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? Continued on page 4 RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 3 • CLINICAL NEWS DISORDERS OF CONSCIOUSNESS 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.