(Warning: minor spoilers ahead!) You’ve seen the baby Yoda memes that have exploded all over the internet after The Mandalorian debuted on Disney Plus on November 12, 2019. He could very well be the cutest character of all time on TV. I know he made my heart grow three times bigger this holiday season.
Now let’s talk about one of the recent episodes, “The Reckoning.” There’s a loving montage of a character Kuiil rehabbing a droid, named IG-11, who’d been killed. Kuiil rebuilt the droid from scratch after “Its neural network was almost completely gone.” He had to piece IG-11 together, which may be a little beyond our day-to-day job, but the recovery process is certainly something many of us speech-language pathologists have participated in.
Medical speech-language pathologists work in hospitals, inpatient rehab facilities, skilled nursing facilities, private practice, and outpatient clinics with many neuro patients: stroke, traumatic brain injuries, brain bleeds, degenerative diseases, etc. In this episode, Kuiil uses skilled SLP treatment, as well as physical and occupational therapy methods, to rehabilitate the droid.
Kuiil states in his monologue, “This is not something that can be done (easily)… It requires patience, repetition.” After a disease, injury, or disorder has damaged the nervous system,((https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/neurological-rehabilitation)) neurorehabilitation requires thousands of repetitions by licensed, skilled, graduate-school educated therapists to invoke neuroplasticity, the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.
Principles of neuroplasticity include salience, intensity, repetition, and specificity. The episode doesn’t mention all of these principles by name, but they are demonstrated in the 3-minute scene. (Don’t ask how many times I watched this scene!)
Specificity means train what your patient needs to do! As a therapist, you want to incorporate tasks for therapy that the patient will need to do in order to improve that actual skill. Your patients will willingly consent to treatment and work hard in therapy sessions when they can see that their treatment is functional and successful, and tied to their everyday life. It’s important for therapists to keep in mind that our patients have the right to make informed decisions regarding care and the right to refuse treatment.((§482.13(b)(2) The patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient’s rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment.)) It’s our job to make therapy meaningful so they see the benefit of participating. The Mandalorian scene shows Kuiil programming the droid to become a servant, so we see the droid feeding the Blurrg, pouring water/tea, moving boxes, and doing all the things a servent would be expected to do.
Intensity and repetition are mentioned with a simple quote: “I spent day after day reinforcing its development with patience and affirmation.” If you choose tasks that the patients *want* to do, they’ll choose to participate in endless repetitions with the hope to rebuild their skills. The Mandalorian episodes are only 30-40 minutes long, and neuro rehab takes months, if not longer, so we’ll have to forgive the show for glossing over how long it takes.
Salience is choosing tasks that interest patients to help them be more emotionally invested in their recovery. If they want to golf, work step-by-step on golfing. If they want to cook, look at recipes to help their attention, visual scanning, problem-solving, etc. IG-11 was programmed by Kuill to be interested in becoming a servant, so he is shown to be picking up cups in order to be able to serve tea to visitors (or Kuiil after a hard day’s work rehabbing him–he may be on to something).
Other principles of neuroplasticity:
• Use It or lose It
• Use It and Improve It
• Time Matters
• Age Matters
• Transference
• Interference
One aspect of cognitive rehab therapy that SLPs use is metacognitive strategy training to improve executive function, which is managing oneself and resources to achieve goals. In the montage, we see the droid unsafely drop a box on top of a lizard. Kuiil helps him by pointing out what he did wrong, and later, we see the droid look at a lizard and shoo him out of the way before setting it down. Of course, it’s a little more complicated than this, but we’ll give Kuiil a break. We went to school for a long time to learn how to treat like this.
The droid’s rehab was extremely successful. Unfortunately (or fortunately for our characters), he doesn’t get back to work as a bounty hunter, but he does have a new job as a household servant for Kuiil. At the end of the montage, you see the droid safely pouring glasses of hot tea and offering them to all the characters present.
What a great example of neurorehabilitation shown on TV to the general public. It can be used to highlight the importance of therapists in improving stroke and TBI survivors’ lives. We just have to educate people on what we do all day long. Kuiil is a representation of the three disciplines (SLP, OT, and PT), which are all necessary for neuro re-education and returning to a prior level of function. Stroke rehab may seem difficult and too hard from the perspective of survivors, but as Kuiil put it,
“Reconstruction was quite difficult but not impossible.”
Julie Fechter, MS, CCC-SLP is a speech-language pathologist in Seattle, WA. She opened her own private practice this year specializing in Parkinson’s disease. You can find her at on Instagram at julie.365.weekend and at Sound Speech and Swallow
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