After a brain injury, it is normal to experience fatigue. Your brain is healing, rewiring and adapting.  People often experience three types of fatigue: physical, mental, emotional, and interpersonal. Physical fatigue after brain injury is becoming more tired by physical activity than before your brain injury.  Mental fatigue shows up as feeling unable to concentrate or focus.  Angry outbursts and intense instances of crying are examples of emotional fatigue.  Interpersonal fatigue is experienced by challenges tracking conversations or affect.  Sometimes these all blend together - walking in the grocery store can impact someone physically, mentally, emotionally, and interpersonally. 

Why is it important to manage energy levels? Because fatigue can affect your physical performance, create thinking foggy, increase symptoms of depression and anxiety, make memory challenging, and impair communication. 

Here are five tips for managing energy after a brain injury. 

Count your "Brain Bucks"
When you wake up, consider your energy level.  How did you sleep? How are you feeling? Perhaps rate your energy in "Brain Bucks" on a scale of 0-100. Jot that number in your planner.  As you go through your day, check in with yourself.  How many brain bucks do you think you have left? Does your plan for the day need to change?  If you find yourself in a deficit, it's hard to climb back out, so manage your brain bucks for each day as best you can. You'll notice you are running low on brain bucks if your symptoms increase or you find yourself with an unusual quirky need that feels unfamiliar. 

Create a Visible Routine 
The less new stimulus the brain has to pay attention to, the less it has to work. Create a routine to follow each day so your brain can use it's energy for working on recovery. Write your routine in large print and post it around your home for a visual reminder.  For some people, this routine also includes limiting choices.  After all, Einstein has several variations of the same grey suit, so he wouldn't have to use brain power to decide what to wear each morning. 

"Do a little, rest a little." 
We call this pacing, and you'll hear this reminder from all of our clinicians, no matter what discipline. Taking time to rest gives the brain an opportunity to recoup the energy it is exerting, allowing you to do more over the course of the day than if you overexert yourself and need a longer rest period. 

Improve your sleep
Many people find their sleep impacted by brain injury, which then decreases energy. Work with your doctor, your pt, your it, and your counselor on improving sleep.  Each discipline holds a piece of the puzzle to getting a refreshing night of rest!

Embrace your Journey 
Every brain injury recovery is different. Self compassion is key to your recovery. Remind yourself when you are struggling that your brain is healing, and your brain has its own timeline. Embrace all the feelings that come up as you recover, and find ways you feel supported in your recovery. For some people, this is through TBI Support Groups, for others it's educating supportive friends and family, and for others, it's using social media to share your story and connect with others on the same path. 

Progressive Rehabilitation Associates provides multidisciplinary Brain Injury Rehabilitation, as well as support for the community at large.  Check out our Instagram and Facebook as well as our resources page for support in your brain injury recovery. 

​We are thrilled to introduce the new Medical Director of our Brain Injury Rehabilitation Program, Dr. Natalie Boodin.  It is instantly obvious that Natalie is a perfect complement to our dynamic and experienced comprehensive team.  She prefers to be casual and comfortable with clients, and strives to listen more than she talks; when clients meet her for the first time, she refuses to wear a white coat and introduces herself by saying “call me Natalie.”  

Her attitude is approachable, but her education and experience are extensive.  Dr. Natalie Boodin grew up outside of Detroit Michigan, and achieved the deans list at University of Michigan for her undergraduate education, completing her BS in Biopsychology and Cognitive Science.  She then received her MD from Ohio State University, while receiving recognition for being an Outstanding Student in Physical Medicine and Rehabilitation.  Schwab Rehabilitation Institute, a stand alone rehab unit in Illinois, was where she completed her residence.  Se reflects “there was a significant amount of trauma in Chicago.”  Serving individual recovering from brain injury became a passion.  She also has training in medical acupuncture, which she has found effective for treating headache/migraine related to brain injury.  She moved to Portland, Oregon in 2008, and has worked at PeaceHealth and Providence, as well as smaller independent practices. 

She often sees individuals struggling to recover from a Traumatic Brain Injury as “the walking wounded”.  “This is an invisible injury.  So many people don’t understand TBI, and there are such varied and individualized symptoms and outcomes.”  She is excited to lead a team of experts in treating TBI, because, “we can’t physically see what is going on inside the brain, so treatment needs to be creative.  There are so many ways to treat brain injury, and each person needs an individualized treatment plan.”  

If you are attending a first visit with Natalie, you will find her approachable and down to earth.  She’s also an excellent listener and very validating.  She shares “by the time people get to me, they have been blown off by many medical providers who don’t know why they aren’t getting better.”   Her patients will be reassured that she knows everyone heals differently.  You’ll find that she wants to really understand both your history and the impact this injury is having on your life.  She wants to understand your unique symptoms.  She’ll complete the physical exam, and discuss the plan with you.  

She’s delighted to be the medical director at Progressive Rehabilitation because treating brain injury is by it’s very nature collaborative.  She views herself as just one piece of the treatment puzzle, or “the glue that holds the team together, making sure everything is working well for the patient.” She notes that multidisciplinary treatment is ideal, because communication is easier for the team and the clients when everything is in one place.  

In addition to her exceptional clinical skills, Natalie has a lively personal life.  She is married and has eight year old twins.  Her partner is a musician, and together they operate a guitar store, venue, and bar in Portland.  In addition her two children are studying music, with her son taking piano lessons and her daughter taking guitar lessons.  Her favorite part about living in Portland I the outdoors.  “I love getting out and going hiking.”  She also loves animals and has one dog and will be adding another furry friend to the family soon.  

At Progressive Rehabilitation Associates, we are committed to individualized treatment for people with Traumatic Brain Injury, and we know that Natalie’s warm demeanor and extensive experience will serve our clients exceptionally well.  Please join us in welcoming her to our team. ​

Interested in learning more about Natalie and the Comprehensive Brain Injury Program or the Comprehensive Pain Program? Feel free to drop us a line on our contact page!

​By Nimuë (Angie I. Cruz, MAE, LMHC, MHP, R-DMT)

So there you have it.  Now you have some extra “tools” to play with.  Now go out there and sing, dance, paint and sculpt!  I can’t think of a more enjoyable to way to lower one’s pain while increasing one’s general feeling of wellness!  Happy Healing! Note to the reader: Sara is a fictional client representing a blend of clients we see at PRA. ​

As a counselor, Kris treasures the moments she spends with people rebuilding a meaningful life after a significant injury or heartbreaking event.  Specializing in Pain and Traumatic Brain Injury Rehabilitation, Kris supports people as they learn to accept their new life while finding ways to live whole heatedly and authentically.  Kris utilizes a variety of modalities to facilitate this process, including mindfulness, expressive art, writing, movement, as well as Cognitive Behavior Therapy and Acceptance Commitment Therapy.  Kris applies these modalities with individuals, couples, and with groups.  When she is not at Progressive Rehabilitation Associates, you'll find Kris deep in the woods riding her off road motorcycle far from civilization.

One of Kris’s passions is using movement to facilitate healing for clients in our Comprehensive Multidisciplinary Pain Program.  While Cognitive Behavioral Therapy helps people reframe problematic thoughts and challenge core beliefs about pain, movement helps clients access non-verbal emotions associated with their injury that are contributing to fear of movement and impeding full recovery.  Using trauma-informed movement (https://www.traumasensitiveyoga.com/), clients experience the physiological symptoms of activating their sympathetic nervous system. The natural response to movement is increased heartrate and shortness of breath, which mimic a stress response, however when this stress response is engaged in the context of the therapeutic relationship and grounded in coping skills, the associated fear of movement that diminishes.  In this practice, clients learn how to set boundaries and listen to their body, and with this newfound influence over their physiological state, their fear related pain often diminishes.

As an acupuncturist and practitioner of East Asian Medicine it’s often assumed that I am against Western medicine and most certainly against vaccinations.  This assumption was somewhat true until I went to school for Chinese medicine.  

My journey to study Chinese medicine started with my own health.  I was a sickly kid. Nothing major or serious but always sick. Adolescence brought an increase in fatigue beyond the normal teenager's need to sleep and I was given the nebulous diagnosis of chronic fatigue syndrome. This set off a series of specialist appointments all of which left me with few answers and big feelings of frustration.  From my perspective my doctors did not see me as a whole person who was struggling with daily life, they just saw a moody teenager with unexplained health issues. Unfortunately I walked away from this experience with the misguided idea that doctors as a general rule didn’t really care about my health and well being.  Fortunately my wise Mother took me to see a practitioner of East Asian medicine (AKA an acupuncturist) and my first treatment was nothing short of profound. I left the appointment knowing that I was not healed but that I was on a path towards health.  I had newfound hope and most importantly I felt seen and heard by my new healthcare provider.

This sequence of events put me on a path to rejecting all that Western medicine had to offer.  I believed that anything short of an emergency trauma situation could and should be treated by Chinese medicine. My teenage brain was incapable of recognizing that just because a few doctors were unable to help me that did not mean that all of Western medicine was a sham.

I held on tightly to my new belief system. So tight in fact that I needlessly suffered through 3 weeks of a horrific bacterial sinus infection that eventually spread to my ears.  I was past the point of Chinese herbs and it was my acupuncturist who told me I needed to see a doctor and get antibiotics. She was right. Within 24 hours of starting the antibiotics I felt a change, within 48 hours I felt better. I had invested so much time and energy into the belief that Western medicine was bad and not to be trusted that I doubled down on my beliefs and decided that I was to blame for getting sick and that I just had to live a healthier lifestyle and prevent all major illness.  It was up to me to stay healthy and If I needed Western medical intervention I had done something wrong.  

I started Chinese medicine school with this flawed and dangerous belief system. During my four arduous years at the Oregon College of Oriental Medicine (OCOM) I had the great pleasure of learning from amazing acupuncturists, naturopathic doctors, chiropractic doctors  and medical doctors, all of whom shared their unique perspectives on the nuances of medicine and the human body.  I came to understand that the all or nothing thinking that I carried with me as I started school needed to be shed in order for me to see the full picture of human physiology and pathology as well as the true nature of medicine. Like all things humans do medicine was and is created by us, humans. As a result medicine carries with it our flaws in thinking, the history of medicine both recent and ancient shows our triumphs of understanding as well as our deficiencies and sometimes fatal process to understand our own bodies.

My time at OCOM gave me the opportunity to see that all medicine, Western, Eastern and everything in between is living and evolving. Learning from practitioners from across the spectrum of medicine allowed me to recognize that the end game is not to avoid a particular kind of treatment or medicine but to find the right treatment for each individual person and the ingredients that make up their life and health.

Prevention is wonderful but the reality is that most people experience varying layers of societal oppression that are often incompatible with a healthy lifestyle. It’s hard to focus on living your best life when you are just trying to survive.

Chinese medicine is a powerful and elegant tool that continues to amaze and delight me everyday that I have the privilege to practice. However, Chinese medicine in the US is a topic for a different day. Today and everyday for the foreseeable future we have to talk about vaccinations. We have to talk about the pandemic and realistic ways to move forward during this incredibly difficult time.

Our system of healthcare is flawed but that does not mean that the medicine itself is unreliable or should be avoided. At this moment in time we are facing ICU beds at 77% capacity in the Portland/Vancouver area.  Many of those ICU beds are occupied by people with COVID-19. Though a variety of non Western modalities can help support your immune system we as a society have collectively passed the point of those modalities being enough. I invite you to consider not only your own health but the health of everyone you come in contact with before you make a decision about getting vaccinated. Herd immunity has been receiving a lot of attention in the media recently and with good reason. In order to stop the spread of COVID-19 we have to achieve herd immunity which means that an estimated 70-90% of the population need to be immune to COVID-19 in order to halt the spread of the virus. It’s still unclear if those who have recovered from COVID-19 are immune to future infection or spread of the virus which means that for the time being the vaccines are our best hope of ending the pandemic.  Not everyone is a good candidate for the COVID-19 vaccine, you can learn more about the vaccine and who should and should not get it. Alternatively, visit the Mayo Clinic's COVID-19 site for more information. The CDC is always a good source of information and for those of you who enjoy a deep dive into data the vaccine adverse event reporting system is an amazing resource.  Like all healthcare decisions the choice to vaccinate or not comes with potential costs and benefits.  I encourage you to weigh the costs and benefits of the COVID-19 vaccine to your health and the health of those around you with facts from trusted resources.

My last term of school was in Nanjing, China and I was tasked with weighing the costs and benefits of several vaccinations before I traveled.  I had never experienced side effects beyond a sore arm or a slight fever after receiving an immunization so it wasn’t a difficult decision for me to choose to be immunized for hepatitis A.  If I got the vaccine I could experience mild nausea and a headache for 1-2 days. If I did not get the vaccine I could get hepatitis A which at best would cause diarrhea, cramping and nausea for a few weeks to a few months and the possibility of permanent liver damage.  I chose to get the vaccine and I experienced uncomfortable side effects.  Within 2 hours of the injection I felt like a bag of sand, I was barely able to move, nauseous and I had a splitting headache. I spent the next 48 hours in bed in the comfort of my own home. Two weeks later I left for China and though I did experience some minor and brief diarrhea in China I am happy to report that I did not get hepatitis A. I can say without hesitation that I made the right choice to get a hepatitis A vaccine.  
​
As soon as I am able I plan to get vaccinated against COVID-19, not just for me and my health but for the health of my clients, coworkers, community, family and friends. I will keep taking my supplements and doing qigong but this is a moment to use every tool in the tool box. We have lost too many lives already.

​We are excited to welcome Dr. Patricia Zeisler to PRA! For over twenty years, Dr. Zeisler has helped clients with severe cognitive or physical deficits achieve their highest level of independence. She has practiced in a variety of settings from schools to correctional institutions, and is thrilled to bring her skills to our interdisciplinary rehabilitation program because on of her passions is collaboration. She immediately sensed the passion of each team member, and has eagerly jumped into working with our clients and team. 
 
Her collaborative style comes through in her approach with clients, helping them identify personally meaningful treatment goals, and consistently and transparently directing the treatment toward the established goals. Her experience in helping people improve function and increase independence shines through in her treatment with our clients with traumatic brain injury and pain.
 
Patricia recently moved to Portland, Oregon and is loving life in the city. Welcome Patricia!

As we enter the holidays, people are getting busier.  While social distancing might put a damper on some holiday celebrations, it is important at Progressive Rehabilitation Associates that as a staff, we focus on our own self care in the ways we teach our clients. 
 
That is why every year, we have a healthy habits challenge through November and December!  The entire staff is divided onto two teams to encourage a friendly competition.  People submit their points weekly to watch their team points grow.  People come up with bonus challenges, which are fun ways that as a team, people can earn extra points while spending time with their colleagues.
 
One aspect we appreciate during the challenges is the focus on whole person health.  Yes, exercise is a category, because we know movement is medicine.  However, the categories also include sleep, water, creating a new habit of your choice, letting go of a habit of your choice, practicing mindfulness, communication with friends, accountability, and coming up with one long term goal to work toward over the two months.
 
As we enter into this busy holiday season, what are you doing for your self care?  How can you encourage yourself to engage in joyful movement, to call a friend, or practice mindfulness?  What strategies are you using to help manage your symptoms from traumatic brain injury or pain?  PRA is here to help; we have behavioral health counselors and groups designed to help you support your healthy habit goals. 

​Dr. Stason, D.O., is the Medical Director for the Comprehensive Pain Program here at Progressive Rehabilitation Associates.  He is an osteopathic physician who specializes in musculoskeletal pain, mild Traumatic Brain Injury, vision issues, dizziness and psycho-somatic complaints.  He is board certified in Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine through the American Osteopathic Association. He uses conventional medicine including medications, laboratory evaluation, imaging (x-rays, MRI's, etc) as well as osteopathic manipulation as part of his care.  This manipulation is a hands on treatment that is gentle, safe and effective at unwinding strains and releasing tissues to function more normally.
 
Being from Massachusetts, he went to the University of New England College of Osteopathic Medicine on the coast of Maine for osteopathic medical school, completed his medical internship in Worcester, MA and then his residency in the Bronx, NY.  After teaching and practicing in New York City for a few years he made a sane decision and moved to Portland, OR in 2012 to continue in private practice as well as teaching second year Osteopathic medical students.  He has been associated with PRA since 2015.
 
He loves spending time with his 5 year old daughter, being outdoors, studying birds and bird language, windsurfing and when he can find the time, going on silent meditation retreats.

Learn more about the Comprehensive Pain Program, Comprehensive Brain Injury Program (Brain Injury Rehabilitation Center), and the Vancouver Pain Rehabilitation Program at PRA.