mainstream medical establishment currently. 

[00:57:27] Carole Blueweiss: And how can someone get in touch with you? 

[00:57:30] Mara Yale: My website is marayale.com and I have a number of resources there and I'd love to hear from you.

[00:57:39] Carole Blueweiss: You have so much to share with everybody and so much experience, and you choose to really help others. So I'm glad that you joined us today on Wisdom Shared, and you certainly shared a lot of that wisdom with us all. So thank you very much. 

[00:57:53] Mara Yale: Thank you. I'm so excited to see the additional stories coming out, and I'm super happy that you're listening to the voices of parents because I think that they need to be amplified and it's really important.

[00:58:08] Male Voice: What will be when you grow up?

[00:58:10] Mia Yale: I don't know, maybe a doctor or something. 

[00:58:15] Male Voice: Why would you wanna be a doctor? 

[00:58:18] Mia Yale: Because I feel like that I could, and it takes a lot to be a doctor. So I think I could do that.

[00:58:35] Carole Blueweiss: Thank you so much for listening to Wisdom Shared. If you enjoyed this episode, please be sure to check out all our other episodes wherever you get your podcasts, or visit www.caroleblueweiss.com. If you like what you're hearing on Wisdom Shared and if you feel so inclined, please spread the word and share this podcast with a friend. Or leave a review or subscribe so you can receive some wisdom every month. Thank you for listening.