Rainbow A Quarterly News Magazine for Acquired Brain InjuryVisions Professionals, Survivors and Families www.rainbowrehab.com Rainbow Rehabilitation Centers, Inc. Volume IV No. 2 March is Brain Injury Awareness Month 2007 Spring TBI & Post Traumatic Stress Disorder Dual-Diagnosis & Treatment

Interview with Military TBI & PTSD Survivor Charlie Morris Mark Evans & Vicky Scott, NP on Rainbow’s NeuroRehab Campus Helmet Technology Advances–Part 1 | 2007 TBI Conference Dates March2007 is brain injuryAwareness month.

What’s News in the Industry which severely shake the brain within the skull, have become the signature injury of Raising Awareness the War in Iraq. These blasts often cause

By Bill Buccalo, President devastating brain injuries, and patients may have long-term cognitive, psychological and medical consequences. The most severely injured service members will arch is Brain Injury Awareness York Times article, Dr. Bennet Omalu, a require extensive rehabilitation and lifelong Month. Raising public awareness University of Pittsburgh neuropathologist, personal and clinical support. of the “silent epidemic” of brain injury recently examined the brain tissue of We are concerned about whether the is important in the fight to decrease the former NFL player Andre Waters. Mr. Department of Veterans Affairs (VA) can Malarming number of injuries sustained each Waters (44 years old) had committed fully address the needs of our service year; to increase the access to services suicide in November subsequent to men and women on a variety of fronts. for those who have sustained an injury, as a period of depression. The doctor During a September 2006 hearing of the well as to create a more compassionate concluded that Mr. Waters’ brain tissue House Veterans’ Affairs Subcommittee and understanding community in which had degenerated into that of an 85 year old on Health, a statement for the record survivors live. Many people in the industry man. He believes this was due in part, to indicated that the 20-year healthcare cost have stated that we should not focus sustaining successive concussions while estimate for TBI could exceed $14 billion. awareness on just one month, rather we playing football. The League states they are Additionally, although the VA has an should be working to raise awareness beginning a study of their retired players to established network of TBI Lead Centers every day. Over the past few years, there look at general issues related to concussion. around the country (currently there are has been more discussion in the media However, we believe the League as well four locations), partnerships with private regarding brain injury than I can ever as colleges and high schools all need to providers will likely become necessary recall. take more proactive steps to deal with in order to adequately address needs of Leading up to this year’s Super Bowl, concussions and the issues surrounding veteran TBI survivors. Clinical services there was a great deal of discussion and return to play (see RainbowVisions Fall should be delivered in the communities media attention surrounding the NFL’s 2006 issue at www.rainbowrehab.com for where they live. In addition, there have handling of concussions and return to play extensive information on concussion related been news media accounts and reports by policies. Multiple concussions sustained topics.) veterans with TBI who claim that the VA’s by Pittsburgh Steeler quarterback Ben In this issue of RainbowVisions, the brain injury care is not up to par, requiring Roethlisberger as well as the recent news focus is on war related brain injuries. Of them to seek out rehabilitation services in stories on the death of former player Andre particular interest are our veterans returning the private sector. Waters have spurred the discussion. It was from war. More than 2,700 American We need to meet these challenges by nice to see Mitch Albom and his colleagues men and women have died and nearly ensuring a robust VA healthcare system spend significant airtime in the hour prior 20,000 more have been wounded since as well as an unprecedented level of to kickoff confronting the issues. fighting began in 2001. Traumatic brain interagency cooperation so that together According to a January 18th New injuries (TBIs) resulting from bomb blasts, Continued on page 3

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Survivors and Families. Injury Professionals, gazine for Acquired Brain Visionsc. IV No. 2 a rs, In Volume RainbowA Quarterly News M Rainbow Rehabilitation Cente ab.com www.rainbowreh Table of On the March is Brain Injury Awareness Month tress Disorder TBI & Post Traumatic S Treatment Clinical article on Dual-Diagnosis & Spring 2007 Charlie Morris Contents Interview w/ Military TBI & PTSD Survivor & Vicky Scott, NP on Rainbow’s NeuroRehab Campus Cover Mark Evans | 2007 TBI Conference Dates Helmet Technology Advances–Part 1 Photo by Fred J. Pushies of U.S. INDUSTRY NEWS Military members of the Central What’s News in the Industry – Brain Injury Awareness 1 Command area of operations using ground mobility vehicles BIAA Media Release on Cognitive Therapy 3 (GMVs). RainbowVisions ABI Clinical News – Treatment of Dual Diagnosis TBI & PTSD 5 thanks Mr. Pushies (Author & Technology Corner – Helmet Technology Advances (Part I )–Military 11 photographer of The Complete Behavior Analysis – An Implicit Technology for Generalization, Part II 17 Book of U.S. Special Operations Forces for contributing several of his photographs for this Industry Conference & Event Calendar 25 publication. Pictured below: Fred Pushies in front of an MH-53 Pave Low with the Air Force Special Operations Command. TBI SURVIVOR STORIES Survivor Corner – An interview with US Navy Veteran Charlie Morris 7

INSIDE RAINBOW NeuroRehab Campus Interviews with Mark Evans, Program Director

& Vicky Scott, Nurse Practitioner 15 Notable Changes – NeuroRehab Campus newly hired professionals 19 Rainbow Satisfaction Survey – 2006 results 21 Rainbow Visions editor & designer – Kimberly Paetzold TBI Child Focus Series – When Children are Injured / Part 4 27 Assistant editor – Mary Mitchell The Last Word – Rainbow’s Valued Leadership 29 Staff photographer– Heidi Reyst Employee of the Season – Fall 2006 30 E-mail : [email protected]

A Specialty Transportation Company We offer personalized, attentive and expert transportation services for individuals with special needs throughout Southeastern Michigan.

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Getting around just got easier! RainbowVisions 2 Raising Awareness by Bill Buccalo, President Continued from page 1

word. I would like to take a moment to each and every quarter. And lastly, thank thank all of the clients and family members you to all the Rainbow employees and the who have been brave and shared their extended network for all of the work and we are focused on meeting the specialized stories over the years. I would like to thank dedication you show to all of our clients. needs of our returning soldiers. all of the contributors of articles and all of Keep raising the awareness. As an organization, Rainbow employees those who have subjected themselves to work to be advocates for those living with interviews and photographs to help spread If you have any questions or comments, the affects of brain injury and to increase the word, to educate and help others. I feel free to contact me at: the level of community awareness every would like to thank Kimberly Paetzold, our [email protected] day. Our RainbowVisions News Magazine RainbowVisions Editor, for her outstanding has been one outlet for us to spread the work in putting this magazine together

The Brain injury Association of America BIAA (BIAA) has published a position paper (11/2006) regarding their view on the Media Release treatment of cognitive dysfunction. The on Cognitive Therapy paper discusses research evidence of cognitive therapy and brings to light the burden on caregivers/survivors because of Lack of Funding for Rehabilitation

coverage limitations. Following is the Media January 8, 2007 Media Release Release (January 8, 2007). Copies of the position paper can be obtained by visiting Access to cognitive rehabilitation is a way organization and daily activities such as the BIAA web site at www.biausa.org of helping brain-injured patients regain calendars, pagers, alarms or PDAs. function in areas that are essential for a “The benefits of cognitive rehabilitation MEDIA RELEASE McLean, Virginia, January return to independence and a reasonable have been discussed in more than 700 8, 2007 – The Brain Injury Association of quality of life. published research studies and are evident America (BIAA) today released a position “Cognitive rehabilitation can help in positron emission tomography (PET) statement that calls on lawmakers and people regain their independence, but scans and other neuroimaging techniques,” private sector payers to eliminate barriers many insurance companies deny coverage said Dr. Douglas I. Katz, Brain Injury to access and delivery of cognitive claims and public health agencies limit the Programs Medical Director at Braintree rehabilitation treatment for patients with scope, duration and timing of treatment,” Rehabilitation Hospital in Braintree, acquired brain injuries. said Susan Connors, BIAA President and MA, and first author of the BIAA’s Cognitive Rehabilitation: The Evidence, CEO. “Patients with brain injury and family position statement. “Numerous scientific Funding and Case for Advocacy, addresses caregivers suffer because of lack of access organizations and professional societies the fact that an overwhelming majority to this important treatment modality.” have adopted treatment guidelines and of brain injury survivors have cognitive Cognitive rehabilitation is a acknowledged the value of cognitive impairments, or thinking problems and that systematically applied set of medical and rehabilitation.” they often have challenges accessing the therapeutic services provided by physicians The BIAA believes that cognitive treatment modality that has been shown and allied health professionals to improve rehabilitation should be provided by the through research to benefit them the cognitive functioning after brain injury. The existing national network of qualified most: Cognitive rehabilitation. Cognitive treatment requires patients to work through practitioners who have fulfilled the impairments interfere with the brain-injured thinking exercises that restore attention, requirements for certification and licensure patient’s ability to function effectively memory, word recall and other language in their respective fields. Dr. Mark J. in school and at work and also have an abilities. Brain injury survivors also Ashley, Chairman of the Board of BIAA impact on their personal relationships. learn to use tools to help with planning, and President/CEO of the Centre for

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Neuro Skills headquartered in Bakersfield, as an excuse to withhold payer support for • Expanded clinical education and CA, cites the current needs of the ever- treatment. “Many people who sustain brain certification for allied health practitioners increasing number of servicemen and injuries make remarkable recoveries when who work with brain-injured patients women returning from Iraq with blast they get the appropriate treatment,” said • Increased emphasis on research brain injuries as an immediate opportunity Dr. Gregory J. O’Shanick, BIAA Medical • Improved integration of cognitive to demonstrate the advantages of Director and President/Medical Director of treatment in public vocational and social accessing this service provider network. the Center for Neurorehabilitation Services, services “The Veterans’ Administration (VA) has PC in Richmond, VA. “We can learn much • Greater attention to the particular advocated for advancing rehabilitation more about what works through additional needs of brain-injured children in throughout its history and stands to lead research, but we need Congressional special education so they can move the way to promotion of better treatment support to do so. The Traumatic Brain seamlessly throughout their lives within a availability for our servicemen and Injury (TBI) Model Systems, housed in the comprehensive, coordinated system of care women,” said Ashley. “The opportunities U.S. Department of Education’s National that is designed to improve their level of for substantial functional improvement Institute on Disability and Rehabilitation functioning, independence and, ultimately, associated with cognitive rehabilitation Research, hasn’t had a pay raise in years. give them back some of the skills and are especially relevant for these returning It is time to increase our investment in abilities stolen by their brain injury. heroes. While the VA does not currently applied research as well as examine have the capacity to treat the large number coverage denials and payment practices in About the BIAA–Founded in 1980, the of servicemen and women returning with the public and private sectors as related to mission of the BIAA is to create a better traumatic brain injury, it should consider treatment for victims of both traumatic and future through brain injury prevention, contracting with civilian partners and acquired brain injury.” research, education and advocacy. The providers in the private sector who have Moving forward, the BIAA advocates BIAA and its nationwide network of state been providing these services for many the following priorities to provide a more affiliates, chapters and support groups years to the nonmilitary sector.” comprehensive continuum of care for represent the 5.3 million Americans who The BIAA acknowledges the need for brain-injured patients: live with a lifelong disability as a result of additional research on the benefits of • Expanded public and private payer TBI, as well as their families, researchers, cognitive rehabilitation for brain-injured coverage of sufficient scope, duration and clinicians and professionals who provide patients. It also believes that the need for intensity to accommodate the changing treatment and long-term care. For more further exploration into the benefits of and long-term needs of patients with brain information about brain injury or the BIAA, cognitive rehabilitation should not be used injury visit www.biausa.org.

2007 LEGACY SOCIETY AWARD WINNER

The Community Service and Leadership Award will be presented to Bill Buccalo at the BIAMI’s Legacy Society 9th Annual Tribute Dinner & Auction

Sunday, March 11th at the Inn aton St. John’s in Plymouth, Michigan.

This award recognizes an individual who has rendered exceptional community services and leadership skills that advanced the mission of the BIAMI along with benefiting the community and/or persons with brain injury and their families.

RainbowVisions 4 Acquired Brain Injury Clinical News who were married before the Vietnam War became divorced within six months of D U A L D I A G N O S I S returning home. Treating TBI & PTSD I had the pleasure of talking with two very brave people. The first is a man who By Colin King, Ph.D. Director of Adult Behavioral Services willingly and unselfishly placed his life on the line on behalf of his country. The second is a special education teacher who nother Mountain to Climb was caught in the line of fire. Charlie joined the navy as a young Mike’s heart is pounding wildly in his naïve teenager in 1969. Little did he Achest like a jackhammer crushing concrete. According to the Walter Read Army realize that the next few months would His throat is parched and feels drier than Medical Center in Washington, between be the most traumatic time of his life. the arid desert that hasn’t seen rain in January 2003 and February 2005, After only eight months in the navy, months. The voices in his head yell with a physicians (at Walter Reed) treated more and while returning from a mission, his feverish intensity “pull the trigger,” “shoot than 450 wounded service members for helicopter came under intense hostile fire. him now!” Everything moves in slow TBI. Among patients exposed to explosive The helicopter did not come down, but motion. What actually is a split second blasts, 60% were diagnosed with TBI Charlie took a hit directly to the head. The seems like eternity. Mike knows he must and roughly half of these cases were bullet entered behind his ear and exited shoot this kid. “He is a kid, I can’t shoot categorized as moderate to severe. It is through the top of his head. The only thing him!” Mike mutters as cold sweat gushes further documented in the book Nam Vet that kept Charlie from falling out of the down his forehead. Even as Mike utters the by Chuck Dean that 38% of battle survivors chopper was a mangled seat belt, which words he knows he must take action. This held him. The next few months were filled same 10-year-old kid has just detonated with medical complications and surgery explosives strapped to his bicycle, killing ...more than 25% of (military) after surgery. The most devastating part 10 marines. The kid was now riding quickly bomb blast survivors have was the resulting sequealae from the TBI. away most likely contemplating his next Charlie experienced extreme paranoia, attack. Mike deftly takes aim and cradles sustained a TBI. night terrors, sleep depravation and a host his finger around the trigger. His feet are of other psychological disorders directly shaking uncontrollably as if they were dry leaves in an autumn wind. A split second before he pulls the trigger, he hears the all too familiar voice of his wife shouting, “Mike! Mike! Wake up! You are having those night terrors again.” With a violent jerk, Mike tosses the sweat drenched sheets off his clammy sleeping clothes as he simultaneously gasps for air. “OK! OK! I’ll go for counseling this time. I can’t take these night terrors anymore.” Mike’s plight is not dissimilar from thousands of other war veterans who have sustained physical and psychological trauma from battle. Many of the unsung heroes and heroines suffer in silence and more often than not, in obscurity. Photo courtesy of Fred Pushies courtesyPhoto of Fred

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Traumatic events are marked by a sense of horror, helplessness, serious injury, or the threat of serious injury or death. related to the injury and the effects of Post Traumatic Stress Disorder (PTSD). Common Responses to a Traumatic Event Charlie spent many nights sleeping with a big knife above his bed and a loaded gun Physical Emotional underneath his bed. Things became so bad Nausea Shock that Charlie turned to alcohol for relief. Light-headedness Numbness However, the alcohol only made his short- Dizziness Feeling overwhelmed term memory worse. Thanks to a supportive Gastrointestinal problems Depression family, Charlie was able to get help. He Rapid heart rate Feeling lost managed to quit drinking, complete college Tremors Fear of harm to self and/or loved ones and is currently working as a peer mentor. Headaches Feeling nothing Charlie is the author of the book, Just A Grinding of teeth Feeling abandoned Regular Guy (For more on Charlie’s story Fatigue & poor sleep Uncertainty of feelings see page 7 for a survivor interview.) Pain Volatile emotions Jackie, on the other hand, was not Hyper-arousal & jumpiness a Vietnam veteran. She was a special education teacher who was flying to Cairo, Cognitive Behavioral Egypt from Athens Greece when the aircraft Poor concentration Suspicion & irritability she was traveling on was hijacked by three Confusion Arguments with friends/loved ones terrorists. Jackie was shot at point blank Disorientation Withdrawal range in the head, tossed onto the tarmac Indecisiveness Excessive silence 25 feet below and left for dead. As she Shortened attention span Inappropriate humor drifted in and out of consciousness, Jackie Memory loss Increased/decreased eating used every ounce of energy in her body Unwanted memories Change in sexual desire/functioning Difficulty making decisions Increased smoking to stay alive. The days, weeks, months Increased substance use or abuse and years that followed were filled with apparently insurmountable challenges. Source: Department of Health–Centers for Disease Control and Prevention Jackie’s faith and indomitable will Coping With a Traumatic Event: www.bt.cdc.gov/masscasualties/copingpub.asp has helped in her recovery. She has been a guest speaker on syndicated talk shows such as Oprah and Larry King Live. She has also Signs & Symptoms of a Mild TBI been featured in numerous articles around the world Physical Behavioral Cognitive such as Eden Prairie News, Headaches Irritability Concentration problems The Malta Times and a Nausea Depression Attention difficulties Dizziness Anxiety Memory problems host of other newspapers. Insomnia Sleep disturbances Orientation problems One common thread Fatigue Problems with emotional control that weaves through the Uneven gait Loss of initiative fabric of both Charlie’s Blurred vision Problems related to: Employment, and Jackie’s stories is their marriage, relationships and battle to overcome the home/school management ravages of the combination Source: Department of Health–Centers for Disease Control and Prevention of PTSD and TBI. Traumatic Brain Injury Facts; www.bt.cdc.gov/masscasualties/explosions.asp Continued on page 10 Photo courtesy of Fred Pushies courtesyPhoto of Fred

RainbowVisions 6 Traumatic Brain Injury Survivor Hello Charlie, Thank you for interviewing Corner with RainbowVisions. Could you tell us a little about your gunshot wound incurred

AN INTERVIEW WITH during the Vietnam War? It’s interesting because I consider Charlie Morris everything from the time I was shot until I went home to be a miracle and a blessing. By Kimberly Paetzold, Editor I still get chills thinking about it. I was shot by enemy fire–the bullet from an AK-47 harlie Morris grew up in Ohio with went in behind my ear and came out on the ambition to join the Navy and the top of my skull. I was wearing a plastic learn a trade. He married in 1966 and helicopter. As he swung back, he realized jet jockey helmet and the bullet made a three years later fulfilled his dream of he was hit. small hole in the back and completely Cjoining the Navy. After completing his Charlie was transported to Long Binh shattered the top where it exited. I actually training, Charlie was stationed in Vietnam and was prepped for neurosurgery. The fell out of the helicopter after I was hit, as part of the Navy Seawolves. Eventually result of his injures included right side with only a safety strap preventing me he became part of the Sealords, a group paralysis with the prognosis to spend from falling to the ground. I hung outside that served as a pickup/delivery service to the rest of his life in a wheelchair. After the helicopter the entire way back to the and from Seawolf detachments in the field. his Navy discharge, through hard work firebase. On January 9th, 1971 Charlie was and determination Charlie was able flying a mission in the Mekong Delta with to overcome and manage his physical ...the bullet... two rookie helicopter pilots. Flying fast disabilities and eventually was accepted and low, the helicopter followed a canal. into Kent State University in 1972. He went in behind my ear As they passed a village they noticed earned his college degree in 1977. and came out on the something odd – it was empty. All of a Charlie became a High School Teacher sudden they heard small arms fire and, as and taught marketing education for 18 top of my skull. the crew chief, Charlie tried to locate the years. Over the years, he endured not only source. As he swung outside the door to get the physical and cognitive issues associate Even though the doctors doubted me, a better look, Charlie saw a lone man in the with traumatic brain injury, but also I remember the moments right after I was doorway of a hut pointing an AK-47 at the learned to cope with a severe case of Post- shot. I knew I was hurt bad and I thought Traumatic Stress Disorder (PTSD). that if I closed my eyes that I would die. So He retired from teaching in 1995 and I did all I could to remain conscious and with the help of the VA’s Vocational awake. When they finally got me to the Rehabilitation department, mobile surgical hospital at Long Binh I was purchased a professional embroidery fortunate that there was a brain surgeon machine and began a small business. stationed there, as I never would have That business was sold in 2006, and survived the long flight to Japan. The left Charlie now works as a volunteer side of my head now has a plastic plate splitting his time between the VA instead of skull bone. There were so many helping PTSD survivors and as a shell and bone fragments, the surgeon counselor for brain injury survivors. decided to remove a section of the brain In 2006, he published the book Just instead of removing the fragments. A Regular Guy, based on his life story, and professionally speaks to What were some of the problems that you PTSD Veteran Groups, Brain Injury suffered after you came home? Groups and TBI Associations. Aside from working very hard to speak and walk again, the most difficult problem Charlie (left) and his son Matt I faced over the years was coping with

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Post Traumatic Stress Disorder (PTSD). It Did you have cognitive therapy to help you deeply affected my life. I still suffer with cope with the effects of brain injury? bouts of depression, but with counseling I didn’t have formal TBI cognitive and training I can identify the signs and rehabilitation, but I did get support from Charlie playing tennis symptoms before it takes hold. What I did the VA. I wanted to attend college and discover going through all of this is that only had reading skills at a 7th grade level individuals with brain injury and PTSD can because of my injuries. A therapist from get a lot of outside help, but true recovery the VA worked with me to get my skills is up to the individual. up to college level so I could apply. We One therapist told me, “Charlie you’re worked hard and I did get into college. My probably the only person I’ve ever ran four-year degree was finished in 1977, and into that PTSD counseling made a big I began working as a teacher. difference.” When someone said I wasn’t capable of doing something, I would get You just recently celebrated your 40th angry and do whatever I could to prove wedding anniversary and your wife, Fran, them wrong. I wanted to live a normal life. has been a wonderful support to you. I didn’t want people to see my disabilities–I How did she cope with everything over just wanted them to see Charlie Morris. the years? In the end, I didn’t turn out to be like I have a PTSD joke I like to tell–When everybody else, I actually achieved more people say, “Your wife is really something - than the average person because I did not she must really love you!” I say, “Either that want my injury to define who I was. or she’s just crazier than me.” From the very beginning, Fran was How did you overcome the disabling very supportive. In fact, the more I effects of PTSD? accomplished, the more she expected. I admitted myself into a VA hospital Some of our fights were because she would for mental health counseling. The PTSD expect things I truly could not do. She caused me to have terrible sleep problems often said, “Charlie, you’re able to do so and anger issues. The combination of the many things that sometimes I just forget two led to some severe depression. To that you have a disability.” For example, give you an idea of how anger affects Continued on page 9 individuals with PTSD, let’s assume the average individual walks around with anger level at about 1 (we’ll use a scale of 1 being peaceful and 10 being extremely angry). Then let’s say that individual gets really worked up. They may reach an anger level at about 5. The veteran with acute PTSD starts out with an anger level at about 7 or 8–that’s how they are without being provoked. You can imagine that even small issues can set an individual like that off on a tirade. Then when you add the issues associated with TBI, such as disinhibition, you have someone with real problems. My PTSD training on anger management really has helped me. Holding back the issues Charlie playing golf Pictured above: Charlie (right) and his wife Fran on their 40th wedding anniversary. associated with this affliction isn’t good.

RainbowVisions 8 An Interview with Charlie Morris Continued from page 8

once when I was working on her car and I I found my work, myself and my God.” needed an extra pair of hands since I only We can get past the notion that the have the use of one arm. She was busy and disability is “The most terrible thing got really indignant about helping me. I that has happened to me” and instead became angry, and finally she remembered realize that we have the opportunity to that I had only one working arm and really change direction. did need her help. It’s nice; people close I once heard a man speak and he to you look at you the way you want to be said, “I have a BRAIN injury, not a seen. MIND injury.” Our mind still works and our job as survivors is to find a way to You mentioned that your faith has given tap into it. Maybe you won’t be able to CHARLIE’S BIO you a lot of strength and helped you in go back to college, but perhaps you are your recovery. Can you elaborate? artistic or you have some special ability. FAMILY: Charlie Morris (59) is married to You look at survivors and wonder why Perhaps it’s listening and volunteering to Fran, his wife of 40 years. they can’t see that it takes faith to recover. help others. I have to admit, I get angry He has one son–Matthew (33). When I was in combat in Vietnam, I lost with myself that I didn’t get involved a lot of my belief because of the things with helping others suffering with PTSD HOBBIES: Charlie loves the outdoors & I witnessed. Those who lose all faith are sports: Golf, tennis, camping and fishing. all alone. They have nothing to hold on He also enjoys cruising in his vintage to. If you don’t have faith in something or Take little baby steps in Ford Torino. somebody, you don’t have anything. I have recovery and don’t only a speech topic where I speak on what I feel PETS: The family has a Britney Spaniel (5 are the four keys to success. Number one concentrate on years old) named Winstin. is faith, second is family, third is friends, taking big leaps. and fourth is fortitude. As nice as it is to have faith, family and friends, when you are disabled, fortitude also becomes a key and TBI earlier. I always thought, even brain injury so now I’m not going to try factor to success. You have to be able to when I was teaching school, that maybe I anymore” where would that have gotten go out there and risk making a fool out was in the wrong profession. I always felt me? That attitude doesn’t make sense to of yourself. When you are a TBI survivor, that maybe I should put my energies into me. People shouldn’t spend too much time you have to realize that it’s OK to fail. You helping other wounded veterans, to help blaming others, their situation and their life aren’t going to succeed at everything. As them see the benefits they can bring to status. You can’t change things unless you I get older I realize that we need to relish their local communities. Hopefully now I change yourself. and celebrate the small successes–not just am finally making this a reality. the big ones. We always focus on achieving Charlie, in your experience volunteering big and lofty goals and never give ourselves Charlie, you are so positive and energetic, to help TBI & PTSD survivors, how does a credit for the daily triumphs because they I think that’s why you’ve been so dual diagnosis affect individuals trying to seem small. As Helen Keller said, “I yearn successful. How can other survivors reach recover? to accomplish great tasks, but realize that your level of achievement? Those attempting to help TBI survivors small tasks accomplished are great.” It’s not a special quality that only I have. must take it slow and make sure they If we can take little baby steps in our It’s in ALL of us. There is nothing so special truly understand what the therapy and recovery and don’t only concentrate on about me. Dig inside yourself and look groups are trying to accomplish. Due to taking big leaps, then we can feel satisfied for your own personal successes. Don’t memory loss, that becomes difficult and and realize that there is much we can do. constantly look at others and compare. reinforcement is necessary. Even those Another quote by Helen Keller is “I am Realize that failures are inevitable. If I suffering with PTSD can have memory thankful for my handicaps–through them would have taken the attitude, “I got a Continued on page 14

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Treating PTSD & TBI by Dr. Colin King, Ph.D., Dr. Colin King, Ph.D. Continued from page 6 Director of Adult Behavioral Services at Rainbow Rehabilitation Centers, Inc. What is Post Traumatic Stress Disorder (PTSD)? Education: Ph.D. in Counseling Psychology from According to the Diagnostic and Wayne State University in Detroit, Michigan. Statistical Manual of Mental Disorders Experience/Specialty: Dr. King has more than 13 years (DSM-TR), PTSD is defined as an anxiety of experience as a psychologist with clinical practice. disorder that develops after exposure to a His focus consists of severe behaviors, dual diagnosis, terrifying event or ordeal in which grave substance abuse and the treatment of psychiatric disorders. Dr. King is active in the physical harm occurred or was threatened. education and supervision of master’s level students in the study of psychology. Psychologists agree that the diagnosis of PTSD requires the symptoms to be present for at least one month and interferes with one’s normal level of functioning. can be identical in certain areas, making interventions. Physicians can prescribe Survivors who experience PTSD typically treatment potentially complicated and Selective Serotonin Reuptake Inhibitors experience the following: difficult. PTSD and TBI symptoms that may and other antidepressants that have shown • A re-experiencing of the event or events overlap include attention, concentration, promising results. through flashbacks or nightmares. memory, anxiety and irritability problems. Continued on page 20 • Having an intense physical and Issues unique to TBI would be distinguished emotional reaction to the event. by such symptoms as increased processing • Feeling that one can never relax for fear time, problems with abstract thinking, ...about 30% of Vietnam of something happening. muscle fatigue, loss of coordination and People who have been involved in car problems with speech, hearing, vision etc. combat victims suffer accidents are sometimes afraid to drive, A number of treatment options for this from Post Traumatic Stress tend to avoid freeway traffic or, if they dual diagnosis currently exist and include are being driven, become easily upset if pharmacological and or psychological Disorder (PTSD). they sense something is going to happen. Being upset or afraid are not necessarily abnormal reactions to such stressors. However, reliving the trauma to the point where one becomes emotionally paralyzed is suggestive of an acute response.

How often does PTSD occur? According to the National Institute of Health roughly 3% of people in the general population experience PTSD in the age group 18-52. In contrast, about 30% of Vietnam combat victims suffer from PTSD. The rate of PTSD for The Persian Gulf War veterans is about 8%.

How does one deal with the dual diagnosis of TBI & PTSD? The symptoms of mild TBI and PTSD

RainbowVisions 1 0 TechnologyABI Corner

Helmet Technology

By Kimberly Paetzold, Editor

istorically, the incidence of traumatic brain injury (TBI) in the military has always been high compared to the civilian population–even in peacetime H(see Figure 1.) Of course, incidence levels rise during times of conflict. According to government statistics, about 14-20% of combat survivors in previous wars sustained a TBI. Even though we don’t with gunfire and shrapnel wounds. of two-pieces: An outer steel shell and have firm statistics from the current Iraq Improvised Explosive Devices (IEDs) a separate inner liner containing the and Afghanistan conflicts, blast injuries are a huge problem in Iraq–one of the suspension system. The helmet shell was have become common, and it has been most mine-infested nations in the world. stamped from a single sheet of manganese suggested that over 50% of injuries Helmets offer protection against shrapnel steel with a chinstrap made of cotton sustained in combat are the result of and gunfire and can help reduce some webbing. explosive munitions. injuries when soldiers encounter bomb During the 1970’s, researchers looked Due to medical advances, people are blasts. The head receives up to seven times to reduce the weight of the M-1 helmet. surviving head injuries that only a few more wounds than would be expected They wanted something that fit better and decades ago would have proved fatal. given its size relative to the body. With the Personnel Armor System Ground Troops Improvements in combat medicine and statistics showing that head injuries are body armor have reduced casualties on more likely to be fatal, helmets play a vital Figure 2 the battlefield. According to some reports, role in protecting our troops. about 86% of all American soldiers wounded in the Iraq and Afghanistan Recent History of the Military Helmet conflicts have survived their injuries–the The U.S. M-1 Helmet highest percentage in the history of In 1941, the M-1 “steel pot” helmet made warfare. In contrast, about 75% of all its debut (see Figure 2.) This helmet was casualties survived in both the Persian Gulf designed to protect against flying fragments and Vietnam War. and extended down the sides and back Brain injury is prevalent in these conflicts WWII M-1 Helmet of the wearer’s head. The M-1 consisted because of bomb blasts in combination Figure 3

Figure 1 TBI Military Incidence Level in Peacetime It is estimated that 9 in 10,000 U.S. civilians suffer a TBI each year. In peacetime, the incidence level in the military population rises to an estimated 22.5 per 10,000 for active duty male soldiers and about 15 per 10,000 for active duty female soldiers (Rose.) Those numbers rise during times of conflict. Photo courtesy of DuPont

Kevlar Helmet 1 1 RainbowVisions www.rainbowrehab.com SPR i n G 2 0 0 7

(PASGT) or “Kevlar” helmet was the answer The story of Stephanie L. Kwolek & Kevlar and became standard issue in the 1980’s (see Figure 3.) This helmet is a one-piece tephanie L. Kwolek developed the first structure composed of multiple layers of Sliquid crystal polymer which provided Kevlar ballistic fiber and phenolic PVB the basis for the Kevlar® brand fiber. Ms. resin. It is designed to provide ballistic and Kwolek earned a degree in chemistry from fragmentation protection. According to what is now Carnegie Mellon University DuPont, the four-pound helmet lined with and joined DuPont in 1946. Several years up to 24 layers of Kevlar are up to 40% into her career at DuPont, she was asked more resistant to shrapnel compared to the to help develop the next generation of old steel helmets used in the Vietnam War. high-performance fibers. At the time, there One of the problems associated with were fears of a global energy shortage and the M-1 steel helmet was that it was only researchers where struggling to develop available in one size. The Kevlar helmet a stiffer and tougher nylon-related fiber. is available in five sizes, from XS – XL DuPont wanted something that would make weighing between 3.1 pounds (XS) to 4.2 tires lighter and cars more fuel-efficient. pounds (XL). Typically olive drab in color, In 1965, Kwolek came up with an this helmet can be fitted with cloth covers amazingly strong fiber through experiments Stephanie Kwolek in varying camouflage patterns (Figure 4.) with compounds called polymers, Photo courtesy of DuPont Continued on page 13 collections of molecules that form chains. DuPont refined the fiber and named it Kevlar®. It was a flameproof, ultra-light fiber initially made to reinforce the tread of radial tires, but tire makers developed cheaper steel-belted Figure 4 radials. During the same period of time, a DuPont colleague of Kwolek’s, Joseph Rivers, was looking for material to use in bulletproof vests and today Kevlar is best known for its application in the field of bullet-resistant personal body armor. Current applications for this lightweight and strong fiber are many–Kevlar is used in boats, airplanes, ropes, cables, tires, tennis racquets, skis, etc.—in total about 200 applications. Stephanie Kwolek has received many awards for her invention of the technology behind Kevlar fiber, including induction into the National Inventors Hall of Fame in 1994. In 1996, she received the National Medal of Technology, and in 1997 the Perkin Medal, U.S. Army helmet with camouflage presented by the American Section of the Society of Chemical Industry. r cover. This one served in Iraq. Sources: www.chemheritage.org/classroom/chemach/plastics/kwolek.html

How does a TBI blast injury occur? Photo courtesy of Fred Pushies

Blast injuries result from the complex pressure wave generated by an explosion. The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast over pressurization wave. Most susceptible to injury are air-filled organs such as the ear, lung, gastrointestinal tract and organs surrounded by fluid-filled cavities such as the brain and spine. The over pressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion. In a blast, brain injuries can also occur by other means such as impact from debris, the individual being physically thrown, burns and/or inhalation of gases and vapors. Even soldiers not in close proximity to the blast can sustain a concussion or mild TBI, and it is feared that many go unidentified. r RainbowVisions 1 2 Helmet Technology Continued from page 12

Figure 5 It has a two-point chinstrap and a cradle- Four-point Chinstrap Design type suspension providing space between the head and inner helmet surface allowing The new four-point chinstrap for ventilation and deformation during anchors over the ear–one strap impact. One major criticism of the Kevlar in front and behind the ear on helmet is the strap suspension system–It is each side–securely holding the considered unstable, allowing movement helmet in place. and skull-helmet contact when force such as a bomb blast is applied. The two-strap “pocket” at the In 2000, the Army of Safety Engineers chin remains the same tested whether the weight of the Kevlar helmet increased neck injuries or caused other problems in accidents. The evidence from real-world analysis showed that composed partly of comfort foam (where Most of the material was removed from Kevlar helmets appear to protect against the pads touch the head) and mostly of the front of the helmet, with a smaller head injury and are not necessarily “slow-memory” impact foam with the amount removed from the sides. The ACH associated with neck injuries. The PASGT resilience of a wrestling mat. The foam was designed to absorb energy in order to system has been subject to a number of is like a shock absorber against a striking reduce head injury risk during blunt impact modifications over the years including bullet. A special cloth covering helps events. a newer lightweight helmet shell and absorb moisture, keeping soldiers cooler. changes in the suspension system and Also different is the four-point chinstrap 3. Lightweight (LWH) Helmet straps. (see Figure 5.) The two-strap “pocket” at The United States Marine Corps will the chin remains the same as the Kevlar replace the standard Kevlar helmet with Today’s Technology helmet, but instead of anchoring over the Continued on page 24 Although the new helmets don’t look all ear, one strap in front and behind the ear that different, they have improved in almost on each side securely holds the helmet. every way with new materials improving This strap system is seven times more The Army launched a study on the fragmentation protection and the ability to stable than the Kevlar, so these helmets effectiveness of the new Advanced stop a direct hit from a 9mm round. Lab won’t move or fall off. There are three new Combat Helmet in late 2005, amid testing showed a 40% improvement in helmets the military has introduced. concerns that it offered less protection impact protection. The new, lightweight due to its reduced size. Surveys ballistic helmets incorporate excellent 1. The Modular Integrated revealed that roughly half the soldiers protection with the ability to interface with Communications Helmet (MICH) in the field were wearing their helmets most tactical communications headsets Although molded like the Kevlar improperly, increasing the risk of and microphones. What else is different? helmet, the MICH trims away the edge for injury including concussion. The The innovative seven-pad suspension improved visibility, unobstructed key to successful helmet protection system. The suspension pads are hearing, reduced weight (less than 3 pounds) and easier integration with body is a proper fit. The fit, the wear, and armor the placement of pads all affect Four-pound helmets lined with vulnerability. In addition, the helmet up to 24 layers of Kevlar are up to 2. Advanced Combat Helmet (ACH ) is just one item of personal protective The ACH is slated to replace the Kevlar equipment and needs to be worn in 40% more resistant to shrapnel helmet in the future with advanced features conjunction with other pieces such as compared to the old steel helmets based on the MICH helmet design. It is the interceptor body armor with the smaller, reducing the area of coverage, but collar on and ballistic eye protection. soldiers used until the 1970s. improving the field of vision and hearing– providing maximum sensory awareness.

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Charlie Morris, Continued from page 9

There are a lot of veterans out there with can be done. PTSD and TBI will not go loss, making group sessions and therapy coping issues, and they want to become away. Just like someone with alcoholism, difficult. I am currently involved with successful in overcoming them. they will always have to deal with it. But groups of veterans that have PTSD and we The one thing I have found to be if you can adapt and use the coping tools are using the PTSD manuals to also help constant is that survivors can have all the available, when problems arise you will be TBI patients. We want to help them with help in the world, but until they decide to in control and succeed! t their relationships and coping abilities. help themselves, there is nothing that really

“An inspiring survivor story!”

Just A Regular Guy

The story of Charlie Morris growing up in Ohio with the ambition to join the Navy, learn a trade and raise a family. His life took an abrupt turn when, in 1971 while serving in Vietnam, he was hit by enemy sniper fire while on a helicopter mission in the Mekong Delta. The result of his gunshot wound in the head was right side paralysis with the prognosis to spend the rest of his life in a wheelchair. Through hard work and determination Charlie was able to overcome his disabilities and eventually earn his college degree. Despite his physical limitations his desire was to fit into normal society without standing out from the crowd. His believe that life’s hardest battles were behind him was shattered when the effects of Post- Traumatic Stress Disorder (PTSD) invaded his life. This book is a heart-warming story of a traumatic brain injury and PTSD survivor that managed to flourish and help others along the way.

“One of the people I admire most is Helen Keller. My favorite quote from her is one of her most famous: When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which had been opened for us.” – Charlie Morris

“Charlie is quite a person. How he changed from someone who really hated school to becoming a High School Teacher AFTER incurring his injury is amazing. I think the Navy gave him purpose and pride.”

“It has been interesting to see the reaction from readers who personally know Charlie. It’s like a light bulb went off–Charlie does have a disability. It was such a shock for people to read this story because he never outwardly displayed that he was having any difficulties.” – Dean Siegman, Writer

Dean Siegman currently works as a free-lance writer. He began working with Charlie on the book “Just A Regular Guy” in 2005. He conducted interviews with Charlie for approximately three months and spent nine months compiling the information. The book was published in May of 2006. Dean Siegman

RainbowVisions 1 4 Meet NRC Rainbow Professionals

INTERVIEWS WITH... Mark Evans, Program Director & Vicky Scott, Nurse Practitioner

By Kimberly Paetzold, Editor

ark Evans, MA, CRC, CBIS, northwest corner of the current residential Could you tell us about the residences at is the Program Director for Rainbow’s facility, behind the garden. This will the NeuroRehab Campus? NeuroRehab Campus. be a temporary therapy space until the Each residence has a dining room, family MMark earned his Master of Arts Degree permanent building is constructed, but or community room and both facilities from Eastern Michigan University and almost all therapies will be handled here. share an activity room and salon. Almost Wayne State University, is a Certified The new state-of-the-art Neuro Therapy all of the bedrooms are private–with the Rehabilitation Counselor and a Certified Center building will include a pool and exception of a few suites–and each room Brain Injury Specialist. He has experience should be completed in 18 to 24 months. has a private bath. Bedrooms are equipped in the field of brain injury rehabilitation Rainbow’s Oakland Center is located for phone, Internet access and cable in a variety of areas, both clinical and just four miles away on Grand River in TV (clients will need to have their own administrative. Mark originally joined Farmington. Many clients will have the personal computer and e-mail account). Rainbow Rehabilitation Centers in 1988. opportunity to participate in activities Clients are welcome to bring some of at this location from time to time. The their own furniture and belongings to Hello Mark. We have had quite a few Oakland Therapy Center has an accessible personalize their room. questions regarding our newly opened swimming pool and a large activity room, NeuroRehab Campus. Could you tell us among other therapy spaces. How will Meals be served? a little bit about this campus setting and Meals will be served family style in the what it has to offer? How will clients get into the community dining room. Cynthia Jeffrey, Rainbow’s The campus currently consists of two for personal appointments, outings, home Executive Chef, will be preparing the twenty-bed facilities that are licensed as visits and the like? menus and managing the kitchen. Menus Adult Foster Care homes by the State of Rainbow will use the same therapeutic will be selected with input from clients, Michigan. These homes will house adults model of rehabilitation as we currently do our registered dietician (Catherine Hahn) with brain and/or spinal cord injuries. in our other facilities. We will maintain speech pathologists and our chef. Entree Each client will have access to Rainbow’s a number of vehicles on-site to assist options and side dishes will be available full Continuum of Care including active our clients in getting out for community at each meal for variety and to provide a therapy, community outings and supported events, appointments, therapy sessions and well balanced diet. We will have the ability living for individuals with medical needs. personal shopping. Special transportation to prepare meals for specialty diets, heart In the next few weeks, we will have a requests will be scheduled in advance to healthy diets, mechanical soft, pureed therapy building placed just outside the ensure appropriate resources are available. foods, no-added salt, no-added sugar and other special meals as needed.

1 5 RainbowVisions of monitoring. Staff will have improved The prescriptions, when physician writes access to a nurse when issues arise. them, will be delivered that same day. Treatments (IV antibiotics, dressing Medications will be passed from carts changes) or conditions that require nursing that are packed by the pharmacy and intervention and/or assessment will be double-checked by our nurses. Clients taken care of by the nurses on-site. who get their medications from a mail- Rainbow has hired three full-time nurses order provider or other source will be and three contingent part-time nurses to accommodated. icky K. Scott, R.N.C., N.P., has provide this coverage. There are both RNs a Master of Science Degree in Nursing (Registered Nurse) and LPNs (Licensed Will there be a physician rounding at the from the University of Michigan in Ann Practical Nurse). The NeuroRehab nurses, NeuroRehab Campus? Arbor, Michigan. She is a Certified Nurse as a group, have years of varied nursing Rainbow’s Medical Director, Dr. Owen VPractitioner and Certified Neuroscience experience. The nurses names are Virginia Perlman, will be rounding at the facility Registered Nurse. Vicky has many years of “Ginny” Dory, Vickie Bey-Walker, Diane monthly. Dr. Perlman is a Physical varied clinical experience, including being Knotts, Paula Nichols and Rebecca Smith, Medicine and Rehabilitation Physician a Nurse Practitioner with Neurosurgical who is coming back to cover a few shifts. (PM&R) who specializes in traumatic practices in Ann Arbor, Michigan and Please welcome them. brain injury. He has a long history of Lexington, Kentucky. She has experience as The Rainbow nursing staff has been involvement in the development and a Clinical Nurse Specialist in neuroscience actively involved in training the staff that implementation of quality rehabilitation at Genesys Regional Medical Center, will be working with the clients at the programs for survivors and is well known working closely with the trauma team and NeuroRehab Campus. Training included for his clinical skills in treatment and neurosurgeons treating acute traumatic sections on diabetes care, medication management of the full spectrum of brain brain injury. Vicky also has four years administration, tracheostomy care and injury. experience providing primary care in a suctioning, tube feeding and intermittent Dr. Owen Perlman is the Medical rural Michigan Family Practice. Vicky will straight catheterization. Our Speech Director at Rainbow Rehabilitation Centers lead the Nursing Team at Rainbow’s new and Language Pathologists provided and the cofounder of Associates in Physical NeuroRehab Campus. instruction on swallowing issues and food Medicine and Rehabilitation, P.C. For a consistencies that included a simulated full biography, Vicky, could you tell us how nursing lunch. (The food was real.) please log coverage will be handled at Rainbow’s new on to www. NeuroRehab Campus? How will pharmacy services be handled? rainbowrehab. Let me preface my answer by saying Kentwood Pharmacy will provide com and select how excited we are as a company and pharmacy services. They will bubble pack professional as a nursing staff to be able to provide our medications as they currently do in staff under Adult 24 hour/ 7 day-a-week nursing coverage the community homes and deliver them to Brain Injury. t for our clients. Having on-site nursing the NeuroRehab Campus. Kentwood will coverage will provide an increased level provide a dedicated driver for our building.

RainbowVisions 1 6 ABI

Behavior learn by living example. Incorporating Analysis all the necessary cues (visual, hearing, touch, etc.) and rewards (praise, attention, physical contact, tangible items) provides the framework for AN IMPLICIT TECHNOLOGY FOR success. Generalization Train Loosely By Joseph J. Welch, MS, LLP Behavior Analyst “Loosening” control means providing natural opportunities to solve unique everyday challenges not usually fter graduating college in 1989 and encountered in treatment sessions. Aworking in sales and marketing, Joe Typically, rehabilitation environments Welch became really interested in the non- I reviewed three of the eight identified are quite complex and dynamic, so plans economic reasons as to why people “do procedures that propose specific that are inflexible often become obsolete. the things they do.” After a return to school methodologies to improve Generalization. Thinking the right way is the only way to to study behavioral psychology in 1996, Joe They included: do things is inaccurate. Training loosely graduated with a second bachelor’s degree 1) Train and Hope better reflects the natural world, dynamic summa cum laude. His interest in helping 2) Sequential Modification current conditions and allows individuals people change blossomed into a passion. 3) Introduction of Naturally Maintaining to achieve success or failure through real Pursuit of a graduate degree in 1997 in Consequences life experiences. behavioral psychology, with internships The remaining procedures, covered in as a psychometrician at St. Joseph Mercy this review, are identified as improving Using Indiscriminable Contingencies Hospital and as a psychotherapist at successful rehabilitation and attributable to Intermittent schedules of reinforcement Eastern Michigan University’s Snow Health Generalization are: are the most powerful way to encourage Center, led to graduation and limited 4) Train Sufficient Exemplars learning and reliably produce functional licensing as a psychologist in 1999. 5) Train Loosely behaviors that are more resistant to The majority of work since that time 6) Use Indiscriminable Contingencies extinction. First, reinforcing every single has been as a behavior analyst working 7) Program Common Stimuli trial then slowly making the schedule with people who sustained brain injuries 8) Mediate Generalization intermittent is naturalistic and the most and also as a contractual psychotherapist. effective way to build skills! Making it Mr. Welch is a life long Ypsilanti resident, Train Sufficient Exemplars appropriately challenging to determine married with two young sons. His pastimes Considered one the “most valuable if the learning contingencies are still in including friends, exercise and numismatics areas of programming,” training sufficient effect promotes learning. Situational factors (the study and collecting of coins and exemplars is defined as; rewarding that influence life and activity are highly medals.) appropriate behaviors in certain settings complex, and treatment plans that are too and then adding more settings (one after predictable do not model real life. Simple Classic Article Review Part II another) with more rewards until the plans, that may be effective at first, can A classic article of literature, “An desired performance can be reliably become “too predictable” and not take Implicit Technology for Generalization” expected. This technique–gradual into account important motivating factors. (Stokes & Baer, 1977) was reviewed in introduction of additional settings–has Natural living environments involve many an earlier edition of RainbowVisions– shown to provide a powerful effect of variables difficult to decipher for the Winter 2005/2006. It best describes daily living skills generalizing for greater individual and encourage experimentation what comprehensive behavior analysis independence. Differential attention has to maximize exploration and achievement. services can provide for people recovering been used to reinforce appropriate speech in residential rehabilitation settings. In habits in treatment sessions, then it is Programming Common Stimuli: review, Generalization is defined as the applied systematically in other settings What are the common denominators acquisition of skills in one specific area (i.e. at home) to promote generalization, in most treatment? We, the rehabilitation of rehabilitation and the subsequent or and then finally in environments such as workers, are one. Living environments eventual improvement of performance in community outings. Rehabilitation Staff are another. When clients become stable other areas of functioning. who demonstrate how and what to do and independent in their residence and In the Classic Article Review Part I, provide clients with opportunities to re- at the treatment center, the likelihood is

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greater that they will operate on this level gaining greater skills often are faced overnight change from being wheelchair in new environments. Quality training with “problem solving” situations, which dependent to using a walker full-time! for staff and therapists to implement therapists describe as managing a problem By recognizing and reinforcing positive program procedures reinforces functional not encountered before. I have witnessed behavior, this individual continues skill acquisition. This is the best way to clients actually using this term themselves to progress. The probable effects of describe the programming of common and it reminds them to “step back” from behavioral momentum and simply stimuli. Our clients get better quicker the situation, explore alternatives and even recording successful trials to use the when rehabilitation staff are trained to do wait for solutions to make themselves clear. walker encouraged this profound leap in the same things as the therapists (and vice Finally, “training to generalize” involves functioning. t versa.) Utilizing the same techniques across reinforcing generalization itself as if it For a complete copy (part I & II) of the continuum of care provides consistent were a specific behavior. One of the most this classic article review, please log on programming. significant examples of generalization to www.rainbowrehab.com and select effects I have witnessed was an individual Education/Publications - Article downloads. Mediating Generalization rewarded for the absence of problem Reference: Mediating generalization is defined behaviors–specifically, self-injury Stokes, T. F.; & Baer, D. M.; An Implicit as teaching habits and skills that can be and physical aggression. One of the Technology for Generalization, Journal of Applied Behavior Analysis, 1977, 10, 349-367. utilized for problems or situations. Clients unpredicted side effects was the almost

Garden City Apartments

Family & Pet Friendly Garden City Apartments offer a unique and supportive family environment where residents with traumatic brain injury are empowered to work toward therapy and recovery goals. At Rainbow’s Garden City Apartments, adults can reside as a single, as part of a family, or as parents caring for their children–Rainbow’s Staff provides the necessary support.

To download a brochure log on to: For a tour or more information call... www.rainbowrehab.com select Education/Publications 1.800.968.6644

RainbowVisions 1 8 Professional News FALL / WINTER 2006 & 2007 – Notable Changes

11/06 Dr. James Gall, Ph.D., B.C.S.M – Behavioral Analyst / Mental Health Dr. Gall is a board certified psychologist in Acute Stress Management. Prior to joining Rainbow he served as the chief staff clinical psychologist at St. Joseph’s Hospital for 15 years and has been a professor at Oakland University since 1996. He also maintains a private practice in Rochester Hills, Michigan. Dr. Gall joins Rainbow in the Oakland County area working with adult clients as a Behavioral Analyst.

11/06 Virginia Dory, LPN – Nurse Dr. James Gall Virginia comes to us with 40 years of experience as an LPN in long-term, hospice and in the hospital care. She will man the midnight shift at Rainbow’s NeuroRehab Campus.

11/06 Nicole Rondini, OTR – Occupational Therapist Nicole has joined the Pediatric Program at the Oakland Center. Having earned her Virginia Dory Masters of Occupational Therapy from Grand Valley State University, Nicole brings with her OT experience in the home health setting, visiting clients with varied needs.

1/07 Vickie Bey-Walker, LPN – Nurse Vickie joins our nursing team with over 20 years of experience in a variety of fields, including long-term care and community outreach programs. Vickie has extensive Nicole Rondini experience in HIV/Aids counseling and education. Vickie will serve as a nurse at our new NeuroRehab Campus as well as a “Touch Base” group counselor.

1/07 Paula Nickols, LPN – Nurse Paula joins the NeuroRehab Campus team as an LPN with over 5 years of nursing Vickie Bey-Walker experience in both long-term care as well as providing nursing services for Wayne County Correctional Facility. Prior to her career in nursing, Paula worked as a direct care provider, which gives her special insight into level of care our clients require.

1/07 Amanda Miuccio, OT – Occupational Therapist Amanda did her internship here at Rainbow and has earned her Masters of Occupational Therapy from Eastern Michigan University. She spent four years working within a hospital Amanda Miuccio inpatient care setting prior to joining us. Amanda will provide therapy in the Ypsilanti and Oakland Centers assisting clients with independent living skills

1/07 Katrina Johnson, LPN – Nurse Katrina Johnson Katrina is joining Rainbow as a field nurse in Oakland County. She earned her MBA from Davenport University and comes to us with 20 years of experience in direct patient care within long-term care and home health settings.

1/07 Derek Glenn, OT – Occupational Therapist Please welcome Derek Glenn to the Ypsilanti Center as an OT. Derek has been employed with Rainbow as a rehabilitation assistant and assistant RPM in the Oakland area. Derek Derek Glenn worked his way through school while employed at Rainbow and we are thrilled to have him join us full-time.

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Treating PTSD & TBI

by Dr. Colin King, Ph.D, Continued from page 10 them work through the trauma (American and therapeutic environment for survivors Journal of Psychiatry, Archives of General to recover. Invariably, the road to recovery After working with combat victims psychiatry). and integration into society is plagued and TBI patients, I have found both Group therapy with TBI survivors and with psychological and social land mines. individual and group therapies to be combat victims has also shown promising However, with the help of trained staff, effective. Individual therapy helps to results. Individuals experience what some compassionate family members and forge a therapeutic working relationship psychotherapists term “Universality.” This support from significant others, individuals where the person learns to trust again. means they experience symptom relief can overcome that previously thought Often, rebuilding trust is a huge issue. For knowing that someone else in the group insurmountable mountain-TBI. t understands what they are going through. instance, someone who was involved in Sources: a car accident as a passenger may have Given the problems with attention and Amstrong, K, Best, Suzanne & Domenici, P (Courage After Fire) 2006 a difficult time being driven by someone concentration that surface subsequent else. This same lack of trust is seen with to a trauma, it is critical that individuals Dean, Chuck (Nam Vet) 2000 some combat/PTSD survivors. Jackie Pflug, relearn how to focus, problem solve and National Institute on Mental Health (Reliving Trauma: Post-Traumatic Stress Disorder), 2001 the survivor of a terrorist gunshot head execute executive functioning tasks. Some Marks, I Lovell K, Noshirvani H et al. Treatment of wound, was afraid to go outside–she feared TBI treatment providers, like Rainbow posttraumatic stress disorder by exposure and /or a terrorist would once again find her. Rehabilitation Centers, employ speech cognitive restructuring: a controlled study. Archives Psychological interventions include therapists, occupational therapists and of General Psychiatry, 1998; 55(4) group therapy, cognitive behavioral mental health specialists to assist in Lubin H, Loris M, Burt J, et al. Efficacy of psycho therapy and exposure therapy. These developing compensatory strategies so educational group therapy in reducing symptoms of posttraumatic stress disorder among multiple different modalities have shown efficacious individuals can properly deal with their traumatized women. American Journal of Psychiatry, results in helping survivors gradually and deficits. 1998 155(9): 1172-7 repeatedly relive the terrifying event under As a treatment provider, we are charged New England Journal of Medicine 2005;352:2043- controlled conditions and have helped with the responsibility of providing a safe 2047

About Jackie Pflug

On Thanksgiving weekend in November of 1985, Jackie Pflug was flying to Cairo, 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 and after the terrorists took control they began to execute one passenger every 15 minutes. Jackie, an American citizen, was shot and left for dead. 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.

Rainbow has a new website with Jackie’s full story and interview. New @ Log on for a complete list of survivor interviews and articles. www.rainbowrehab.com select Education/Publications

RainbowVisions 2 0 Survey Results

close to meeting our target for the groups RAINBOW REHABILITATION that had a statistically adequate sampling of respondents–Families & Guardians 2006 Satisfaction Survey of Residential Adults, Outpatient (Adult & Pediatrics) and Case Managers. In By Heidi Reyst, Ph.D., CBIST Systems Director three of the six catagories or scales, the number of surveys returned was too low (less than 7 respondents) to ensure a n an annual basis, Rainbow sends a representative sample and therefore are not satisfaction survey to all consumers: included. Those scales include: Family/ Clients, families & guardians, case Guardian Pediatric Residential, Claims managers, discharge planners and claims • The level of client activity on Representatives and Discharge Planners. Orepresentatives. The focus of this article weekends We would like to thank all of our is on external parties and families. Client • The price charged as compared to families, Case Managers, Claims satisfaction will be addressed in the next services rendered Representatives and Discharge Planners issue of Rainbow Visions. • The safety of our programs. that participated. Overall, we feel good In 2006, we sent out 1,119 surveys with The survey scale used for all of the about the results. There are areas of 105 being returned–almost a 10% response assessments is illustrated below. (For an strength that demonstrate the quality of rate. We assessed satisfaction over a wide overview of descriptive statistics used for programming we feel we provide. There variety of areas; a sampling of the items analysis, please see the sidebar on right.) are also areas of growth that we need to included: The overall mean scores by three consumer address. We appreciate the feedback and • The cleanliness of our facilities groups are also listed below. Our target intend to use it to better our services and • The level of progress made by clients was an overall mean rating (for each scale) programs for all of our clients. • Our levels of communication of 4.2, indicating general satisfaction with • The quality of programming the majority of items. We met or came For a statistical breakdown Survey Scale of survey results for 1 2 3 4 5 • Family/Guardian Adult Residential, • Family Guardian Outpatient • Case Managers, Very Somewhat- Neither Somewhat- Very please go to page 23. Dissatisfied Dissatisfied Satisfied nor Satisfied Satisfied Dissatisfied

Satisfaction Survey Scores by Consumer for 2006

Survey n Target Actual Mean Mean Rating (Standard Rating Deviation) Family/Guardian Adult Residential 53 4.2 4.3 (.8) Family Guardian Pediatric Residential 6* 4.2 – Family/Guardian Outpatient (Adult & Peds) 19 4.2 4.5 (.7) Claims Representatives 3* 4.2 – Discharge Planners 3* 4.2 – Case Managers 20 4.2 4.0 (.8) *sample size too small to ensure an accurate representative sample 2 1 RainbowVisions www.rainbowrehab.com SPR i n G 2 0 0 7

Descriptive Statistics Overview

A Mean is a measure of central tendency that our programs. They collectively provide information provides information about the population being about the average response, the typical response and surveyed based on taking a sample of respondents the most frequent response. The last tool employed in from that population. But means can only provide a this analysis is the standard deviation. true estimate of the population if the sample size is The standard deviation gives us a very important inherently large enough to ensure a representative indicator about the sample of responses. It tells us sample. how dispersed (or variable) the scores are around the There are other analysis tools which are useful mean. For example, if the mean on a 5 point scale in conjunction with a mean score. This includes a is 2.5, and the standard deviation is .5, we then Median score. The Median is computed by ordering know that 69% of respondents scores were between all scores from low to high, and taking the middle 2.0 and 3.0 (The mean -.5, and the mean + .5). If score. It tells us about the typical response from the the mean is 2.5 and the standard deviation is 1.0, sample. Another tool is the Mode, which is the most then we know that 69% of respondents scores were frequently occurring value in the set of scores. It between 1.5 and 3.5 (2.5 - 1.0, and 2.5 + 1.0). In the tells us about the most common answer provided. first example, the dispersion around the mean was All together, the mean, median and mode far less than that in the second example. Thus the first provide us information on how a sample of our example shows less variability in the sample. r consumers felt about our services and the quality of

SPRING 2007 After School & Saturday Day Programs

Created by Pediatric Rehabilitation Specialists, Rainbow’s After School & Saturday Day Programs are structured around the needs of children & teens with brain injuries. Our Programs integrate structure, group or individual therapies, individual tutoring, group academic support, recreational activities and social skills training.

Programming is available up to 6 days-per-week with a high staff-to-child ratio, a certified teacher and professionally trained pediatric therapists.

Saturday Day Program To receive an After School & brochure, Call Rainbow’s Admissions Department at: 1.800.968.6644 E-mail: [email protected]

RainbowVisions 2 2 Survey Results Results of our highest and lowest scores are listed on the graphs below, utilizing the Mean (in red), Median (in blue), Mode (in green) and first Continued from page 21 Standard Deviation (in purple) for each item.

Adult Residential - Outpatient (Adult & Peds) - Case Managers Family & Guardian Family & Guardian 53 respondents 19 respondents 20 respondents 21 items on survey 15 items on survey 10 items on survey Overall mean score: 4.3 Overall mean score: 4.2 Overall mean score: 4.0

Overall Mean Score Overall Mean Score Overall Mean Score X = 4.2 X = 4.5 X = 4.0 Me = 4.7 Me = 4.5 Me = 4.1 SD = .8 Mo = 5.0 SD = .8 SD = .6

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Areas of Strength Areas of Strength Areas of Strength

Your Loved One’s Progress Made at Rainbow Level of Therapy Services The Safety of Your Clients Residing at Rainbow X = 4.2 X = 4.7 X = 4.4 Me = 4.0 Me = 5.0 Me = 5.0 Mo = 5.0 Mo = 5.0 Mo = 5.0 SD = .9 SD = .5 SD = .8

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Cleanliness of Rainbow’s Facilities Your Loved One’s Progress Made at Rainbow The Warmth and Compassion of our Employees

X = 4.4 X = 4.7 X = 4.6 Me = 5.0 Me = 5.0 Me = 5.0 Mo = 5.0 Mo = 5.0 Mo = 5.0 SD = 1.0 SD = .5 SD = .7

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Communication with Treatment Team, RPM’s & Team’s Ability to Educate/Assist Families Our Responsiveness to Your Concerns Case Managers (aggregate) X = 4.3 X = 4.5 X = 4.8 Me = 4.5 Me = 4.8 Me = 5.0 Mo = 5.0 Mo = 5.0 Mo = 5.0 SD = 1.0 SD = .8 SD = .6 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Areas of Growth Areas of Growth Areas of Growth

X = 2.8 Follow Up After Discharge Amount of Community Involvement Available The Level of Vocational Services Provided Me = 2.5 X = 3.9 X = 3.3 Mo = 1,2,3,4 Me = 4.0 Me = 3.0 SD = 1.7 Mo = 5.0 Mo = 3.0 SD = 1.3 SD = 1.1

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Level of Weekend Activity Level of Weekday Activity Provided The Level of Follow-up Provided Post Discharge

X = 4.0 X = 4.2 X = 3.3 Me = 4.0 Me = 5.0 Me = 3.0 Mo = 5.0 Mo = 5.0 Mo = 3.0 SD = 1.2 SD = 1.3 SD = 1.2

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Military Helmets Continued from page 13 a new, more bullet-resistant Lightweight in providing helmet/head or cranium Would You Like To Help our Troops? Helmet (LWH). As the helmet’s name separation to protect from blast waves. Unless military budgets and/or priorities suggests, it’s about one-half pound lighter. Nearly a decade ago, helmet liner pads change, outfitting each soldier with a Comfort is improved and the original were developed by private industry to meet Ballistic Helmet Upgrade kit is only five sizes remain, but Marines can easily the original specifications of the MICH possible with donations. If you would like adjust headband circumference and height helmet. Tests conducted at independent to help our troops in Iraq and Afghanistan, for a better fit. One reason the Marines laboratories confirm their superior shock you can contact the following non-profit didn’t go with a trimmed helmet like the absorption. organizations: MICH or ACH, is because they sit too Because of budget constraints, not high. Being able to make adjustments every soldier in Iraq or Afghanistan has a Operation Helmet, Inc. helps accommodate Marines when they’re shock-absorbing pad suspension system http://operation-helmet.org wearing masks or hoods or when any in his or her helmet. The war our troops helmet-mounted displays or optics are are facing deals with an enemy that uses Helping Our Troops, Inc. www.helpingourtroops.com attached. high explosives (IEDs) on a regular basis. When a soldier does not have the proper Houston Marine Moms What about blast and current helmet shock strap suspension system, a blast causes www.houstonmarinemoms.org absorption abilities in the existing Kevlar the helmet to ‘rock’ on the head, making helmets in the field? violent contact with the skull. The impact NOTE: Operation Helmet specifically Currently, standard issue helmets are can cause skull fractures, intracranial accepts tax-deductible donations to engineered to protect against bullets and bleeding and/or TBI, possibly leading to purchase upgrades to fulfill requests only offer “fair” protection from bomb death. Aside from bringing our troops from the troops. If you are interested in blasts. The older helmet technology home, the simple solution to reducing the supporting any of these organizations, depends on a strap suspension system to amount and severity of TBI’s caused by please contact them directly. ‘float’ over the head to maintain helmet/ blasts is to install shock-absorbing pads in head separation. A shock-absorbing every helmet. pad suspension system is far superior Sources: Mark Emmons, “The signature wound of the war on terror – part 2 of 5” Mercury News, 14 December 2002, www.mercurynews.com/mld/mercurynews/news/special_packages/ frank_sandoval/16237114.htm

Olive Drab: www.olive-drab.com

Wikipedia encyclopedia: http://en.wikipedia.org/wiki/Personnel_Armor_System_for_ Ground_Troops_Helmet

Military Analysis Network: www.fas.org/man/dod-101/sys/land/pasgt.htm

Operation Helmet: www.operation-helmet.org/helmets.html#MICH

Elizabeth Book, “Special Ops Helmet,” National Defense Website, February, 2003 www.nationaldefensemagazine.org/issues/2003/Feb/Special_Ops_Helmet.htm

Global Security.org: “Advanced Combat Helmet ( ACH )” www.globalsecurity.org/military/systems/ground/ach.htm

Press Release “(No: 03-28) –U.S. Army Soldier Systems Center-Natick, MA,” 25, July, 2003

Sandra Jontz, “Head Injuries Push Improvements In Gear” 30 January, 2004 Stars and Stripes website www.military.com

Kurt Samson, “VA Reinforces Stateside Rehab Units for Iraq Blast Injuries,” Neurology Today, 18 April, 2006 Volume 6(8); pp 18, 24 Pictured above: Interior of a military helmet. The Independent Budget www.vawatchdog.org This is the current U.S. military issue in use today with a strap suspension system Christopher G. Brady, “An Analysis of Wound Statistics in Relation to Personal Ballistic Protection (Abstract)” DSTO Systems Sciences Laboratory, September 2003

RainbowVisions 2 4 2007 Conference & Event Schedule March–May

March April March 11, 2007 April 4, 2007 BIAMI Legacy Society Auction/Dinner at the Inn at St. John’s in Spring Conference for Critical Care Nursing at the Fisher Plymouth, MI For info log on to: www.biami.org Center Auditorium (Providence Hospital) in Southfield, MI For info e-mail: [email protected] March 14 - 15, 2007 Illinois Workers’ Comp Forum at the Hyatt Regency McCormick April 13, 2007 Place, Chicago, IL – For info log on to: www.ilwcforum.com Brain Injury Association of Kentucky Brain Injury Summit at the Cardinal Hill Rehabilitation Hospital in Lexington, KY March 14 - 17, 2007 For info log on to: www.biak.us Contemporary Forums Spinal Cord Injuries: Issues & Advances at the Intercontinental Boston in Boston, MA April 20, 2007 For info log on to: www.contemporaryforums.com Michigan Health & Rehab Conference (Wright/Filippis) at the Troy Marriott Hotel in Troy, MI March 15 - 16, 2007 For info log on to: www.firsttoserve.com Brain Injury Association of Iowa Conference at the Hotel Fort Des Moines, Des Moines, Iowa April 22 - 25, 2007 rd For info e-mail: [email protected] ACMA Clinical Case Mgmt Conference 3 Annual Medical Director Forum at the Doral Golf Resort & Spa, Miami, FL March 15, 2007 For info log on to: www.acmaweb.org MTLA ADR Evening Forum at the Crowne Plaza Hotel in Novi, MI For info log on to: www.mtla.net April 24 - 27, 2007 Contemporary Forums: Psychiatric Nursing Update in March 20, 2007 Philadelphia, PA – For info log on to: www.contemporaryforums.com MI-ARN Conference at the Laurel Manor in Livonia, MI For info log on to: www.miarn.org April 27, 2007 WMBIN Conference at the Crowne Plaza in Grand Rapids, MI March 26 - 30, 2007 For info e-mail: [email protected] Contemporary Forums: The Young Child With Special Needs at the Hyatt Regency, Chicago, IL April 28, 2007 For info log on to: www.contemporaryforums.com Beaumont SLP Conference at the Beaumont Auditorium - Royal Oak, MI – For info e-mail: [email protected] March 28 - 29, 2007 Michigan Health/Safety Patient Safety Conference at the April 29 - May 3, 2007 Somerset Inn, Troy, MI RIMS (Risk/Ins Mgmt Society) 2007 Conference at the Morial For info log on to: www.mihealthandsafety.org Convention Center, New Orleans, LA For info log on to: www.rims.org March 28 - 30, 2007 Contemporary Forums: Leadership Excellence Management Solutions for Neonatal, Obstetric and Pediatric Nursing in New Orleans, LA – For info log on to: www.contemporaryforums.com

March 31, 2007 Carnival of Care Hosted by Care Forward CMSA at Club Venetian in Madison Heights, MI Case Management Society of America For info log on to: www.carnivalofcare.com Detroit Chapter www.cmsadetroit.com March 30, 2007 Day Long Conference @ Burton Manor in Livonia, MI

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May May 2 - 5, 2007 Contemporary Forums/Florida BIA: 5th Annual Multidisciplinary Conference on Brain Injuries at the Disney’s MBIPC Coronado Spring Resort in Orlando, FL Michigan Brain Injury Providers Council For info log on to: www.contemporaryforums.com Learn over Lunch May 4, 2007 MTLA Annual Rapid-Fire Seminar at the Hyatt Regency, in Scheduled meeting times are 12:00 - 2:00 pm Dearborn, MI – For info log on to: www.mtla.net (Registration at 11:30 am)

May 8, 2007 Cost: Member $20 / Non-member $50 Nightingale Nursing Awards at the San Marino Club in Troy, MI For info log on to: www.oakland.edu/nursing/nightingale.cfm For further information e-mail: [email protected] May 9, 2007 MPRO Healthcare Provider’s Conference Beneficiary March 13, 2007 Protection and Hospital Payment Monitoring Program (HPMP) Holiday Inn South - Lansing, Michigan at the Radisson Hotel Lansing in Lansing, MI “The Language of Art” For info log on to: www.mpro.org/bphc/index.htm Speakers: Christine Schneider, CCC-SLP (Hope Network) May 10 - 11, 2007 - Rochester, NY and Nikki Booth, Client/Consumer May 17 - 18, 2007 - Princeton, NJ E-mail: [email protected] Workers’ Comp Forum (dates/locations above) For info log on to: www.nynjforum.com April 10, 2007 Holiday Inn West - Livonia, Michigan May 18, 2007 “Pre-morbid Functioning” UM/SJMH Rehab Nursing Conference at the Kensington Court in Speaker: Dr. Gordon Horn, PhD Ann Arbor, MI – For info call: (734) 712-8674 E-mail: [email protected] May 24 - 26, 2007 Vocational Outcomes in Traumatic Brain Injury Second May 8, 2007 International Conference at the University of British Columbia in Applause Banquet Center - Grand Rapids, Michigan Vancouver, British Columbia–Canada “Predictors of Depression After Mild–Moderate TBI” For info log on to: www.tbicvancouver.com Speakers: Esther Bay, RN, PhD (MSU) and Jacobus Donders, PhD (Mary Free Bed) May 30 - June 1, 2007 E-mail: [email protected] Michigan Self-Insurer’s Association Spring Conference at the Grand Traverse Resort in Traverse City, MI For info log on to: www.michselfinsurers.org Watch your mail for confirmed dates, topics & locations!

RINC Meetings Rehabilitation & Insurance Nursing Council

Members Only Registration begins at 11:30 am @ Followed by lunch / presentation at 12:00 pm New

For more information contact Rainbow has a new website with Adrienne Shepperd: (248) 656-6681 ALL Conferences & Events listed for 2007! March 16, 2007 Log on for the most up-to-date list of Industry Events. April 27, 2007 www.rainbowrehab.com May 18, 2007 Select Education/Publications Topics & Locations TBD

RainbowVisions 2 6 Acquired Brain Injury Child Focus from wrong and still rely on parental guidance. Kids are typically happy Series but may act silly. Friendships are very important, and by the end of the WHEN CHILDREN ARE INJURED eleventh year they may start to show an interest in the opposite sex. Kids The Elementary Years of this age are still respectful and affectionate towards their parents, By Dr. Mariann Young, Ph.D., Rainbow Pediatric Program Director so enjoy this time because middle school is right around the corner! A great deal of a child’s time Part 4; 6–11 Years of Age is spent in play, walking, or riding Why did...? bikes. These areas are often the Why? Why? Why? most fun, but can also be the most dangerous for children. Inadequate n the early school years (grades 1 or using a new saying. Early elementary use of bicycle helmets is associated with through 3) you will notice an increase in school children have a strong need for love many motor vehicle related injuries or the amount of questions a six, seven, or and understanding and want approval and deaths. Proper use of bicycle helmets eight year old will ask. This is the way that attention from their parents. can eliminate 65-88% of bicycle-related they learn to understand the world. The Upper elementary children (9 and 10 brain injuries and 65% injuries to the I questions are continuous and kids seem to year olds) show intellectual, emotional upper and middle regions of the face be pros at asking. In these grades children and physical change. Skill level and (fractures and lacerations.) As parents it is have a longer attention span and begin to endurance improve. Children of this age important to protect your child by insisting display serious and logical thinking. They have excellent fine motor control, can that they wear a bicycle or sports helmet. try to solve more complex problems and manipulate tools well and draw pictures Remember that you must also wear parents will be able to see the individual with a large amount of detail. They yours when engaging in sports with your learning style that each of their children may stay with an activity until they are children. In-line skating, skate boarding use. Conversations improve and at the end exhausted and are typically active and and scooter use without helmets pose of third grade a child almost converses energetic. At the end of their eleventh year substantial injury risk. Hospitalization data at an adult level (almost!) Reading may many children begin showing their first indicates that skateboarders are more likely be a major interest and a six, seven, or signs of puberty. Girls may have softening to sustain head injuries than roller bladers eight year old will begin to understand the and rounding of their features as well as the or scooter riders. However, since the concept of reversibility (4+2=6 is the same first signs of breast development. They may lightweight foot propelled scooters were as 6-2=4). also shoot up in height. Boys may start to introduced to the United States in 2000, Children in the early elementary grades have more muscle development. Boys and 42,500 people sought emergency room can be helpful and cheerful, but their girls in this age group are developing their care for injuries (most of these were not emotions may change quickly and then conscience but may not always tell right brain injuries.) they may be bossy, rude or selfish. They tend to be obsessed with money and this becomes a big motivator especially by the time that they are in the third grade. Kids of this age typically make friends rather easily and like to have close friendships with the same gender. They like to feel a part of the group and early elementary children are usually engaged in group play on the playground at recess and lunch. Early elementary school children will begin to experience peer pressure. This may be the first time that they “try on behaviors”. They may pick up a behavior from a friend and try it out at home. This could be a different way of laughing or responding,

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Pedestrian (motor vehicle) injuries are the most common cause of serious head trauma in the lower elementary age group. This is typically due to the mid-block dash/dart into the street or the attempt to beat traffic at an intersection. These account for 60-70% of the injuries to children under the age of ten. Children are more frequently injured in heavily populated urban areas due G to the large volume of traffic. It is important to teach your child ILIN INTO to never cross between parked cars. When crossing at the light, 3A remind them to look both ways before stepping into the street and watch for turning cars. When an early elementary school-aged child suffers a brain injury there may be personality or behavioral changes. Their emotions may increase in intensity to the point that they become S ! out of control. Dramatic or rapid shifts in behaviors may also u n occur. These are usually not related to or in agreement with the m u event that triggered them. A child who has had a brain injury may mer F become whinier, irritable, or upset with the smallest issue. If the child has a frontal lobe injury, then inhibition of the behavior may become difficult. Once a child engages in a behavior, they may be unable to stop or curtail it without intervention. Other changes Coming June 18– August 24, 2007 that may be observed include: • Inability to get along with siblings Join us for our 14th year of • Changes in play habits • Changes in coloring and handwriting • Changes in understanding and following parental direction Summer Fun! • Changes in developmental milestones (e.g. bed-wetting may reappear) Filled with discovery, play and learning, • Change in sleeping and eating habits. our programs are designed by Pediatric • Little ability to soothe themselves or be comforted Rehabilitation Specialists specifically • Upset if corrected at school or at home about mistakes for children and teens with brain injuries. Pediatric brain injury also affects a family in the following ways: • The brain injured child becomes the center of attention Give your child the structure, supervision • Needs of other siblings may not be met due to the care and and academics needed when school is energy put into treating the injured child not in session. • Parental needs may not be met because of the overwhelming amount of time spent on the needs of all of the children • Time becomes a commodity that no one has Call for a program brochure • Parents may feel guilty or that they are failures and schedule... • There may be a feeling of overall unhappiness • There may be a diminished quality of life for the entire family. t 1.800.968.6644

References: Or e-mail: [email protected] “Developmental Milestones: The 7-Year Old” http://www.schwablearning.org/articles “Developmental Milestones: The 8-Year Old” http://www.schwablearning.org/articles “Child Development: 9 to 12 Year Olds” http://www.schwablearning.org/articles “Best Practices: Child Pedestrians” http://depts.washington.edu/hiprc/practices/topic/pedestrians/index.html “School Health Guidelines to Prevent Unintentional Injuries and Violence” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5022a1.htm “Traumatic Brain Injury in Children & Adolescents” http://www.brainevaluation.com/articles/traumaticchildren.html RainbowVisions 2 8 The Last Word to bail us out. All I saw were the heels of

R A I N B O W ’ S V A L U E D folks going the other way out the revolving door. We were alone. Leadership I brought in Arthur Andersen because I hit it off with Gerry Spencer who ran the Written by Buzz Wilson, CEO Ann Arbor office. One of the grunts was William R. Buccalo– ‘Buccalo Bill’ as we ur president, Bill Buccalo is getting call him. I didn’t know Bill at that time, an award next month, and it’s about but to make a long story short, we were a time. Bill has been instrumental in the million bucks in the red! AA ran up a huge growth of Rainbow, has helped stabilize strong company with effective leadership. bill helping me sort things out, and they Ofunding for all providers, and has helped This March is Brain Injury Awareness weren’t paid until much later. increase the level of communication month, and I thought I would introduce As part of the climbing-out-of-the-hole among providers and between providers some of the key players from my point of process, I looked for a CPA to handle and payers. In other words, he is the view. the accounting–What we now call a point guard for the protection of funding As an attorney, I formed Rainbow in controller. Back then it was good enough for individuals with brain injuries in the November of ‘82 (we go back that far!) to get the trial balance to balance. I never state of Michigan. More importantly, he is I took over in ‘87 (for real in ‘88) and could, so I needed help in a hurry. I called darned good at it. inherited quite a few of the old timers still Gerry Spencer and asked him if he could The TBI Rehabilitation Industry used at Rainbow. This is our greatest strength–the recommend someone. He sent Bill. to be filled with gossips, malcontents and corporate philosophy to do good, do well, That Bill was not the outgoing, cheats. We were different, and it’s because and have fun. That produces low turnover, backslapping jock that we all love today. of Bill and like-minded folk who take a and that’s why so many folks show up at In the interview, I think I had to bring in an quiet, professional attitude toward the the company 15+ year dinner. In future amplifier because he was so quiet and soft- industry. When insurance companies need articles, I thought I would introduce spoken and unsure of himself! I swear it’s an expert witness as to what “a fair rate some of these folks to you, show how true. Now Sherri McDaniel (HR) hates to should be,” they call on Bill. Because of they were hired, promoted, or tolerated. listen in to my interviews because I violate that trust, they listen when he insists upon There are so many, but it is worth noting every one of her interviewing sacred cows. coverage for an injured client. their contributions to the greater good. I But how do you interview someone who Bill will be presented with the love to tell stories, and I love to talk about gives you one-syllable word answers? That Community Service and Leadership Rainbow, so readers beware. may have been one of those rare periods Award from the Brain Injury Association of Arthur Andersen (AA) saved Rainbow. when MSU reigned supreme in the football Michigan’s Legacy Society on March 11, Bill was an AA working stiff assigned to world. So, being the Michigan follower 2007. The society will recognize him for the audit team (Background; Rainbow has that I am, we had something to discuss. his superior commitment and leadership in had an audit done by a prominent big 8 Somewhere there was enough of a spark the growth and development of Michigan’s firm starting in 1985.) I took over at a time to warrant bringing him on board. Besides, BIA and rehabilitation services offered to when Rainbow was in deep trouble, but Gerry recommended him and his picture individuals with brain injury. Now I can no one knew it–though I should have. I needs to be in the Rainbow hall of fame. finally say with no small amount of pride, had suspicions but was not in a position One bit of history; Gerry’s retirement party Rainbow is the biggest and best in the of discovering the truth until May of ‘88. was scheduled for September 12, 2001. I nation. We have been around for 25 years Another vaunted accounting firm missed was to be a roaster at that celebration, but and Bill has been for at least 20 of those the fact that payroll taxes withheld from no planes were flying that day so I missed years–So it’s about time. wages never made it to the IRS or the it. Gerry got out before Enron destroyed I think a lot about Rainbow’s future. I State of Michigan. This was not a mistake– what was America’s finest accounting firm, worry about taking care of the old guard– everybody shared in the blame. and Bill was safely out, too. those folks who grew up along with the When I discovered what was Bill began at Rainbow with a staff of TBI Rehabilitation industry. They deserve a happening, I looked for allies with money dedicated though inexperienced folks. He

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had to work with me in bringing things then at Willow Tree and then God knows banking issues, vehicle issues, or hiring around. Reports had to be reworked, and where. I was either talking or listening issues. The list was endless. I had to face up to cost accounting. Lucky to Bill on the phone, but was always on Bill has the difficult task of keeping for me Bill relishes cost accounting (he the phone with him. Bill can relate that me on the straight and narrow. Julie (Bill’s understands that all costs are variable at every traffic ticket he incurred happened wife), Nicole and Mitch (his children) are a some point in their life). At first, I spent because of these phone calls. I would land true testimonial to his character. three nights a week at one of Rainbow’s in Cincinnati, dial Bill’s cell, and for the Stay tuned for the rest of the Rainbow apartment settings, first at Davis Street, next 30 minutes or so we would deal with story(ies). t

Employee of the Season - Autumn 2006

Rehabilitation Assistants

Ann Arbor Apts: Altie Johnson & Jan Duke Garden City Apts: Elizabeth Jackson Shady Lane: Paul VanDyke

APFK I: Lakisha White Gill: Juanita Horton & Toya Moore Southbrook: Julia Brown & Enjoli Ray

APFK II: Adrienne Gazdag Glenmuer: Megan Clark Talladay: Nicole Vedder & Melanie Foreman

Arbor: LaTanya Ellis Golfside: Emonda Burroughs & Melanie Johnson Textile: Jacquelyn Lester

Bemis: Felisa Rowsey Highmeadow: Marcia Williams Townhouses: Qiana Samuels

Briarhill: Stephanie Drake Home Health: Lola Vines (LS), William Weems (MG), Westmoreland: Bridgette Fox Ashley Ryan (SB), Pat Bauld (DP) Brookside: Keith Richardson Whittaker: Ugunda West Maple: Faye Brown Carpenter: Vanessa Jones Woodside I: Pat Nash Page: Tanya Tell Denton: Aaron Peters Woodside II: Cheryl Hinkle Paint Creek: Deanna Pasquariello

House Managers Professional Therapy Staff Administration/OEI

TBA TBA David Michael • Dan Milbrath Perry Keith

Congratulations to our Outstanding Staff!

Regret the Error – Employee of the Season Summer 2006 Oops! We forgot to include Christine Brady & Natalie Bartkiw (Rehabilitation Assistants) for Hillside House in our Fall RainbowVisions - Congratulations!

RainbowVisions 3 0 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

NeuroRehab Campus 25911 Middlebelt Road Farmington Hills, MI 48336 248.471.9580

For more information call toll free... 1.800.968.6644 E-mail: [email protected] www.rainbowrehab.com

P.O. Box 970230 Ypsilanti, Michigan 48197

If you do not wish to receive copies of Rainbow Visions, please e-mail: [email protected]