“The new year stands before us, like a chapter in a book, waiting to be written.”
From the President
We have turned the page on 2020 and look forward to a more normal 2021. First, I want to thank each of you for your support and donations in the past year. You make a big difference. Then, a big thank you to Ruth Shilling for all her efforts on behalf of SAO. Consider this a verbal hug!
I also want to welcome two new members to the SAO team. Madeleine Meyer, who provided essential support to our online auction will stay on with SAO as our Outreach Coordinator. In particular, she will help us with implementing programs related to grants we have received to extend our activities to Crook and Jefferson counties as well as southern Deschutes. We also have hired Sheri Terry to be our Office Manager. Sheri has extensive experience, most recently with the Central Oregon Builders Association. A warm welcome to these talented ladies.
I completed a Stroke 101 presentation via Zoom to the Rotary Club of Sarasota, Florida. Technology worked and opened my eyes to many possibilities. Another presentation is scheduled closer to home for the HOA at Eagle Crest 1/14. I look forward to the time I can add back the in person discussions to Zoom as a way to promote F.A.S.T. awareness.
Happy New Year to each of you. 2021 holds great things for Stroke Awareness Oregon.
Dennis Schaberg, MD
AdvenChair is Ready to Roll Boldly into 2021
"I have great expectations for exploring the world with my family and the AdvenChair!"
– Patrik Nabelek
AdvenChair has already brought smiles to dozens of faces, and we know that there are many more waiting to experience the "tonic of wildness." It has been used by the young and old, veterans with Parkinson's disease and dementia, adventurers with cerebral palsy, hikers with degenerative muscle diseases and muscular dystrophy, not to mention amputees and stroke survivors. If not for the pandemic, AdvenChair would likely have been used by a pilgrim on the Camino de Santiago in Spain, a trekker in New Zealand, and a student at an outdoor school. What’s more, if not for the pandemic and two wildfires in California, it might already be on trails there too. AdvenChair has been featured in a variety of publications, broadcasts, podcasts, videos, and blogs including Your National Forests, Bend Source, NPR Morning Edition, Strokecast Episode 063, two fantastic videos by the Denver Channel and Ansys, and the Wheel The World blog, (this was also translated into Spanish). We've had inquiries or words of support from Australia, Belgium, India, Mexico, Costa Rica, Canada, Portugal, Spain, the rainforest of the Congo, and even from someone interested in viewing gorillas in Uganda. The trail ahead for AdvenChair is limitless!
We are now taking orders for our inaugural production run through February 15, with delivery in early June of 2021. See www.advenchair.com for more details.
"All over the world, people just like me are waiting to be told 'let’s do the impossible!' by the people we love. Having no idea that what was thought to be impossible is just the beginning."
– Emory Babb from Wheel The World Blog
The Onward Project LLC
Deciding what to do and when to do it is difficult. Ask yourself these things?
- Can my loved one call for help? Phone or button or? Will they?
- Does my loved one wander off or leave unattended, Fall, Safety?
- Is there a threat to their or others physical safety with the stove left on, Doors left open, Medicine management unsafely?
If these occur more often than they should you should talk to me or other professionals. I have Specialists who can do an assessment as to the level of care needed. First call should be to me!
Remembering to bring a reusable bag on every grocery trip has been my New Year’s Resolution for the past 8 years and I still only get it right about 75% of the time. Some people might find making the same resolution year after year to be maddening, but stroke survivors know that tenacity and repetition can change outcomes! In 2021, with the help of developments in neuroscience, I hope to improve my brain health and remember a bag every time. How am I going to do it? Using the same research on brain health that physical therapists use to promote recovery in their patients who have had a stroke. 1. Increase my daily cardiovascular activity 2. Do more movement that requires me to engage both sides of my brain 3. Laugh!
Cardiovascular exercise and brain health
Remembering to put the reusable bag back in the car is my biggest mistake. Fatigue at the end of a busy day plus a shopping trip and the chaos of arriving home distract me from completing the task. Looking to the science, it’s clear that aerobic exercise can help memory and executive functioning and not just in neurotypical brains. A 2019 analysis of 19 different research studies found stroke survivors who performed cardiovascular exercise 4x per week for about 30 minutes significantly improved their endurance and walking capacity and they saw this benefit whether they started right after their stroke or years later. Additionally, neuroimaging indicates that consistent aerobic exercise increases gray matter volume in brain regions associated with memory processing, cognitive control and motor function. Cardiovascular exercise examples include biking, walking, dancing, recumbent stepping. If you do not have a current aerobic exercise plan prescribed by your physical therapist, follow up with your preferred rehabilitation provider for assessment.
Cross brain activities
As a stroke survivor, you know firsthand how important the communication between the hemispheres of your brain is. Cross brain activities strengthen the bridge between the right and left side of the brain allowing impulses and information to pass freely. This helps not only with coordination tasks like reaching across your body but also thinking based activities and focus. And I think in order to keep my New Year’s resolution I need to improve my focus. Some examples of cross brain activities are:
1. Seated reach across midline, an example of this is playing solitaire. Be sure your card array is equally positioned on your right and your left. . You can use your sound or affected hand to move and flip cards.
2. Draw Figure Eights (the infinity sign or an 8 turned on its side) on paper or in the air with a finger. While drawing the Figure Eight follow the path closely with your eyes, but do not allow your head to move. Then try it again, keeping your eyes quiet while allowing your head to move as you follow the Figure Eight.
3. Touch the opposite elbow and to knee. You can begin by touching your elbow of the strong side to the knee of your weak side, and then vice versa. You can do this in seated or standing depending on your risk for falls.
4. Cross one foot over while sitting, then alternate. To make this more difficult, cross one foot over the other while standing against the wall.
5. Windmills. Stand against a wall with feet spread wide and arms extended out to the sides. Bend slightly at waist and tap right hand to left hip, thigh or knee. Stand back up and then bend and tap left hand to right hip, thigh or knee
If you would like to learn more about the benefits of cross brain activities and similarly complex movements, follow up with your preferred physical therapist or rehabilitation provider for assessment.
Laughter is a great medicine
After an unprecedented year in 2020, we all need to laugh more and connect with the joy of life. Laughter allows your brain to release a cascade of “feel good” neurotransmitters: dopamine, serotonin, and endorphins. These are important healing chemicals for the brains of stroke survivors and they also help to keep me on track to remember a grocery bag for every trip! Studies have shown improvements in short term memory tasks following 20 minutes of humorous videos. The stress hormone cortisol interferes with memory and laughter reduces it and has the secondary benefit of lowering blood pressure and increasing mood state. So find your favorite TV or movie comedies at the library or a stand-up comedy special on your streaming service and take some time to laugh.
Stay safe, active and take those opportunities to laugh! Together, we will move forward with hope. Know that your friends at Stroke Awareness Oregon are here to answer any questions or connect you with resources.
Kate Maguire, PT, DPT is the owner of GroundWork Physical Therapy in Bend.
Update on progress made by the St. Charles Stroke Program
By Steve Goins, MD. SAO Medical Advisor
Before 2019, all neurology and patient care was provided by community neurologists. There were concerns about availability and quality. The number of monthly inpatient neurology consults was much lower than the current level. But there had been increasing conversations between community neurologists and the hospital administration about creation of a neurohospitalist system, where neurologists would be employed solely to provide care for hospitalized patients with neurological disorders. Finally, in the fall of 2018, a contract between the OHSU and St. Charles was negotiated. OHSU has been contracted to provide the neurology service for St. Charles. Dr. Goins was hired by OHSU as the first neurohospitalist in March 2019. Later, Dr. Scott Rewinkel, who had recently completed his stroke fellowship at OHSU, joined Dr. Goins. The summer they were joined by Dr. Katy Hagen, also from OHSU so that we now have a team of three inpatient neurologists capable of covering the hospital from 7 AM to 7 PM each day. Overnight neurology coverage has been provided by a small team of OHSU neurologists, working by telemedicine. These doctors are also members of the St. Charles medical staff and have electronic access to brain imaging studies and EEG and can examine patients using a telemedicine secure video system.
In 2018, two articles published in the New England Journal of Medicine demonstrated high effectiveness of catheter-based treatment for clot retrieval or thrombectomy, for the treatment of severe stroke. This has changed stroke care around the world. In early 2019, Dr. Goins and Dr. Jeff Absalon, St. Charles Chief Executive Physician, met with Dr. Ray Tien, vascular neurosurgeon and several interventional radiologists who had recently joined the medical staff to discuss creation of a stroke interventional panel. The panel became active in 2020. A series of meetings led to the creation of a 24/7 stroke interventional panel. This panel has enabled St. Charles to become the only stroke center in Oregon, east of the Cascades, capable of providing round-the-clock neurointerventional care for severely affected stroke victims.
In the summer of 2019, Dr. Goins, working as the St Charles stroke medical director, met with all of the EMS chiefs of Central Oregon who form the East Cascade EMS Council. A new Stroke One Protocol was devised which allowed paramedics encountering stroke victims that met criteria for large vessel occlusion stroke, the most devastating form of stroke, to be able to activate immediate air ambulance transport by Airlink or Lifeflight directly to Bend even when that meant bypassing closer local hospitals. This allows the patient to more quickly be seen by a neurologist and to potentially undergo rapid catheterization procedures by a stroke neurointerventionalist. This concept of bypassing closer, smaller hospitals had been considered unconventional and not previously recognized by the American Heart Association however the AHA is now accepting that triage program with bypass components, are necessary for some communities like Central Oregon.
While the new stroke triage protocol had been adopted by the Central Cascade EMS Council, the plan was not really being used in practice by regional paramedics. But last summer, Dr. Goins and Dr. Rewinkel, started the Stroke Program Outreach Project to educate regional EMS providers about up-to-date stroke care and instructions on how to utilize the new triage program. Dr. Goins and Dr. Rewinkel gave presentations to Harney District Hospital, Blue Mountain Hospital, LifeFlight, Airlink Redmond EMS, LaPine EMS, Sunriver EMS, Sisters/Camp Sherman Fire, Jefferson County EMS as well as a presentation to a joint meeting of emergency room physicians from Redmond, Madras and Prineville. A presentation to Lakeview is scheduled for February. Many copies of the stroke instructional book, ‘A Primer on Stroke’, were distributed and the value of Stroke Awareness Oregon’s FAST educational program was also discussed at each of these presentations. This project has been very successful and has led to a huge change of practice affecting all of Central Oregon. We are now seeing consistent rapid transport by air ambulance of severely affected stroke victims directly to Bend. This is allowing us to perform mechanical thrombectomies for clot removal several hours earlier because of this efficient system. In major stroke due to large vessel occlusion, 1.9 million brain cells die for every minute that the occlusion remains. The difference between treatment at one hour versus three hours can make the difference between recovering to normal life or surviving with permanent handicap.
In 2014, only one patient was treated with thrombectomy at St. Charles but this number has risen steadily. So far, 33 patients with massive stroke due to large vessel occlusion have been treated by emergency thrombectomy in Bend this year. 79% of these patients had successful re-cannulation of the occluded artery. Most of these patients who would’ve been destined for a nursing home or death, have had excellent recoveries. A few of them have walked out of the hospital front door a few days later with no residual symptoms. We anticipate that the number of patients treated with thrombectomy each year will continue to grow and the number of lives saved will also continue to increase.
However there have been many other changes in the stroke program besides creation of a thrombectomy treatment program. TPA has formally been a mainstay for treatment of stroke as long as the patient arrived to the ED within 4.5 hours. However, this year St. Charles has switched from TPA to tenecteplase, a very similar thrombolytic drug which can be administered much faster. Also, ED physicians and nurses at all four of St. Charles hospitals have become highly motivated and self-educating about the process of rapid treatment with TPA or tenecteplase. We have seen our average “door to needle times”, the time it takes to actually treat a patient with TPA or tenecteplase after arrival to the ED, drop from 79 minutes to 54 minutes over the last five years.
And the stroke program has been seeing rising numbers of stroke patients each year. In 2015, 510 stroke patients were treated at St. Charles. This number has risen to 649 in 2019 and there appears to be a trend for increasing numbers over the next several years.
Despite, the terrible impact of COVID 19 on our community and healthcare delivery system, St. Charles stroke program has continued to make rapid gains. Nonetheless, many challenges remain. Even though we now have three neurohospitalists, we do not have sufficient staffing to provide enough staffing for our growing inpatient neurology consultation service. Several meetings with St. Charles administration had led to some encouraging comments but so far, there has been no action taken on recruiting another neurologist for the very busy neurohospitalist service. Also, the hospital will be undergoing the recertification process to keep its certification as an AHA approved Primary Stroke Center anytime in the next few weeks. But we no longer have a full-time stroke coordinator and recruitment for this important position at this vital time, has stalled. So, for every three successes, it seems that the stroke program encounters a new obstacle. But our trajectory and momentum remain positive.
I wish to give great thanks to Dr. Scott Rewinkel and Dr. Katy Hagen as well as the seven OHSU nighttime neurologists, for their energy and dedication for development of the neurohospitalist service. In particular thanks to Dr. Rewinkel who has stepped in as the new stroke medical director. Also, thanks to the extremely dedicated and tireless Dr. Ray Tien. Dr. Tien continues to take the bulk of the stroke interventional call responsibility and has traveled back to the hospital in the middle the night dozens of times over the last year. And thanks to Dr. Ben English, Dr. Dana Mann and Dr. Garrett Schroeder, interventional radiologists, who also have worked so hard and have brought in new techniques and skills for the stroke interventional panel. The improvement of our capability for treating devastating strokes has surpassed all of our hopes and we are excited about the direction that our program is heading.
Steve Goins, MD
Maura Murphy, MSOT, OTR/L, CHT, CEAS, NC
Lifestyle Redesign® is an Occupational Therapy intervention which aims to improve physical health, social functioning, mental health and life satisfaction. It utilizes thoughtful reflection and purposeful engagement in meaningful activity to foster a sense of well being.
Lifestyle Redesign® grew out of a large scale study conducted from 1994-1996 at the University of Southern California called The Well Elderly Study and followed by The Well Elderly Study 2 conducted from 2004-2008, both of which demonstrated that preventative occupational therapy intervention slows age related decline.
Lifestyle Redesign® has since been tailored to meet the needs of a individuals living with a wide range of health risks, illness, or injury including diabetes, weight management, fibromyalgia and stroke.
Lifestyle Redesign® is an customized intervention delivered in an individual and/or group format that may address such areas as:
• Occupation, health, and aging
• Community mobility
• Activity: physical, mental, spiritual, social, and productive
• Stress and inflammation management
• Dining and nutrition
• Time and Occupation
• Home and community safety
• Relationships and occupation
• Navigating health care
• Hormones, aging and sexuality
We all derive meaning from our history of occupations such as career, hobbies, and relationships. Often one’s life narrative ends as he or she enters older adulthood or experiences a life altering illness or injury. Lifestyle Redesign® allows for a continuation of an individual’s life narrative.
Clark, Florence A et al. (2015). Lifestyle Redesign: The intervention tested in the USC well elderly studies. Bethesda, MD : AOTA Press, The American Occupational Therapy Association, Inc.
We Need Some Help!
Like most nonprofits, Stroke Awareness Oregon always seems to have a lot to do and not enough people to get it all accomplished. Our amazing staff works hard and fast but what we need now are some great and dedicated volunteers. Every month is a busy month here at SAO. Can you help? Here’s what we need:
- People to deliver F.A.S.T. postcards to various locations in Bend and Redmond (cards are in Spanish and English)
- Office help throughout the month to include answering phones, returning calls and other office type duties
- Stroke Support Group Volunteer
Or if you have bigger aspirations, maybe you would like to sign on to
help us put together an entire volunteer program.
There is much work to do and you can be part of our interesting and life-saving work. SAO is making huge changes in the way Central Oregon understands and responds to stroke. Please help us by calling the SAO office at 541 323-5641 or CLICK ON OUR LOGO BELOW.
Being a Part of
Stroke Awareness Oregon
Did you know that there is an option for you to be a monthly donor to SAO? Many of us are unable to make a ‘large’ donation all at one time, but you can still make a difference. You can be a monthly donor with an amount that is comfortable and fits your budget. Simply go to www.strokeawarenessoregon.org and go to donations. There is an option for a hassle free, automatic donation that will help SAO continue to save lives.
"The SAO support group is so helpful for managing life after stroke. I’ve belonged to many groups in the past but Keith’s welcoming nature and the helpful speakers make this my favorite groups."
Joyce Hoffman, Hoffman Communications
Every Monday at 11am, Anne and Keith at Northwest Brain Network in Portland lead a sing-along for stroke survivors on Zoom. They have invited us to take part in their weekly meetings. Join the meetings and sing along.
Go to this link for the most up to date meeting link:
To join the mailing list and receive updates about the group, contact Anne 503-775-6041 or email Anne@nwbrain.network.
Stroke Support Group
Next Meeting: 1/12 Guest Speaker: Lynne Becker with Power of Patients, and 1/26 Guest Speaker to be determined.
TIME: 3 PM Pacific
SEE below for Zoom instructions
Join Zoom Meeting on your device, click zoom.us/j/2671668755
To call in, dial 669-900-9128, enter the meeting ID: 267 166 8755
You can always find the meeting link in our calendar at our website for the appropriate meeting.
Caregiver Support Group
Next Meeting:1/11 at 1:00PM
Do you provide care to anyone suffering from a debilitating illness or condition? Join others who understand at this confidential meeting.
Join Zoom Meeting on your device, click zoom.us/j/2671668755
To call in, dial 669-900-9128, enter the meeting ID: 267 166 8755
If you have questions, contact Ofelia at firstname.lastname@example.org.
Never used Zoom? We have a cheat sheet to download the app and attend a meeting. Join us from your smart phone, computer or tablet.
Exercise During COVID Quarantine
Exercise is a good way to maintain your health through recovery, rehabilitation, and the rest of your life. Exercise can keep you fit and healthy – physically and mentally – to reduce the chance of another stroke and to improve your quality of life, and it can be done from the comfort of your own home during coronavirus self-isolation. But stroke is a complex condition, which can impact your ability to exercise safely. An individualized exercise plan by a physiotherapist will set you up properly to meet your needs and abilities.
CONNECTING WITH THE COMMUNITY
Have equipment? Need equipment?
Request to join the Facebook group called "Bend Medical/Adaptive Used Equipment Swap". It's a platform for posting gently used equipment for sale or trade, or to find equipment you need in Bend and Central Oregon.
Did you know that each purchase you make on Amazon can support Stroke Awareness Oregon? Click the button below to get started!
Dennis Schaberg, MD, SAO Board Chair
Katie Tank, Attorney at Law, Tank Law PC, SAO Board Secretary
Lawnae Hunter, Owner Plus Property Management, SAO Board Treasurer
Marcus G. Beebe Jr., J.D.
Sarah Burke, Windermere Central Oregon Real Estate
Josie Fitzsimons, MD, Rehabilitation Medicine
Kyley Hjeresen, US Bank Wealth Management
Mindy Laidlaw, Occupational Therapist, St. Charles Health Care
Kate Maguire, PT, DPT, Owner Groundwork Physical Therapy
Debroah McMahon, DMC Consulting Services, LLC
Norwyn Newby, MD, Neurosurgeon
James C. Reedy, MBA, MHA, RN, CPHQ, CHFP, NEA-BE, FACHE, St. Charles Health Care
Keith Taylor, Owner Strength After Stroke
Stroke Awareness Oregon
695 SW Mill View Way | Bend, Oregon 97702
541-323-5641 | email@example.com