FALL 2018 Volume XV No. 3

For and about the brain injury and spinal cord injury community. Rainbow Rehabilitation Centers, Inc. RAINBOWrainbowrehab.comVISIONS • PRESIDENT'S CORNER

A Look Back in Time–Buzz was ‘all in.’

By Bill Buccalo, President & CEO Rainbow Rehabilitation Centers

t was April 1988. I was wrapping up my first busy practice, turned around the finances, and dedicated the Iseason as an auditor with the then accounting firm next 20 years of his life to building Rainbow. He saw the Arthur Andersen. I was to head out and join a team potential for Rainbow to ‘do good’ very early on. working on a brand-new account, Rainbow Tree Center. Below is a portion of a letter co-founder Joyce Doele Upon my arrival, the audit team was gathered in a large wrote to Buzz in June of 2005 after seeing a copy of our conference room combing through multiple check new newsletter (Rainbow Visions). registers. Nothing was making sense. They were trying Hey Buzz… to reconstruct history, as the company Controller had [I was given a copy] of your newest newsletter... walked off the job the night before, noting the company and I must say I was VERY impressed! had severe cash flow problems. It was a bad scene. I can’t tell you how pleased I was to see what direction Buzz Wilson, Rainbow’s long-time leader, had just you have taken the company from a clinical standpoint... taken over as President the year before. However, he was it is so nice to see the professionalism and clinical still running his employee benefits law practice in west expertise that is now a part of your ever expanding Michigan while trying to take the reins of a relatively new company. The nursing and therapy staff/programs you start up. Rainbow had opened its doors in the summer of have put in place appear to meet—and maybe even 1983 and had expanded rapidly to meet the demand for exceed—the industry best practice. individuals surviving significant brain injuries. You have gathered a group of clinical professionals Joyce Doele, nurse case manager, along with Buzz’s that I am sure have been very helpful in making the law partner, Roger Bird, nurse Judy Whiteside, started appropriate recommendations to bring the infantile Rainbow Tree Center. Joyce had worked with several RTC into a strong player in the marketplace and a place catastrophically injured clients and had a vision for how that has helped many, many folks to achieve their rehab strong clinically supported community integrated care potential. You have completed the vision I always hoped should be done. The fledgling company brought Buzz on would become a reality, and you have done it so very well to the board in 1985 to provide some business acumen. that I just had to write and let you know how happy I Over the course of the next couple of years, Buzz saw the am that Rainbow has survived in such a wonderful way! tremendous potential in Rainbow’s clinical services and You have done an excellent job, and I know it couldn’t wonderfully caring employees. But he still was only half have been easy—so thanks for fulfilling all the promise in at Rainbow and half in his law practice. of a simple concept that came out of my work with the I imagine while I was getting my first glimpse into cat [catastrophic] cases of old and the help of a devoted Rainbow and the audit team was updating Buzz on an friend who agreed to move to Michigan from Indiana hourly basis of the mounting scale of the company’s and come and work with me to get that vision started. problems, Buzz was facing one of the biggest decisions You have done us proud, and I am grateful! of his life. Does he retreat to the law practice and let the Thanks so much! — Joyce Rainbow experiment end? Or does he jump in with both Rainbow has evolved through the years due to the feet and fight his way out of the situation? efforts of so many employees past and present. From Fortunately, for the thousands of individuals Rainbow these humble beginnings 35 years ago, we have become a has served over these past 35 years, and for the many leader in the industry. Thank you employees, friends and employees and families that have been touched by vendors for your contribution to who we are today! ❚ Rainbow, Buzz was all in. He wrapped up the law • ON THE COVER the people we s Rainbow is celebrating piring erve Ins for 35 of years of inspiring the people we serve to reach their greatest potential! 35 Our anniversary theme Editor is INSPIRE! so we asked our wonderful clients Barry Marshall to create artwork based Associate Editor/Designer on this message. On the cover is a collage of Jill Hamilton-Krawczyk some of their unique creations. Contributor Valerie Kolesar We hope that this issue inspires you as well! Email questions or comments to: [email protected] Page 20

Copyright September 2018—Rainbow Rehabilitation Centers, Inc. All rights reserved. Published in the United States of America. No part of this publication may be reproduced in any manner whatsoever without written permission from Rainbow Rehabilitation Centers, Inc. Contact the editor: [email protected]. 10 14 18 Features 2 Clinical News Understanding Disorders of Consciousness Lynn Brouwers, MS, CRC, CBIST 10 Success Story For the Love of Animals Kalyn Sanderfer, LLMSW 14 Medical Corner Diabetes and TBI: Fact or Fiction? Kim Phelps, RN, CRRN, CBIS 18 Therapy Corner Reaching Casey’s Goals Jason Dusza, OTR-L, CBIS and Alissa Humes, PT, DPT, NCS, CBIS 24 Medical Corner Unique Nutritional Needs Blake Avery, RD and Brandi Jed, RD 28 Technology Corner Walking Again Andrea Sweet, PT, DPT, CBIS News at Rainbow 32 Conferences & Events 800.968.6644 34 Summer Fun! | 2018 BIAMI | NRC Renovation | Cutest Pet Contest rainbowrehab.com 36 Pillar of Excellence Awards | Employees of the Season

Our mission is to 38 New Professionals at Rainbow inspire the people we serve to realize their greatest potential • CLINICAL NEWS

2 | RAINBOWVISIONS • FALL 2018 Understanding DISORDERS of CONSCIOUSNESS New guidelines released for managing disorders of consciousness in persons with brain injury

By Lynn Brouwers, MS, CRC, CBIST Rainbow Rehabilitation Centers

Loren, a 25-year-old graduate student, was injured when he lost control of his car on a snowy Michigan winter morning. Loren’s injury occurred two years ago. He spent nearly three months at a trauma hospital and was then transferred to a subacute brain injury program. Since that time, he has not been able to establish any way to reliably communicate his needs to his family or caregivers. He does get restless when his therapists walk in the door to provide passive range of motion which they perceive is uncomfortable but needed to preserve his physical functioning. He also seems to be more attentive when his mom is in the room. He has laughed spontaneously at inappropriate jokes. Is Loren in a coma? A vegetative state? A minimally conscious state?

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Continued from page 3 Disorders of consciousness (DoC) are a set of disorders that the brain is static, and that restoration of function in that affect wakefulness or consciousness in a person people with severe brain injury is not possible. This old after illness or injury. DoC includes three phases; coma, view said that once the brain was damaged, repair and vegetative state (VS) and minimally conscious state recovery were not possible, and that coma was a natural (MCS). These disorders have been called some of the precursor to death. most misunderstood conditions in medicine and are an The contemporary belief is that the brain is plastic, and important challenge for scientific research.1 people with DoC have potential for long term recovery. Published estimates of diagnostic error among people Well documented cases of late recovery point to the with disorders of consciousness range from 35-40 remarkable plasticity of the human brain. Neuroplasticity percent.2 This means that they are conscious but unable to refers to the brain’s ability to change structurally when respond and are mistaken for being in a vegetative state. stimulated by the environment.1 “Misdiagnosis may result in premature or inappropriate Professionals who developed the guideline reviewed the treatment withdrawal, failure to recommend beneficial available scientific literature on diagnosing, predicting rehabilitation treatments, and worse outcome,” said lead outcome, and caring for persons with prolonged guideline author, Joseph Giacino Ph.D. at Harvard Medical DoC. There is a recognition that people with DoC School and Spaulding Rehab Hospital in Boston.3 need specialized health care managed by clinicians These conclusions are based in part on new technologies knowledgeable in treating this disorder. in functional neuroimaging and electrophysiologic procedures that have been used to study people with THE CHALLENGE OF MAKING AN ACCURATE DoC. A landmark study published in 2010 showed that ASSESSMENT IN PERSONS WITH PROLONGED it is not always possible to know who is aware but unable DISORDERS OF CONSCIOUSNESS to respond. In this study, functional MRI was used to When a person demonstrates functional communication determine the incidence of “undetected awareness” in a (yes/no response or gestures) or the functional use of group of people classified as vegetative. Of the 54 patients, objects (puts toothbrush in mouth, hairbrush to head), five with TBI could modulate their brain activity by the person is no longer classified as having a disorder generating voluntary, reliable, and repeatable responses in of consciousness. This simple determinant can be predefined neuroanatomical regions of their brain when complicated by other disabling characteristics like aphasia prompted to imagine performing a task. It is interesting (loss of ability to understand or produce language), paresis to note that in this study, people with brain injury from (weakness), or apraxia (inability to perform purposive non-traumatic causes were not able to willfully respond in actions due to damage to certain areas of the brain). a way that showed awareness on the functional MRI. In rare instances, the person may be diagnosed with a A newly published guideline developed by the locked-in syndrome (see sidebar on page 5). Medical American Academy of Neurology, American Congress complications and some medications can impact arousal of Rehabilitation Medicine (ACRM), and the National and awareness making it difficult to judge the person’s level Institute on Disability, Independent Living and of consciousness. Rehabilitation Research released in August 2018 also The newly published guideline suggests that clinicians indicates that there is a moderate amount of evidence use standardized evaluations that have been shown to be that people who injure their brains through trauma have valid and reliable in a DoC population and that they assess a better chance of recovery than people who injure their the individual several times in order to reduce potential brains from other causes.3 diagnostic error due to variability in responsiveness in this Professionals who developed the guideline reviewed the population. available scientific literature on diagnosing, predicting THE IMPORTANCE OF SKILLED outcome, and caring for persons with prolonged CLINICIAN OBSERVERS AND THE NEED DoC. There is a recognition that people with DoC FOR SPECIALIZED TREATMENT PROGRAMS need specialized health care managed by clinicians To date, research and development of evidence-based knowledgeable in treating DoC. treatment for persons with DoC is limited. People with The results of these new studies and the well- DoC do have unique problems such as autonomic documented reports of late recovery challenge the old view dysfunction syndrome, heterotopic ossification, the need

4 | RAINBOWVISIONS • FALL 2018 LOCKED-IN for augmentative communication devices, and SYNDROME management of severe tone and spasticity which require the skills of a specialized rehabilitation Locked-in syndrome is a rare team. Physicians who understand MCS may use neurological disorder in which there medications to affect arousal and awareness. is complete paralysis of all voluntary In fact, the guideline suggests that there is a muscles except for the ones that moderate amount of evidence that the drug control the movements of the eyes. Individuals with locked- amantadine can hasten recovery when used in syndrome are conscious and awake, but have no ability to produce movements (outside of eye movement) or to within one to four months post injury.3 speak (aphonia). Cognitive function is usually unaffected. Specialized team members understand the Communication is possible through eye movements or need to focus in on how best to assess awareness blinking. Locked-in syndrome is caused by damage to the and can focus on which sensory system is most pons, a part of the brainstem that contains nerve fibers that intact for communication. Sensory systems relay information to other areas of the brain.13 Fred Plum and of seeing, hearing, smelling, tasting, moving, Jerome Posner coined the term for this disorder in 1966.13 and touching are the ways people connect with the environment and others. Rehabilitation goals include improving responses, tolerating stimulation, staying healthy, and caregiver training. ASSESSMENT OF CONSCIOUSNESS LONG-TERM PLANNING FOR PERSONS WITH PROLONGED DoC Since consciousness cannot be directly observed, clinicians must observe Family members, in the absence of the injured behavior and draw conclusions person making a living will, may be asked or about an individual’s underlying may consider on their own what their family state of consciousness. The Brain Injury-Interdisciplinary member’s wishes would be if confronted with Special Interest Group Disorders of Consciousness Task living in a vegetative state. Some may make the Force, composed of experts from the American Congress of decision to take a palliative approach to care and Rehabilitation Medicine, reviewed available scales and made others may seek the most aggressive medical evidence-based recommendations for clinical practice.14 and rehabilitative treatment available. Courts have been involved when there are questions The Coma Recovery Scale Revised, (CRS-R), received the highest recommendation. The scale consists of 23 items that of awareness (VS or MCS?) and when there is comprise six subscales addressing: family disagreement. • auditory With attentive care, people in VS and MCS can • visual live for years at home, in skilled nursing facilities, • motor and in brain injury residential programs. • oromotor A HISTORY OF ADVOCACY, ACRM’s • communication SPECIAL INTEREST GROUP AND • arousal functions EUROPEAN TASKFORCE ON DoC The scale is free and available at A report was delivered to Congress in 2011 by tbims.org/combi/crs/index.html 15 an esteemed group of rehabilitation specialists, physicians, and researchers requesting funding Other scales with acceptable standardization include: and support nationally for a specialized • Coma/Near Coma Scale (CNC) neurorehabilitation center and a structured • The Disorders of Consciousness Scale (DOCS) support network. Their concerns were that the • Sensory Stim Assessment Measure (SSAM) 16 current system of care (acute care followed by • Western Neuro Sensory Stimulation Profile (WNSSP)

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Continued from page 5 transfer to a nonspecialized skilled nursing facility or a less dismal prognosis and may therefore lead to less discharge home) makes long-term research difficult and cessation of treatment in select patients. may be responsible for the poor outcomes of many people “We find it high time to propose a new, more neutral and with disorders of consciousness. descriptive term. By calling it ‘unresponsive wakefulness It is especially important to know how many individuals syndrome,’ we describe what we clinically see but do not are in a minimally conscious state and have a “life of judge whether there is consciousness or not,” said Dr. the mind” but are misdiagnosed as vegetative state. The Moonen, a member of the Task Force. prospect of such individuals harboring consciousness “Overall, we hope that this new wording will help to but being misidentified or simply ignored because of the herald a change in the ethical approach towards patients perceived futility of additional long-term assessment is who need more, not less, attention by their environment, an ethical concern. Lack of specialists and specialized since they are not able to claim on their own their right to care centers also perpetuates the historic disregard of this human contact,” said Dr. Laureys, a member of the task marginalized population.4 force.5 The European Task Force on Disorders of Consciousness has even suggested different names for these states of consciousness; unresponsive wakeful syndrome in place UNDERSTANDING of vegetative state and minimally responsive in place of minimally conscious state. It is hoped that these will infer DISORDERS OF CONSCIOUSNESS GLASGOW COMA SCALE UNDERSTANDING THE DEFINITION OF COMA, BEHAVIOR RESPONSE SCORE AN INDICATOR OF BRAIN INJURY SEVERITY A coma is a state of unconsciousness whereby a Spontaneously 4 EYE OPENING person cannot be wakened with touch or noise. The To speech 3 RESPONSE inability to waken differentiates coma from sleep. It is (E) To pain 2 the length of time that a person remains in coma that No response 1 has commonly been used to determine the severity of a person’s brain injury (see Glasgow Coma Scale). A coma Oriented to time, place and person 5 or unconsciousness of less than 30 minutes is considered a mild traumatic brain injury or concussion. Less than VERBAL Confused 4 one day of coma is considered moderate brain injury. Any RESPONSE Inappropriate words 3 coma lasting more than a day is considered to be a severe (V) Incomprehensible sounds 2 brain injury. No response 1 An “induced” coma can make it difficult to use the Glasgow Coma Scale as a predictor of traumatic brain Obeys commands 6 injury (TBI) severity. Moves to localized pain 5 WHY COMA OCCURS, THE PHYSIOLOGICAL Flexion withdrawal MOTOR from pain 4 RESPONSE TO BRAIN TRAUMA RESPONSE Abnormal flexion In TBI, coma can occur when there is an injury to (M) (decorticate) 3 the brain, particularly the brain stem. The brain stem Abnormal extension 2 processes the automatic, unconscious control systems (decerebrate) of the body including heart rate, blood pressure, body No response 1 temperature, and breathing. The reticular activating system (RAS), located within the brain stem, is the important “on/ E + V + M = TOTAL SCORE off” switch for consciousness and sleep (Fig. 1, pg. 8). To A fully conscious patient has a Glasgow Coma Score of 15. A person in a deep coma has a score of 3 (there is no lower score). be awake, the RAS and at least one cerebral hemisphere must be functioning. Coma can also occur when both

6 | RAINBOWVISIONS • FALL 2018 DIAGNOSTIC CRITERIA COMA All of the following criteria must be evident cerebral hemispheres have shut down, for on bedside examination: example, with loss of oxygen in situations like near drowning or a TBI followed by a respiratory • No eye opening and absence of sleep-wake cycles on EEG arrest. • No evidence of purposeful motor activity The reticular activating system stops working • No response to command in two situations: • No evidence of language comprehension or expression • Brain stem bleeding or loss of oxygen: • Inability to discretely localize noxious stimuli Cells in the area of the RAS have lost their blood supply and the oxygen and glucose VEGETATIVE STATE that the blood supply delivers. This shuts off All of the following criteria must be evident the reticular activating system. on bedside examination: • Swelling: Increased swelling in the brain • No evidence of awareness of self or environment pushes down on the brain stem causing it • No evidence of sustained, reproducible, purposeful, or to fail. The skull is a rigid box that protects voluntary behavioral responses to visual, auditory, tactile, the brain. Unfortunately, if the brain is or noxious stimuli injured and begins to swell (edema), there is • No evidence of language comprehension or expression no room for the additional fluid. Increased • Intermittent wakefulness manifested by the presence of intracranial pressure causes compression sleep-wake cycles of the brain tissue against the skull bones. • Sufficiently preserved hypothalamic and brain-stem This swelling within the skull can cross autonomic functions to permit survival with medical the midline of the brain and affect the and nursing care undamaged hemisphere. • Bowel and bladder incontinence THE IMPORTANCE OF ACUTE MEDICAL • Variably preserved carian-nerve reflexes and spinal reflexes CARE WHEN A COMA OCCURS If the intracranial pressure continues to MINIMALLY CONSCIOUS STATE increase without being treated, the brain will At least one of the following criteria must be continue to swell until it pushes down through clearly evident on bedside examination: the opening at the base of the skull, thereby • Simple command following damaging the brain stem where the reticular activating system is located. This affects the • Gestural or verbal yes/no responses ability of the brain to stimulate breathing and • Intelligible verbalization control blood pressure and can be the reason for • Movements or affective behaviors that occur in contingent death in the hours or days after injury. relation to relevant environmental stimuli and are not When the members of the trauma team attributable to reflexive activity. Any of the following examples provide sufficient evidence for this criterion are concerned about swelling of the brain, an intracranial pressure monitor may be placed • Pursuit eye movement or sustained fixation that occurs in inside the skull to monitor the pressure. Or, a direct response to moving or salient stimuli portion of the skull may be temporarily removed • Episodes of crying, smiling, or laughter in response to the to minimize the risk of further injury to the linguistic or visual content of emotional but not neutral topics or stimuli brain due to the swelling. This allows the trauma team to monitor the brain’s pressure and provide • Vocalizations or gestures that occur in direct response to the linguistic content of comments or questions treatment to minimize the “secondary brain injury” that can occur from swelling, bleeding, • Reaching for objects that demonstrates a clear relationship between object location and direction of reach and lack of nutrients and oxygen to the brain tissue. • Touching or holding objects in a manner that accommodates the size and shape of the object Doctors may also “induce” a coma to decrease Source: The Mohonk Report. (2011) Continued on page 8

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Continued from page 7 intracranial pressure and rest the brain. Barbiturate medications such CEREBRAL as Pentothal and pentobarbital can be HEMISPHERE injected similar to providing a general anesthetic. These medications can decrease the metabolic rate, protecting the brain. Twenty to 40 percent of persons with injuries this severe do not survive, even with the best of medical care.6 THE NORMAL COURSE OF AWAKENING FROM A COMA For people with days to weeks to months of unresponsiveness, coma usually evolves into the vegetative state or a higher level of consciousness within HYPOTHALAMUS two to four weeks amongst those who THALAMUS survive.7 PONS Unlike what is seen in fictional portrayals of coma, it is very unusual RETICULAR SYSTEM for a person to move from a coma to CEREBELLUM full wakefulness without experiencing MIDBRAIN SPINAL CORD VS, MCS, and/or the confused state that MEDULLA follows. A person can move through the levels of consciousness (see sidebar on page 7) or remain in Figure 1. The Reticular Activating System (RAS) a vegetative or minimally conscious state for the duration of their lives. AWARENESS IS THE IMPORTANT In the TBI population, 35 percent of individuals who DIFFERENCE BETWEEN VS AND MCS remain in VS for three months will recover consciousness Although VS and MCS both involve severe alteration by 12 months post-injury. Among this group, 20 percent in alertness and awareness, there is clear and growing will be left with severe disability, while the remaining 15 evidence that important clinical differences exist. The percent will have a moderate to good outcome.1 prognosis is different for VS and MCS. Estimates are that It is difficult to track the incidence of MCS because 315,000 Americans are living with DoC; including 35,000 there is no International Classification of Diseases (ICD) in VS and 280,000 in MCS.8 diagnostic code. Persons in MCS retain large scale cortical Vegetative state can be transient or long-term networks responsible for language processing despite their (persistent) following coma. Persons in VS may move in inability to communicate reliably.9 The recovery for this a non-purposeful manner and may smile, grimace, tear, population is slow and long. In the MCS group, 50 percent and moan. Individuals in VS generally do not visually will have moderate to severe disability while 27 percent track or fixate on objects. If tracking is seen, it can often will have mild to moderate disability.10, 11 ❚ mean that the person is transitioning to MCS. Both the terms “persistent” and “permanent” are controversial, with References advocates suggesting that the term “permanent” not be 1. The Mohonk Report. (2011). A Report to Congress. Disorders of Consciousness: Assessment, Treatment, and Research Needs. used until the VS state has lasted 12 months for persons 2. Tresch DD, Sims FH, Duthie EH, Goldstein, MD, Lane PS. (1991). Clinical with TBI and three months for people with non-traumatic characteristics of patients in the persistent vegetative state. Arch Internal 9 brain injury. Med,151:930-932.

8 | RAINBOWVISIONS • FALL 2018 3. https//acrm.org New Guideline released for Managing Vegetative and Assessment and management of persons in the persistent vegetative Minimally Conscious States state. Neurol, 45:1015-1018. 4. Fins JJ. (2003). From Psychosurgery to Neuromodulation and 11. Giacino JT, Kalmar K. (1997). The vegatative and minimally conscious Palliation: History’s Lessons for the Ethical Conduct and Regulation of states: A comparison of clinical features and functional outcome. J Head Neuropsychiatric Research. Neurosurgery Clinics of North America, 14(2): Trauma Rehabil,12(4):36-51. Giacino, J & Kalmar, K. (2006). 303-319. 12. Whyte J, Katz D, Long D, DiPasquale M, Polansky M, Kalmar K, Giacino 5. European Neurological Society (ENS): Oral abstracts 238, 242, and 267. J, Childs N, Mercer W, Novak P, Maurer P, Eifert B. (2005). Predictors of Presented May 30, 2011 Outcome in Prolonged Posttraumatic Disorders of Consciousness and Assessment of Medication Effects: A Multicenter Study. Arch Phys Med 6. Sherer, M, Vaccaro, M, Whyte, J, Giacino, J (2007) Facts about the Rehabil, 86:453-462. Minimally Conscious States after Severe Brain Injury, Consciousness Consortium 13. https://rarediseases.org/rare-diseases/locked-in-syndrome/ (accessed May 28, 2013) 7. Plum F, Posner J. (1982). The diagnosis of stupor and coma, 3rd Edition Philadelphia: F.A. Davis. 14. Seel, Ph.D., Sherer, Ph.D., Whyte, M.D., Ph.D., Katz, M.D., Gianco Ph.D., Rosenbaum, Ph.D., et al. (2010). Assessment scales for disorders of 8. Multi-Society Task Force on the Persistent Vegetative State. (1994). consciousness: evidence-based recommendations for clinical practice Medical aspects of the persistent vegetative state, part I. N Engl J Med, and research. Arch Phys Med Rehabil, 91:1795-1813. 330:1499-1508. 15. Coma Recovery Scale-Revised. The Center for Outcome Measurement in 9. Strauss DJ, Ashwal S, Day SM, Shavelle RM. (2000). Life expectancy of Brain Injury. http://www.tbims. org/combi/crs/ (accessed May 28, 2013) children in vegetative and minimally conscious states. Pediatr Neurol, 23:312-319. 16. The Essential Brain Injury Guide Edition 5.0, Brain Injury Association of America 10. American Academy of Neurology. (1995). Practice parameter:

About the author

Lynn Brouwers, MS, CRC, CBIST Director of Program Development Lynn Brouwers holds a Master of Science in Rehabilitation Services from the University of Wisconsin-Stout in Menomonie, WI. She has more than 35 years of leadership experience in medical rehabilitation with a specialty in programs for persons with traumatic brain injury and other neurologic injury. She has managed neurological rehabilitation programs in hospitals, skilled nursing facilities, residential and outpatient facilities, and in the home and community. She is a Certified Brain Injury Specialist Trainer and a surveyor for CARF International.

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RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 9 • SUCCESS STORY

10 | RAINBOWVISIONS • FALL 2018 FOR the LOVE of ANIMALS Dedication to the vocational rehabilitation process helped Cortez to realize his dream

By Kalyn Sanderfer, LLMSW Rainbow Rehabilitation Centers

uring our teenage years, most of us are just trying from TBI-related incidents.1 While many parents are to figure out what it means to be independent. privy to the dangers of drugs, sex, bullies, and bad grades, It is the age of new freedoms, the beginning of most families are woefully unprepared for the very costly adulthood, and a time of joy and transition for consequences of their child sustaining a TBI. Family Dmany young people. Unfortunately for Cortez Marcelis, members average over $130,000 in personal costs for now a 29-year-old dog groomer from Detroit, trauma and rehabilitation care in as quickly as his coming of age story was cut short at the six months.2 With Cortez being so young age of 18 by a drunk driver. and inexperienced at the time of his TBI, he His mother remembers getting a phone faced a long road that could have resulted call in the middle of the night. “It was in a substantial loss of potential income 2007… his friends called. They were and productivity years. scared, breathing hard, yelling that Cortez spent the next five years Cortez was in the car with a drunk learning how to walk, talk, eat, and driver.” Cortez was a passenger in live again. He recalls, “Everything a vehicle that hit a wall, and he was was a challenge.” Still, he found a way ejected out the front window. He was to stay motivated and push through his rushed to St. John’s hospital and diagnosed treatment at a time when he should have with a traumatic brain injury (TBI). His been experiencing his first college course or mother recalls seeing him soon after. “I was first real job. shocked… he was unresponsive, and they put a stent in his He joined Rainbow’s Vocational Rehab Campus (VRC) brain to relieve the pressure.” Of all the dangers she could in 2012 with the hope of sharpening his work skills and have foreseen, a traumatic brain injury was nowhere on eventually becoming an animal groomer. However, there her list of worries. were some new challenges present because of his traumatic The unfortunate reality is that because of the social brain injury. Cortez had regained his physical strength identities held by Cortez, he was (and still is) at a higher and was able to maintain it fairly easily, but he was also risk of sustaining a traumatic brain injury. Men, African dealing with a host of new mental health challenges. Americans, and children ages 0-19 are among the groups Moderate to severe TBI is associated with an increased with higher risks of sustaining a TBI. Moreover, African risk of subsequent psychiatric illness… about 50 percent Americans have higher rates of death and hospitalization Continued on page 12

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Continued from page 11 of survivors show symptoms in the first year following environment that would help him prosper financially, injury.3 Although it would not be easy, Cortez pushed physically, and mentally. He began working on his own ahead with hope that his support system of family and business ideas while looking for a more suitable placement health care professionals would help him to excel. within the VRC. While employed at the VRC, Cortez had the opportunity In the Spring of 2018, Rainbow was able to partner to work in a variety of roles related to his interest in Cortez with a local kennel owner and create a unique job animals. At Starry Skies Equine Rescue and Sanctuary, experience for him. He now works as a groomer at Curry he tended to horses that had been rescued from unsafe Family Pet Care in Romulus, MI, and it seems to be a conditions. He trained as a groomer and stock person perfect fit. at PetCo and has improved his organizational skills Cortez uses his individual vocational time to work on by assisting with various tasks at the VRC including business plans for his dog grooming business, Cortz Tails, packaging, sorting, and computer tasks. and the space at Curry Family Pet Care allows him to Alas, none of these roles seemed to be a good fit for practice his craft with an experienced job coach. Cortez’s particular set of needs and interests. It was When he is not grooming dogs, Cortez is passing out difficult to find an environment that allowed him to reach flyers and business cards to local vets and business owners his full potential while being sensitive to the side effects to promote Cortz Tails. He envisions one day having his of his injury. Cortez had a new definition of “normal.” own mobile dog grooming business. “I want to make it He spent a lot of years re-strengthening his mind and easier for the animals. I’ll come to them,” he says. body, and didn’t want to rush into a job that could So far, Cortez has done an amazing job grooming the compromise his growth. So it was important to find a work kennel dogs and building up his personal clientele. Even his job coach’s dachshund, Gryffindor, stopped by for a bath. His latest project is renovating a van he plans to use for his mobile grooming business. “I work on it almost every day,” he says. Although his journey has been a long one, Cortez Marcelis is a prime example of what all clients can achieve through dedication to the vocational rehab process. Like all successful people, Cortez has had some failures and bad experiences along the way. But he stuck it out, and now he can do what he loves in a safe environment with the supports he needs. We’re all excited to see what the future holds for Cortez. ❚

References 1. Arango-Lasprilla, J.C. (2010). Racial and ethnic disparities in functional, psychosocial, and neurobehavioral outcomes after brain injury. Journal of Head Trauma & Rehabilitation. 25(2), 128–136. 2. Gary, K.W., Arango-Lasprilla, J.C. & Stevens, L.F. (2009) Do racial/ethnic differences exist in post- injury outcomes after TBI? A comprehensive review of the literature. Brain Injury, 23:10, 775-789, 3. Fann, J., Burington, B., Leonetti, A. (2004) Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Arch Gen Psychiatry.61. 53-61. Retrieved from: https://www.liftcare.org/wp-content/ uploads/2013/11/LIFT-Fann-Psychiatric-illness- following-TBI-adult.pdf

12 | RAINBOWVISIONS • FALL 2018  Don Daniels, Vocational Manager, Cortez Marcelis, Chelsea Lupone, Job Coach, and Gryffindor the dachshund.

About the author

Kalyn Sanderfer, LLMSW Case Manager Kalyn works at Rainbow’s Ypsilanti Treatment Center as a case manager. She earned her Master of Social Work and Bachelor of Sociology from the University of Michigan. Previously, she served as a Resource Coordinator/Intake Counselor at the University of Michigan Pediatric Advocacy Clinic and as a Patient Care Assistant.

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 13 • MEDICAL CORNER DIABETES and TRAUMATIC BRAIN INJURY FACT or FICTION?

By Kim Phelps, RN, CRRN, CBIS Rainbow Rehabilitation Centers

iabetes is frequently described as a disease Type 2 diabetes is more often diagnosed in older that affects the way the body uses glucose. adults or during middle age. With Type 2 diabetes, While this statement is true, diabetes is more your body still produces insulin, but it may not be complicated than that, and when a traumatic enough insulin or enough usable insulin to control Dbrain injury (TBI) is added into the mix, the blood glucose. This is characterized as insulin management of diabetes and the TBI can be further resistance. complicated. The risk factors for Type 2 diabetes include obesity, There are several types of diabetes, but Type 1, sedentary lifestyle, and genetics. For many who are Type 2, and Diabetes Insipidus are the three types diagnosed with Type 2 diabetes, diet and exercise that can impact the management of diabetes due to a can significantly improve blood glucose levels and traumatic brain injury. can prevent further issues or improve the associated Type 1 is defined as a chronic autoimmune disease complications. If these lifestyle changes do not in which the immune system kills the insulin decrease blood glucose levels, then oral medications producing beta cells in the pancreas. The cause is will be prescribed. If these medications do not provide unknown but can follow a viral infection. Genetics adequate glucose control, then insulin will be needed. can also be a risk factor for Type 1 diabetes. A person Diabetes Insipidus (DI) is a condition that leads who is diagnosed with Type 1 diabetes will typically to frequent urination and excessive thirst. It can be prescribed insulin immediately. be caused by a deficiency of antidiuretic hormone There is no cure for Type 1 diabetes. Diet, exercise, (ADH). Trauma from head injury, tumors, or surgery and strict glucose control with insulin are all part can damage the pituitary gland or hypothalamus and of diabetic care to keep glucose levels in an optimal lead to ADH deficiency. Medication and fluid intake range. control is needed for management of DI.

14 | RAINBOWVISIONS • FALL 2018 FACT or FICTION? Treatment for Type 1, Type 2 and Diabetic Insipidus Follow up with an endocrinologist is recommended are the same. to help you determine a treatment plan. FICTION: Though all three forms of diabetes are related to the endocrine system, treatment for A traumatic brain injury will impact my treatment Type 1 and Type 2 diabetes are similar, but DI is for diabetes or vice versa. different. Type 1 and 2 are related to the pancreas and FACT: Type 1 and 2 diabetes or DI can have an impact production of insulin which controls blood glucose. on care regarding treatment and outcome. Symptoms DI is related to the hypothalamus and pituitary gland of Type 1 and 2 diabetes can be exacerbated after a and lack of production of antidiuretic hormone. severe TBI. Following a TBI, factors such as stress, Diabetes is caused by eating too much sugar, and DI inflammation, surgery, IVs, diet, decreased is caused by drinking too much water.1 mobility, change in metabolism, and infection can FICTION: Sugary foods do not cause diabetes, but all lead to hyperglycemia. Several classifications can elevate blood glucose if you have diabetes. If you of medications can also lead to hyperglycemia, are diagnosed with Type 1 or 2 diabetes, following especially antipsychotics which may cause unwanted a healthy diet by consuming a variety of foods is weight gain. Hyperglycemia is also a known cause of recommended. Your physician or a dietitian can give cognitive deterioration. you guidelines on how to count carbohydrates and Regardless of the cause of hyperglycemia following suggestions for healthy eating. a TBI, the course of treatment will focus on You cannot contract diabetes insipidus by drinking returning glucose to normal parameters and prevent too much water. Damage to the hypothalamus by hypoglycemia. trauma or disease process can be the cause of DI. Continued on page 16

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 15 • MEDICAL CORNER DIABETES

Continued from page 15 A person will not be able to manage their diabetes Many of these devices can also be used by the independently following a TBI. visually impaired. FICTION: Factors such as decreased cognition, There is a wealth of adaptive supplies available. visual and/or physical changes may cause challenges See your endocrinologist or diabetic specialist for a following a TBI, but there is a variety of adaptive complete guide that can assist you with your specific equipment and techniques available that can assist needs. with managing diabetes as independently as possible. Just as each brain injury is different, each course For those with impaired cognition, there are alarm of diabetes is different. When these two worlds watches and phones to remind you to take your collide, a new set of problems can arise. By following medication or insulin, continual glucose monitors recommendations from your physician and treatment that alert family members if your glucose is too high team, developing skills and techniques to manage or too low, insulin pumps that read your glucose and your brain injury and diabetes can help you reach administer insulin, and memory insulin pens. your optimal level of independence and health. ❚ For those with physical limitations, there are larger meters, lancet devices you can use with one hand, References lancet drums with multiple needles, larger syringes, 1. Myths and Facts: Stop Diabetes” website: http://www.stopdiabetes.com/ cozies for insulin bottles, safety shields for bottles, and get-the-facts/myths-and-facts.html (accessed July 6, 2018 vial safe bottles for better gripping.

SPINAL CORD INJURY PROGRAM

RESIDENTIAL Rainbow Rehabilitation Centers provides specialized residential and therapy services for individuals recovering from spinal cord injury. Residential services include beautiful wheelchair accessible homes with 24-hour supervision and assistance available. The living environment can be equipped with voice-activated environmental control systems. Our goal is to facilitate the independence of our clients and design individualized treatment plans to meet their specific needs. Services can range from assisted living level of care through intense rehabilitation services. OUTPATIENT We have comprehensive outpatient therapies with special emphasis on recreation and community re-entry. Our facilities are equipped with all necessary equipment to meet the rehabilitation needs of the individual with a spinal cord injury and the family.

No finer promise of achievement 800.968.6644

16 | RAINBOWVISIONS • FALL 2018 Brain and Spinal Cord Injury Rehabilitation Programs for People of all Ages

There’s no better place to heal! With multiple residential programs, five treatment centers, a NeuroRehab Campus® and two vocational centers, Rainbow Rehabilitation Centers offers services that span nearly every aspect of brain injury rehabilitation and spinal cord injury rehabilitation. From hospital discharge to community re-entry, Rainbow Rehabilitation Centers has programs to treat each client with optimal care at every stage of their rehabilitation. There’s no better place to heal!

Residential Programs • Outpatient Services • Day Treatment • Spinal Cord Rehabilitation Home & Community-Based Rehabilitation • Home Care • Vocational Programs Comprehensive Rehabilitation • Medical Care • NeuroBehavioral Programs

To schedule a tour or to speak with an Admissions team member, call 800.968.6644 rainbowrehab.com

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 17 • THERAPY CORNER

18 | RAINBOWVISIONS • FALL 2018 REACHING CASEY’S GOALS A Collaborative Approach to Therapy in a Home Setting

By Jason Dusza, OTR-L, CBIS and Alissa Humes, PT, DPT, NCS, CBIS Rainbow Rehabilitation Centers

Simple tasks such as getting up from the sofa, walking up and down the stairs, and even taking a shower are activities that most of us take for granted. But when you are severely injured, these simple endeavors become extremely difficult. Parts of your own home may become inaccessible, and simple actions are now daunting and can induce anxiety.

WHAT IS HOME OT AND PT? The American Occupational Therapy Association Occupational therapy (OT) and physical therapy (PT) states that OT helps people across their lifespan perform have an important role to play in the home and community the activities they need and want to do to in order to live environment. These roles are very different than those in life to its fullest. Occupational therapy can help promote inpatient and outpatient settings. Providing therapy within better health and prevent or manage injury, illness, or the home environment is unique in that it allows the client disability through the therapeutic use of daily activities to practice activities within a familiar setting. (occupations).3 This can be accomplished in the home Research has shown that home rehabilitation services by analyzing the environment, recommending changes can help clients improve or maintain their physical level of to better support the client’s needs, goals, and safety, and function, improve their quality of life, and increase their performing an analysis of the demands of various tasks overall independence.1 Additionally, home care services and activities that are important to the client. Activities can also address home- and community-related issues with such as home management tasks, cooking and medication caregivers in real life settings. This can improve caregiver management can be directly addressed in the setting they involvement and allow family to cope with their family are accustomed to instead of being simulated, as they often member’s new level of function, which may lead to the are in the clinic. client being able to stay in their home longer.2 The American Physical Therapy Association describes OT and PT each have their own unique approach PTs as health care professionals who work toward reducing to home- and community-based therapy that, when pain and improving mobility by examining each individual combined, can work synergistically to meet the client’s to develop a plan and start a treatment program. Through goals in a more holistic and well-rounded manner. Continued on page 22

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 19  Elwell, Rainbow’s first residential home in Belleville, MI.  Rainbow was originally named Rainbow Tree Center.

RAINBOW THEN & NOW In 1983, Rainbow Rehabilitation Centers (originally Rainbow Tree Center) opened the doors to its first residential home, Elwell, in Belleville, MI. The vision was to build comprehensive rehabilitation programs for individuals who have sustained traumatic brain injury—something that was severely lacking at the time. Today, Rainbow has grown to include five comprehensive treatment centers, a NeuroRehab Campus®, three vocational centers and more than 38 community-based residential program locations. To this day, Rainbow holds true to our mission:

REMEMBERING LAURIE SHIPLEY This past June, Rainbow lost a very dear friend and colleague, Laurie Shipley. Laurie started her career at Rainbow 35 years ago. She was Rainbow’s first hired employee. She was pure Rainbow— looking out for clients and employees every step of the way. Laurie’s impact on clients and employees as a Residential Program Manager was remarkable. She was a great leader, honest, compassionate and above all else, was incredibly kind. In Laurie’s own words, “It is all about the clients. They are the ones who have taught me compassion, heroism and stick-to-itness. The older I get the more I get it.” As Rainbow moves forward, we will continue to serve our clients the way that Laurie had so beautifully displayed for 35 years.

20 | RAINBOWVISIONS • FALL 2018  2005. Buzz Wilson cuts the ribbon for the opening of the renovated PT gym at Rainbow’s Ypsilanti Treatment Center

Rainbow began as such a tiny company with just a few clients and staff, and it has grown into something amazing now. What I love is that back then it was like a family, and now we are just a big family! I am proud to be a part of the Rainbow family.” Barb Wilson, Owner & Board Member

When Rainbow’s first residential home, Elwell, opened its doors in July of 1983, Rainbow had a total of 9 EMPLOYEES

Rainbow currently has over 900 EMPLOYEES all with the same goal of improving the lives of individuals who have sustained traumatic brain and spinal cord injuries

Rainbow now has over 38 Brain InjuryBrain Specialists

at Rainbow are Certified Rainbowat are residential program facilities across 104 EMPLOYEES central and southeast Michigan pediatric Do Good, 2 treatment centers Do Well,  Every year Rainbow celebrate those employees celebrating milestone employment anniversaries (5, 10, 15, 20, 25, 30+ years) vocational rehab Have Fun. with a fun outing such as a sports game, a riverboat tour, museum 3 centers Buzz Wilson exhibits, a day at the zoo or a performance at a comedy club.

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 21 • THERAPY CORNER REACHING CASEY’S GOALS

Continued from page 19 this, PTs “promote the ability to move, reduce pain, history of Parkinson’s disease. Slowed cognitive processing, restore function, and prevent disability” as well as educate memory impairments, anxiety, decreased coordination, individuals on healthier lifestyles.4 and difficulty with motor movements became exacerbated A physical therapist is typically brought into the following his surgery, which added additional challenges to home when a person is unable to leave their house for his recovery. various reasons such as transportation issues, not having the strength or endurance to leave the home or being CASEY’S THERAPY GOALS unable to enter or exit the home independently. In the Rainbow’s OT and PT team worked with Casey to home, the PT assists with improving mobility to increase identify and develop goals that were meaningful and overall independence, whether that be with various important to Casey and his spouse. It was quickly evident assistive devices (walker, knee scooter, wheelchair, cane), that Casey’s main goal was to access and use his basement strengthening exercises, or improving overall activity bathroom, as it was the only shower in the home he could tolerance. utilize. At the time of the initial evaluation, Casey was unable to manage a full flight of stairs due to his physical A TEAMWORK APPROACH and cognitive impairments. As a result, he was limited to Both the OT and PT have the common goal of meeting a sponge bath at his kitchen sink with assistance from his the individualized wife. needs of the Once Casey’s client, and it main goals were has been proven When OTs and PTs work together they identified, the team that “working in discussed how each teams and sharing are able to combine their skills to truly discipline would skills eliminates maximize the client’s independence address, prioritize, confusing and and organize exasperating in an efficient and meaningful way. therapy in order to duplication of tasks meet Casey’s overall for the patient.”5 goal. Both OT and Research and the PT complemented first-hand experiences of clients has concluded that OTs each other throughout the therapy process by targeting and PTs working together is a more effective method of different aspects of the goal unique to their discipline. delivering care.5 Each therapist will have discipline specific For example, the OT evaluated Casey’s upper body goals on which they are working during each session. strength and range of motion to assess whether there When OTs and PTs work together with a client within would be any physical barriers to complete showering his or her home, the therapists are able to combine their tasks. They assessed the bathroom for fall risks, provided skills to truly maximize the client’s independence in an recommendations on adaptive equipment to utilize, and efficient and meaningful way. completed a simulated shower for practice. The PT focused on improving Casey’s independence CASEY’S BACKGROUND with his walker, scooter, and managing stairs, as this was Recently, one Rainbow client benefited from a successful a main barrier to accessing the lower level basement. OT and PT collaboration. Prior to being involved in a car Throughout this process, OT and PT remained in accident on August 20, 2017, Casey was independent and communication by frequently updating each other on active at home and in the community. He and his wife progress, concerns, and successful techniques that were were hit head on by another vehicle resulting in Casey working for Casey so that each therapist could implement sustaining multiple contusions, abrasions, and a Lisfranc the same strategies in a consistent manner. fracture in his right foot. Casey was unable to bear weight Remaining consistent in the therapeutic strategies used through his right leg for nine weeks due to an open with Casey was important due to the cognitive deficits reduction internal fixation surgery and therefore needed present such as memory impairments, difficulty with various assistive devices to help him move, including a complex commands, following instructions, and increased knee scooter, a walker, and a wheelchair. Casey also had a

22 | RAINBOWVISIONS • FALL 2018 anxiety, especially with new tasks. All these deficits made was educated on the proper use of his shower chair, grab it challenging for Casey to carry over new techniques. bars, and the hand-held shower to improve safety and Therefore, OT and PT attempted to utilize the same independence. He then completed a simulated shower to cueing and education techniques as well as overall physical improve carryover and reduce anxiety prior to completing instruction during each discipline’s session. a real shower. Once Casey demonstrated safe techniques In addition to individual sessions, the OT and PT also and reported confidence with these tasks, he was able completed multiple co-treatment sessions in which both to meet his main goal of taking a full shower after many therapists worked with Casey at the same time. This months. He continued to complete showers successfully allowed the therapists to problem solve together, improve with his spouse’s supervision. patient safety, and decrease Casey’s anxiety during tasks that were more difficult for him. REACHING CASEY’S GOALS For example, during one of the co-treatment sessions, Casey is an excellent example of how OT and PT teams Casey worked with both therapists to simulate the process can work together in the home, utilizing their individual of transferring from his knee scooter to the floor prior to skill sets to maximize a client’s function as well as help the trialing this complicated task at the stairwell. Casey had client meet the most challenging goals they have at home. reported significant anxiety over practicing on the stairs, Ultimately, Casey could put weight on his foot without but this simulation allowed him to master the skill needed having to wear a boot, which resulted in him being able in a safe and comfortable setting prior to completing the to go up and down stairs without any issue. However, move on the actual staircase. This strategy was developed during the months he was unable to do this, occupational after both therapists worked closely with Casey’s spouse therapy and physical therapy helped him regain his ability who helped by locating items within their home that could to perform an everyday activity that most would take for ❚ be utilized as well as helping to problem solve through granted—taking a shower. various barriers that they came across. Casey’s spouse had References also previously received PT following the same accident 1. Armstrong J, Sims-Gould J, Stolee P. Allocation of rehabilitation services and was able to offer many helpful suggestions based on for older adults in the Ontario home care system. Physiotherapy Canada. her experiences in therapy. 2016; 68(4); 346-354; doi:10.3138/ptc.2014-66. During individual sessions, PT continued to work with 2. Warner G, Stadnyk R. What is the evidence and context for implementing family-centered care for older adults? Physical and Occupational Therapy Casey on improving techniques to manage the staircases in Geriatrics. 2014; 32(3); 255-270. and practiced transferring from his scooter to the steps. 3. American Occupational Therapy Association. 2018. About Occupational Once Casey completed the entire process of transferring Therapy. https://www.aota.org/About-Occupational-Therapy.aspx from his scooter to the staircase and going up and down 4. American Physical Therapy Association. 2015. Who Are Physical the stairs, OT began the next step towards meeting his goal Therapists? http://www.apta.org/AboutPTs/. by working with Casey on using the bathroom. 5. Smith S, Roberts P. An investigation of occupational and physiotherapy The OT team first worked with Casey on completing roles in a community setting. International Journal of Therapy and transfers from his wheelchair into and out of his shower Rehabilitation. 2005; 12(1). while maintaining his weight-bearing precautions. He

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RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 23 • MEDICAL CORNER

24 | RAINBOWVISIONS • FALL 2018 THE UNIQUE NUTRITIONAL NEEDS of those receiving enteral nutrition

By Blake Avery, RD and Brandi Jed, RD Rainbow Rehabilitation Centers

or many people, nutrition is no more complicated Immediately following a severe brain injury, metabolic than choosing what to eat. However, for individuals rate can increase up to as high as 240 percent1 greater Fwith a traumatic brain injury (TBI), getting adequate than those without TBI. An increase in metabolic rate nutrition can be extremely difficult. Due to the complex and catabolism can increase protein breakdown which nature of brain injuries, pinpointing one specific cause of can lead to malnutrition. More often than not, persons in altered nutritional status is nearly impossible. Contributing the hospital following a TBI cannot consume an adequate factors can include a decreased appetite, lack of motor amount of oral nutrition required to meet the body’s skills, increased metabolism, dysphagia (trouble with increased demands. Thus, calorie and fluid intake is often swallowing), and more. As a result of these complications, supplemented or entirely provided via enteral nutrition. many people will require enteral nutrition support, also Early initiation of tube feeding is often the preferred referred to as tube feeding, at some point in their recovery protocol to prevent malnutrition, speed recovery, and process. reduce overall length of stay. Almost every patient will Enteral nutrition therapy involves placing a tube along require a high protein and/or high calorie formula to meet the patient’s digestive tract and infusing a specialized liquid these increased needs. formula that provides the individual with fat, protein, As individuals transition out of the acute care carbohydrates, water, vitamins and minerals. setting, they may no longer need tube feeding support. Registered Dietitians (RDs) are professionally trained However, those who cannot meet their daily nutritional to assess each person’s unique nutritional needs in order requirements through oral intake may still require total or to provide the correct tube feeding formula, amount, and partial enteral support as they continue their recovery. rate. Specially trained RDs at Rainbow assist and monitor Clients requiring long-term tube feeding support may clients requiring tube feeding to ensure they are receiving need even more individualized nutritional plans which the best nutrition therapy for their individual needs. take into account pre-existing medical conditions and Information to consider when choosing the right enteral post-injury complications. Chronic health conditions nutrition formula include time since injury, client age, pre- to consider include diabetes, heart disease, obesity, and existing health conditions, and post-injury complications. renal disease, all of which have corresponding therapeutic

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 25 • MEDICAL CORNER ENTERAL NUTRITION

formulas. For example, a formula with a special balance tolerance to provide evidence-based interventions in of protein and electrolytes can be provided for individuals order to reduce these symptoms as much as possible. One with chronic kidney diseases, and a formula with low- example may be a high fiber tube feeding formula or a glycemic carbohydrates will help support clients with fiber supplement to help alleviate constipation. altered blood sugar control. Clients with traumatic brain injury will have an evolving Some formulas contain immune enhancing vitamins, nutritional status on their road to recovery. In the acute minerals and other additions to help combat metabolic care setting, nutritional status is at its most critical point and gastrointestinal stress. Prebiotics and probiotics may with malnutrition prevention being the number one be added to a formula for “good” bacteria growth in the priority. As they transition to post-acute settings, their colon. Increased amounts of antioxidants, vitamin C and E needs shift to preventing exacerbation of pre-existing may be added to reduce free radical damage. The addition conditions and preventing long-term complications. No of EPA and DHA omega-3 fatty acids can help fight matter where a client is in their tube feeding journey, a inflammation and support immune function. Arginine Registered Dietitian will be there to help them along the and glutamine support immune function and can assist way. ❚ with wound healing, while hydrolyzed proteins are often included for optimal absorption. References Once a formula has been carefully selected and 1. Horn, Susan et. Al. Enteral Nutrition for Patients with Traumatic Brain initiated, close observation for any potential intolerances Injury in the Rehabilitation Setting: Associations with Patient Pre-Injury and Injury characteristics is required. Common long-term complications that can and outcomes. ___Archives of Physical Medicine and Rehabilitation. arise are constipation, diarrhea, and malabsorption. RDs 2015: 96(8suppl3):S245-55. will continually assess and closely monitor tube feeding https://www.archives-pmr.org/article/S0003-9993(15)00321-4/pdf

Day treatment designed around "U" A therapeutic approach to day treatment programming for residential and outpatient clients Rainbow U is adding more options than ever in more places than ever! Our day treatment program is offered in Washtenaw, Oakland and Genesee Counties. Contact a member of the admissions team today to learn more about this innovative and popular program! 800.968.6644

26 | RAINBOWVISIONS • FALL 2018 Proudly serving Southeast Michigan for 15 years!

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RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 27 • SUCCESSTHERAPY STORY CORNER WALKING AGAIN Client and Therapist Perspectives

By Andrea Sweet, PT, DPT, CBIS Rainbow Rehabilitation Centers

n our Fall 2017 issue of Rainbow Visions, readers were introduced to the ReWalk exoskeleton. The ReWalkTM is a robotic device that integrates the user’s movements with a system of motors at Ikey joints to externally control gait.1 The ReWalk device has helped many individuals with spinal cord injury around the world to stand and walk again. In this article we will explore therapist and client experiences with training on the ReWalk for the first time.

THERAPIST PERSPECTIVE As always, safety is at the forefront of the therapist’s When a therapist meets a client who is going to trial a mind when guarding or assisting the client. While safety ReWalk device for the first time, there is a lot of learning is critical, the therapist must be cautious to not assist too that must occur for both the therapist and the client. much, especially as the client progresses. Assisting too Clinicians who use the ReWalk undergo specialized much, whether intentional or not, can inhibit progress. training which includes identification and understanding If the therapist is making all the error corrections, the of all parts and components of the device, how to identify client will never be able to truly feel the errors (such as appropriate candidates for ReWalk use, how to assess loss of balance or inadequate or too much weight shift in and fit a client for the device, understanding and using a particular direction) and learn how to correct them. As the software, how to operate and adjust the device, and with most skills, this improves with experience, both with understanding the skills inventories. Therapists who are the device and when working with that specific client. being educated on using the ReWalk must also complete The overall experience of learning the ReWalk and hands-on training with the device and the client. working with a client to use the device has been wonderful. Learning the rhythm of the device and gauging how It is always helpful to learn different treatment approaches much assistance to provide were the main challenges I and expand my treatment toolbox as a clinician, and it experienced as a therapist working with the ReWalk for the is exciting to have the opportunity to use sophisticated first time. When a client first starts out on the ReWalk, the technology. It has also been rewarding to watch my client therapist must provide hands-on assistance as the client is progress and be on this journey with him as he gets closer operating the device. It is essential that the therapist move to reaching the goal of using the ReWalk device in the in sync with the device and the user in order to maximize community and interacting with his family and peers in the effectiveness of the training. ways he thought would never again be possible.

28 | RAINBOWVISIONS • FALL 2018 RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 29 • THERAPY CORNER WALKING AGAIN

CLIENT PERSPECTIVE while in motion. Recently, Tommie was able to experience Tommie McMullen began ReWalk training in June taking a walk alongside his grandson for the very first of 2017 at Rainbow Rehabilitation Centers. Since then, time. Tommie has worked hard to train and improve his skills. Realizing the benefits of using the ReWalk does require He has noticed several physical improvements and has some learning, hard work and commitment. Tommie been able to experience some of the emotional and social reported that learning the rhythm of the machine was benefits of the ReWalk. As he continues to train, he is one of the most difficult parts for him at first, but with looking forward to the ongoing physical benefits and the practice and repetition he quickly caught on. Once he had potential for more social and emotional opportunities. the rhythm down, Tommie had to work to improve his There are many physical changes that a ReWalk user endurance to allow him to tolerate increased distances and may undergo with training. Research has demonstrated to progress to more challenging skills. He has also had to improvements in strength, (based on ASIA motor scores. further improve his core strength and posture to optimize Developed by the American Spinal Injury Association his balance in the device and has been working on this in [ASIA], the scores are a way to conjunction with occupational measure and classify muscle therapy. function in individuals with The experience of Despite how tiring some of spinal cord injury) resting being able to walk again the training sessions with the and training heart rate, and ReWalk have been for him, improvement in bowel and is definitely worth the Tommie feels that out of all the bladder regulation.2 Tommie’s walking methods he has tried, the experience has aligned with time and effort! ReWalk is easiest to use, the most the research. Specifically, he functional, and is still less tiring has noticed changes in muscle definition and strength than other methods. This is because other methods tend to in his legs, and his core strength and posture has also require high energy cost or result in rapid muscle fatigue in improved. Outside of the ReWalk, not only does he have those with spinal cord injury or lower-limb paralysis.3 better posture when seated in his wheelchair, he also is Although the ReWalk is not for everyone, Tommie able to maintain that posture longer. Tommie’s physical recommends that anyone who is a good candidate give it endurance and tolerance has also improved significantly a try. It may seem intimidating and challenging initially, with training. but it gets easier with practice. A list of indications Using the ReWalk has many social implications and can and contraindications for ReWalk use can be found on improve one’s quality of life.2 The ReWalk allows him to the ReWalk website (rewalk.com), and any interested stand without overexertion and feel safe while doing so. individual would need to be assessed for appropriateness. Others who have trialed the ReWalk have also reported To those just starting out using the ReWalk, Tommie significantly reduced fatigue and feeling safe in the device.1 offers encouragement to keep going and not give up. The This provides an opportunity for social interaction by experience of being able to walk again is definitely worth standing and is one aspect to which Tommie is most the time and effort! ❚ looking forward. He has spent several years unable to interact with family and peers at eye level, and he feels References that being able to look someone in the eye gives him more 1. Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi A. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation confidence in his interactions. by people with complete spinal cord injury: A pilot study. J Spinal Cord Additionally, the ReWalk gives Tommie an opportunity Med. 2012; 35(2): 96–101. doi: 10.1179/2045772312Y.0000000003 for functional walking, whereas other methods he 2. Raab K, Krakow K, Tripp F, Jung M. Effects of training with the ReWalk attempted only offered walking for therapeutic purposes.1 exoskeleton on quality of life in incomplete spinal cord injury: a single case study. Spinal Cord Series and Cases. 2016;3,15025. doi:10.1038/ The energy and effort required to ambulate with the scsandc.2015.25 ReWalk has been found to be acceptable and practical for 3. Asselin P, Knezevic S, Kornfeld S, Cirnigliaro C, Agranova-Breyter I, everyday use.3 This will allow him to go for walks with his Bauman W, M Spungen A. Heart rate and oxygen demand of powered family and friends while still having enough energy and exoskeleton-assisted walking in persons with paraplegia. The Journal of Rehabilitation Research and Development. 2015;52(2):147-158. doi: focus left to converse and better attend to the environment 10.1682/JRRD.2014.02.0060

30 | RAINBOWVISIONS • FALL 2018 Discover Specialized Residential Programming in Genesee County It’s about reaching Introducing a safe, supportive environment for your potential the last critical steps toward independence Rainbow Rehabilitation Centers’ Young Adult • Graduated program allows for greater levels of independence Facility Features Program is specially designed to assist individuals • Vocational and educational focus • Furnished and unfurnished living with traumatic brain or spinal cord injury in gaining environments • Graduated medication management • Accessible one- and two-bedroom meaningful employment, developing the skills • Program fosters independent necessary to initiate and maintain long-term financial management units on the ground floor relationships and solidify their identity. • Coordination of driving • Laundry facilities in the unit evaluations/training • Cable/Internet-ready • Discharge planning and community • Transportation available care follow-up services • Community outings For more information, call To register or for more information, call • Professional staff available 24/7 • Individual therapies and 800.968.6644 800.968.6644 therapeutic groups Outpatient and Day Treatment Programs PEDIATRIC • ADOLESCENT • YOUNG ADULT • ADULT Rainbow provides outpatient and day treatment services to clients living in their own homes who wish to participate in rehabilitation programs at one of our state-of-the-art treatment centers. Our in-house staff of highly trained and experienced professionals provide individual and group therapies at all of our centers. Programs feature individualized care plans and treatment, regularly scheduled progress meetings and peer grouping to promote socialization and skill building. No better place to heal 800.968.6644

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 31 • 2018-19 CONFERENCES & EVENTS

September September 13-14 BIAMI Annual Fall Conference Lansing Center – Lansing, MI biami.org September 25 ACMA Great Lakes Conference & Expo Suburban Showplace Diamond Center - Novi MI acmaweb.org September 27 Mary Free Bed Spinal Cord Injury Conference Prince Con. Ctr. at Calvin College – Grand Rapids, MI maryfreebed.com October October 4-5 Comprehensive Brain Injury Rehabilitation Training Rainbow Rehabilitation Centers – Livonia, MI rainbowrehab.com October 4-5 MAJ No-Fault Institute Sheraton Detroit - Novi, MI michiganjustice.org October 5 Michigan Adjuster’s Association Bavarian Inn, Frankenmuth, MI [email protected] October 9-10 Michigan Self Insurers’ Association Fall Conference Mariott Ypsilanti at Eagle Crest - Ypsilanti, MI michiganselfinsurers.org October 17-20 ARN National Conference Palm Beach County Con. Ctr. – West Palm Beach, FL rehabnurse.org October 19 CMSA Detroit Day Long Conference Burton Manor – Livonia, MI cmsadetroit.org October 26 Michigan Guardianship Fall Conference Amway Grand – Grand Rapids, MI michiganguardianship.org/conference October 27 CPAN Auto No-Fault Gala Eagle Eye Banquet Center – Bath Township, MI ProtectNoFault.org November November 1 MSU Case Management Conference Kellogg Center - East Lansing, MI nursing.msu.edu November 5 BIAMI Quality of Life Conference Crowne Plaza Lansing West - Lansing, MI biami.org December December 5-7 National Workers’ Comp Conference Mandalay Bay – Las Vegas, NV wcconference.com 2019 Feb. 28 - March 2 CCMC New World Symposium Gaylord National Resort - Washington, DC ccmcertification.org March 7-8 Comprehensive Brain Injury Rehabilitation Training Rainbow Rehabilitation Centers – Livonia, MI see page 39 for details March TBD MBIPC Annual Executive Lunch Lansing, MI mbicp.or March 13-16 IBIA World Congress on Brain Injury Sheraton Centre Hotel - Toronto, Ont Canada ibia2019.org March 13-16 NABIS Conference on Legal Issues in Brain Injury Sheraton Centre Hotel - Toronto, Ont Canada nabis.org May 2-3 ICLE Annual No Fault Summit The Inn at St John’s - Plymouth, MI icle.org June 10-14 CMSA National Conference & Expo Mirage Event Center - Las Vegas, NV cmsa.org July 16 BIAMI East Golf Outing The Inn at St John’s - Plymouth, MI biami.org

32 | RAINBOWVISIONS • FALL 2018 Rehabilitation Learn Over Lunch Insurance Nurses Council

Meeting times are noon – 1:30 p.m. (Registration at 11:30 a.m.) Registration at 11:30 a.m. • Lunch at Noon Cost: MBIPC Member $25 / Non-member $60 Presentation 12:30–2 p.m. For information call 810.229.5880

UPCOMING MEETINGS October 9, 2018 Location: Calvin College, Prince Conference Center, Grand Rapids, MI Location and Topics TBD September 21, 2018 November 13, 2018 Location: Schoolcraft College, VisTaTech Center, Livonia, MI October 12, 2018 December 11, 2018 TOPIC: Ethics Location: Calvin College, Prince Conference Center, Grand Rapids, MI Sponsored by Rainbow Rehabilitation Centers Location: The Inn at St. John’s, Plymouth, MI January 8, 2019 Location: Schoolcraft College, VisTaTech Center, Livonia, MI November 16, 2018

February 12, 2019 January 18, 2019 Location: Calvin College, Prince Conference Center, Grand Rapids, MI February 15, 2019 April 9, 2019 Location: Schoolcraft College, VisTaTech Center, Livonia, MI March 15, 2019

May 14, 2019 April 19, 2019 Location: Calvin College, Prince Conference Center, Grand Rapids, MI May 17, 2019 June 11, 2019 Location: Schoolcraft College, VisTaTech Center, Livonia, MI RINC meetings are generally presented the third Friday of each month except July, August and December For updates on meetings, visit rainbowrehab.com or mbipc.org For location of meeting or more information, please email [email protected]

NOTICE: The conferences and events information listed on these pages is dated information. For the most up-to-date information on industry-related conferences and events, please visit: rainbowrehab.com/calendar.

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 33 • NEWS AT

Summer Fun! Road Trip 2018 Pediatric clients enjoy a virtual drive across America

This summer, Rainbow’s pediatric and young adult clients at our Oakland Treatment Center and Genesee Treatment Center learned, socialized and explored during the Summer Fun! Program. The theme of this year’s program was Road Trip – a virtual drive across America. Created by Rainbow’s pediatric rehabilitation specialists, this therapeutic program provides structure, support and fun for children ages four through young adult who have sustained traumatic brain and spinal cord injuries. The Summer Fun! program schedule was packed with a variety of classes and activities including Crafty USA, Road Trip Games, Reading Across the USA, Going the Extra Mile and more. These classes challenged our clients to reach their therapeutic goals, all while having fun with their friends! Summer Fun! program participants also went on weekly outings including, Greenfield Village in Dearborn, MI, water parks, an overnight camping trip, arcades and a talent show. Community outings are used as “therapy in disguise” to assist with rehabilitation goals such as socialization, mobility, endurance and combating anxiety and depression. With school now back in session, Rainbow’s Oakland Treatment Center and Genesee Treatment Center offer After School and Saturday programs for children and young adults. If you are interested in learning more about this program, visit rainbowrehab.com/after-school-saturday.

Rainbow Presentations at the Annual Brain Injury Association of Michigan Conference in Lansing

Rainbow encourages all of our employees to attend and present at conferences locally, nationally and internationally. This fall, Rainbow is humbled to have eight Rainbow employees presenting at the Fall 2018 Brain Injury Association of Michigan (BIAMI) conference in Lansing, MI. The presentations include: Lynn Brouwers – The Lesser of Two Evils: Ethical Challenges for Clinicians, Kirk Howard – An Exploration into Tai Chi and Ai Chi, Mariann Young – Grief, Loss and Hope, Carolyn Scott and Lynn Brouwers – An Introduction to Brain Injury, Marissa Cruz and Payal Desai – Balance After Brain Injury, and Aurelia Wiltshire and Sabrina Bentley – Cultural Awareness; Let’s Talk! Presenting at this conference is a great opportunity for these employees to share their expertise and best practices with conference attendees including brain injury professionals, clinicians, individuals who have sustained brain injury and their families. In addition to presenting at conferences, several of Rainbow’s professional staff are available to present on a number of topics including Post-Traumatic Confusion and Behavior: Understanding the School Reintegration Process Following a TBI, Balance After Brain Injury: Vestibular Disorders–Anatomy, Assessment and Treatment, and Traumatic Brain Injury and the African American Male: How Identity Can Effect Post-Injury Outcomes. To learn more about Rainbow’s in-service presentations, contact a member of our admissions team at 800.968.6644 or email [email protected].

34 | RAINBOWVISIONS • FALL 2018 Rainbow breaks ground on NeuroRehab Campus® expansion and renovation project Exciting things are happening at Rainbow! Construction is underway for the NeuroRehab Campus® expansion and renovation project. Located in Farmington Hills, MI, the NeuroRehab Campus® is our facility that is specially equipped for individuals who require intensive post-acute rehab and care. The renovation project includes the construction of a new therapy gym. This space will feature state-of-the-art equipment and technology that will provide even more opportunities for success and recovery for our clients. In addition to the therapy gym, there will also be a renovated lobby and common areas and remodeled client rooms and bathrooms. The new design will be based on the calming color palette and diverse textures used at Rainbow’s newest facility, The Southfield Center. This project will significantly improve the flow and feeling of this 40-bed residential and rehabilitation facility. Every detail of the design has been selected by a team of experts to increase the satisfaction of our clients, guests and NeuroRehab Campus® employees!

 On June 14, 2018, a groundbreaking ceremony was attended by Rainbow’s executive team, board of directors, employees and clients, plus key individuals who have been supportive in the launch of this project including, State Representative Christine Greig, Andy Martin of FH Martin Constructors, Jason Altman of Hooker Dejong Architects, Mary Martin, Executive Director of Farmington Area Chamber, and Terry Solomon of Fifth Third Bank. Rainbow holds Cutest Pet Contest to support the Michigan Humane Society

This summer, Rainbow’s Employee Activities Committee organized a company-wide fundraiser for the Michigan Humane Society to support homeless and mistreated animals in our community. To raise money for the Humane Society, employees participated in a Cutest Pet Contest. Employees submitted pictures of their pet, and for $1 per vote employees could cast a ballot for who they thought was the cutest pet. The committee received over 60 submissions which included dogs, cats, a bunny and a gecko! In total, the cutest pet contest raised $627 for the Michigan Humane Society. The winning pet was Dolce, the Shih Tzu! Dolce enjoys being pampered by her mom, Jennifer Griewahn, Human Resource Generalist. Dolce also loves belly rubs and car rides. She is very demanding and sassy and is a picky eater. She will only eat a specific kind of dog treat and will turn her nose away from anything else. Dolce is spoiled rotten! Congratulations Dolce! This contest helped provide food and care for many other cute animals just like her.

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 35 • NEWS AT

Employees of the Season Winter 2018

Each season, Rainbow employees are recognized for the amazing things they do every day, such as helping with extra shifts, taking care of our client’s needs, and keeping our facilities sparkling clean. The following are the employees recognized for Winter of 2018:

Rehabilitation Assistants RPMs Professional/Administrative Staff Chayla Turman Crystal Bajos Kristian Powell Arbor: Pamela Dagostino Maple: Autumn Landrum Debbie Trumbull Nickole Burnham Amy Gelso Ann Arbor Apts: Brian Poma, NRC: Kalyd Manville, Antonia Starks, Cindy Treharne Tresa Ellis Stephanie Huhn Daniel Shafer Jacqueline Murray-Bey, Lizzietta Battle, Joann Arpino Susan Zaitounh Kathleen Sobczak Bemis: Juanita Washington, Florence Palmore, Nautica Scott Debbie May Sarah Caruso Oakland Townhouses: Deirdre Brown, Porsha Moore Birchwood: Ashli Terrell, Heather Vitale, Whitney Perry Clinical and Therapy Staff Michelle Smith Jessica Reid, Dawn Eichenberg, Spring Valley: Sierra Stone Daria Goodman-Smith Stephanie Lighte Julie Mooring Jillian Zamenski, Cheylon Schneider, Shady Lanes: Toya Moore, Lynn Vaughn, Angelica Lanning Susan Matson Tara Paris, John Antoniotti Angel Hudson, Brandon Schubert, Sara Comer Leslie McIntyre Briarhill: Glen Kurz Nicole McClain Maintenance Angela Asperger Kayla Beach Carpenter: Chalaha Begum Southfield: Latesianna Thrower Team Ann Moncrieff Kerri Torzewski Garden City Apts: Kenyatta Young, Talladay: Alyssa Adams, Kelli Pinder Dennis Dauphinais Lillian Durecki Paige Cicchini Marocca Davis, Emonda Burroughs, VRC: Chelsea Lupone Charlie Allen Kim Wagenknecht Alison Brinkman Debra Parks, Jacquelin Jordan, Whittaker: Jennifer Lynch Jason Rosentreter Timothea McBee Kirk Howard Danita Whitt, Lashanda Williams, Woodsides: Kathryn Sobaszko, Ron Keen Cereste Duprat-Fabre Angie McCalla Crystal Carr, LaKendra Bushey, Amanda Thornton, Judy Hartman Derek Bennett Jill Coval Marketta Crutcher, Hilda Bracy Ypsilanti Center: Millie Staton, Golfside: Elizabeth Kerkes Brandy Antoniotti, Tuesday Crites Home Care: Roberta Wendt, Rehab Trans: Juanita Jones, Veronica Kimble, Debra Kemp Ted Higginbotham

Pillars of Excellence Awards At the luncheon honoring the Winter 2018 Employees of the Season, Rainbow presented the Growth Pillar Award and Safety Pillar Award to two distinguished employees. The Growth Pillar Award recognizes an employee who has contributed significantly to areas that promote this pillar including business diversification and increasing or executing key projects that facilitate growth. The Safety Pillar Award recognizes an employee who has contributed significantly to decreasing employee injury rate, or any other activity that contributes to the safety of our clients and employees. Marisa Cruz, Division Director, was chosen as the recipient of the Growth Pillar Award for her tremendous work that she has done to promote growth in her division. In the few years that Marissa has been with Rainbow, she has helped expand and enhance many areas including home care, outpatient services and more. She is always thinking of new and innovative ways to improve the quality of service for our clients and is a supportive leader for everyone working in her division.  Pillar of Excellence Award winners Marissa Cruz and Bill Carlton. Bill Carlton, Director of Facilities and Construction Management, was the recipient of the Safety Pillar Award for his above and beyond efforts at Rainbow helping to improve efficiency and safety for our clients and employees. Every day, Bill’s number one priority is the safety and well-being of our clients and employees, and Rainbow is a better place because of it. Congratulations to Marissa and Bill! Rainbow is honored to have employees like you!

36 | RAINBOWVISIONS • FALL 2018 Please join us in congratulating these outstanding employees!

Rainbow Rehabilitation Centers has provided quality care and therapeutic rehabilitation services for individuals with brain injuries, spinal cord injuries and other neurological disorders. It is our mission to inspire the people we serve to realize their greatest potential.

View open positions at rainbowrehab.com/employment

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 37 • NEWS AT New Professionals

Teresa Austreng, RN, BSN Lauren Snyder, OTR/L Nurse Case Manager Community Occupational Therapist Teresa joins Rainbow as a Nurse Case Manager Lauren comes to Rainbow as a Community at the Genesee Treatment Center in Flint, MI. Occupational Therapist at the Genesee She earned her degrees at Oakland University Treatment Center. She earned a Master of in Rochester, MI. Teresa has been a nurse for Occupational Therapy from the University 25 years. She has worked in critical intensive of Findlay in Findlay, OH. Lauren’s previous care units and an internal medicine clinic, experience includes two years serving inpatient and was also a Director of Nursing at an and outpatient populations in a critical access ambulatory surgery center. hospital and 13 years with a neurological population.

Earl Jenkins, MBA Sue Turner, BS Talent Acquisition Manager Senior Business Analyst Earl joins Rainbow as a Talent Acquisition Sue joins Rainbow as a Senior Business Analyst Manager in the Human Resources in the Information Technology department Department at the Corporate Center in at the Livonia Corporate Center. She earned a Livonia, MI. He earned a Bachelor of Arts from Bachelor of Science in Computer Science from Arizona State University in Tempe, AZ and the University of Michigan in Dearborn, MI. earned a Master of Business Administration Previously, Sue worked at one of the largest at Saint Xavier University in Chicago, IL. Most health systems in southeast Michigan. recently, Earl managed talent acquisition for Common Ground in Bloomfield Hills, MI.

Dina Marsh, RRT Lauren Wu, DPT Respiratory Therapist Physical Therapist Dina joins Rainbow as a Respiratory Therapist Lauren joins Rainbow as a Physical Therapist at the NeuroRehab Campus® in Farmington at the Farmington Hills Treatment Center in Hills, MI. She earned an Associate in Applied Farmington Hills, MI. She earned her degree Science from Macomb Community College from Central Michigan University in Mt. Pleasant, in Warren, MI and is working toward a MI. Though she’s a new graduate, she does have Bachelor of Science degree in Health Care previous experience working with brain and Administration. Dina spent 15 years working spinal cord injuries. at a level 1 trauma center.

Sarah Pozza, DPT Physical Therapist Sarah joins Rainbow as a Physical Therapist at the Ypsilanti Treatment Center in Ypsilanti, MI. Work With Us! She earned a Bachelor of Science in Kinesiology from Michigan State University in East Lansing, MI and a Doctor of Physical Therapy from Rainbow is looking for Central Michigan University in Mt. Pleasant, exceptional people who MI. Sarah has previous experience with skilled nursing care and home care/assisted living. want to make a difference!

Melissa Rayburn, MPT Physical Therapist Melissa joins Rainbow as a Physical Therapist working at the NeuroRehab Campus® in Farmington Hills, MI. Melissa earned her degree from Wayne State University in Detroit. She has been a physical therapist for 12 years—six of those years with a neurological focus including Learn why you should consider joining our team at: traumatic brain injury, spinal cord injury and rainbowrehab.com/employment cerebrovascular accident (stroke).

38 | RAINBOWVISIONS • FALL 2018 Earn 14 CCM and/or RN CEs FREE CBIS TRAINING

Become a CERTIFIED BRAIN INJURY THIS CLASS IS NOW SPECIALIST 2 DAYS The Academy of Certified Brain Injury Specialists (ACBIS) offers a national certification AND USES THE program for experienced professionals working in the field of brain injury. ACBIS provides an opportunity to learn about brain injury, to demonstrate learning with NEW a written examination, and to earn a nationally recognized credential. EBIG 5.0 As a service to our brain injury community, Rainbow is offering a free training course to prepare for the CBIS exam. Receive a discounted exam fee of $200 ($100 less than Textbooks will be the individual application cost) when you take the exam with Rainbow’s group. available for loan with a deposit or purchased Nurses, case managers and other professionals who partner with Rainbow and at a discounted have at least one year of experience working in the field of traumatic brain injury price of $80 rehabilitation are invited to attend.

2019 SERIES COMPREHENSIVE BRAIN INJURY REHABILITATION TRAINING MARCH 7-8, 2019 • 8:30 a.m.–4:30 p.m. PROCTORED EXAMS Scheduled at your convenience Join more than 1,500 Certified LOCATION Michigan Rainbow Rehabilitation Centers Professionals 17187 N. Laurel Park Dr., Suite 160, Livonia, MI 48152

Email [email protected] ASAP to reserve your spot!

This activity has been approved by the Ohio Nurses Association. The Ohio Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission. (OBN-001-91). This program has been approved by the Commission for Case Manager Certification to provide board certified case managers with 14.0 clock hour(s). To verify successful completion of this program and 14.0 contact hours, you must sign in and sign out on-site each day, attend the entire presentation and complete an evaluation form after the program concludes. The planners and faculty have declared no conflict of interest. Please call Marianne Knox at 734.482.1200 for more information about contact hours.

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 39 One Thousand Words

As we celebrate Rainbow’s 35th anniversary, our thoughts turn to Buzz Wilson who helped establish the company in 1983. Buzz was a great leader. He challenged his employees to make Rainbow a better place for themselves and clients alike. He was a fierce advocate for Rainbow clients and created the culture that everything we do is centered around them. Buzz passed away in 2008, and to this day people still share fond memories about him. The story usually started with, “Remember when Buzz...” He coined the phrase “Do Good, Do Well, Have Fun” and you see this every day in various manifestations throughout the company. Thank you, Buzz, for the opportunities you’ve given so many.

800.968.6644 [email protected] Locations rainbowrehab.com GENESEE COUNTY Oakland Treatment Center WAYNE COUNTY Genesee Treatment Center 32715 Grand River Ave., Farmington, MI 48336 Rainbow Corporate Headquarters 5402 Gateway Centre Dr., Suite B, Flint, MI 48507 T: 248.427.1310 F: 734.629.0453 17187 N. Laurel Park Dr., Suite 160, Livonia, MI 48152 T: 810.603.0040 F: 810.603.0044 Southfield Center T: 734.482.1200 F: 734.482.3202 OAKLAND COUNTY 25285 W. Eleven Mile Rd., Southfield, MI 48033 THROUGHOUT MICHIGAN Farmington Hills Treatment Center Home Care WASHTENAW COUNTY 28511 Orchard Lake Rd., Suite A Ypsilanti Treatment Center T: 800.968.6644 Farmington Hills, MI 48334 5570 Whittaker Rd., Ypsilanti, MI 48197 Home and Community-Based Rehabilitation T: 248.306.3170 F: 248.306.3197 T: 734.482.1200 F: 734.482.5212 T: 810.603.0040 F: 810.603.0044 NeuroRehab Campus® Vocational Rehab Campus Rehab Transportation® 25911 Middlebelt Rd., Farmington Hills, MI 48336 5 West Forest Ave., Ypsilanti, MI 48197 A wholly owned subsidiary of Rainbow Rehabilitation Centers T: 248.471.9580 F: 248.471.9540 T: 734.390.2450 F: 734.217.8174 rehabtransportation.com T: 800.306.6406

40 | RAINBOWVISIONS • FALL 2018 Rainbow Rehabilitation Centers SOUTHFIELD CENTER The new Southfield Center offers comprehensive rehabilitation services provided by professionals who specialize in caring for individuals who have been injured. The program focuses on treating medically stable individuals with: Traumatic brain injuries • Spinal cord injuries Neurologic impairments • Orthopedic injuries • Co-morbidities The Southfield Center is conveniently located in Southfield, MI, close to medical facilities, community activities and major freeways. The fully-accessible facility boasts numerous amenities including: Beautifully appointed 14-bed living environment • Fully accessible private rooms and baths Cable TV, phone and Internet availability in each bedroom • On-site dining services Therapy areas on-site • A large patio deck, perfect for outdoor activities

If you would like to tour Rainbow’s newest premier facility, give us a call at 800.968.6644 Presorted Standard U.S. Postage PAID 17187 N. Laurel Park Drive, Suite 160 Permit 991 Livonia, Michigan 48152 Ypsilanti, MI

INSIDE: Understanding Disorders of Consciousness

Tell us what you think about RainbowVisions! Do you have a story idea or comment? Email: [email protected]

Therapies and skill building for children and teens with brain injuries

Take steps to boost academic and social success Rainbow’s After School & Saturday Programs are designed to foster academic and social success in addition to advancing a child’s treatment goals. Created by pediatric rehabilitation specialists Rainbow’s After School and Saturday Programs provide education and structure for children pre-school age through adolescence, all in a setting that is safe and fun. Engaging activities Tutoring provided by certified teachers • School-based groupings • Individual therapies Therapeutic groups • Recreational groups • Swimming and fitness activities Community outings • Meals and snacks

Now offered in Oakland and Genesee Counties! 800.968.6644