Jackie Pflug Clinical Newson Susan Connors

Transcription

RainbowVisions
A Quarterly News Magazine for Acquired Brain Injury (ABI) Professionals, Rainbow Rehabilitation Center Clients and their Families.
www.rainbowrehab.com
Rainbow Rehabilitation Centers, Inc.
VOLUME III
No. 2 March 2006 is Brain Injury Awareness Month
SPRING
2006
Featuring...
Clinical News on
MRI Technology
Q & A Session with
Jackie Pflug
TBI Terrorist Survivor
Interview with
Susan
Connors
National BIAA President
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March 2006
is brain injuryAwareness
L I N G I NT
I
A
3
O
month.
Contents
n!
Su
mm
er Fu
Coming June – August,
INDUSTRY NEWS
2006
Join us for our 12th year of
Summer Fun!
Filled with discovery, play and learning,
our programs are designed by Pediatric
What’s News in the Industry - Hiring practices & current legislation
3
Clinical News - Magnetic Resonance Imaging
5
Survivor’s Corner - Interview with terrorist survivor Jackie Pflug
9
Meet Susan Connors - President of the BIA of America
11
Conferences & Event Calendar 23
CMSA / RINC / MBIPC calendars
25
MIS Technology Corner - WI-FI 26
RAINBOW CLIENTS
Rehabilitation Specialists specifically
for children and teens with brain injuries.
From Rainbow’s Homes – Meet James Summers
13
Alumni Corner – An interview with Heather Sell
19
Give your child the structure, supervision
and academics needed when school is
INSIDE RAINBOW
not in session.
Call for a program brochure
and schedule...
1-800-968-6644
Or e-mail: admissions@rainbowrehab.com
Behavior Analysis - Unintentional Misbehavior
21
Employee News - Notable changes
24
Ask Vicky Scott - Immunizations
27
Better Speech & Hearing - What is SLP?
29
The Last Word - Voices from the front lines
31
Employee of the Season
34
RainbowVisions
Magazine for Acquired
A Quarterly News
Professionals,
Brain Injury (ABI)
m
ehab.co
Rainbow Rehab
ation Center Clients
Rainbow Rehabilit
ilitation Cente
rs, Inc.
On the
and their Families.
VOLUME III
No. 2
reness Month
Brain Injury Awa
March 2006 is
www.rainbowr
SPRING
2006
Featuring...
Clinical News on
MRI Technology
Q & A Session with
PflugSurvivor
JackieTerroris
t
TBI
Rainbow Visions editor & designer – Kimberly Paetzold
Staff photographer – Heidi Reyst
To contact the editor or for comments or questions,
e-mail: Rainbowvisions@rrciweb.com
Interview with
n Connors
Susa
t
National BIAA Presiden
Cover
A Magnetic Resonance
Image (MRI) of the brain.
In this issue, Dr. Reyst
writes on this cutting edge
technology – its uses , what
it is and how it works. For
the full article see page 5.
2
State Employment
Standards
What’s
NEWS
in the Industry
1 - 8 0 0 - 9 6 8 - 6 6 4 4 The chart to the right outlines Rainbow’s standards for hiring as compared to the State’s requirements as of
January, 2006. Currently, we live and breathe our own strict hiring standards all in an effort to deliver the best
care possible. That’s our promise to our clients – improving their lives and continually improving upon the
services we provide to them.
Rainb ow Visions
As the 2006 year unfolds, Rainbow continues to seek innovative and improved ways to help our clients
recover. With the recent movement in both the Michigan House of Representatives and the Senate, Rainbow
is working to partner with and support certain legislative and trade association efforts to improve the State’s
hiring standards for our industry.
Dear Rainbow family and friends,
Rainbow’s hiring practices have long exceeded state guidelines and regulations—it’s always been our
belief that our caring staff is what makes us unique and we strive to ensure we have the best people on our
team. With our stringent hiring practices as a model, we intend to work with the State of Michigan to push
industry standards to new heights. Some recent movement in our Legislature to strengthen industry hiring
practices, specifically bills dealing with background checks, is a step in the right direction towards ongoing
improvement of our industry.
As always, we exist to serve you and your loved ones; feel free to offer your suggestions or concerns. Our
doors are always open.
3
Sincerely,
William R. Buccalo
President, Rainbow Rehabilitation Centers
S P R IN G 2 0 0 6
The following table lists hiring and retention guidelines
of the State of Michigan compared to Rainbow’s internal
requirements for ALL employees. (1/1/2006)
Rainbow’s
Hiring & Retention
Requirements
(All employees)
• For candidates who have resided in Michigan 3+ years, a Michigan
State Police Criminal Record Check is completed upon hire
• For candidates residing in Michigan less than 3 years, State Police
records are searched where the applicant resided in preceding 5 years
• Social Security Number (SSN) Verification
• When SSN is verified State Police records are searched
in all states where applicant applied for credit
• Agreement to notify AFC Administrator of arrest or conviction
• Annual State of Michigan criminal record check
• Nationwide criminal record check
• Sex offender registry check
• Residency disclosure statement
• Conditional employment of applicant prior to receiving a criminal history report
– Applicant must sign a statement denying the existence of criminal history
• TB Skin Tyne test upon hire & every 3 years
• Pre-hire physical signed by a physician acknowledging the health of applicant
• Pre-hire drug screen
• Annual review of health status signed by employee
• Name, address, phone #, and SSN of each employee
• Professional or vocational license with number (if applicable)
• Verification of licensure through National Practitioner’s database
• Copy of employee’s driver’s license (if driving is required)
• Motor vehicle record check prior to hire
• Requirement that employee(s) maintain a Chauffeur’s License
• Subscription service for Motor Vehicle Record (MVR) checks
– RRC is mailed a MVR copy each time an employee receives a
moving violation, suspension or other traffic infraction.
• Verification of age
• Verification of experience, education & training
• Background search to verify at least 10 years of experience
• Verification of 2 reference checks
• Verification of at least 3 reference checks
• Family Independence Agency Child Abuse/Neglect Central Registry clearance check
✔
State of Michigan Requirement
State of Michigan’s
ADULT
Small Group Homes
Requirements
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔ Rainbow will not ut ✔
s witho
● hirfirest apgeplitticangnt criminal ✔
✔
✔ history checks.
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
In an effort to keep our clientele safe, Rainbow
Standards exceeding
✔ Rainbow
State of Michigan Requirements ● does not offer “conditional” employment
opportunities
4
ABI
Clinical
News
A LOOK AT
Magnetic Resonance Imaging
Reyst, PhD, CBIT Systems Director
1 - 8 0 0 - 9 6 8 - 6 6 4 4 By Heidi
Rainb ow Visions
Magnetic
W
hen I started to think about Brain
Injury Awareness month, I was
determined to increase my own awareness
in an area of which I had relatively little
experience. I have been increasingly more
interested in the utility of imaging since I
first saw Dr. Erin Bigler from BYU speak
in Washington, DC in 1994. So, I chose
Magnetic Resonance Imaging and I can say
without hesitation that it has only served
to pique my curiosity even more! While
this article is technical in nature, I hope it
will serve to increase your knowledge of a
technology which we have all heard of, but
perhaps not fully understood.
What are the uses of MRI?
To begin, not only are there a variety
of scanning methodologies available,
but there are also a variety of MRI
methodologies available which provide us
in vivo ‘pictures’ (Latin for in the living),
of the human body. Some scanning
methods include computed tomography
(CT), positron emission tomography (PET),
and single-photon emission computed
tomography (SPECT), to name a few. In
regards to MRI, examples include T1
5
weighted MRI, T2 weighted MRI, fluid
attenuated inversion recovery (FLAIR-MRI),
diffusion weighted (DW-MRI), diffusion
tensor (DT-MRI), and functional magnetic
resonance imaging (fMRI). With such an
array of tools, what makes MRI the tool
of choice for assessing individuals with
acquired brain injury?
One variable to take into account when
choosing a scanning method is time of
injury. Because of the properties of MRI
(specifically the magnetic properties), the
use may be contraindicated due to metals
contained in the equipment required
during the trauma phase of injury (Bigler,
2005). For this reason, CT is the preferred
scan used in the acute stage of injury.
According to Bigler (2005), “The most
important aspect of acute CT imaging is the
initial management, monitoring and surgical
intervention for any treatable lesion(s).”
In the post acute stages (or chronic
stages) of injury, MRI is the preferred
scanning method. It is an excellent tool
to detect brain anatomy at a level more
specific than gross anatomy which is the
limit of CT scans. It also can do so in any
plane in the body. MRI can detect many
pathologies associated with the chronic
stages of brain injury including hematoma,
edema, atrophy, changes in ventricle
volumes, contusion, shear (diffuse axonal
injury) and white matter abnormalities
(Bigler, 2005). In summary, CT is most
useful in the acute stage of brain injury,
while MRI is most useful in the post acute
or chronic stage of brain injury.
What is Magnetic Resonance Imaging?
Magnetic Resonance Imaging (MRI) is
a scanning technology which provides in
vivo high resolution images of anatomical
structures within the body. The technology
originally started out as tomography, which
is a two-dimensional image of a slice
or section through a three-dimensional
object. A Computed Tomography (CT) scan
is another form of tomography. CT scans
send an x-ray beam through the body to
measure tissue densities and record the
different densities along various angles.
This data is then applied to a computer
program algorithm which makes an image
of the slice of the body measured. MRI, on
the other hand, utilizes different technology
to get not only two dimensional tomograms
but three dimensional volumetric images
as well.
How Does MRI Work?
The technology behind MRI is deeply
rooted in numerous disciplines including:
Physics (specifically quantum mechanics),
biology, chemistry, computer science,
mathematics, statistics and medicine.
Methodologies and advancements from
each of these fields have come together
to provide the tools needed to allow for a
non-invasive, relatively risk free method of
looking at anatomic structure, pathology
and function. The focus of this article is on
the basic methodology of obtaining an MRI
scan. MRI is an extraordinarily complex
procedure that must be broken down into
its component parts to better understand it.
To do this, we must first start with the most
basic elements of all matter – the atom.
The Atom
The hydrogen atom is the key to MRI
because of its abundance in the human
body and because of its specific atomic
properties (NAS). The human body
contains approximately 63% hydrogen
atoms, due in large part to the fact that
hydrogen is a main building block in both
water and fat (Hornak). Take for example
water, which is made up of 1 oxygen
molecule and 2 hydrogen molecules
(Figure 1). The hydrogen molecule is
S P R IN G 2 0 0 6
Resonance Imaging – MRI
comprised of an electron (negative charge)
that is bound with a proton (positive
charge). The proton is the nucleus of the
hydrogen atom (Figure 2).
Spin & Magnetic Moments
All protons have a fundamental property
termed ‘Spin.’ Spin can be quantified,
and can be thought of as a planet spinning
about its axis (Hornak), as in Figure 3. This
spinning generates a small magnetic field
and creates what is called a ‘Magnetic
Moment.’ The magnetic moment can be
weak or strong, and has direction much
like a magnet has North and South poles
(NAS; Figure 4).
When the proton is placed in a strong
external magnetic field, as happens when
Continued on page 7
Figure 1 – Water Molecule
ABOVE: Normal MRI scans of humans. Magnetic Resonance Imaging
(MRI) is a non-invasive diagnostic imaging technique. It creates
a thin section image from any angle and provides more accurate
information with less risk.
Figure 2 – Hydrogen Atom
Figure 3 – Proton Spin
Figure 4 – Proton
North
South
6
Continued from page 6
one is placed in an MRI machine, the
proton either aligns with or against the
magnetic field (Figures 5 and 6).
Because the hydrogen atom has a
strong magnetic moment, it has a strong
tendency to flip direction when placed in
an external magnetic field, causing it to
align with or against the magnetic field.
Once the hydrogen atoms align themselves,
many of them cancel each other out. In
other words, one proton aligned with the
external magnetic field will cancel out one
proton aligned against the magnetic field.
Some of these protons are extra in that
they do not cancel each other out (Figure
7). These “extra” protons are of high
importance to MRI, because of another
property of atoms related to spin.
Figure 5
Rainb ow Visions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 www.rainbowrehab.com
MRI
Figure 6
Magnetization
Figure 7
Magnetization
X
X
X
X
X
X
Extra Protons
7
Wobble & Resonance Frequency
When the proton spins about its axis,
it also wobbles much like a spinning
top. This wobble occurs at a particular
frequency, which is specific to the type
of atom (NAS). Again, this spin property
of the hydrogen atom is taken advantage
of for use in MRI. While in the external
magnetic field, a radio frequency is pulsed
through the magnetic field via a coil at
an appropriate frequency (in this case the
frequency specific to the hydrogen atom).
The ‘extra’ protons that did not cancel each
other out are then induced to flip direction
or spin in a different direction. When
the frequency of the pulsed radio beam
matches the frequency of the hydrogen
atom, which induces the protons to flip,
this is called the ‘Resonance Frequency’
(Gould). The reason that the proton flips
is due to the absorption of energy from the
beam and is the next important element in
MRI.
Relaxation Times and Signal
When the pulse of the radio frequency is
stopped, the concept of ‘Relaxation Time’
becomes important. The cessation of the
pulse allows the proton to return to its
previous “un-flipped” state. When it does
so, it releases the energy it had absorbed,
and this release of energy is a signal that
can be recorded. The time it takes for the
pulse to stop to the proton returning to its
former state (and thus emitting the signal)
is the relaxation time. Precisely when
or how the signal is recorded is of great
importance. One measure of relaxation
time is T1. This measure records the time
from the cessation of the pulsed radio
beam to the signal being emitted. This is
called the ‘spin lattice relaxation time.’
Another measure of relaxation time is T2.
This measures the length of the signal once
the proton has un-flipped and released
the signal. This is called the ‘spin-spin
relaxation time.’ Figure 8 illustrates these
times.
So, lets take a moment and recap what
we know so far.
1. Within our bodies, we have numerous
hydrogen atoms. We know that they have
a proton that spins and wobbles.
2. This spin and wobble creates a small
magnetic field.
3. These hydrogen protons have a
specific magnetic moment with direction
and magnitude.
4. When the protons are placed in
a strong external magnetic field, their
magnetic moment property induces them
to align with or against the magnetic field.
5. Most of these protons then cancel
each other out, but some do not, leaving
extra protons.
6. When a specific pulsed radio
frequency is introduced through the
external magnetic field which matches the
‘wobble’ frequency of the hydrogen proton
(called the resonance frequency), the extra
protons flip direction.
7. When the pulsed frequency is stopped
and the protons return to their original
state, they emit a signal which can then be
measured via various methods.
The preceding is a basic rendering of
how signals from living tissue can be
captured. In reality, the processes and
technologies that are used to capture that
signal are far more complex. For example,
varying pulses (by using short pulses versus
continuous pulses) allowed for better
information from the signal (NSA).
S P R IN G 2 0 0 6
hydrogen atoms at precise locations within
the subject being scanned. There is one
gradient magnet to vary the magnet field
from top to bottom, one gradient magnet to
vary the field from side to side, and a third
to vary the magnetic field up and down.
Figure 9 illustrates a basic MRI schematic.
To make MRI practical to use, the speed of
collecting signals needs to be quite short,
since it requires that the patient remain
very still throughout the process. One
way to speed up the process of collecting
the signals is to send out multiple signals
simultaneously (without affecting other
signals) and recording the multiple signals
that are emitted. The resulting signals are
measured as are the combination of the 3
spatial coordinates of the signal from the
gradient magnets. This allows for a “map”
of the signals to be created.
Radio Pulse Frequency
Figure 8 – T1 and T2
Relaxation Times
Signal
T1
Image Output
The process of going from signals to an
image involves the use of what is called
the Fourier Transformation. This takes the
raw signal data and transforms it creating
the map of the signals. Early on, the use of
the Fourier Transformation was only limited
T2
Continued on page 15
Gradient Magnets & Signal Collection
Now we are at a point where we are
able to measure signals. But how does
that translate to an image of the body?
To understand this, we must begin to
understand the components of the MRI
machine itself. Within an MRI machine,
there is the Main Magnet, which creates a
large, stable magnetic field. In addition,
there are 3 other magnets called Gradient
Magnets. These magnets allow for scanning
a slice at any angle, without requiring the
person being scanned to move. But how
do they work?
The gradient magnets work in
conjunction with the coils that send out
the pulsed radio frequencies, allowing for
precise measurement of any area within
the field of view inside the scanner. The
coils send out the radio frequency pulses
while the gradient magnets turn on and
off to change the magnetization of the
Figure 9 – Basic MRI Schematic
Main Magnet
Gradient Magnets
Patient Table
Radio Frequency Coils
8
ABI
Survivor’s
Corner
MOTIVATIONAL SPEAKER
Jackie Pflug
Rainb ow Visions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 Interview by
Kimberly Paetzold, Editor
O
n Thanksgiving weekend in
November of 1985, Jackie Pflug
was flying to Cairo, Egypt from Athens
where she had attended a volleyball
tournament with her husband (a physical
education teacher) and his students.
Jackie and her husband Scott had only
married a few months before, and at
the time, Jackie was a special education
teacher at the Cairo American School
in Egypt. Ten minutes into the flight,
three men calling themselves the Egypt
Revolution began to wave their guns and
proceeded to take control of the airplane.
A gun battle ensued as the terrorists
took control of the flight at an altitude
of 35,000 feet. The plane was forced
to land in Valetta, Malta. The terrorists
began to execute one passenger every
15 minutes until their demands for fuel
were met. Jackie, an American citizen,
was shot at point blank range, execution
style, just like four passengers before her.
She was thrown from the plane onto the
tarmac and left for dead. For five hours,
Jackie drifted in and out of consciousness
until an airport grounds crew retrieved
her body on its way to the morgue.
In total, 59 passengers died by
execution, the ensuing gun battle between
authorities and the hijackers, or by fire and
smoke inhalation when the plane exploded.
Jackie lived.
Over the years, Jackie adapted to the
effects of being shot in the head and the
resulting brain injury, effects which include
severe vision impairment and short-term
memory loss. She has developed epilepsy
and endured a lengthy rehabilitation
process during which she drew on
her background in special education
to master her learning disabilities.
9
Hello Jackie – Thank you for interviewing
with Rainbow Visions. We usually
interview individuals that have incurred
a TBI due to an accident. In your case,
the injury was purposely inflicted – the
result of a hate crime. In reading your
book, “Miles to Go Before I Sleep”, it was
apparent that this fact had a major impact
on your recovery. Can you tell us how
you overcame the terror and emotional
difficulties attached to being a terrorist
victim?
Being a terrorist victim did have a
major impact on my recovery. Actually,
it changed my life forever. My life took a
whole different course: I eventually got
divorced and had to let go of my teaching
position. It changed who I was inside.
The hate crime aspect of my injury was
something I had to work through. A car
didn’t hit me, and my injury could in no
way be considered an accident. At first,
I didn’t think the emotional part would
be a big deal – I thought the physical
impairments would be the most difficult
part to deal with. But as it turns out, the
emotional part was just as hard. I had
serious TRUST issues, and the emotional
trauma of the hijacking dragged me down.
I had frequent violent nightmares. Once I
began to emotionally deal with what had
happened in therapy, the nightmares left.
So the mental health aspect of
rehabilitation was helpful in
recovering?
Therapy was a tremendous help
in my recovery, and I was surprised
how important it was. Looking
back, I don’t know why I was so
surprised, because I do have a
degree in psychology. But it really
was wonderful to talk to someone
about the hijacking.
After being shot in the head, I
certainly wasn’t myself. It seemed
people gave me a year to get
my act together and then they
lost patience. I don’t think they
understood what they were doing.
I kept hearing, “You are not the
person I knew.” I also added to the
problem by saying, “I know I’ll get the old
Jackie back – I know I’ll be able to keep up
again one day.” You know, one day I was
able to keep up, but what I didn’t know is
that it would be 15 years down the road.
Through therapy I learned, “So what if I
can’t keep up like before!” I learned to live
with, like, and even love the person I had
become.
The physical aspect of recovery was also
a big piece. Because of my brain injury, I
could not keep up a fast pace. My shortterm memory and sight were significantly
impaired, and I had a difficult time
perceiving what people were saying to me.
If someone would say “Go mow the lawn”
– I heard, “Go mouw the tawn.”
What type of therapy in addition to mental
health did you receive?
I didn’t. You know I don’t know how
that happened. Not receiving therapy for
my physical disabilities was a big ball that
got dropped. I should have been sent to
a rehabilitation center and received more
medical help. In the end, I relied on my
background and training in special needs
education to get me through.
In addition to my initial physical
limitations, a few years after the hijacking I
developed epilepsy. I was very angry I had
to deal with this. For a period of time the
seizures were frequent but after receiving
S P R IN G 2 0 0 6
the right medication, I was seizure free for
a year but still lived in fear that they would
reoccur. Finally, someone said to me “If
you look at your epilepsy as something
to be frightened of all the time, you’re
letting it wreak havoc in your life and it
will run you. But if you find someway to
come to terms with it, the epilepsy won’t
be so important”. So I started to look at it
differently. I approached it more logically
and thought, “OK, if I have a seizure, I’m
going to talk to my doctor and tell him
the medication is not working the way it
should. We can work on something new”.
Since I always had physical warnings about
2 or 3 minutes before a seizure, I had time
to put myself in a safe position. Also, it
gave me time to give directions to someone
so they could help. It made me strong.
Now I don’t even think about it, but there
was a time when it scared me to death.
You used several compensatory strategies
to help you deal with your impaired vision
and loss of short-term memory. Could you
elaborate on these strategies?
One example I wrote about in my book
was my morning orange juice routine.
Because of my short-term memory loss,
(my recall was really bad) I had a hard
time remembering what I did just moments
before. I love orange juice; so every
morning I would fix myself a glass. After
pouring it I would put the pitcher back
into the fridge and would study it trying to
remember how full or empty it was. The
next day I would test myself. How full or
empty was my orange juice pitcher?
Also, I could no longer read. After my
accident I knew the alphabet and the
sounds of each letter, but I couldn’t read
words or sentences. Due to vision damage,
my eyes always wanted to go to the right
side of a word or page. To teach myself
to read again, every morning I would
take the newspaper and a red felt tip pen
(because red stood out and I could focus
on it) and I would start at the beginning
of a sentence. I circled the first letter of
each word without lifting my pen and kept
doing that throughout the sentence. Take
the word BAT. Initially I would only see
the T but by circling the B in red, I could
see the left side of the word. This method is
called tracking, and I used to do it with my
special education children. I did this every
single morning for years and never let up.
Eventually I was able to read from left to
right and see the words in their entirety.
Not long after your hospital stay, you tried
to get back to work full-time but found it
enormously taxing. Your doctor said it was
too early to attempt so much. What advice
do you have for others going through the
same situation?
How do you know you can’t do
something unless you try? Nevertheless, I
knew deep down inside it was too soon to
go back to work full-time. I did it because
of external AND internal pressures to get
back to where I was. That pressure to get
going and get back on track pushed me to
reach too far. My husband pushed because
he wanted everything to be OK. It wasn’t a
bad motivation on his part, he just wanted
everything to be back to normal, and he
wanted so badly for his wife to be all right.
It’s difficult, but taking it slow and being
conscious and aware of your limitations
is important. Take baby steps. You know,
even in my darkest days somehow I knew it
would be OK again some day. I also knew
that as the days went by, everything was
getting better, even though I didn’t always
see or feel the progress.
You were asked to go back to Malta soon
after the hijacking to identify the man
who shot you. Can you tell us about this
experience?
The first trial was in Malta in 1986 (the
hijacking took place in 1985). I was set to
fly there, but in my gut I knew I couldn’t
go. I wasn’t ready to deal with it yet.
Miles to Go Before I Sleep
A Survivor’s Story of Life After a Terrorist Hijacking. Jackie’s message of faith and forgiveness is
timeless. Miles to Go Before I Sleep reminds us that tragedy and suffering always contain the seeds of
new growth and learning. It contains a message about weathering adversity, about going for dreams
and goals and about not giving up. Though we are powerless over many of the forces that shape our
lives, Jackie believes we have power over our responses and power in the choices we make.
Jackie’s healing journey began when she realized she had two options. She could slip into self-pity
and blame, and see herself as a victim for the rest of her life; or she could reclaim her life and dreams
despite the slow, painful years it would take to recover. In her book, Jackie shares her story and the
lessons she learned during her recovery and rehabilitation.
“Be good to yourself. Take care of yourself. Be true to yourself, and above all - love yourself.
That’s where it all begins.” – Jackie Pflug
Order a Personally Signed Book at www.jackiepflug.com
10
Meet
Susan Connors
BIAA President
fairs and distributes bike helmets. Another
program is LAPS Walk (Leadership and
A NATIONAL PERSPECTIVE ON
Awareness to Promote Safety Walk). The
first LAPS event was held in Michigan with
Brain Injury Awareness
Interview by
S
our partners, the Brain Injury Association
Dr. Heidi Reyst, PhD, CBIT
delivers local presentations, attends safety
of Michigan and Race2Safety – a program
Systems Director
established by former NASCAR Driver
Ernie Irvan, and he’s become a national
usan Connors is the President and
spokesperson for us.
CEO of the Brain Injury Association
Years ago, the BIAA had a wonderful
1 - 8 0 0 - 9 6 8 - 6 6 4 4 of America. For more than a decade
Susan has been a tireless advocate for
as devastating as a traumatic brain injury. I
individuals, families and professionals.
was grateful to have so many friends in the
She was Executive Director of the
field – Professionals who could translate
National Association of State Head
what the doctors were saying and a support
Injury Administrators from 2001 – 2005
network that helped tremendously. You
and National Director of State Affairs for
know, the Brain Injury Association is built
BIAA from 1995 – 2001. She has served in
on the concept “You are not alone”! There
advisory capacities and on expert panels
were people all over the country who
for several federal agencies, universities
supported, helped, informed and educated
and nonprofit organizations. She has a
me. When you combine the yearly 1.4
degree in public communication from
million traumatic brain injuries and the
George Mason University.
750,000 strokes in the United States
– everybody knows somebody with a brain
Susan, thank you for taking time to speak
with us. How long have you been in the
for you?
Truthfully, I answered an ad in the
newspaper. I joined the Association in
1995 when it was the National Head Injury
“This is a club [brain
injury] anyone can join at
anytime”
with a brain injury. I walked in the office
and felt pulled to TBI. I soon met a terrific
pioneer in the field, a family member
named Wally Walsh, and he used to say,
“Susan, you’ve been bitten by the brain
injury bug.” Ten years later, my mother had
So saying, “This is a club anyone can join
at anytime” is absolutely correct.
Do you feel that being in the field when
your mother had the stroke made it easier
for you to understand what was going on?
Absolutely. An unexpected stroke can be
11
an individual with a brain injury
faces. One poster said, “Imagine not
remembering which goes on first… Your
shoes or your socks. Wear a helmet!”
Of course, I think of the BIAA as
more than one national office. With 41
state affiliates across the country, we
are a nationwide organization and our
state affiliates carry out many important
prevention activities at the local level such
as safety fairs, bike rodeos and if you are in
the right climate, ski safety clinics.
quite a bit of press lately. What are your
thoughts on this?
Sports injuries make up a percentage
of the 1.4 million traumatic brain injuries
sustained each year. Unfortunately, most
Foundation. At that time, I did not have a
family member or personal acquaintance
Posters illustrated some of the challenges
Sports injuries (concussions) are getting
field of brain injury and how did it start
a stroke, which is an acquired brain injury.
Rainb ow Visions
injury.
campaign that I would love to resurrect.
people don’t know about the cumulative
When speaking of prevention, what is the
effect of multiple concussions. That’s why
BIAA doing at this point in time?
it is a good idea to introduce helmets to
It helps to start with the premise that in
kids when they’re very young. Like most
order to prevent a brain injury, you have
youngsters, I could play soccer long before
to know what it is. If you’ve never heard
other team sports like baseball or football,
of brain injury, or you are not aware that
but we never wore helmets. Why not start
your brain will not heal the way a broken
youngsters off with helmets or protective
bone does, then you probably will not
safety gear as early as possible? It may
pay attention to prevention messages.
be easier to get young children to wear
The BIAA has an Annual Brain Injury
helmets versus teenagers.
Awareness Campaign; this year’s theme
is “Living with Brain Injury” but that
When I speak with individuals outside
campaign is one of many activities we
of the TBI industry about sports like
conduct throughout the year. An example
football or hockey, my perception is that
is The Lynn Fund through which the BIAA
concussions are still not viewed as serious
S P R IN G 2 0 0 6
or a brain injury. To have Ernie Irvan stand
and say, “I have a brain injury. I experience
provides evidence of that. Do you
up and tell his story is amazing to me. In
some struggles but I have accommodations
foresee a day, through the efforts of the
your estimation, are there more Ernie
and I’m living with brain injury.” This can
BIAA, when we can rid ourselves of this
Irvan’s out there?
only help to make the public more aware.
moniker?
There are an amazing number of
That’s a tough one! I hope that someday
celebrities and public figures who have
sustained a TBI and for many reasons they
are unwilling (or unable) to come forward
and say, “I have a brain injury.” There are
a handful of very brave souls in visible
positions who have stood up: People like
James Brady (former Presidential Press
all individuals with brain injury will
...the Brain Injury
Association is built on
the concept “You are not
alone”!
Secretary), Dick Button (Olympic Skater),
live and work in the community of their
choice. The “silent epidemic” statement
implies that there are inadequate services
and supports available for people to live
in appropriate social, living, and work
situations. Advocacy is a cornerstone of
BIAA’s mission. I don’t think we’ll ever stop
Amy Davis (former Miss Utah who had a
Brain Injury has long been called the
advocating but our focus may change over
cheerleading accident) and of course Tricia
“silent epidemic.” My experience is that
time. For example, if we had adequate
Meili (the “Central Park Jogger”). Now
there is far more misinformation about
funding for treatment and services for every
Ernie Irvan (NASCAR Racer) has stepped
brain injury than real information – a
up. I am hopeful that more will step up
quick perusal of television and movies
Tr ansitions Throughout A Lifespan
26
th
AnnuaL
c o n f e r e n c e
Save the Dates:
Thursday, September 28, 2006
& Friday, September 29, 2006
Lansing Center – Lansing, Michigan
For more information, visit
us online at www.biami.org.
12
From
Rainbow’s
Residential Homes
R A I N B O W C L I E N T. . .
James Summers
Rainb ow Visions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 By
J
im Summers is thoughtful and likes to
analyze all the angles before he makes
a decision. But that wasn’t always the
case; there was a time when he would act
impulsively and try to escape his thoughts
and feelings...
In 1995, Jim was walking down a dark
road with no sidewalk when a drunk driver
going home from a local bar swerved and
hit him. He went through the windshield.
His injuries included a TBI (frontal lobe)
and many broken bones.
Jim was given his last rites in the
hospital, but after a few days the medical
professionals expected he might survive.
His prognosis? He would never again walk
independently. Jim didn’t want to hear that,
so he would wheel himself to a quiet area
of the hospital late at night and use the wall
rails for walking props. “I didn’t think I was
getting enough therapy during the day – a
couple of hours each day wasn’t going to
do it” Jim stated. He later received therapy
at Rainbow to help him master walking and
regain balance.
After spending 100 days in the hospital,
Jim was admitted to Rainbow’s Residential
Program. He had problems with short-term
memory and, as part of his rehab, learned
to use a planner. This became key to his
success. According to Jim, “Writing things
down combined with lots of repetition is
what got me through.”
After graduating from the group home
setting, Jim moved on to Rainbow’s
Townhouse Program where he had greater
independence and less supervision. Within
a short period of time, Jim decided he had
completely rehabilitated and discharged
from Rainbow without completing all the
established therapy and independent life
skill goals. He moved in with family and
13
worked for a locksmith company where he
remained employed until the shop closed.
Jim eventually purchased a trailer home
and found new employment with a plastic
recycling company in the shipping and
receiving department. He stayed employed
for three years, but as business slowed,
Jim was laid-off. Discouraged, he took a
year off and then began working for his
brother. During that time, he pushed hard,
but found he couldn’t keep up. In addition
to the difficulties resulting from his brain
injury, Jim was diagnosed with cancer and
began treatment. Life was getting quite
difficult. After much struggling, Jim decided
he needed more help and called Rainbow.
August 2005 - Jim readmits to Rainbow
Since admitting in August of 2005, Jim has
advanced from the Townhouse Program,
which offered ongoing supervision, to
the Apartment Program, which is less
restrictive. Jim can access help at any
time, but daily ongoing supervision is no
longer needed. His cancer is in remission
and things are looking up. Jim continues
to work on money management skills
and has begun to consider a new career
direction that is more suitable. Currently,
he participates in outpatient therapy and
has Clubhouse activities to help him reach
his rehabilitation goals.
Jim’s advice for others...
Anyone dealing with brain injury needs
to have a strong faith. I believe there is a
higher power and that there is always a
way provided. Use the resources available
– family, friends and rehabilitation
services. When I wasn’t succeeding, my
doctor suggested I return to Rainbow for
additional therapy and support. I did not
want to accept the fact that I hadn’t
completely returned to the person I was
prior to the accident. That was really hard
for me. After going through financial ruin
and destroyed relationships, I realized I
really did need some help.
My Dad and brother thought that I
was basically the same person and that’s
why working for my brother didn’t work.
He didn’t understand my deficits or
difficulties, and that negatively affected
our relationship. It’s vital to become
informed as a family member so you can
understand your loved one.
Writing was also highly beneficial for
me. Writing allowed me to examine how
I was feeling and evaluate the reasons for
my thoughts – it helped me determine
whether they were accurate or not. Often,
I have a hard time articulating what I
want to say, and writing gives me the
opportunity to communicate effectively.
I’m grateful for who I am now. Everyday
I see people who go through similar
situations and are far worse off. I am
indeed very fortunate – a very lucky
person. But I learned not to demand too
much too quickly. I left Rainbow before
I was ready because I was anxious to get
on with my life. Combine that with the
anger I was feeling, and you don’t get a
formula for success. Getting over self-pity
is a big thing – it’s part of the anger.
I have now learned to accept and look
at the good things. Stay away from the
negative thoughts. Negatives and positives
surround us. We need to concentrate and
embrace the positive. Negatives only tear
down and lead to nothing good. It makes
me always think of my blood type – B+.
(Did we mention that Jim has a great
sense of humor?) t
S P R IN G 2 0 0 6
A New Beginnin
g
You ask yourself, how
can I move on?
Everything I knew, no
w it seems gone.
You hear to be gratefu
l, forget what you lost
,
While you are alone,
are paying the cost.
So many problems, so
many fears
But the only real answ
er reflects in the mirr
or
The weak just diminish
The strong will persev
ere
You lost it all, except
your last breath
This leaves you pond
ering
Why were you cheated
from death?
I don’t have the answ
er, or claim that I do.
Only God knows why
I want to expound on
who dies, dies
But I respect the chea
ters of death,
Those who SURVIVE
!
- James Summers
Jim’s Bio
e
Personal Goals: Take som
lish
Pub
/
s
rse
cou
t
journalis
the
y
a book of poetry / Pla
stock market
ntball,
Hobbies: Reading, pai
nding
people watching and spe
ld son.
r-o
yea
time with his 17her,
Family: Jim has his mot
and
ter
sis
r,
the
bro
a
,
father
one son.
New
es
v
i
t
c
e
Persp
was
my life
,
o
g
a
atever.
years
te, wh
fa
s. Ten
r
it
u
o
ll
y
r
ca
at
n ente
e, and
ept wh
eeds
pe I ca
, I acc
e blam
o
s
c
h
le
I
la
g
t the s
.
p
g
u
,
u
b
ld
e
r
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,
s
o
m
ts
w
d
n
la
r
e
b
a
ave
my
the ev
d outw
ld take
t -Ih
me to
ned on
ner an
. I cou
though
n
Welco
d
in
f
e
la
f
r
o
p
o
e
lt
y
in
s
tra
year
ally a
Nobod
st my
many
drastic
cident.
rs, I lo
c
e
a
, over
d
e
a
n
n
e
a
r
li
as
ry
Bottom
n. (Sor
y life w
ed
fruitio
d in m
e
to
n
chang
e
w
p
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hap
e been
nd gr
v
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h
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ms. Th
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t li
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a hea
of mos
but to
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ir
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retain
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Fina
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when
14
1 - 8 0 0 - 9 6 8 - 6 6 4 4 Rainb ow Visions
MRI
by the ability of computers to process the
information quickly. When computer
technology was able to process Fourier
Transformations rapidly, the utility of MRI
was realized. Given that the first MRI scan
of a human body in 1977 took nearly 5
hours, it is evident that speed of capture
would determine its practical utility (Tesla
Society).
Once the transformation is made, we are
left with an image in the form of a slice that
tells the reader what types of tissue were
scanned. We know this, by and large, due
to the known properties of hydrogen. For
example the signal from healthy white
matter (WM) will differ from unhealthy
WM, because we know the difference in
hydrogen properties from these tissues.
Gray Matter (GM) will differ from WM,
and will differ from cerebral spinal fluid
(CSF), and so on. Determining what type
of scan sequence to utilize will depend on
what outcome is desired. For example a
T1 weighted sequence will show anatomy
best, whereas a T2 weighted sequence will
show pathology best.
The key to differentiating one tissue
type from another is contrast. While the
image from an MRI is not a photograph,
the analogy of a black and white picture
will help to explain contrast in MRI. When
you see a black and white photo that
has lots of gray tones but very little black
and white tones, it tends to be dull and
15
lifeless. When you see a black and white
photo with good tonal range from dark
blacks to white whites, it stands out due
to the contrast between the tones. For an
MRI image, it is the range of tones that
help distingush the different tissue types.
For normal tissue, a T1 weighted scan
will result in GM that is gray, WM that is
white, and dense bone and water that is
dark (Johnson). For a T2 weighted scan, fat
and water will appear bright, dense bone
and air will appear dark (Johnson). For
abnormal tissue, a T1 weighted scan will
reveal blood as bright and a tumor as dark
(Johnson). A T2 weighted scan will show an
infarct, blood, tumor or MS plaque as very
bright (Johnson). To differentiate WM and
GM from CSF, a T1 weighted scan would
be called for, and to determine if there is
abnormal tissue, a T2 weighted scan would
be appropriate.
The range of advanced techniques for
MRI scans is absolutely dizzying. There
are new techniques being created that find
yet another use for this technology. While
this article served to highlight the most
basic components of MRI, it does not delve
into the true complexity of the technology
involved. For an excellent, thorough and
technical review by J.P. Hornak, go to:
www.cis.rit.edu/htbooks/mri/index
The true potential of MRI at this
point may not be fully realized, but its
current utility is evident. MRI can detect
abnormalities in the form of lesions,
infarcts, dead tissues, changes in white
matter, gray matter or cerebral spinal fluid
volume changes. The use of MRI to further
understand acquired brain injury is clearly
evident, and one can expect continued use
of MRI to help us understand how the brain
responds to injury. Look to this space for
continued illumination of this technology
and others that can so greatly impact
our knowledge of ABI and its long-term
consequences. t
How is an MRI scanner rated?
MRI scanners “main magnets” are rated in Tesla. A rating of 1 Tesla equals 10,000 Gauss or
20,000 times the earth’s magnetic field. The stronger the main magnet the more stable
the magnetic field, the better the MRI image. The following table shows current Tesla
ratings.
Low Field
.2T and under
Mid Field
.2T to .6T
High Field
1T to 2T
Ultra High Field
3T and higher
For clinical use, the current approved MRI rating is 3 Tesla. There are however, MRI’s
ranging from 4T to 35T+ used for imaging research.
MRI References & Bibliography
Johnson, K. A. Neuro-imaging Primer. www.med.harvard.edu/AANLIB/htm
Parrish. T.A. Image Processing in Magnetic Resonance Imaging. www.asnr.org/elec_2004/
parrish_fMRI/index.htm
Gould, T. A. How MRI Works. http://electronics.howstuffworks.com/mri.htm
Conlan, R. Magnetic Resonance Imaging. National Academy of Science. www.beyonddiscovery.
org/content/view.txt
Hornak, J.P. The Basics of MRI. www.cis.rit.edu/htbooks/mri/index
Bigler, E (2005). Structural Imaging. In the textbook of Traumatic Brain Injury, pp 79-105. Etc. J.M. Silver, T.W. McCallister & S.C. Yudolsky.
S P R IN G 2 0 0 6
Susan Connors, BIAA President
person who had sustained a brain injury
in this country, we may direct our efforts
to more research or focus exclusively on
prevention. I do not envision a day when
the Brain Injury Association of America or
its charted state affiliates will no longer be
needed.
In the last 2 years, I have been to some
pretty interesting conferences including
the BIAA sponsored conference in
Washington (2005). I saw some fabulous
is seeking independent status for the
National Center for Medical Rehabilitation
Research (NCMRR) within the NIH
(National Institutes of Health). In the late
1980’s, there was an effort to establish a
freestanding rehabilitation institute. At the
time, advocates were told the field was
too young to warrant a separate institute.
We are now going back and saying we
have been working on this for 25 years;
we know more and it’s time to elevate
rehabilitation to its rightful place. We
didn’t make it happen this year, but we’ll
continue to lobby for it.
speakers doing imaging studies to quantify
brain injury. Do you see this technology
working to help the BIAA in it’s efforts of
advocacy, prevention, and getting more
money for basic research from the NIH
(National Institute of Health)?
It seems we’re talking about apples and
oranges here so let me rephrase what you
are saying. What do I think the impact of
technology is on our field and the people
that we all work for? I would say is that
the potential is incredible. Many of us
grew up watching the Six Million Dollar
Man and the Bionic Woman. We have
bionic hands now as well as nanobots and
robots. It’s no longer fantasy television.
Imaging technology is going deeper and
deeper; pinpointing the location of injury
within the brain. There is no question
that the science and technology ahead of
us will have a huge impact for those who
sustain a brain injury.
The second part of the question
– will the BIAA, as the leading advocacy
organization, in partnership with other
organizations, be able to put brain
injury at a level of consciousness among
policy makers to ensure more brain
injury research is done? I hope so! We
work on this every day. For example,
the BIAA, as part of a national coalition,
Is there anything that providers, family
members or survivors can do to get the
word out?
With respect to NIH initiative, we’re
working directly with federal employees
to help them understand how far
rehabilitation has come as both an art and
a science. When our focus moves from
educating federal agencies to educating
the U.S. Congress, that is, when we start
writing legislation, it will be time for
grassroots advocacy. For now, we need
individuals, families, and professionals to
contact their representatives in Washington
to urge them to support the TBI Act; the
TBI Model Systems research program,
Defense and Veterans Brain Injury Center,
and to join the Congressional Brain Injury
Task Force. Fact sheets about each of these
efforts can be found on our website at
www.biausa.org.
Is there anything that you want our
readers to know about?
Every single component of the BIAA
mission is absolutely critical – Prevention,
research, advocacy. Information and
education, also a cornerstone of our
mission, is a huge part of what we do.
This year, BIAA is hosting a Caregiver’s
Conference June 2-4, 2006 in Washington
D.C. There will be two tracks: One for
families who are relatively new to brain
injury and a second for those who have
been at this for 25+ years. We are excited
about this – it’s our effort to reach out to
long time TBI advocates, help bring in new
families and professionals together, and
increase our value to the people we serve.
One last question Susan. What are your
thoughts on the American Academy for
the Certification of Brain Injury Specialists
(AACBIS)?
The BIAA is here to serve survivors and
their families, professionals, providers, state
agencies, and federal agencies, and finally,
people who have not yet experienced
brain injury. When we think in terms of
education, we have as much responsibility
for individual and family education as
we do for professional education. For
me, AACBIS is fundamental. It is, as far
as I know, the only way to demonstrate
knowledge and expertise specific to
TBI. I would like to see the certification
program expanded to more professionals,
paraprofessionals and others who might
need such training.
Reverting back to my personal
experience, when my mother had her
stroke, I cannot tell you how critical it
was to have professionals who knew what
they were talking about: From tests to
procedures to therapies. When somebody
threw out a new term, I could pick up the
phone and ask about it. I was lucky to be
working with people who were current in
the field. The BIAA wants more people
to have that level of knowledge. People
can learn through articles, abstracts,
educational conferences, presentations and
other forms of training. AACBIS is great
way to help make this happen. t
16
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17
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RAINBOW ALUMNI
Heather Sell
Rainb ow Visions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 By
W
e talk about an individual’s will to
succeed as being key to successful
TBI rehabilitation, but often there is more
to the story. Loved ones that fully support
and realistically approach brain injury
rehabilitation can make a big difference.
When someone loses cognitive abilities,
having someone close to the survivor to
fill in the blanks for therapists and the
rehabilitation team helps the process.
Premorbid personality traits don’t go away.
Knowing likes, dislikes, motivational
hot points, etc., helps specialists identify
treatment approaches. It’s also important
that family and friends understand
that rehabilitation takes time and that
cognitive deficits can be difficult to deal
with. Understanding and patience is so
important and often comes from being
informed.
Many wonderful families and individuals
have successfully moved through
Rainbow’s Continuum of Care. Their
stories are inspirational and demonstrate
the importance of family education and
support. The following story offers insight
of a supportive and successful family…
Heather Sell’s accident
It was spring, 2004, when Heather
and her fiancé (Pete) went motorcycle
riding. Pete (the driver) and Heather (the
passenger) were in Indiana where state law
does not require helmets. It wasn’t long
until they collided with nature: A deer ran
into their Harley. Heather required a trach
tube at the scene and incurred a traumatic
brain injury (TBI) with aphasia, damage to
her vision, dental trauma, a fractured finger
and right-sided weakness. Pete was also
badly hurt with broken bones, but was able
to leave the hospital after a week.
ary, 2006 (From left to right)
(Above) The Sell Family visits Rainbow in Janu
Letitia (sister).
and
her)
(mot
Robert (Father), Heather, Sharon
ers and sister Letitia just
(Pictured right) Heather (in blue) with her 3 broth
after she left the hospital in 2004.
Heather’s Hospitalization
Heather remained hospitalized for 3
months. When I asked Heather’s parents
how they coped, they replied, “At first
we felt despair, but each day we would
see some small improvement that kept us
going. One day, she read the numbers off
a sales receipt. It took another month until
she read numbers again, but every day we
had something. When she was in the ICU
we would watch her, and we knew our
Heather was still in there.”
The Sell Family spent day after day at
the hospital, and when it finally came time
for Heather to discharge, they knew she
needed additional therapy. Well informed
about her injuries and impairments,
they visited TBI Rehabilitation Centers.
According to her sister Letitia, “We felt the
treatment offered at each facility we visited
was good, but Rainbow was by far the most
appealing and warm. [Their Residential
Program] was the most like home. We
didn’t want to be selfish and make
[traveling] easy for the family; we wanted
the best rehabilitation for Heather.”
Heather comes to Rainbow
When Heather first admitted into
Rainbow’s Residential Program, she was
unsteady and spent most of her time in
a wheelchair. Debbie May (Residential
Program Manager) recalls Heather being
angry the first day she came. “She definitely
did not want to stay. She cried, and
because of her aphasia, she would mix up
her words and become frustrated,” stated
Debbie. “Initially, Heather didn’t eat well,
couldn’t walk, didn’t speak well and was
very weak.“
Wedding Day
S P R IN G 2 0 0 6
Wedding Bells Ring!
Heather (top right) & Pete (far left)
finally were able to marry! They tied
the knot this past October in the
church next door to their home. They
had their honeymoon in December
– a cruise.
The Sell Family was realistic about
Heather’s injuries and rehabilitation
process. They helped enormously by
encouraging her – they would tell her,
“This is your job Heather – something you
have to do. It’s like going back to school.”
Her ultimate goal was to go home, and she
got up every day ready for rehab, trying to
reach this goal. The family worked hand-inhand with the treatment team and sought
guidance from Rainbow professionals: “We
feared pushing her [Heather] too hard to
regain back her old life. We wanted her to
be motivated but not pushed, so we let the
professionals and Heather guide us,” stated
Sharon Sell.
Debbie May worked with the Sell family
and commented, “Their love, support and
encouragement was Heather’s inspiration.
The family made it their business to
know about the acute rehab setting. They
provided us with complete and accurate
information, which helped us do our
job better. I was impressed with how
they made it their business to become
informed.”
Heather was fortunate to have such
a loving and supportive family. Their
interaction was frequent: Her mother and
father would try to come every weekend
and her siblings would visit during the
week. Heather worked hard, and that led
to quick progress. Within nine months,
she learned to feed herself without
assistance, took care of her personal
needs, could do her own laundry, learned
to walk and made significant speech
improvements. In March of 2005, just
short of a year since her accident, Heather
attained most of her rehabilitation goals
and was able to transition home with
outpatient services.
Continued Progress...
Heather has made gains since leaving
Rainbow’s Program. She had eye
surgery due to double vision, and her
corrected vision has helped her progress
even further. She had dental work
completed and feels much better about
her appearance. She recently married
her fiancé, got her driver’s license, and
volunteers at church and a dental office.
The Sell family shares their thoughts...
Heather’s Mother: “We wanted Heather
to become as independent as possible. We
never held her back and we let her lead us.
Heather is now living quite independently–
but we still keep an eye on her.”
Heather’s Sister Leticia: “We were a little
concerned that we were taking Heather
out of Rainbow’s program too early, as she
was making rapid gains there. We didn’t
want her to become depressed by not
being able to come home when she did,
and it turned out well. She has continued
to make progress.”
When Heather saw the medical and
therapy paperwork that went into her
rehabilitation, her family told her, “That’s
how we put Humpty Dumpty back
together, Heather. These are all the people
that helped you get better.” Heather broke
down and cried. She doesn’t remember all
the therapy, but she knows that her family
and a dedicated team of professionals
worked hard to get her back. t
20
ABI
Behavior
Analysis
A LOOK AT
Unintenional Misbehavior
Rainb ow Visions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 By Joseph
A
J. Welch, MS, LLP Behavior Analyst
s a care provider, understanding and
accepting my own limitations and
potential is critical to delivering quality
care. Recognizing our own attitudes and
not blaming others allows us to keep
situations in perspective. It also allows us
to view problems separate from, and not
the fault nor intention of, those to whom
we provide services to.
A technique known as ‘reframing’ is an
effective way to look at frustrating events.
Putting a new “frame” around a situation
by not inferring intention, or blaming, but
rather, remaining focused on what we
can do to help. A helpful way to look
at challenging situations is to recognize
what the “usual suspects” are when those
difficulties occur. These usual suspects
can be situations, changes or delays in
scheduled events. They could happen
when our clients recognize discrepancies
between other clients’ programs, which to
them may indicate potential favoritism.
People become frustrated when their
goals are not being met. Not enough
time (stress), or too much time (boredom),
not enough money, too much noise, not
enough sleep, hunger, the list is near
limitless. It is these events that we, as
people, typically find frustrating and the
tendency is to take out this frustration on
people or to blame. If it is not our fault,
whose is it? It must be yours! Creatively,
we want to affect the things we seem
to have control over and people are
conveniently all around us. Does this
tendency to express frustration at others
occur when we don’t reach certain goals
as often as we like? Or is it simply our
perception that it is these people who
frustrate us?
Epictetus, an ancient Greek philosopher,
identified this particular human trait
21
succinctly by noticing that “It is not specific
events that trouble us, but our perception
of those events”. He clearly expressed
that we have the potential ability to alter
our perceptions and deal with situations
that others may find difficult or impossible.
When working with others, dealing
with frustrating situations and helping
change perspectives effectively facilitates
rehabilitation. Our job as rehabilitation
professionals is to be aware of the skills
necessary to “reframe” situations quickly
and then help our clients develop this
awareness as well.
People with injuries have even less
control over their constantly changing
situations due to the multitude of dayto-day activities necessary for supported
residential living. These difficulties
are exacerbated by poor memory and
attention. Helping our clients reframe
situations by identifying the variables
(and not the folks involved) that usually
accompany the difficulty and then problem
solving ways to control those variables
is effective. I think this helps us provide
one of the most powerful rehabilitative
methodologies available.
“Be careful, Joe (a client) is very
manipulative.” I hear this frequently
when discussing clients who have a lot
of potential for rehabilitative growth.
Manipulation infers that Joe intentionally
attempts to deceive others. Stay on guard!
Whatever you do don’t trust Joe! The
more objective, (and less frustrating), way
to perceive this situation is to recognize
that Joe is highly social and verbal, merely
attempting to maximize his chances
towards reaching his goals. Does this
approach of removing intention relieve
Joe of any responsibility for his actions?
I believe not. It merely helps us identify
things we can change in programming
and procedures to improve environmental
conditions and ultimately help clients
achieve success.
To summarize, awareness of the
difficulties our clients experience can
increase by listening to them as they
express themselves. Realize that our
own attitudes about the situation may be
inaccurate. Once their viewpoints have
been expressed, see if you can rephrase the
wording they have used to eliminate blame.
Also, identify specific variables that are
commonplace whenever they feel this way.
If you can do this and express yourself
in such a way that helps them see the
situation more accurately, chances are their
responses will become more appropriate,
and feelings of hope will follow. t
S P R IN G 2 0 0 6
Jackie Pflug
Three months after the hijacking, the
FBI and Malta police were requesting that
I attend the trial and testify, and I was so
nervous. I wanted to help put him away,
but I also wanted it to be over. I feared that
if I testified, one of his friends would find
me and retaliate. Finally, I asked to help
without going to Malta. I felt dumb at the
time, but the FBI said they could take a
deposition here. That was the first trial.
I was proud of myself that I didn’t go.
Individuals with brain injury need to be
their own cheerleaders and realize it’s OK
when they are not ready for something.
Standing up for yourself and your
limitations is good.
The second trial was ten years later. The
first trial put the hijacker away for 25 years
in a Malta prison, but he was released
after 8 years because of good behavior
and pressure from Libya. The US got wind
of this, reopened the case and began a
second trial in Washington. I went several
times to Washington to prepare for the
trial, one time in particular to identify the
man who shot me in a line-up. That lineup
was a very good thing for me. At the time,
I was upset I had to do it, because I had
identified him in photos several times. The
reason it was good is because I knew I had
forgiven him when I looked at him face to
face. That freedom felt good – it was the
forgiveness that really set me free.
Forgiving is not saying, “What you did
to me was OK”. It’s not that at all. People
say to me all the time, “How can you
forgive someone who did that to you?”
Well it’s not about letting him off; it’s about
doing it for you. Somebody recently said
to me, “You forgive to set yourself free”.
And really, that’s the truth. Now this type
of forgiveness is not in your head, it’s
something that comes from deep inside. I
got there through therapy, and let me tell
you it took many years. Some people can
do it right away, but if you still have a lot
of anger, you’re not there yet. It doesn’t
happen just because you say it – you must
actually feel it. Forgiveness is being free,
and it’s a wonderful feeling.
How did your mental health therapy help
you achieve this?
By recreating the hijacking, I said all
the things I wanted to say and did all the
things I wanted to do, but couldn’t because
I had a gun to my head. When I left those
sessions, I felt like a new woman. For the
first time I was in control, not somebody
else. I was empowered to go outside
without feeling like I was going to get
shot in the head again. I was empowered
to go to bed at night and not anticipate a
horrible nightmare.
A lot of individuals get stuck with
“Why did someone do this to me?” You
know what? The person who wronged
you or your loved one will never give
you a satisfactory answer. The thing
survivors need to concentrate on is not the
perpetrator – your survival and recovery
is not about them – It’s about you. Why
a hate crime or accident happens has
nothing to do with recovery. Finding peace
and moving through is what’s important.
The key is forgiveness, acceptance, moving
on, loving yourself and finding happiness.
Jackie, you’re now a motivational speaker
and try to inspire others on the road to
recovery. Do you have some additional
advice for survivors and their families?
Take one step at a time. Even though
it feels like you are getting nowhere, you
are getting better. Survivors can thrive
– not just exist. There are a lot of people
out there with brain injuries who are
doing better than before their injuries. Just
because I got shot in the head and lost
some of my vision and short-term memory
doesn’t mean I can’t succeed in moving
forward.
The first four years after my brain injury
were darks days. Even though I didn’t want
to get out of bed, brush my teeth, put my
makeup on, go outside and talk to people
– I did it anyway. I knew if I didn’t do it I
would get lost. One day I heard on a talk
show, “You need to behave your way to
success.” I realized that’s exactly what I
had been doing. Put one foot in front of
the other and get the help you need. Brain
Injury is a hard road, and I don’t wish it on
anyone, but I’m happy that I endured the
turmoil. To look back and see how strong
I’ve become is wonderful. If you keep at it,
you become a different person because of
the strength that comes from the endurance.
Live with no regrets. Appreciate what
you have and those who love you. t
NOTE: The hijacker who shot Jackie is
now serving a life sentence in Colorado.
Jackie’s Bio
Jackie & Scott divorced 3 years
after the hijacking. She stayed
single for 7 years and then married
her current husband – Jim. They
have been married for 10 years and
have an eight-year-old son.
Hobbies:
Jackie loves to workout and spend
time with her family.
Work:
Jackie speaks throughout the
country on the topic “The Courage
to Succeed.” She also authored the
book “Miles to go before I Sleep”
with Peter J. Kizilos, a freelance
writer.
Terror
On
Flight
737
M Magazine published an
article recounting the events of
November 23, 1985 on Egypt Flight
737. To download your PDF copy
of the article, log on to:
www.rainbowrehab.com & select
“What’s News”.
22
2006
Conference
& Event Schedule
March – June
March
March 9-11, 2006
2nd Federal TBI Interagency Conference Integrating Models
of Research and Service Delivery at the Hyatt Regency Bethesda
1 - 8 0 0 - 9 6 8 - 6 6 4 4 in Bethesda, Maryland
For info log on to www.tbi-interagency.org
e-mail: info@tbi-interagency.org or call: 973-243-6812
March 12, 2006
BIAMI Legacy Society Dinner & Auction at the St. John
Conference Center in Plymouth, Michigan
For info log on to www.biami.org or call: 810-229-5880
March 16 - 17, 2006
BIA of Iowa Provider’s Conference Best Practices in Head
Injury Service Delivery at Hotel Fort Des Moines in Des Moines,
Iowa. Contact Jean Kelly at 319-272-2312
March 16 - 17, 2006
BIA of Maryland Annual Educational Conference at the
May
13th Annual Conference on Neurobehavioral Rehabilitation
in Acquired Brain Injury at Hamilton Convention Center in
Hamilton, Ontario.
Call Georgia Georgiou at 905-521-2100 ext. 74499
or e-mail: georgg@hhsc.ca
May 10
Nightengale Nursing Awards at the San Marino Club in Troy, MI.
For info call Oakland University School of Nursing: 248.370.4081
May 11 – 13
Contemporary Forums Spinal Cord Injuries Conference at Las
Vegas Hilton in Las Vegas, NV.
For info log on to www.contemporaryforums.com
May 18
Michigan Health & Rehab Conference (formerly known as “The
Spring Rehab Conference”) at the Troy Marriott in Troy, MI.
For info log on to www.firsttoserve.com
or call all Sherri Szep at 248-829-8277
May 19
University of Michigan Health System/St. Joseph Mercy
Health System’s Rehabilitation Nursing Conference
“Advances in Rehabilitative Nursing: Delivering Acute Care
with a Restorative Focus” at Kensington Court in Ann Arbor, MI.
Call Carol Williams at 734-764-6326
or e-mail: cwms@umich.edu
Conference Center at the Maritime Institute, Linthicum Heights, MD
For info log on to www.neuroskills.com/events.shtml
May 31 – June 2
March 21
For info log on to www.firsttoserve.com
MSIA Conference at Grand Traverse Resort in Traverse City, MI
MI-ARN Annual Educational Conference 7:00 a.m. – 4:30
p.m. at Laurel Manor in Livonia.
Contact Kathleen Urban at 734-458-3350 or kurban@gchosp.org
March 21-25, 2006
Contemporary Forums Conference on Brain Injuries at the
Hyatt Regency in San Antonio, Texas
For info log on to www.contemporaryforums.com
March 25, 2006
The Complexities of Concussive Brain Trauma: Basic Science,
Assessment, Treatment and Outcome at St. Vincent’s Catholic
Medical Center 170 West 12th Street, New York City, New York
For info log on to www.nyacadtbi.org/060325.htm
June 2 – 4
June
University of Florida/MediPro Seminars: LLC Medical Coding
Program for Life Care Planners and Medicare Set-Aside
Specialists at Houston Marriott West Loop in Houston, TX.
For info log on to www.mediproseminars.com or call 866-633-4776
June 2 – 4
Caregiver’s Conference in Washington D.C.
For info log on to www.bia.org
June 13 – 17
CMSA National Conference at the Gaylord Texan Resort &
April 23 – 26
April
NICM/ACMA Clinical Case Management Conference at the
Rainb ow Visions
May 4 – 5
Renaissance Hollywood Hotel in Hollywood, CA.
Call Becky Nations at 501-227-5400 or e-mail: bnations@nicminc.net
April 23 – 27
RIMS 2006 (Risk and Insurance Management Society, Inc.) at
Hawaii Convention Center in Honolulu, HI.
For info log on to www.RIMS.org
Convention Center in Grapevine (Ft. Worth), Texas
For info log on to www.cmsa.org/Conference/2006TEXAN/
or call Michele Koch at 501-225-2229 ext. 18
Coming Summer/Fall 2006
2nd Annual L.A.P.S. Walk at the Michigan International Speedway
For info log on to www.lapswalk.org/
September 28-29, 2006
BIA of Michigan 26th Annual Conference “Transitions
throughout a Lifespan” at the Lansing Center in Lansing, Michigan
For info log on to www.biami.org
23
S P R IN G 2 0 0 6
Employee
News
WINTER
2006
– Notable Changes
11/05 Amy Hocken, CTRS - Recreational Therapist
Prior to earning her degree from Eastern Michigan University Amy interned here at Rainbow and now joins our therapy team.
Amy Hocken
12/05 Catherine Hahn, MS RD - Dietitian
Catherine earned her Masters in Human Nutrition from the University of Georgia. She comes to us with over seven years of experience with both in-patient and out-
patient treatment.
Catherine Hahn
12/05 Joanna Middleditch, CMA - Assistant Controller
Joanna comes to us with almost 20 years of experience in corporate accounting, public accounting and real estate. Joanna has earned her Masters in accounting and financial management from Keller Graduate School.
Joanna Middleditch
Promotions...
Robert Clark and Laurie Shipley have both taken on the added responsibility of Facility
Managers. Their additional duties include support to the Administrative Director as well as
monitoring and support of management efforts for a number of assigned facilities.
Robert has been with Rainbow for four years. Since his hire, he has taken on the
position of Residential Program Manager for Textile, Paint Creek and Whittaker facilities as
well as adding additional duties as Facility Manager to his already busy schedule.
Laurie has been employed with Rainbow since the start, in 1983. Currently, she not
only serves as Residential Program Manager for the Arbor Facility, but also shares her
knowledge as part of the management team for the Semi Independent Living Program
in Ann Arbor. Laurie rounds out her time as an employee trainer and now is adding her
responsibility as Facility Manager to the list. r
r
d
An
nual E
v
e
n
Laurie Shipley
Robert Clark
Summer 2006
“If you think it’s hard to meet new
people, try picking up the wrong
BIA Golf Outings
t
23
ball.”
Save the Date:
– Jack Lemmon
Tuesday JulyJune
18,28,
2006
Wednesday,
2006 • Plymouth, Michigan
The Inn at St. John’s (formerly St. John’s Golf & Conference Center)
Shotgun Start at 10:30am
(810) 229-5880 for More Information or
Register Online @ www.biami.org
2006 Eastern Gr and Invitational
July 18, 2006
Brain Injury Association of Michigan
Annual East Golf Outing at the St. John’s Golf
& Conference Center in Plymouth, MI
July 27, 2006
Brain Injury Association of Michigan
Annual West Golf Outing at the Boulder
Creek Golf Course in Belmont, MI
24
CMSA
Case Management Society of America
Detroit Chapter
MBIPC
Michigan Brain Injury Providers Council
Learn over Lunch
For further information log on to:
www.cmsadetroit.com
Scheduled meeting times are 12:00 - 2:00 pm
March 31st, 2006
Cost: Member $20 / Non-member $50
7 am registration / ends at 4:30 pm
full-day conference
For further information e-mail:
Lisha.Clevenger@rrciweb.com
Topic: Comprehensive Pain Management for Case Managers
and their Patients (Multiple Speakers)
March 14, 2006
Topic: Disease State or Medication Reaction?
Complex Presentations
Location: Burton Manor in Livonia, MI
Speaker: Roy J. Meland, DO-Neuropsychiatrist
1 - 8 0 0 - 9 6 8 - 6 6 4 4 Location: Holiday Inn South - Lansing, Michigan
April 11, 2006
RINC Meetings
Rehabilitation & Insurance Nursing Council
Topic: TBD
Speaker: Nancy Schmitt, PhD, RN, CCM
Allamerica Financial, Citizens Insurance
Members Only
Registration begins at 11:30 am
Followed by lunch / presentation at 12:00 pm
Location: Holiday Inn West - Livonia, Michigan
For more information contact
Adrienne Shepperd: (248) 656-6681
May 9, 2006
Topic: Post Acute Guidelines for Treatment of TBI
March 17, 2006
Speaker: Jay Meythaler, JD, MD
Topic & Location TBD
Location: Applause - Grand Rapids, Michigan
April 21, 2006
June 13, 2006
May 19, 2006
Topic: On Site Tour & Demonstration of
Auto Safety Equipment
June 16, 2006
Speaker: Chip Jackson, AutoLiv
Location: AutoLiv Headquarters Auburn Hills, Michigan
Answers to TEST YOUR KNOWLEDGE / WHAT IS SLP from page 29:
1. SLP’s or speech language pathologists evaluate and treat the speech, langauge,
Rainb ow Visions
cognitive, and swallowing disorders that individuals experience.
2. Another word for swallowing disorders is Dysphagia.
3. Better Hearing and Speech month is this May.
4. TBI stands for traumatic brain injury.
5. Communication is an essential part of our lives.
25
S P R IN G 2 0 0 6
MIS
Technology
Corner
will also receive
low-cost computers
http://www.co.oakland.mi.us/wireless/
and technological
www.wirelessoakland.org.
training. Oakland
INTERNET INFO
County will create
Oakland County Wi-Fi
a public/private
Written by
T
wireless internet access (wi-fi) sparked
Industry experts and information
partnership in which
technology professionals continue to debate
the private partner(s)
as to the security of wireless networks in
may charge fees for higher-end services with
businesses and communities. The ability
more bandwidth.
for a computer hacker to crack into such a
Tricia Seddon, MIS Director
he previous newsletter article about
Wi-Fi technology safety & security
The installation of the network is already
network and steal passwords, credit card
some interest in our Michigan readers,
underway and, by March 2006, seven areas
numbers, etc… is a concern to some. Some
specifically in the Oakland County area. In
of the county identified to pilot the network
believe the security measures to protect
February, L. Brooks Patterson announced (in
will have access. These areas include the
against this have come a long way and will
the State of the County Address) that a large
cities of Troy, Birmingham, Madison Heights,
continue to improve. There have been vast
scale project coined Wireless Oakland was
Oak Park, Pontiac, Royal Oak, and Wixom.
improvements made to wireless security, and
underway.
The goal for the entire county to have access
there are still some holes. This is no different
is year end 2007.
than a majority of the most commonly used
The Wireless Oakland initiative entails
the installation of a county-wide wireless
If you are in a pilot area, you should
technology. network. The objectives of this project
receive a notice when access will become
include preparing the Oakland County
available. To take advantage of this offering,
continues to stride towards more secure
workforce for the jobs and technology of the
you will need a computer, laptop, or PDA
environments with measures that are easy
future, improving the residential character of
with a wi-fi card. Some computers have wi-fi
to understand and set up. Security breaches
the community, and supporting the growth
cards built in or they can be purchased at
tend to headline in the news, but this doesn’t
of electronic government services. Access
retail computer stores.
necessarily depict the whole picture. To
to the internet and email will be available
The Wireless Oakland initiative is being led
The information technology industry
make sure your internet transactions are
for free at a low bandwidth to everybody
by Phil Bertolini, Deputy County Executive
secure, educate yourself on the measures
in Oakland County, including residents,
CIO. You can obtain more information,
that you can take with the software and
the workforce, and visitors. Certain areas
including maps of the pilot areas, at:
network that you are using. r
Ope ni ng th is Sp ri ng
Garden City
Apartments
A New Concept in Assistive Living...
• Affordable
• Family & pet friendly
• Internet access
• Wheelchair accessible
• Community Lounge area
• Fire suppression
• Generator backup
• Elevator access
For more information, call Admissions:
1.800.968.6644
26
Ask
Scott
Vicky
MEDICAL WATCH
Disease Prevention - Vaccines
Rainb ow Vis ions
1 - 8 0 0 - 9 6 8 - 6 6 4 4 Written by
Vicky Scott, RNC, NP Director of Nursing
D
isease prevention is the key to public
health and vaccines are the key to
disease prevention. Vaccines help prevent
infectious disease and save lives. Many
infectious diseases that were once common
in this country (whooping cough, German
measles, mumps, tetanus, and polio) have
been controlled by vaccines.
While the United States currently
has near record low number of cases of
vaccine- preventable diseases, the viruses
and bacteria that cause them still exist.
The world is a very small place with the
increase in air travel. Diseases are easily
spread country to country by travelers.
How does the immune system work?
You get sick when germs invade your
body. When measles virus enters your body
it gives you measles. Whooping cough
bacteria cause whooping cough, and so
on. It is the job of your immune system to
protect you from these germs. Here’s how it
works: Germs enter your body and start to
reproduce. Your immune system recognizes
these germs as invaders from outside your
body and responds by making proteins
called antibodies. Antibodies have two
jobs. The first is to help destroy the germs
that are making you sick. Because the
germs have a head start, you will already
be sick by the time your immune system
has produced enough antibodies to destroy
them. But by eliminating the attacking
germs, antibodies help you to get well.
Now the antibodies start doing
their second job. They remain in your
bloodstream, guarding you against future
infections. If the same germs ever try to
infect you again even after many years,
these antibodies will come to your defense.
Only now they can destroy the germs
before they have a chance to make you
sick. This process is called immunity. It is
why most people get diseases like measles
or chickenpox only once, even though
they might be exposed many times during
their lifetime. This is a very effective system
for preventing disease. The only problem
is you have to get sick before you develop
immunity.
How do vaccines help?
The idea behind vaccination is to give
you immunity to a disease before it has
a chance to make you sick. Vaccines
are made from the same germs (or parts
of them) that cause disease; measles
vaccine is made from measles virus, for
instance, and Haemophilus influenzae
typeB (Hib) vaccine is made from parts
of the Hib bacteria. But the germs in
vaccines are either killed or weakened
so they won’t make you sick. Then the
vaccines containing these weakened or
27
killed germs are introduced into your body,
usually by injection. Your immune system
reacts to the vaccine the same as it would
if it were being invaded by the disease by
making antibodies. The antibodies destroy
the vaccine germs just as they would the
disease germs. Then they stay in your
body, giving you immunity. If you are ever
exposed to the real disease, the antibodies
will be there to protect you.
Immunizations help develop protection
against future infections. The good news is,
with vaccines you don’t have to get sick to
get protection.
Are immunizations safe?
Experts who monitor the use of vaccines
agree that today’s vaccine supply in
the United States is the safest and most
effective in history. All vaccines undergo
years of testing before they are approved
for use. Once they become available,
vaccines are continually checked for
safety and effectiveness. Any problems
that arise can be reported to the Vaccine
Adverse Event Reporting System (VAERS),
which reviews the problem and further
investigates those determined to be vaccine
related. Appropriate actions are taken up
to and including withdrawing the vaccine
from use.
Immunizations are very safe, but they are
not perfect. Like any other medicine, they
can occasionally cause reactions. Usually
these are mild, like a sore arm or a slight
fever. Serious reactions are rare, but they
can happen. Your health care provider can
discuss the risks with you before you or
your child gets their shots. The important
thing to remember is that getting the
diseases is much more dangerous than
getting the shots.
How many shots does my child need, and
when?
Some children should get their first shot
(hepatitis B) before leaving the hospital
after birth. Others begin at two months of
age. You will have to return for more shots
S P R IN G 2 0 0 6
nearly as much as we used to. Measles
used to kill thousands of people in the
United States every year. In the 1940’s and
1950’s, tens of thousands of children were
crippled or killed by polio. As recently as
the mid-1980’s, 20,000 children a year
suffered from meningitis and other serious
complications as a result of Hib disease.
These diseases aren’t as common as they
used to be but they haven’t changed. They
can still lead to pneumonia, choking, brain
damage, heart problems, liver cancer and
blindness in children who are not immune.
They still kill children every year, even in
the United States.
several more times before the child starts
school. Your health care provider will tell
you when to come back.
Why do children need so many shots?
There are 12 potentially serious diseases
that vaccines protect against: Measles,
Mumps, Rubella (German Measles),
Diphtheria, Tetanus (lockjaw), Pertussis
(Whooping Cough), Polio, Haemophilus
Influenzae type b (Hib Disease), Hepatitis
B, Varicella (Chickenpox), Hepatitis A and
Pneumococcal disease. At least one shot is
needed for each of these diseases and, for
some of them, several doses are required
for the best protection.
This adds up to a lot of shots and several
are usually given at the same time. Some
parents worry that it is not safe to give
several shots at once. They feel that they
may not work as well or that they will
overload the child’s immune system.
But studies have shown these fears to be
unfounded. Vaccinations are just as safe
and just as effective when given together
as they are when given separately. The
immune system is exposed to many
foreign substances every day and will not
be overburdened by vaccines. Several
combination vaccines already exist (such
as MMR and DTaP) in which multiple
vaccines are given in a single shot, and this
reduces the number of shots needed. More
combinations are being developed, so in
the future, even fewer shots will be needed
for the same number of vaccines.
Why are vaccines given at such an early
age?
Vaccines are given at an early age
because the diseases they prevent can
strike at an early age. Some diseases
are far more serious or common among
infants and young children. For example,
up to 60% of severe disease caused by
Haemophilus influenzae type B occurs in
children under 12 months of age. Infants
less than 6 months of age are at highest
risk for serious complications of pertussis:
72% of children under 6 months who get
pertussis must be hospitalized and 84%
of all deaths from pertussis are among
children under 6 months. The ages at
which vaccines are recommended are not
arbitrary. They are chosen to give children
the earliest and best protection against
disease.
How serious are these diseases?
Any of them can kill a child. It’s easy
to forget how serious they are because,
thanks to vaccines, we don’t see them
What will happen if my child doesn’t get
these immunizations?
Basically, one of two things could
happen: (1) If your child goes through
life without ever being exposed to any
of these diseases nothing would happen,
or (2) if your child were exposed to any
of these diseases there is a good chance
he would get the disease. What happens
then depends on the child and the disease.
The child could get mildly ill and have to
stay inside for a few days. He could get
very sick and have to go to the hospital. At
the very worst, he could die. In addition,
he could also spread the disease to other
children and adults who are not immune.
If there were enough unprotected people
in your community, the result could be an
epidemic with many people getting sick
and some dying.
Isn’t getting all these immunizations
expensive?
It doesn’t have to be. Vaccines are free
if you take your child to a public health
clinic – for instance, a state or local clinic
– although you might have to pay a small
fee for the nurse to give the shots. If you
go to a private doctor, vaccines might
be covered by your health insurance. A
program called Vaccines for Children (VFC)
might pay for your shots if you are enrolled
in Medicaid, don’t have health insurance or
are an American Indian / Alaska Native. t
28
May is Better Hearing
&
Speech
y
p
a
r
e
Th
Month
coordinates nerve impulses to execute
activities such as speaking, swallowing and
thinking which can be disrupted when one
What is Speech Language
Pathology?
sustains a TBI.
Ryckman, MA, CCC-SLP
One in six Americans
has a hearing, speech or
language problem...
By Christine
1 - 8 0 0 - 9 6 8 - 6 6 4 4 The American Speech Language and
Hearing Association has identified the
life. It enables individuals to express their
month of May as Better Hearing and
wants and needs, develop relationships,
Speech Month. In recognition of this, I
learn and enjoy participating in day-to-day
have written this short article about what
life. One in six Americans has a hearing,
speech-language pathologist’s (SLP) do.
speech or language problem – a condition
that makes it difficult to communicate with
There are numerous areas of
communication and cognition that
others (1).
may be affected following a TBI. An
and treat the speech, language, cognitive
How a Brain Injury Can Cause Disruption
experience difficulty in some, but not
and swallowing disorders that affect many
in Communication
Who are Speech Language Pathologists?
SLP’s are those who identify, evaluate,
Between 2.5 and 6.5 million Americans
lives.
have had a Traumatic Brain Injury (TBI)
Why is Communication Important?
Anything that limits one’s ability to
What Skills May Be Affected
(2). Impairments resulting from sustaining
a TBI depend on the severity and location
communicate places limitations on their
of injury along with premorbid factors
life. Communication is an essential part of
such as medical history and age. The brain
individual who has sustained a TBI may
all, of the following: Word retrieval,
orientation, comprehension, problem
solving, intelligible speech, sequencing,
abstract reasoning, pragmatics, planning,
writing skills, language use, memory/recall,
attention and information processing.
These skills are important for many aspects
TEST YOUR KNOWLEDGE
Fill in the blanks below...
1. ________________________________________ evaluate and treat the speech, langauge, cognitive, and swallowing disorders
that individuals experience.
Rainb ow Vis ions
2. Another word for swallowing disorders is ________________________________________.
3. Better Hearing and Speech month is this _________________________.
4. TBI stands for ___________________________________________________________.
29
5. _____________________________________ is an essential part of our lives. (Answers on page 25)
S P R IN G 2 0 0 6
of everyday life such as working, attending
school, communication interactions or
living independently.
Goal of Speech Language Pathology
The overall goal of speech therapy is to
determine the changes in communication
and swallowing skills following a TBI
and to provide treatment to improve
skills. “Rehabilitation professionals must
provide two types of intervention: One that
facilitates restoration of basic cognitive and
communicative processes and another that
facilitates mastery, implementation, and
generalization of compensatory strategies”
(3). SLP’s, along with other members of
the therapy team, develop individualized
rehabilitation plans to meet the needs of
each client. Treatment during the initial
portion of the rehabilitation process is
typically provided in individual and small
group settings. As improvements are made,
treatment moves toward closely resembling
realistic, real world settings.
Swallowing Issues
In addition to helping individuals with
communication issues, SLP’s also treat
improvements over many years” (3).
Sources:
clients with swallowing difficulties. 30% –
Compensatory strategies are utilized to
1. American Speech Language & Hearing
61% of TBI’s result in swallowing disorders
ensure individuals are able to participate
Association (2005). Seek Help for Speech,
(3). The individual’s cognitive and motor
in many aspects of life – personal, social,
Language, and Hearing Problems, Advises
functions must be taken into account when
academic, and vocational – as they
National Health Association. Accessed
the assessment and treatment plan is being
continue through the rehabilitation process.
1/11/06: www.asha.org/about/news/
releases/05BHSMrelease.htm
developed. Swallowing treatment such as
teaching compensatory strategies and/or
If you would like more information
diet consistency modification often allows
on speech language pathology you
2. American Speech Language & Hearing
individuals to tolerate oral intake safely.
can contact any member of the Speech
Assoc. (2004). Communication Facts: Special
Continued monitoring of swallowing status
Department (Rainbow Rehabilitation
Populations: Traumatic Brain Injury - 2004
is essential for safety and progress.
Centers) at 1-800-968-6644. Alternatively,
Edition. Accessed 1/11/06: www.asha.org/
you can log on to the American Speech
members/research/reports/tbi.htm
Compensatory Strategies
“Some aspects of cognition and
communication may improve rapidly
with little intervention; other areas
Language & Hearing Association at www.
asha.org/findpro or call them at 1-800-
3. Hux, Karen (2003). Assisting Survivors of
638-8255. t
Traumatic Brain Injury: The Role of SpeechLanguage Pathologists. Pro-Ed: Austin. r
may progress more slowly, with gradual
30
The
LastWord
1 - 8 0 0 - 9 6 8 - 6 6 4 4 that brain injury facts
and information are
Front Line Perspectives
spread throughout our
Buzz Wilson, CEO
local communities. As a
rehabilitation provider,
I
n the interest of “Brain Injury
Rainbow requires
Awareness”, I thought I would do
I also try to determine what’s best for
something a little different. Over the
the individual and which goals should be
with acquired brain injury (ABI) – TBI
past year and a half, I have mentioned by
accomplished first – always starting with
(traumatic brain injury) facts should be
name several wonderful and competent
small steps. We might start with something
common knowledge.
Rainbow employees. These individuals
as simple as eating two ounces of food one
have impacted many lives with their
day and building to four ounces within a
resulting in a disruption of brain function.
dedication, expertise and unconditional
week. Or it could be building stamina by
Based on statistics from the Brain Injury
caring. They are on the “Front Line” and
getting a good night’s sleep so that they can
Association of America, traumatic brain
care 24/7 for our residential clientele.
make it through a full half hour therapy
injuries are a major public health concern
session. How much assistance each client
and are a leading cause of death and
a first hand education, I thought you,
needs can change from day-to-day, and
disability in children and young adults.
our readers, might be interested in their
our staff must always be ready to adjust
For survivors, brain injury is life altering.
experiences and opinions...
accordingly. Sensitivity to client needs
Many have serious physical impairments
helps the professional treatment team and
and a variety of cognitive, behavioral and
paves the way for rehabilitation goals to be
emotional complications. TBI costs our
met. All the small steps combined together
nation a staggering $56.3 billion each
lead to big gains.
year, and more Americans will experience
In the interest of real “Awareness” and
My Experience on the Front Line...
Hi, my name is Debbie, and I’ve been
My name is Betty, and I feel it’s important
A LOOK AT
Written by
working in the industry of brain injury
My reward for all the hard work is when
employees be trained to help those afflicted
A TBI is a blow or jolt to the head
brain injury than HIV/AIDS, breast cancer,
rehabilitation for 16 years
a client gives me that big smile as I enter
multiple sclerosis and spinal cord injuries
at Rainbow. Currently, I
the room and when family members brag
combined.
am the house manager at
about the Rainbow staff and programs. I
Crane, a home that serves
must say, on the whole, my “front line”
it’s the day-to-day experiences that really
clients with high medical
experience has been very rewarding.
hit home. Once, I had to pick up a new
and active therapy needs.
– Debbie May
When a client comes into my home, as a
caretaker I always look at that individual as
Statistics offer important information, but
client from the hospital who could not situp, walk or eat. I truly thought this child
Debbie May is a Residential Program
would never walk or talk again. Now, he
a whole person rather than concentrating
Manager at Rainbow. She has an Associates
lives at home, walks and speaks. In order to
only on their injuries. I always ask myself,
Degree in Business Management from
get this child back on his feet, the assigned
who else is involved in this person life?
Monroe Community College and is currently
Rehabilitation Assistant at Rainbow had to
Do they have family, friends and /or
pursuing Occupational Therapy Assistant
work closely with the nursing and therapy
an external treatment team? What part
(COTA) certification.
staff. Being part of the team that helped this
do those individuals play in the healing
Rainb ow Vis ions
The importance of TBI Awareness...
Previous professional experience includes:
child succeed in recovery was a wonderful
process? What was the person like before
Hazardous waste removal and clean up; a
experience – but wouldn’t it be better if
the injury and who will they become? For
Certified Nurses Aide Degree (1988); home
fewer children had these types of needs?
our clients, brain injury affects every aspect
healthcare experience with Monroe County
Let’s help build awareness and reduce the
of their life and, as a caregiver, I must
Program, staff builders and service as a private
incidence of TBI.
always remember that fact.
care technician for quadriplegics.
31
– Betty Williams
S P R IN G 2 0 0 6
professionals often fail to recognize and
to provide support to the survivors of
Manager and has been employed by Rainbow
validate those people who do not have
brain injury and their families, and to offer
for over 9 years. She came to Rainbow with
obvious physical dysfunctions resulting
continuous education to those who are
200+ hours of on the job training in Medical
from a brain injury – Instead they have
affected by brain injury. I also feel it’s my
Training Course Work and has a certificate
more subtle effects related to social
responsibility to provide the most effective
in Medical Billing from Marygrove College in
interaction, cognitive functioning and
advocacy for those entrusted in my care
Detroit.
emotional/mental health which can be
and to maximize their quality of life.
Betty Jean Williams is a Residential Program
equally devastating when these effects
– Marty Humphry
result in job loss, poor school performance
Prevention & Prevalence...by Laura
PREVENTION is the main idea that
and failing interpersonal relationships.
I believe that if we can accept and
Marty Humphry MA, LPC, CBIS is a
Rainbow Case Manager. She has her masters’
comes to mind when
support the diverse people in our lives,
degree in Guidance and Counseling from
I think of brain injury
we can learn valuable lessons, not just
Wayne State University in Detroit, Michigan
awareness. I’ve worked
in medicine and rehabilitation, but in
as well as a Bachelor of Science degree in
with individuals with
tolerance and awareness as well.
Criminal Justice from the same college. Marty
brain injury for 14 years
– Laura Konrad
and have developed
an awareness that has led me to make
is a Certified Brain Injury Specialist (CBIS).
She worked with youth and families in both
Laura Konrad OTR, NDTC, CBIS is
the juvenile justice and foster care systems.
more safety-conscious choices when
a Rainbow Clinical Team Leader. She
Her experience also includes individual, group
participating in sports, physical activities
has a Bachelor of Science degree in
& family counseling, case management and
and while in an automobile. As a child
Occupational Therapy from Eastern
court testimony/advocacy. Memberships
and young adult (before becoming an OT),
Michigan University and is a Certified
include: American Counseling Association
I would frequently ride my bike and horse
Brain Injury Specialist (CBIS). She came
(ACA).
without a helmet and occasionally ride in a
to Rainbow with experience in the field
car without wearing a seatbelt.
of brain injury and pediatrics where she
Now that I’m the parent of two young
utilized Sensory Integration and Neuro-
“It is said that when the student is ready,
children, I find myself making safety-
Developmental Therapy. Memberships
the teacher will appear” - Chinese Proverb
conscious choices. Some people in my
include: American Occupational Therapy
family jokingly refer to me as “The Helmet
Association (AOTA) and the American
fascinating career. I answered an ad for a
Nazi” or “The Seatbelt Nazi”. Even though
Association of Certified Brain Injury
new company specializing in brain injury
it is a humorous reference, to me it is quite
Specialists (AACBIS).
rehabilitation. After a week of orientation, I
simple: The results of a brain injury are so
devastating that there is no option but to try
In the early 1980’s, I embarked on a
felt content that this was the career for me.
My personal mission...
My name is Laurie, and
and prevent a tragedy. While a helmet or
Every 21 seconds, one person in the
seatbelt cannot eliminate all injury risk, it
US sustains a Traumatic Brain Injury. Out
take a wheelchair bound
seems that anything that lessens the effects
of the 1.4 Million that will sustain a TBI
client to purchase a new
of an accident is worth learning to use
each year, 50,000 of these victims will die.
pair of shoes. We arrived
correctly and using consistently.
Most of these injuries are preventable and
at the store, he picked a
that’s why creating awareness of this silent
brand and I decided to measure his foot.
epidemic is so important.
He measured a size 10. The salesman
When I think of brain injury, I also tend
to think in terms of PREVALENCE. I have
come to realize that so many people are
My name is Marty and
my first assignment was to
arrived and the client stated he wanted his
affected by brain injury: The person who
my personal mission as
selection in a size 11. Quickly, I corrected
has suffered the injury, friends, loved ones
a Case Manager working
him and said he needed a size 10. In a very
and caretakers. Unfortunately, society
in the field of Brain
loud voice he restated his desire for an 11.
as a whole and even some medical
Injury Rehabilitation is to
Using my therapeutic voice, I reminded
increase the awareness,
32
The Last Word
our travels to and from U of M Hospital.
Working with severe brain injuries can
him that I had measured his foot and that
be difficult but is a rewarding challenge.
life work and on my eighteenth birthday,
it clearly was a 10. He rolled his eyes and
My staff and I often reminisce about the
I began working in a group home. I have
informed me that since he did not walk
challenges of having three of our six
remained on this career path since that
(remember, he’s wheelchair bound) he
clients using augmentative speech devices.
time. It has always been important to
bought shoes bigger so that he could put
We called them “speech pacs”. You can
be employed in a good, solid program.
them on independently! That was my first
imagine the interesting conversations
I wanted to work for a facility that
of many lessons with a wide variety of
around the dinner table!
offered nice, well-supplied and very
wonderful teachers.
1 - 8 0 0 - 9 6 8 - 6 6 4 4 What this humble student has learned
The communication with my extended
clean accommodations. The home had
“Rainbow family” keeps us in constant
to be properly licensed with a trained
working with TBI individuals is what they
contact, so much so that we actually have
and well-mannered staff that delivered
want in life is to be respected, loved, have
each other on speed dial. It is a great
superior care all the time. After signing
a purpose and acceptance. Hum, isn’t that
feeling when you know that you have made
on with Rainbow, I realized this was
what we all strive for?
a difference in someone’s life.
the place I was looking for. I am able to
– Laurie Shipley
– Gwen Washington
manage my homes with full compliance
of standards set by the state while adding
Laurie Shipley is a Rainbow Residential
Gwendolyn Washington has been active
personal touches and delivering the best
Program Manager and she has specialized
in the field of brain injury rehabilitation since
possible service. My passion is residential
training in the field of traumatic brain injury
1985. She has extensive experience with the
programming, and I now fully understand
rehabilitation since 1983. Her experience
TBI population as a Rehabilitation Assistant,
the adage: Home is where the heart is.
includes developing and implementing semi-
Team Leader, Assistant Facility Coordinator
independent programs, follow-up support
and currently as a Residential Program
services, discharge planning and client
Manager.
advocacy. Laurie has a Liberal Arts Associates
Rainb ow Visions
This event affected me tremendously.
I vowed to make TBI rehabilitation my
– Tim Music
Tim Music has 17+ years experience
Gwen has a degree in Medical Assistance,
managing residential programs for individuals
Degree and is a Certified Brain Injury
from the Michigan Paraprofessional Institute
with developmental disabilities. Currently
Specialist (CBIS).
in Southfield, an associate’s degree in Science
a Rainbow Residential Program Manager,
from Wayne Community College and is a
Tim has experience in recruiting, scheduling,
Certified Brain Injury Specialist (CBIS).
management and the planning / development
Building relationships that make a
difference...
of vocational programs.
Hello, I’m Gwen and I
began working at Rainbow
My life ambition...
My experience with
Tim attended Washtenaw Community
College (General Studies) in Ypsilanti, MI and
as a Rehabilitation
traumatic brain injury
is State of Michigan Department of Mental
Assistant in 1985. Given
(TBI) began early. When
Health certified.
my years of experience
I was quite young, my
working in brain injury
father and I drove the
By now you have an idea of the
rehabilitation, you can imagine the
streets of Detroit with a close family
many interesting stories that I could tell
strength of the Rainbow team. There
member who had a traumatic brain injury
and, more importantly, the quality of the
are 500 such voices and they are walking
(TBI). At that time, TBI was not his primary
relationships that I have built.
ambassadors for the quality of care
diagnosis due to lack of information. Still,
These relationships are not only with
available not only at Rainbow but
we were trying to find a residential facility
the staff with whom I work and the clients
from many providers in Michigan. The
or program that offered good supervision,
I treat, but also with the families of these
citizens of Michigan should be proud.
was clean, had adequate programming and
clients. My stories include an incident
The delivery of quality care is our
offered mental health support. There were
nearly 20 years ago, and I still laugh with
mission. It will never be reduced to a
none to be found. Unfortunately, my close
a client’s family when I see them about our
“money game” as long as I am around. I
family member ended up in prison because
unique experience of getting lost during
am forever in debt to these folks – Their
there was no help for his condition.
inner strength sums up TBI awareness. t
33
– Buzz
S P R IN G 2 0 0 6
Employee of the Season
Winter 2006
Ann Arbor Apts.: Eric Pylkas
APFK I: Errin Chatman
Autumn 2005
Arbor: Akeshia Speight
Rehabilitation Assistants:
House Manager:
Ann Arbor Apts: Michelle Orr & Lamont Miller
Debbie May
APFK I: Kathy Cousins
APFK II: Derek Glen
Professional Therapy Staff:
Arbor: Rodney Davis
Rick Herman
Bemis: Talisa Brown
Matt Ban
Briarhill: Kecia Dixson & Darlene Townsend
Wilbur the Therapy Dog
Brookside: Duane Jones
Carpenter: Roxanne Green
Administration:
Denton: Victoria Smith
Kim Paetzold
Elwell: Karen Fischer & Mario Harvey
Kim Waddell
Gill: Jaime McCourt
Bob Adams
Glenmuer: LaShaunedra Steed
Belleville: Terrance Wilson
Bemis: Charletta Felder
Briarhill: Glen Kurz & Terrance Priestly
Brookside: Ebony Davis
Carpenter: LaTease Lykes
Denton: Lauren Taylor
Gill: Juanita Washington
Glenmuer: Johnnie McCall
Golfside: Kelley Rains
Highmeadow: Anise Chappell
Hillside: Lisa McCollister
Home Health: LaMetra Smith (LS)
& Kelly Burba (SB)
Maple: Evelyn Williams
Golfside: Kelly Wagner
Page: Tanya Tell
Highmeadow: Tonia Russell
Paint Creek: Ella Walker-Lyles
Hillside: Christa Craddick
Home Health: Joann Kilgore (LS), Jacqueline R. Mitchell (RS), Marocca Davis (SB) &
Christina Bauchat (Page)
Southbrook: Candice Nelson
Stoney Creek: Scott Clausen
Talladay: Shanika Smith
Textile: Quania Atkins
Maple: Cynthia Woods
Townhouses: Joyce Williams
Page: Michael Monford
Westmoreland: Bridgette Fox
Paint Creek: Shane Cole
Whittaker: Michele Murphy
Southbrook: Leesa Smith
Woodside I: Marketta Crutcher
Stoney Creek: Terri Schweim
Stoneham: Laura Sarten & Judy Hartman-Brown
Talladay: Amy Hall & Anders Oygarden
Textile: Jean Grishaber
Woodside II: Pamela Scott
House Manager:
Rell Lee
Townhouses: Amy Martinez
Westmoreland: Johnnie McCall
Professional Therapy Staff:
Whittaker: Betty Onwumere
Woodside I: Cassandra Taylor & Pat Nash
Woodside II: April Chisholm
to our
s
n
o
i
t
a
tul
Congra
taff! S
g
n
i
d
n
Outsta
Marty Humphrey
Kathleen Sobczak
Administration:
Cheryl Helber, Tiffany Alexander
& Nicole Phelps
34
Rainbow Rehabilitation Center
Locations:
Ypsilanti Treatment Center
5570 Whittaker - PO Box 970230
Ypsilanti, MI 48197
734.482.1200
Oakland Treatment Center
32715 Grand River Avenue
Farmington, MI 48336
248.427.1310
For more information call toll free...
1-800-968-6644
E-mail: rainbowvisions@rainbowrehab.com
P.O. Box 970230
Ypsilanti, Michigan 48197
Presorted Standard
U.S. Postage
PAID
Permit 217
Plymouth, MI
If you do not wish to receive copies of Rainbow Visions, please e-mail: rainbowvisions@rainbowrehab.com

Jackie Pflug Clinical Newson Susan Connors

Transcription

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