By Nimuë (Angie I. Cruz, MAE, LMHC, MHP, R-DMT)
Sara was diagnosed with Fibromyalgia six years ago. She had told the doctor right off the bat that she didn’t want to go on pain meds. Her family history included addiction, so she didn’t want to “temp fate” by going on heavy pain meds, so she decided to do everything within her power to learn how to live with chronic pain without medication management. Sara read everything she could on “Fibro” and made diligent efforts to eat healthy, do gentle exercise (mostly swimming and yoga) and basically bought stock in “Icy Hot” and other over-the-counter liniments. However, she still didn’t feel as good as she wanted to. “Is this as good as it gets?” She dishearteningly asked herself. And yet, she continued to seek the answers she sought.
One day, Sara had her niece Alice over who loved to paint. “Grab those watercolors and the paper, I’m going to get the oil pastels and draw over here.” She excitedly giggled to her niece. Suddenly Sara was flooded with memories of doing art when she was young and felt inspired to remember to “play” again. While Sara and Alice did their art, something unexpectedly moved Sara. She noticed she was starting to draw a “pain monster”. Her monster had red spikey horns throughout its body, with a ball and chain attached to it. The eyes looked sad and misunderstood, and tears streamed down its scaly face. “Ohh, your pain monster looks so sad! Why is he sad?” Alice inquired. Sara intuitively said, “It’s sad because on the outside it looks mean and threatening, but on the inside it’s hurting and sad because it feels so misunderstood.” Sara bravely answered. “Hmm, sounds like your pain monster needs compassion” Alice squealed with joy. “Hmm, I think you’re right, Alice!” Sara responded. Suddenly Sara had an inner “knowingness” that she herself needed this hug and felt sad that she judged her own pain so harshly.
Later that night, after Alice had gone home, Sara sat with the drawing of her pain monster “Harold” she had created. She closed her eyes and went into a meditative state to address Harold and let him know that she “saw” him and felt immense love for him (which in reality Sara knew that she was coming to terms with her own body). By externalizing her pain, addressing it, and listening to it, she came home to herself to learn how to be gentler and more appreciative of her body and all it did for her, despite her chronic pain. She started to address herself in a more understanding manner, and practiced listening to her body’s needs, on a daily basis without judging herself as harshly as she did before. While her pain did not necessarily shift, her relationship with herself did. Which in turn, led her to ways to be more patient with herself. While this is a fictional story with fictional characters, many clients have reported this type of response to me when working with them through the creative arts.
Can doing art help you reduce your pain levels? Absolutely! As an Expressive Arts Therapist and Licensed Mental Health Counselor (LMHC) I enjoy teaching my clients how to develop “tools” for their “toolbox” to reduce their pain, anxiety and depressive symptoms naturally, by engaging in activities that may help distract them from their pain and actually close the “pain gates” in order to experience pleasure. How does this work? Well psychologists posit that the perception of pain and pleasure run along the same neural pathways, that is why when we are feeling something pleasurable our pain is dulled, and vice versa. If a person enjoys doing art, it can act as a pleasant distraction from our pain, increase our ability to feel pleasure, and help us process what we are feeling leading us on our journey to healing! Neat, huh? Here are five tips to help you reduce your chronic pain, while having fun experiencing the creative arts.
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.
Should I get the COVID-19 Vaccine? - Acupuncturist Jimmy Sparrow Reflects on the Importance of Vaccination
Author: Jimmy Sparrow, L.Ac.
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.
With our current COVID-19 physical distancing protocols, it can feel like the year has passed with none of it’s usual markers for the passage of time. Traditions have been interrupted and holidays have been muted. At Progressive Rehabilitation Associates, there has been a long standing tradition to celebrate fall with costumes and potlucks. As the end of October drew near, it was announced; there would be some modifications, but our annual celebration could happen!
October 30th arrived, and the staff arrived at work bearing armloads of food and identities obscured by fun disguises. We could see the creativity as one of our staff members created a costume as if 2020 was a person, and another dressed up as a 2020-buster, spreading puppies and rainbows. We couldn’t help but smile as you saw an alien retrieving a human out of the corner of your eye.
This really reminded us of the special way Progressive Rehabilitation Associates works in the field of traumatic brain injury and persistent and chronic pain. Every client we connect with is an individual, with their own needs, traditions, culture, passions, and desires. We don’t treat shoulders or brains or knees, we treat people. We recognize the people who come here have been through tremendous challenges. We meet each person listening as closely as we can to their story, and through this careful listening, helping them find ways to rebuild the most important parts of their life.
This year, finding creative ways to help people connect with each other safely and engage safely in their traditions has been part of our treatment. And, like all good therapists, we start with ourselves, finding our own way through the pandemic, back to the social traditions that bring us joy and meaning.
Provider Spotlight: Greg Smith, PhD, Founder and Leader in Brain Injury and Chronic Pain Rehabilitation
Greg Smith, PhD is founder and CEO of Progressive Rehabilitation Associates, which has operated brain injury rehabilitation, pain management, work hardening and work conditioning programs since 1991, and has locations in Portland, OR and Vancouver, WA. Dr. Smith is well rounded with extensive experience for more than 30 years as a clinician, educator, author, researcher, program surveyor and leader.
Prior to launching Progressive, Dr. Smith was director of a multidisciplinary pain control program and then the director of the Health Psychology Department at Good Samaritan Hospital and Medical Center in Portland, OR. Following, he was the chief of the Psychology Department and then the co-director and program director at the Emanuel Pain Center, Emanuel Rehabilitation Center, Emanuel Hospital and Health Center in Portland.
Since 1987, Dr. Smith has been on the Commission on Accreditation of Rehabilitation Facilities (CARF) surveyor team surveying rehabilitation programs all over the country. He has had opportunities to share best practices with national and international programs, often bringing his learnings back to Progressive to continually improve programs. He has also invited other organizations in to learn from Progressive about how to create successful brain injury and pain programs. Countries where Dr. Smith exchanged learnings include England, Canada, Mexico, Argentina, among others. Dr. Smith has done numerous lectures and workshops for CARF, Pain Society of Oregon, Physical Therapists professional associations and organizations around the world. His teaching experience includes writing the majority of the material in a chapter on Pain in the text book for medical students called Behavioral Medicine: A Guide for clinical Practice, and he served on the faculty for the dental school at Pacific University in Portland. Currently, Dr. Smith is on staff at Southwest Medical Center in Vancouver, Washington, seeing psychiatric inpatients weekly.
“His hopeful, yet practical, ideas and suggestions challenge me to think and act beyond the constraining limits I set for myself so I can engage in activities that bring me joy.”
Dr. Smith received his Ph.D. with an emphasis in Clinical Psychology and his M.A. from the California School of Professional Psychology. After serving his internships in rehabilitation, behavior modification, biofeedback, individual and conjoint psycho-diagnostics, and alcoholism, he did his residency at St. Jude Hospital and Rehabilitation Center.
Dr. Smith’s clinical expertise and leadership have guided Progressive Rehabilitation Associates to become highly regarded by clients for making a huge impact on the quality of their lives. Dr. Smith believes that this success is due to the strong supportive interdisciplinary team at Progressive, stating:
“I can’t do anything by myself. The team is the strength of rehab. All play an important role. I
recognize the synergy of working together moves clients forward.”
Interested in learning more about Progressive's Brain Injury Rehabilitation and Chronic Pain Rehab programs? Check out Dr. Smith's video on PRA's programs, mission, and treatment values
"Dr. Greg Smith is approachable, compassionate, and wise in his understanding of chronic pain in all its complexities. His manner is relaxed and pleasant, and, no matter how stressed or physically uncomfortable I am upon arrival, I'm always calmer and more hopeful by the end of the hour. He listens extremely well. His hopeful, yet practical, ideas and suggestions challenge me to think and act beyond the constraining limits I set for myself so I can engage in activities that bring me joy."
- Miriam Rosser, Healthgrades
Are you a provider interested in learning from Greg Smith? Check out these publications and webinars
When it comes to environmental conservation and the Opal Creek Wilderness, George Atiyeh is a legendary environmentalist. Growing up near the Jawbone Flats, George fought back against the U.S. Forest Service’s plan to log the old growth forest of Opal Creek Wilderness. His efforts changed Oregon’s environmental movement resulting in the timber wars. In 1996, George’s efforts were observed when U.S. Senator Mark Hatfield passed legislation protecting Opal Creek Wilderness.
George Atiyeh attended Progressive Rehabilitation Associates’ Comprehensive Brain Injury Program (formerly the Brain Injury Rehabilitation Center). After going through the extensive program, George and his wife reflect on his recovery in a recent episode of OPB’s Think Out Loud.
“George didn’t start remembering things until about a year and a half after the accident when he was already in outpatient therapy”
- Hilary Atiyeh
At age 72, George’s life was taken in the Beachy Creek Fire. Remains were recovered at Atiyeh’s property and confirmed by family on Facebook. The fires devastated the land George fought to protect. George’s efforts led to protecting the 13,500-acre Opal Creek Scenic Recreation Area and 21,000-acre Opal Creek Wilderness Area. His daughter said in an interview with OregonLive, donations in his honor can be made to the Opal Creek Ancient Forest Center.
Learn more about the our brain injury rehab center and follow the Comprehensive Brain Injury Program. For the full Think Out Loud podcast and article, visit Rebroadcast: George and Hillary Atiyeh
Progressive Rehabilitation Associates: A founding member of the Foundation to Advance Brain Rehabilitation (FABR)
Progressive Rehabilitation Associates (Portland, OR Metro) partners with other National Brain Injury Providers to Establish a Data Consortium to Demonstrate the Value of Post-Acute Rehabilitation
.A select group of leading brain injury rehabilitation organizations from across the United States have announced a unique, one-of-a-kind alliance to improve outcomes in the rehabilitation field. Six organizations – Progressive Rehabilitation Associates, Learning Services, On With Life, Pate Rehabilitation, ReMed and Shepherd Center – have partnered to create the Foundation to Advance Brain Rehabilitation (FABR). The partnership allows the six organizations to aggregate outcome data to launch the only known national collaborative database in the United States that captures the impact of brain injury rehabilitation following the acute care setting.
The six FABR organizations represent 12 US states and comprehensively offer a continuum of post-acute neuro- rehabilitation and neuro-behavioral programs in various settings, including residential, inpatient, outpatient, day treatment, and home and community-based. FABR will utilize outcome data to research and demonstrate the value of post-acute brain injury rehabilitation within this continuum of services.
“Progressive Rehabilitation Associates is excited about participating in a large national initiative that can provide support to programs across the country. The sharing of outcome data will further enhance rehab clinicians’ knowledge base regarding what works for optimal success for clients,” comments Dr. Gregory Smith CEO of Progressive Rehabilitation Associates of the Portland Area.
“The potential impact of improving quality of life, return to work, and community participation of post-inpatient brain injury rehabilitation has increased dramatically in the last 20 years as inpatient rehabilitation stays following acquired brain injury (ABI) have decreased from months to weeks,” shares Dr. James Malec, chief scientific officer for FABR and senior research professor emeritus at the Indiana University School of Medicine. “The power of the FABR data and research is that it will help providers and the entire brain injury field understand best practices and demonstrate the effectiveness of post-acute rehabilitation.”
Beginning in June 2020, outcome data from each FABR organization was submitted to OutcomeInfo, a national web-based database system developed through the National Institutes of Health (NIH). The initial data set will include de-identified patient demographic information and Mayo-Portland Adaptability Inventory (MPAI-4) scores throughout the rehabilitation continuum.
In addition to identifying best practices in post-acute rehabilitation, a key goal in forming the FABR alliance is to justify care interventions and demonstrate a clear and measurable benefit for those interventions. This information can then be used by providers, patients and caregivers to advocate for appropriate access, benefit coverage, intensity and duration of rehabilitation services to achieve desired outcomes.
“Demonstrating the effectiveness and efficiency of specialized rehabilitation can be especially challenging for post-acute care providers,” shares Michael Choo, MD, chief medical officer for Paradigm and FABR’s medical consultative partner. “Rehabilitation benefits typically occur incrementally over the care continuum and the industry would benefit greatly by collaborating together to validate evidence-based minimum effective dose recommendations for many existing care interventions. The impact FABR can have in this area has life-changing potential for patients as well as providing guidance to both payers and policymakers.”
The six founding FABR organizations will remain as independent organizations but have formed a single non- profit entity to protect the confidentiality, aggregation and use of patient data. Founding members plan to add additional FABR organizations after the initial formative year.
Further information, including inquiries on how to become a part of the FABR work, contact Gregory Smith, PhD at Progressive Rehabilitation Associates at: firstname.lastname@example.org
Learn more about the brain injury rehab center and follow the Comprehensive Brain Injury Program at Progressive Rehabilitation Associates.