RainbowVisions - Brain Injury Rehabilitation Centers · Winter 2011 Volume VIII No. 1 A TBI can...

Reducing Agitation and Aggression after a TBI

RainbowVisionsA Magazine for Acquired Brain and Spinal Cord Injury Professionals, Survivors and Families

RAInBow RehABIlITATIon CenTeRs InC.

Winter 2011 Volume VIII No. 1www.rainbowrehab.com

A TBI can cause uncharacteristic agitation. Find out what treatment strategies have proven successful

Therapeutic Ultrasound

Yoga TherapyExploring the mind / body benefits of an age-old alternative therapy

Whooping Cough UpdateCases are on the rise, learn what you can do about it

An effective tool for increasing range of motion and reducing pain

Promoting Great Oral CareStaying healthy through good oral care practices

©iStockphoto.com/hidesy

MARCH IS BRAIN INJURY AWARENESS MONTH

2 RainbowVisions RainbowVisions 3

IT has been just over two and a half years now since Rainbow’s true

founder and inspirational leader passed away. Buzz Wilson lead Rainbow in many ways over the years, but most nota-bly through his focus on the culture and a sense of esprit de corps. His legacy is not the accumulation of brick and mor-tar, employee head count, or sales vol-ume. Rather, his legacy is best noted by the sense to which our shared values and mission are carried on, how we relate and respect one another, and how this energy courses through the veins of the organization. It’s the Culture.

The culture Buzz stood for wasn’t laid out in a textbook or available in a bul-let point list. Rather, it was more of an accumulation of stories, phrases, and repeated actions that made clear what he valued. Phrases like “do whatever it takes,” “the customer is always right,” and “gotta look out for the little guy.” Or “if we don’t do it, who will?,” and “we work for them” (“we” being administra-tion and “them” being the clients, the house staff, and the therapists).

Through our culture, we believe there is no mountain we cannot climb or ob-stacle that we cannot overcome. With teamwork and persistence, we can serve our clients better, we can get the job done, we can achieve, and everybody wins. “We just need to oar together.” Customer Focus. Teamwork. We don’t look at difficult problems and conclude we can’t do it. Rather, we are trained to look at problems and determine what it

would take to do it. At that point, we can determine if we will or won’t – but not that we can’t. Creativity.

Buzz valued Loyalty, Honesty, and Autonomy. He would much rather rein in the super-charged employee than have to push forward the unmotivated. During interviews, he would ask how you spell “no.” Of course, you didn’t know if he meant “no” or “know.” He was usually looking for “K.N.O.W,” unless of course, you were applying for an accounts pay-able position, and then he was probably looking for “N.O.” The point being is that Rainbow has always sought out creative, intelligent, free-thinking individuals who are highly motivated and not afraid to act. “Just get the job done.”

He looked out for the little guy—the client who couldn’t advocate for him-self, or the employee who didn’t have a voice. He would “send a message” to let folks know that we do care. We have done this many ways over the years including improvements to our benefit plans and obsessing over the safety of clients and staff. It is a risky business. As a result, there is no such thing as focus-ing too much on safety.

We miss Buzz dearly and in many ways. We work every day to carry on the legacy that he left behind and to main-tain the culture. I imagine some days it may appear faint, but I assure you, much of the time it is coursing. With time pass-ing, we now have many new employees and clients who never knew Buzz. I am very impressed with the new hires I meet

LEADERSHIP | TEAMWORK | CULTURE

Continuing the Dream

CornerPresident’s

By Bill Buccalo, PresidentRainbow Rehabilitation Centers

every day, as well as the clients I meet at our homes and centers. We have an “awesome” group of people that clearly have “that can-do spirit.” I hope they feel they know Buzz a little through the cul-ture of the organization.

In the time since Buzz passed, there have been many nice tributes, however, one Rainbow client made a request that a picture of Buzz be displayed at the Ypsilanti Center by the end of February. This is a wonderful idea, Roscoe. We are placing plaques in several of the Centers over the next few weeks in honor of Buzz. They will serve as nice remind-ers of the man responsible for much of the culture in which we hope you all enjoy while visiting Rainbow. Buzz was a dreamer— we acted on them and we still do. We need to sieze the day. Or as Buzz would say, “Go for it!”

A Dream Deferredby Langston Hughes

What happens to a dream deferred?

Does it dry up like a raisin in the sun? Or fester like a sore —

And then run? Does it stink like rotten meat?

Or crust and sugar over— like a syrupy sweet?

Maybe it just sags like a heavy load.

Or does it explode?

www.rainbowrehab.com WINTER 2011


Features 10 Reducing Agitation and Aggression after Traumatic Brain Injury Joe Welch, LLP, CBIS, CAAC

17 Choosing the Right Summer Program

20 Promoting Great Oral Care Angie Spears, MA CCC-SLP, CBIS

in each issue 2 President’s Corner – Continuing the Dream Bill Buccalo, President, Rainbow Rehabilitation Centers

4 Medical News – Whooping Cough Kim Wagenknecht, BSN, RN, CRRN

6 Therapy Corner – Yoga Therapy Sara Fink

14 Technology Corner – Therapeutic Ultrasound Tina Kowalski, DPT, CBIS

24 Industry Conference & Event Calendar

news at Rainbow 26 Neuro-Behavioral Program in Oakland Cty.

28 Our Newest CRRNs

28 Rainbow's Employees of the Season

29 New Professionals at Rainbow

Editor — Barry MarshallDesign — Celine DeMeyer

E-mail questions or comments to: [email protected]

Copyright February 2011 – 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].

www.RainbowVisionsMagazine.com

CoverOn the

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800.968.6644www.rainbowrehab.com

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If you do not wish to receive RainbowVisions, please e-mail: [email protected]

20

Cognitive challenges that occur after a brain injury can contribute to frustration and agitation. Read about treatments that work.


ities across the U.S. have been hit hard with a rise in pertussis, or what is commonly known as “whooping cough.” Pertussis, caused by the bacteri-um Bordetella pertussis, is an upper respiratory tract infection that is easily

spread through airborne droplets when an infected person coughs or sneezes. During the first few months of 2010, several states reported increased cases of

pertussis compared to the same time period in 2009. California had the most re-ported cases last year, logging 6,700 cases and reporting that 10 infants have died from it.

In Michigan, the increase was first observed in the second half of 2008 and con-tinued throughout 2009 and 2010. There were 902 reported cases in 2009, and as of Oct. 31, 2010, there were already 1,092 cases. In contrast, there were 315 cases reported in 2008, with an average of 340 cases reported annually since 2003.

SymptomsThe disease starts like a common cold with symptoms of runny nose, congestion, sneezing, mild cough and fever. After one to two weeks, severe coughing begins.

Infants and children with the disease cough violently and rapidly, over and over, until the air is gone from their lungs and they are forced to inhale with a loud “whooping” sound. The coughing can last for weeks, even months. Adults and ado-lescents typically will have a milder form of pertussis; however they can still easily

C

whooping CoughAn EPIDEMIC In MICHIgAn AnD ACROSS THE U.S.

Medical news

By Kim Wagenknecht, BSN, RN, CRRN Rainbow Rehabilitation Centers

The best way to prevent pertussis is to get vaccinated.

Make sure infants and young children get their

recommended shots on time.



spread the infection to others. Pertussis is most severe for ba-bies. More than half of infants less than one year old required hospitalization.

Why is there such a big increase in pertussis cases?There are several reasons for the marked increase in pertussis here in Michigan and across the country. They are:

•Decreasing immunity in teens and adults. Many have not yet gotten their Tdap vaccine booster, and more than half of the cases reported in 2010 have been in teenagers and adults.

•Unvaccinated children. Parents who opt out of vaccinat-ing their children create pockets of vulnerability in the community.

•Change in pertussis testing. A newer test, called a PCR, has become the dominant method of testing, and most likely, more cases are being detected by the new test than in the past.

TreatmentIf someone thinks they have been exposed, they should im-mediately call their doctor. Usually, an antibiotic is prescribed. Until a person has been on antibiotics for five days, they should try to stay away from other people and especially in-fants and young children.

How can pertussis be prevented? The best way to prevent pertussis is to get vaccinated. Make sure infants and young children get their recommended shots on time. Consult a doctor for a vaccination schedule.

Protection from the childhood vaccine fades over time.

Adolescents and adults may need to be revaccinated, even if they were completely vaccinated as children. This is especially important for families with new infants.

Additionally, on a daily basis, one should carefully cover the nose and mouth when coughing or sneezing, wash hands often with soap and water and drink plenty of fluids to avoid dehy-dration.

Clinical ComplicationsPertussis can cause serious and potentially life-threatening complications in infants and young children who are not fully vaccinated.

In infants younger than 12 months of age who get pertussis, more than half must be hospitalized. Hospitalization is most com-mon in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis, approximately 50% will have apnea, 20% get pneumonia, 1% will have seizures, 1% will die and 0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin).

Of those infants younger than 12 months of age who die:

� Refractory pulmonary hypertension is a common, severe com-plication that contributes to death

� Encephalopathy occurs in approximately 20% of cases

� Other complications can include anorexia, dehydration, diffi-culty sleeping, epistaxis, hernias, otitis media, and

urinary incontinence. More severe complications can include pneumothorax, rectal prolapse, and subdural hematomas.

Adolescents and adults can also develop complications from pertussis, but they are usually less severe in this older age group, especially in those who have been vaccinated.

In one study, hospitalization rates were 0.8% for adolescents and 3% for adults with confirmed pertussis. Pneumonia was diag-nosed in 2% of each group.

The most common complications in another study of adults with pertussis were weight loss (33%), urinary incontinence (28%), syn-cope (6%), and rib fractures from severe coughing (4%).

Other complications can include anorexia, dehydration, epistaxis, hernias, and otitis media. More severe complications can include encephalopathy as a result of hypoxia from coughing or possibly from toxin, pneumothorax, rectal prolapse, subdural hematomas, and seizures.

References:

http://publichealth.ewashtenaw.org

http://www.cdc.gov/pertussis

http://www.annarbor.com

http://www.michigan.gov

WHOOPING COUGH CASES IN

MICHIGAN

2008 2009 2010

315

902

1,092

As of October 31, 2010


Therapy corner

6 RainbowVisions

By Sarah Fink Founder and CEO of YogaMedics

Clients of Rainbow’s Pediatric Program participate in yoga groups.



Why use yoga to treat Traumatic Brain Injury? Yoga helps improve flexibility and muscle strength, and promotes relaxation. But there’s more…

very year, an estimated 1.7 million Americans sustain traumatic brain injury (TBI), according to the Centers for Disease Control and Prevention. Most people who have experienced aTBI are treated in emergency

rooms and released. But that doesn’t mean they return to life as usual.The lasting effects of TBI may only be repaired step-by-step

through strategic application of traditional therapies, and new therapies such as the up-and-coming, clinically-based yoga therapy. Combining the age-old wisdom of yoga with the latest medical evidence, Rainbow Rehabilitation Centers has paired up with YogaMedics to run custom classes and individual ses-sions for clients to help them handle life after brain injury. (see

sidebar pg. 8)

Many factors impact health. Social support, stress manage-ment, coping ability and the immune system all play a part in a person’s health. Mind-body medicine addresses all of these.

Mainstream medicine traditionally looks at injury and illness as separate from the person, mind-body medicine considers the cumulative impact of many factors in a person’s wellness picture.

The National Institutes of Health defines mind-body therapy as “interventions that use a variety of techniques to facilitate the mind’s capacity to affect bodily function and symptoms.” Some people are more familiar with the term “alternative med-icine,” which refers to any healing practice that falls outside the scope of conventional medicine.

Societies around the world have long associated good health with more than just taking medicine. Daily diet, exercise, so-cial habits and other factors contribute to a person’s wellness.

Why use yoga to treat TBI? Yoga helps improve flexibility and muscle strength, and promotes relaxation.

But there’s more.•Yoga decreases anxiety and depression.

•Yoga regulates dopamine levels. Research shows that low dopamine levels contribute to addiction and anxiety disor-ders as well as Parkinson’s Disease.

•Yoga increases the release of endorphins, natural mood en-hancers housed in the brain.

Simply put, yoga helps people relax, eliminate stress and increase feelings of well-being.

For TBI patients, the values and practices of yoga help pro-foundly in healing. Yoga’s breathing techniques increases brain activity, focus and awareness.

For those with frontal lobe or forehead injuries who often ex-perience loss of simple movement and the ability to multi-task, medically-based yoga builds the physical body and reteaches skills needed to successfully sequence.

Parietal lobe injuries near the back and top of the head can eliminate one’s sense of body awareness, causing challenges in self-care. Yoga increases awareness and removes distractions.

Other types of brain injuries also benefit from yoga. Whether it’s balance, coordination, movement or simply seeking calm-ness, yoga is one way to strength and wellness. (ezinearticles.com)

Because mind and body are linked, teaching control of the mind helps the body get better. Traditional medicine ad-dresses symptoms of injury or illness. Mind-body medicine addresses the whole person for total wellness. (National Center for

Complementary and Alternative Medicine)

While these methods are gaining in popularity and public attention, they are not new. Until 300 years ago, every medical system treated mind and body as one. During the 17th century, Westerners separated mind and body — the body as a ma-chine with replaceable parts and the mind as a self-sufficient

E

Continued on page 8


RainbowVisions 7


Therapy corner emotional entity. (en.wikipedia.org/wiki/Mind)

While such a perspective led to advances in surgery, trauma care, pharmaceuticals and more, it also diminished the amount of inquiry doctors put into a patient’s emo-tional and spiritual life, impeding total ability to heal.

Stanford University Integrative Psychiatrist James Lake, MD, said: “Extensive re-search has confirmed the medical and mental benefits of meditation, mindfulness training, yoga, and other mind-body practices.” v

References:

National Center for Complementary and Alternative Medicine , http://nccam.nih.gov

Wikipedia, http://en.wikipedia.org/wiki/Mind

http://soulflowyogi.com/Soul_Flow_Yoga_Ask_Flo.html

http://ezinearticles.com/?Yoga-for-Brain-Injury&id=966226

TRIANGLE POSE

BACK BEND POSE

Continued from page 7yoga therapy

Yoga Therapy at RainbowEvery Tuesday and Thursday, YogaMedics therapist Elizabeth Schafer comes to Rainbow’s Apartment Program to serve clients there. She follows a specialized pro-tocol over 12 weeks, combining messaging, education and physical poses to help students with healing. She works with Rainbow’s interdisciplinary therapy teams to ensure that yoga is integrated into a client’s plan of care. She is also responsible for documenting the experience that each client receives during therapy.

“Each week builds upon the week prior,” said Schafer, who studied public health and worked with the U.S. Government but knew nothing about treating TBI until she came to YogaMedics.

“When you start talking about car accidents and veterans from Afghanistan and Iraq, you’re finding problems that may never go away,” she said. “We combine science and medicine and the practice of yoga that we know to be so beneficial physically and mentally, and take it to a clientele that experiences a range of limi-tations and struggles. YogaMedics is a beautiful combination of yoga and public health.”

The messaging in YogaMedics brain injury classes relates yoga to TBI recovery.

“At the beginning, we talk about motivation to live differently. We work on build-ing trust and safety and security within the group,” said Schafer. “We talk about building awareness of physical sensations and ultimately accepting thoughts that clutter the mind.”

Physical poses used in yoga enhance confidence and self-control. “Child’s Pose” relieves anxiety. “Back Bends” open the heart and chest while easing anxiety and depression.

Through the sessions at Rainbow, “people have gotten stronger, and have real-ized improved range of motion, balance and flexibility,” said Schafer. “Our clients use deep breathing techniques to handle anxiety.”

Guided imagery helps them envision the life they want, maintain motivation and believe it into existence.

Rainbow also has a Yoga Group at its Pediatric program in Oakland County. Run by a Rainbow therapist, children and young adults alike actively participate in the group and realize the benefits of yoga.

CHILD'S POSE



The Academy of Certified Brain Injury Specialists (ACBIS) offers a national certification program for entry-level staff and experienced professionals working in the field of brain injury. ACBIS provides those interested with an opportunity to learn about brain injury, to demonstrate their learning with a written examination, and to earn a nationally recognized credential.

As a service to our brain injury community, Rainbow offers free training courses to prepare for the CBIS exam. Nurses, case managers and other professionals who partner with Rainbow and have at least one year of experience working in the field of traumatic brain injury rehabilitation are invited to attend.

Become a Certified Brain Injury Specialist Join more than 1,500 Certified Michigan Professionals

DATES:Training sessions will be held every Thursday from 8:00 a.m. – 9:30 a.m.

July 14 – September 15, 2011

LOCATION: Rainbow Rehabilitation Centers Corporate Headquarters

38777 Six Mile Rd., Suite 101, Livonia, Michigan 48152

INSTRUCTORS: Lynn Brouwers, MS, CRC, CBIST and Heidi Reyst, Ph.D., CBIST

To participate in CBIS training, please contact: Lynn Brouwers at [email protected]


Clinical news

A patient of mine, “Mike,” sustained a traumatic brain injury and had immediate, frequent verbal outbursts and was occasionally physically aggressive. He would

yell and make very disturbing postures and threats. After several sessions of very simple, repetitive breath con-

trol practices, Mike began to take deep breaths independently whenever he felt his anger arise, and would proudly proclaim “I am breathing…I am breathing!”

This young man was successfully able to achieve much great-er self-control over his impulsive (and sometimes explosive) anger and he eventually discharged from treatment.

Mike’s story is not unusual among those with a brain injury. People will often experience periods of agitation immediately following an injury due to the disruption of neurological func-tioning and accompanying confusion. Some people who are recovering from brain injuries may continue to experience pe-riods of agitation for months after their initial accident. A small percentage of people continue to experience states of agitation long after acute hospitalization, seriously disrupting their qual-ity of life and creating many challenges for the people who care for them.

Causes of agitation and aggressionAgitation may best be defined as high irritability and displays of frustration that can include aggressive verbal and physical behaviors such as yelling, swearing, property destruction, strik-ing others, and self-injury. In most cases, family members or caregivers are the most frequent targets. Fortunately, clinically derived treatments can help reduce or eliminate many of these problems that are specifically related to the brain injury.

Physical aggression has been studied by various scientific

disciplines including biological, sociological, and cognitive processing theory.

Biologically, some studies indicate that high testosterone and low serotonin levels are associated with increased levels of ag-gressive behavior in people. People who are experiencing pain or high environmental temperatures have also been found to be more easily agitated. There is strong evidence that higher ambi-ent temperatures increases human violence (Psychological Bulletin,

1989).Behaviorally, a person may act out aggressively to get atten-

tion, to increase access to things they want such as soda or candy, to escape or increase stimulation such as loud noises, or to avoid an unwanted task such as making one’s bed1.

Cognitive challenges that occur after severe brain injury may contribute to frustration and agitation. Memory and attention deficits make learning very difficult. Speech and comprehen-sion impairments can be equally frustrating. Imagine suddenly becoming unable to effectively communicate your needs or understand what others are saying. Add other problems like pain and physical limitations that make doing what was once routine, now impossible. In essence, independently getting one’s needs met after a brain injury can be fraught with frustrat-ing hurdles.

Understanding basic features of agitation and aggression Verbal aggression is the most common form of frustration that is exhibited. Raising one’s voice or swearing may be persistently or intermittently problematic. Threatening to act out physically can be impulsive, defensive, or in response to pain. Verbal ag-gression may be goal-directed to avoid unwanted task demands or events that are perceived as aversive. People may learn that

By Joe Welch, LLP, CBIS, CAAC Rainbow Rehabilitation Centers

Reducing Agitation

and Aggression after

Traumatic Brain Injury

10 RainbowVisions




threatening to get upset or act out may also get them things they want. This is best described as instrumental aggression. Over time, a person may use threats of “getting mad” to get others to do things that they can’t themselves or just don’t want to do. Posturing occurs by threatening to enter someone else’s personal space or by clenching or raising one’s fist. Verbal ag-gression and posturing may be the best indicators of impend-ing physical aggression.

Physical aggression is defined as causing harm toward an-other person or oneself. Property destruction falls into this category (like punching a wall) and is a form of “re-directed” physical aggression. In treatment settings, events of physical aggression towards another person are uncommon and usually short in duration and low in intensity, but can be “crisis-like” for people not familiar with post-acute rehabilitation. Self-injurious behavior is uncommon but is often an expression of frustration and can be as serious as cutting oneself or banging ones head against objects.

Self-injurious and aggressive behaviors, and the settings they occur in, must be thoroughly understood to develop treatment plans to help reduce them.

Treatment worksUnderstanding a person’s cognitive strengths and weaknesses and incorporating them into individualized treatments plans is the focus of all disciplines of rehabilitation.

Speech & language pathologists help people redevelop both receptive and expressive communication abilities. Exercising specific cognitive domains with a supportive speech therapist can greatly improve relationships and reduce frustration.

Everyone has communication strengths that can be

emphasized, as well as, weaknesses that can be minimized by focused treatment in this area. All in all, better communication means less frustration.

Verbal techniques are recommended for verbal aggression1. Not immediately responding to hostile verbal behavior pro-vides a brief time out, and is an effective verbal intervention. Allowing someone to vent during a period of frustration and reducing the audience can lessen verbal outbursts such as yell-ing or swearing. By allowing for time to process this informa-tion, people can move toward more socially accepted methods of gaining attention, asking for help, or accepting “bad news.” A consistently used phrase such as “I will talk to you about this when you are calm” may provide the cue needed for someone to stop yelling or using profanity.

Physical therapists help a person to regain functional effec-tiveness and thus reduce frustration by relearning how to move independently, safely, and successfully. As fatigue can be an antecedent to irritability, strengthening muscles in therapies and exercising regularly helps build endurance. In addition, recognizing that a patient may need to take breaks during certain tasks can help by providing everyone

RainbowVisions 11

Continued on page 12

5Effective Strategies for Reducing Aggression

1. Allow a verbally aggressive person time to vent.

2. Use language such as “I will talk to you about this when you are calm.”

3. Use breathing control strategies to reduce agitation.

4. Implement reward strategies that reinforce self control such as non-contingent rewards.

5. Use collaborative problem solving. Provide empathy, help the person to define the problem, invite them to help solve the situation collaboratively.

©iStockphoto.com


Clinical news

with reasonable expectations of performance and to plan accordingly.

In a comprehensive level of care program, occupational and vocational therapies also add an extremely important dimen-sion by helping people develop the skills necessary to safely complete activities of daily living and thus vastly improving independence.

Recreational therapists help people to relearn the all-too-familiar management of downtime, with fun, social, and con-structive planning and assistance to provide the highest quality of life and to reduce the potential frustration of believing that there is “nothing to do.”

Behavioral therapy is a treatment used with people who are easily agitated after their injuries. Having a psychologist con-duct a functional analysis of specific problem behaviors can help determine why someone continues to act out verbally or physically long after their initial injury. Intermittent dis-plays of frustration, whether verbal or physical, can almost always be reduced or elimi-nated in frequency, duration, or intensity by providing a safe environment with people who are prepared to deal with these problems in an atmosphere of unconditional positive regard.

Anger management At Rainbow Rehabilitation Centers, mental health therapists help patients redevelop their emotional regulation abilities. Most people respond very well to a combination of breath con-trol practice and cognitive therapy to reduce the duration or intensity of periods of agitation2. Teaching these behavioral and thinking skills in therapy sessions and modeling them outside of formal sessions will help increase generalization.

Collaborative Problem Solving (CPS) is another well-con-structed strategy when working with people who have explo-sive tendencies7. This method helps integrate a person’s level of executive functioning and emotional regulation into a system of interaction that pursues reasonable expectations, reduces outbursts, and teaches skills.

The essence of CPS involves a three-step plan: 1. Providing empathy (plus reassurance) toward the person2. Defining the problem situation3. An invitation to collaboratively solve the issue.

Empathy is where a person’s feelings are heard by another person in a supportive relationship and is a core tenet of hu-manistic psychology3. Used unconditionally, empathy rein-forces active communication. Identifying the specific problem behavior with the patient in explicit, understandable terms helps generate greater awareness. Invitation is the process that engages the patient to brainstorm with the therapist ways to solve the problem, thus actively rehearsing executive function-ing and problem-solving skills.

Other proven treatment strategiesReward programs can reduce both verbal and physical aggres-sion. Implementing reward strategies that reinforce self-control, and don’t reward acting out, is an important key to progress in rehabilitation.

Non-contingent rewards (NCR) provide access to enjoyable ac-tivities and attention are supplied or scheduled throughout the day. Basic needs, attention, and preferred activities are provided for unconditionally2. There are indications that this type of re-ward system probably achieves, over time, the greatest reduction in problem behavior and greatest quality of life.

Differential Reward for Other (more appropriate) behavior

(DRO) requires more planning and adjustment during treat-ment, but is proven to be effective at reducing problem behav-iors such as self-injury and physical aggression4. The rewards used to shape behavior can be: giving attention, tangibles (such as spending money), or a time out from a task demand.

Rainbow Rehabilitation Centers incorporates this methodol-ogy into its Adult Levels Program.

“The Adult Levels Program incorporates a client’s goals with clinical time frames that everyone can see, understand, and refer to,” said Dr. Colin King, director of Behavioral Services at Rainbow and developer of the Adult Levels Program. “The Adult Levels Program was developed using proven behavior modification strategies such as differential rewards.”

A specific example of how this works is when someone, who receives an allowance that is only intermittently contingent upon behavior, continues to act out in an unsafe or agitated manner. Making their allowance consistently contingent upon not acting out for specific periods of time (such as daily or week-ly) has helped many people overcome serious behavior issues.

Continued from page 11

Everyone has communication strengths that can be emphasized as

well as weaknesses which can be minimized by focused

treatment. All in all, better communication means

less frustration.




Joseph Welch, LLP, CBIS, CAAC Psychologist, Rainbow Rehabilitation Centers

Joe is a psychologist specializing in brain injury and addictive disorders and is a certified crisis prevention instructor. He holds a master's degree in Clinical/Behavioral Psychology.

Joe has been a Mental Health Therapist at Rainbow Rehabilitation Centers since 2005.

About the author

Rewards that are consistently contingent upon periods of stability have been shown to reduce problem behaviors5. Thus, DRO is a form of contingency management and is effective in reducing problems such as self-injurious behavior and physical aggression2. Family education and the involvement of the en-tire treatment team may be required for this to be successful.

Transitioning from non-contingent schedules to more dif-ferential or contingency-based schedules will help someone achieve greater levels of stability. This is done by making re-wards (such as attention or tangibles) more contingent upon longer periods of stability, and has been shown to reduce prob-lem behaviors5.

Integration of substance abuse recovery into brain injury rehabilitation has greatly helped many people be successful. At Rainbow, Certified Advanced Addictions Counselors can be actively involved in treatment planning, as well as provide individual counseling. Facilitated groups are held at Rainbow and transportation is provided to community-based support groups (such as Alcoholics Anonymous) when a person is ready.

Referrals to addictionists (physicians specializing in substance abuse disorders and pain management) are made when indi-cated and incorporated into the comprehensive treatment plan.

Medication The use of medications in many cases can have demonstrated benefits in reducing agitation and aggression. In cases where there is depression associated with problem behavior, certain anti-depressant medications have also shown efficacy in pro-viding relief from persistent agitation or aggression.

Selective serotonin re-uptake inhibitors (SSRIs) have shown to reduce agitation in some cases where there is high irritabil-ity associated with depression. Anti-epileptic medication and certain anti-hypertensive medications have also been shown to help some patients suffering from anger management problems achieve greater stability.

For more serious or generalized aggression, sedative or anti-psychotic medications may greatly improve a person’s ability to cope. All medication programs that include psychotropics require regularly scheduled assessment by physicians experienced in brain

1. International Association of Nonviolent Crisis Intervention.

2. A comparison of procedures for programming non-contingent reinforcement schedules. Kahng, S.W.; Iwata, B., DeLeon, I.; Wallace, M. (2000); Journal of Applied Behavior Analysis.

3. On Becoming a Person. Rogers, Carl. (1961)

4. The functions of self injurious behavior: An experimental-epidemiological analysis. Iwata, B. et al. (1994); Journal of Applied Behavioral Analysis.

5. The role of attention in the treatment of attention maintained self-injurious behavior: Non-contingent reinforcement and differential reinforcement of other behavior. Iwata, B., Pace, G., Cowdrey, G., & Miltenberger, R., (1994 ); Journal of Applied Behavior Analysis.

References:



TechnologyCorner

Therapeutic Application of UltrasoUndTina Kowalski, PT, DPT, CBIS Rainbow Rehabilitation Centers

14 RainbowVisions

increased cellular activity. Acoustic microstreaming is the result

of pressure forming in the fluid sur-rounding a cell, which facilitates com-ponents required for tissue healing.

During thermal ultrasound, sound waves cause tissue vibration that creates heat in the treatment field. Secondary effects from the production of heat in-clude increasing blood flow to tissue, which delivers important nutrients and removes waste.

Effects of UltrasoundUltrasound may have different effects on tissues depending on the parameters set during treatment.

Thermal effects of ultrasound include any type of heating characteristic, and is used for the reduction or control of pain, muscle spasms (by heating the myo-neural junction), increased circulation and soft tissue extensibility, and altering nerve conduction velocity (how fast a signal travels from the brain or spinal cord to a given muscle).

Thermal effects usually last for 5-10 minutes following treatment, so any subsequent treatment is applied shortly after, such as stretching or soft tissue mobilization (massage).

Non-thermal effects include those characteristics where heating the area

is not the goal of treatment (although there is always some residual heat effect during any ultrasound therapies). Goals of non-thermal, or pulsed, ultrasound involve essential components of tissue healing including edema reduction, pain modulation, and increased capillary density which in turn increases local circulation.

Clinical ApplicationsAmong other clinical applications, ultra-sound is most commonly used in cases of soft tissue shortening and pain control in the traumatic brain injury (TBI) popu-lation. The therapist uses a coupling me-dium, typically gel or water, when ap-plying ultrasound to the treatment area.

Many individuals with brain injuries often present with tightening of muscles due to inactivity, poor positioning, muscle imbalance, and abnormal tone. Abnormal tone decreases an individual’s ability to move muscles through the full range of motion and often leads to contractures. In this situation, ultrasound can apply deep heat to the muscles with limited range, as well as stimulate the golgi tendon organs to activate the pro-tective relaxation reflex.

The use of ultrasound has been shown to be effective in treating shortened muscles, both in research and in clinical

ltrasound was identified during World War II when the use of

SONAR was observed to heat and dam-age underwater life. This finding led to the use of ultrasound in the clinic to heat biological tissues, including muscle, tendons, ligaments, and fascia. These tissues all have high collagen content, creating a lower threshold for heating the material.

Ultrasound creates sound waves that compress the material to which it is applied. It is defined as a sound greater than 20,000 cycles per second (Hz). Therapeutic ultrasound has a frequency of between 0.7 MHz and 3.3 MHz. These frequencies are able to reach tis-sue depths of two to five centimeters. The sound waves travel through the transducer head (the part of ultrasound that contacts the tissue), which in turn converts the electrical energy to sound energy.

In non-thermal ultrasound, this en-ergy produces waves which exert pres-sure on the cell walls, caused by cavi-tation and microstreaming. Cavitation can be described as the effects of the sound waves on the fluid within the cell. Bubbles form and begin to ex-pand and contract, causing increased diffusion across the membrane and

U



Therapeutic Application of UltrasoUnd


RainbowVisions 15

settings. However, as stated, the treat-ment window following ultrasound is short and must be taken advantage of to achieve results. Ultrasound should be used in conjunction with range of mo-tion exercises, orthotics, and/or active exercises as able.

Pain is also a common issue among individuals with TBI. It can stem from a variety of sources, and while it is wise to treat the source of pain, ultrasound can aid in controlling pain during treatment sessions to achieve functional outcomes, independence, and comfort. The non-thermal effects of ultrasound have the greatest effect on pain modulation.

Precautions and ContraindicationsAs with any treatment, there are precau-tions and contraindications of which the therapist must be mindful.

Precautions are based on the individ-ual being treated, and clinical judgment should be utilized in these situations. Precautions for ultrasound include im-paired sensation, cognition, and com-munication due to risk of burning with the use of thermal ultrasound. Other precautions include acute inflammation, use in close proximity of epiphyseal (“growth”) plates, fractures, and breast implants.

Contraindications, or situations where ultrasound should NOT be used, include direct application over implanted stimu-lators, cancerous lesions, anterior neck triangle, eyes and reproductive organs, local infections (sepsis, osteomyelitis), metal in the treatment field, pregnancy, growth plates, central nervous sys-tem tissue, joint cement, and plastic components.

ConclusionTherapists have a metaphorical “tool box” when treating individuals with TBI. Ultrasound is just one tool in the box, and can be used in various situations to increase functional outcomes for indi-viduals with physical impairments and functional limitations.

The clinician should be well versed in the rationale and treatment methods of ultrasound before utilizing it in the field

and should use ultrasound in addition to evidence-based therapy and other mo-dalities as necessary. v

References:

Physical Agents in Rehabilitation: From Research to Practice

Michelle H. Cameron, pp. 195-215

Enhancing treatment outcomes with therapeutic modalities: Electrotherapy and Ultrasound. David Draper, Ed.D., ATC. Course workbook.

About the author

Tina Kowalski is a graduate of the

University of New England in Portland,

ME with a Doctorate in Physical

Therapy. She has clinical experience

in a variety of settings, including

pediatric and adult rehabilitation. Tina

is a Physical Therapist at Rainbow’s

NeuroRehab Campus®.


To register or for more information call...

800.968.6644E-mail: [email protected]

www.rainbowrehab.com

& Saturday Dayafter School

Programs Therapies and skill building for children and teens with brain injuriesSpecifically designed for academic and social success, our programs integrate structure, group and/or individual therapies, personalized tutoring, recreational activities and social skills training.



Choosing the right

Summer Program for children and young adults with special needs

For many adults, summer camp conjures a host of memories such as scary ghost stories, swimming lessons, and gooey s’mores. Children

today, including those with special needs, have an array of summer options in addition to that classic camp experience. Kids with special needs want to participate in activities, make friends and be accepted just like everyone else. Parents want a program that allows their children to maintain the progress they’ve made during the school year. Everyone will want an environment that is safe, supportive and fun. Continued on page 18


Before making a decision, you’ll want to consider the variety of summer pro-grams available. Does the program make accommodations for special needs? Accessible wheelchair ramps, special diets and trained medical staff are some-times available at mainstream camps. Your child will have the opportunity to meet and socialize with peers and partici-pate according to his or her abilities. If, however, your child needs structured therapy throughout the summer then you’ll want to consider a different type of program.

Special needs summer campThere are two types of summer programs for kids with special needs. The first is de-signed to look and feel just like a classic camp. These camps aim to remove barriers to activities that non-disabled children take for granted. There are special needs sum-mer camps for children with physical or mental impairments, behavioral issues, and medical conditions such as diabetes and cancer. Aside from the benefits that everyone receives from a camp experience, children at a special needs camp meet and make friends with others who share their particular abilities.

Therapeutic summer programmingAnother type of summer programming is therapeutic and comprehensive. These struc-tured programs employ professionally trained pediatric therapists and have an appro-priate staff-to-child ratio. Individual therapies are available as well as opportunities for therapeutic learning. Medical personnel are available. Parents who are concerned that their child continues to make gains in therapy and academic skills would choose this type of program.

Therapeutic programming doesn’t mean all work and no play. Art, music, sports and organized games are incorporated into the therapies. Cooking projects reinforce math skills and health lessons, yoga and equestrian activities help to improve balance and core strength, art activities are designed to improve eye-hand coordination. Older chil-dren can also benefit from health management, career-building activities and volunteer opportunities.

Other factors to consider STAFF When choosing a program make an effort to meet the staff and tour the facili-ties. Is it easy to access the director? What is the staff experience level and education? Are medical professionals available? What is the staff-to-child ratio? Are they proactive in learning about your child’s needs? What are their safety plans and procedures?

PHILOSOPHY Find out if the program has particular goals or objectives for their par-ticipants. Are children separated by age, gender or interest? Sometimes mixing ages and grade levels creates disparities in sports and academic abilities. That can lead to frustra-tion for participants of all ages, and the program should foster a sense of community during each child’s stay. COMMUNICATION Letters home were a mainstay of the classic camp experience, but

Choosing the rightSummer Program for children and young adults with special needs


ABOVE: Spending time with friends and enjoying a summer day are important for the children who

participate in Rainbow’s Summer Fun! Program. ABOVE RIGHT: “Noodling around” in the pool is more

than just fun, it’s aquatic therapy. Participants may increase joint mobility, range of motion, muscle

strength and endurance while in the water.



Sailing into...

Summer Fun!

800.968.6644

Therapeutic programming for

children, teens and young adults with

brain injuries.

SAVE

the DATE!June 20 –

August 26, 2011

Two Locations in Southeast Michigan:

Oakland Countyand

Genesee County

To register or to learn more about Summer Fun!

Programs, call toll-free

A therapeutic

summer program

where we don’t count

the days…we make the

days count!

special needs programs should have a communication plan that goes well beyond this. If you are considering an overnight program, what is the their policy for han-dling communications home? How do they handle common issues such as home-sickness, illness and behavior problems?

LICENSING Ensure that the program you are evaluating is properly licensed. Know that licensing requirements vary from state to state. Does the program per-form background checks on prospective staff members? Do they insure that indi-viduals transporting children have valid driver’s licenses? Do care providers have up-to-date CPR or first-aid certifications?

There are many factors to consider, but the most important may be your child’s comfort. Many children feel intimidated by unfamiliar people and surroundings so you may want to reassure them about the new experiences ahead. Keep in mind that the best summer programs allow opportunities to acquire new skills, build con-fidence and foster independence. Above all, remember that any program for kids should be safe, fun and provide great memories for years to come. v

References:

www.camppage.com/summer-camp-choosing.htm

kidshealth.org/parent/system/ill/finding_camp_special_needs.html

www.kidscamps.com

www.rainbowrehab.com

ABOVE: Academic performance needn’t be a casualty of summer. Rainbow’s Summer Fun! Program includes academic support through one-on-one and group lessons.


By Angie Spears, MA CCC-SLP, CBIS Rainbow Rehabilitation Centers

Too tired to brush your teeth?

Too busy to floss? If you’re tempted to skip these daily tasks, remember that your smile and oral hygiene depends on these simple dental care habits. Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums. Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly, as well as de-crease your risk of diseases.

Someone who has experienced a traumatic brain injury (TBI) faces many challenges. The simplest daily tasks can be difficult, including basic day-to-day routines. Oral care can be overlooked when a person experiences a TBI secondary to possible physical and cognitive changes. However, these

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20 RainbowVisions

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impairments should not shadow the importance of oral care. There are many adaptive and assistive equipment devices that can be used for proper oral care, despite the TBI. Oral health education has received increased attention and awareness over the last few years as poor oral hygiene can be an indicator for additional health issues.

oral care and your healthIt is not surprising that your mouth is full of bacteria. The oral cavity is a moist and dark place, often filled with food, chew-ing gum, fingernails, pen caps, etc. Some bacteria are good, and they can fight off germs and viruses. However, some bac-teria are not healthy for your body, as they cause infection and disease if not properly cleared from the mouth. Statistics show these bacteria make the human bite more harmful than a dog bite.

Bacteria attaches to the surface of teeth, gums, tongue, and cheeks. They live in plaque, which is a colorless biofilm that naturally builds up on teeth. If plaque is not removed, it starts to harden within 48 hours. Within 10 days, the remaining plaque becomes dental tarter, which is rock hard. Tarter can-not be removed with a toothbrush, so it must be removed by a dentist or dental hygienist. If plaque is allowed to build up, the bacteria it holds can cause tooth decay, gingivitis, pneumonia and other illnesses. Multiple studies have linked oral pharyn-geal colonization with respiratory infections and illnesses. (American Journal of Infection Control 2005;33:527-41)

Oral health is now seen as a marker for more serious health problems. Poor oral hygiene can no longer be considered just a local problem, but one for the health of the whole body. Many studies have recently connected gum disease with some serious health problems including cardiovascular disease, strokes, and diabetes. Gum disease can cause bacteria to enter the blood-stream where they attach to fatty deposits in heart blood vessels. This can cause blood clots and may lead to heart attacks. Severe periodontal disease has an adverse effect on sugar levels, in-creasing the risk of diabetic complications.

Pneumonia is a common respiratory illness in which there is inflammation of one or both lungs. Pneumonia is caused by bacteria, viruses, and fungi. One way of acquiring pneumonia is by aspirating the bacteria and viruses living in your mouth. A recent study found that in 66% of the cases of pneumonia, the organism causing the pneumonia came from the mouth. (Garrcuate et al., Scannapiceco et al.)

why extra attention for persons with disabilities?There are two significant predictors of pneumonia that are di-rectly affected by oral hygiene. First, dependency for oral care is directly correlated with poor oral health. (Vigild- 88) Those who depend on others to brush and floss their teeth are much more likely to be at risk for aspiration pneumonia. (Langmore et al, 1998) The second significant predictor of pneumonia is the number of decayed and/or missing teeth. Decayed and missing teeth create a direct source of bacteria. (Jette et al, 1993) Bacteria thrive in the open space and worsen tooth decay, thus increasing the likelihood of causing pneumonia.

Physical impairments, uncooperative hands, and unreliable memory from brain injury are just a few reasons someone may require help completing oral care. Oral care can be extremely difficult to perform on ill and non-cooperating patients.

stay hydratedBoth the tongue and saliva play a role in maintaining good oral health. The tongue is always moving around in the oral cavity (in most situations) which helps break up bacteria colonies. The tongue has a rough surface and brushes against teeth while eat-ing and talking.

Saliva keeps the oral cavity lubricated. It is frequently swal-lowed, thereby diluting and removing bacteria from the oral cavity throughout the day. For example, saliva clears sugars and dietary acids, which aids in protecting the teeth against erosion. When saliva is decreased, possibly because of an infection or a side effect from a prescribed medication, a per-son may experience dry mouth, also known as xerostomia. Xerostomia leads to increased bacteria in the mouth because food debris accumulates along with dental plaque without nor-mal salivary flushing.

Dry mouth can also lead to: oral discomfort, loss of teeth, taste and appetite disturbances, oral infections, dysphagia (dif-ficulty swallowing), and speech difficulties. These can lead to a decreased immune system, as they further stress gastrointestinal function, loss of appetite, fear of eating, weight loss, and/or malnutrition.

Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. Some common causes of dehydration include: diarrhea, vomiting, sweat, dia-betes, and burns.

Dehydration is often overlooked and untreated due to in-adequate recognition of some of its causes and symptoms. (Copeman, 2000; Vogelzang, 1999) Symptoms include: dry mouth, low or no urine output (concentrated urine appears dark yellow), not producing tears, sunken eyes, muscle cramps, lighthead-edness (especially when standing), and lethargy or comatose (with severe dehydration).

RainbowVisions 21



Those who depend on others to brush and floss their teeth are much more likely to be at

risk for aspiration pneumonia.


Promoting great

10 Tips for Improving Oral Hygiene

1. Encourage routine visits to dentist

2. Brush teeth daily

3. Never use mouthwash with alcohol (alcohol dries the mouth)

4. Encourage cessation of smoking

5. Reduce intake of sugary snacks

6. Encourage adequate hydration and nutrition

7. Use soft bristled toothbrushes

8. Use sodium bicarbonate toothpaste with fluoride

9. Floss whenever possible

10. Use water soluble moisturizer to lips and oral mucosa (soothes and hydrates the lips and oral tissue)

22 RainbowVisions

Dehydration is a major risk factor for oral and dental disease secondary to reduced liquid intake, reduced salivary flow, and build-up of plaque.

practicing preventive careDaily preventive care helps stop problems before they develop. Some diseases and conditions can make dental disease and tooth loss more likely, but most of us have a good deal of control over the health of our teeth and mouth.

Promoting good oral care may reduce the likelihood of pathogenic bacteria being present in the oral cavity. The most important thing you can do is to brush and floss your teeth daily. Brushing provides the friction required to remove plaque from the large surfaces of the teeth and from just under the gums. Flossing removes dental plaque from between your teeth. Using foam swabs (often referred to as toothettes) removes debris and secretions from the oral cavity, but does not remove plaque from between teeth or sheltered areas.

Some people who have sustained a traumatic brain injury and/or experienced another life altering event may benefit from adaptive equipment to make good oral hygiene easier. Suction toothbrushes are often used for patients who do not have a safe/functional swallow following a brain injury and receive most, if not all, of their hydration and nutrition from a percutaneous endoscopic gastrostomy (PEG) tube.

Suction toothbrushes attach to a suction machine and reduce the risk of aspiration pneumonia by removing unwanted fluids from the oral cavity. A yankuer can also be attached to a suction machine. A yankuer is a hollow tube made of metal or dispos-able plastic with a curve at the end. It can be utilized during oral care to remove ex-cess secretions, debris and saliva to help prevent diseases and pneumonia.

Continued, adequate oral care is a necessity for healthy living. The research con-necting poor oral hygiene to serious health problems is alarming especially for those who are dependent on others for oral care. Keeping the mouth and oral cavity clean reduces bacteria and the chance of infection. v


Suction toothbrushes attach to a suction machine and reduce the risk of aspiration pneumonia by removing unwanted fluids

from the oral cavity.

Some people who have sustained a traumatic brain

injury…may benefit from adaptive equipment to make

good oral hygiene easier.



Angie Spears, MA, CCC-SLP, CBIS Speech-Language Pathologist

Angie has a master of arts degree in speech-language pathology from Cleveland State University and a bachelor of arts degree in communication disorders from Central Michigan University. Angie has worked with the traumatic brain injury population at Rainbow Rehabilitation Centers for four years, and has two years of experience treating the geriatric population with a range of neurological impairments. She has lectured on both recall and swallowing at local and state level. Angie is a Certified Brain Injury Specialist and a member of the American Speech-Language Hearing Association.

About the author

References:

Almsthal & Wilkstrom, 1999

American Journal of Infection Control 2005;33:527-41

Copeman, 2000; Vogelzang, 1999

Dawes 1983

Garrcuate et al., Scannapiceco et al.

Gross et al, 1992; Copeman, 2000; Kleiner, 1999

Jarvinen et al 1991

Lagerlof & Oliveby 1994

Langmore et al. Dysphagia 1998; 13: 69-81

Millns B, et al, Acute Stroke Predisposes to Oral Gram-Negative Bacilli-A cause of Aspiration Pneumonia? Gerontology 2003; 49: 173-76.

Sarosiek, 2000

Vigild- 1988

RainbowVisions 23


Call 800.306.6406

so you can GO!We get youReady

get you Set

The most challenging part of the journey can be getting out the door —

washing, dressing, preparing for the day. Rehab Transportation drivers know

this and are trained in caring for individuals with special needs including

brain and spinal cord injuries. We get you safely from point A to point B, and

if you like, we give you expert personal care assistance at either point too.

Personalized, attentive services 24/7, 365 days a year.

Ready, Set, GO!

RequeSt a RIde onlIne!

www.rehabtransportation.com

24 RainbowVisions

2011Conference & Event Schedule

MayMay 2-4, 2011MALA 2011 Conference & Trade ShowThe Lansing Center, Lansing, MIFor info, please visit: www.miassistedliving.org/conference

May 6, 2011WMBIN Annual SymposiumCrowne Plaza, Grand Rapids, MIFor info, please visit: www.maryfreebed.com

May 10, 2011Case Management Society of America Detroit Chapter Dinner ConferenceFarmington Hills Manor, Farmington Hills, MIFor info, please visit: www.cmsadetroit.org

May 13, 2011U of M / St. Joseph Mercy Rehab Nursing ConferenceKensington Court, Ann Arbor, MIFor info, please email: [email protected]

May 15 – 18, 2011Contemporary Forums Psychiatric Nursing ConferenceHyatt Regency, San Francisco, CAFor info, please email: www.contemporaryforums.com

May 17, 2011Case Management Society of America Greater Grand Rapids Kalamazoo ChapterMuskegon, MIFor info, please email: [email protected]

JuneJune 1–3, 2011Michigan Self-Insurer’s Assoc. Spring ConferenceGrand Traverse Resort, Traverse City, MIFor info, please email: www.michselfinsurers.org

June 14-17, 2011Case Management Society of America 21st Annual Conference and ExpoGonzalez Convention Center, San Antonio, TXFor info, please visit: www.cmsa.org

JulyJuly 12, 2011BIAMI Eastern Grand Invitational Golf OutingThe Inn at St. John's, Plymouth, MIFor info, please visit: www.biami.org

July 21, 2011BIAMI West Grand Ivitational Golf OutingBoulder Creek Golf Club, Belmont, MIFor info, please visit: www.biami.org

Winter/Spring

MarchMarch 8, 2011Case Management Society of America Detroit Chapter Dinner ConferenceFarmington Hills Manor, Farmington Hills, MIFor info, please visit: www.cmsadetroit.org

March 10, 2011DMC/RIM 60th Anniversary CelebrationFox Theater, Detroit, MIFor info, please visit: www.dmc.org

March 11, 2011Educational Rehabilitation SymposiumRadisson-Kingsley Inn, Bloomfield Hills, MIFor info, please visit: www.acclaimedhc.com/events.html

March 12, 2011Carnival of CareSterling Inn, Sterling Heights, MIFor info, please visit: www.carnivalofcare.com

March 15, 2011Case Management Society of America Greater Grand Rapids Kalamazoo ChapterLansing, MIFor info, please email: [email protected]

March 23 – 26, 2011Contemporary Forums Psychiatric Nursing ConferenceSheraton Society Hill, Philadelphia, PAFor info, please visit: www.contemporaryforums.com

March 29, 2011Michigan Association of Rehabilitation Nurses Annual Education ConferenceLaurel Manor Conference Center, Livonia, MIFor info, please visit: www.miarn.org

AprilApril 7 – 10, 2011NICM/ACMA Case Management ConferenceOrlando World Center Marriott Resort, Orlando, FLFor info, please visit: www.acmaweb.org

April 9, 2011BIA of Michigan, 13th Annual Spring Tribute Legacy Society Dinner; An Evening with John GroganSuburban Collection Showplace, Novi, MIFor info, please visit: www.biami.org

April 21, 2011Michigan Health and Rehab ConferenceBest Western Sterling Inn, Sterling Heights, MIFor info, please visit: www.firsttoserve.com

April 29, 2011Detroit Medical Center/Rehab Institute of MI Rehab SymposiumMotor City Casino and Hotel, Detroit, MIFor info, please visit: www.dmc.org


RainbowVisions 25

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: www.rainbowrehab.com

Select Education & Publications from the top menu and then select Conferences & Events

Updated biweekly, the site offers the dates, locations and topics of the industry's most prominent events.


MBIPCMichigan Brain Injury Provider Council

Learn Over LunchMeeting times are noon – 2:00 p.m.

(Registration at 11:30 a.m.)Cost: MBIPC Member $25 / Non-member $60

For info or RSVP contact Mary Mitchell734-482-1200 or [email protected]

March 8, 2011Topic: Updates on MDCH Programs and TBI Prevention

Speaker: Michael Daeschlein and Linda Searpetta MI Dept. of Community Health (MDCH)Location: Kellogg Center, East Lansing, MI

April 12, 2011Topic: TBI and Sexuality: A Multi-Dimensional Perspective.

Speaker: Barbara Barton, MSW, Ph.D.Location: Holiday Inn West, Livonia, MI

May 10, 2011Topic: Mild Traumatic Brain Injury

Speaker: Karen Bergman, RN, Ph.D., CCRNLocation: Applause Banquets & Catering in Grand Rapids, MI

June 14, 2011Topic: Violence in the Workplace.Speaker: Judy Arnetz, Ph.D., MPH, PTLocation: Holiday Inn West, Livonia, MI

For updates on meetings, visit www.rainbowrehab.com

RINC Rehabilitation &

Insurance Nursing Council meetings

MEMBERS ONLY

Registration at 11:30 a.m. / Lunch at Noon Presentation begins at 12:45 p.m.

March 18, 2011Topic: Advanced Stress Management

Speaker: Mary Jo Gavin, Ph.D.Location: Functional Recovery Program at Sinai-Grace Hospital

25900 Greenfield, Suite 502

Oak Park, MI 48237

RSVP to: Brenda Blind at 248-968-5393 by March 7, 2011

April 15, 2011Topic and speaker: TBD

May 20, 2011Topic and speaker: TBD

June 17, 2011Topic and speaker: TBD

RINC meetings are presented the third Friday of each month.

For more information on meetings and membership contact Adrienne Shepperd: 248-953-4079

March 16, 2011Brain Injury Awareness Day on Capitol Hill

Washington, DC

The day’s events include:Brain Injury Awareness Fair

10 am – 1:30 pm

Brain injury rehabilitation briefing 1:30 pm – 3:30 pm

The Brain Injury Association of America and the Congressional Brain Injury Task Force, along with other stakeholders are coordinating the day’s activities.

Visit www.biausa.org for more information.

MARCH IS BRAIN INJURY AWARENESS MONTH


News @Rainbow Expands its Neuro-Behavioral Program for Adults

About the home…

Rainbow’s successful adult neuro-behavioral program is expanding into Oakland County with the opening of a new residential home.

This program will offer adults with neuro-behavioral challenges an effective treatment option in a community setting. The structured program features staff specially trained in behavior modification tech-niques—principles involving positive reinforcement, peer mentoring and modeling.

Educational pursuits and/or vocational training are encouraged in the neuro-behavioral program, and substance abuse counseling is pro-vided when necessary.

Led by psychologist Colin King, Ph.D., the goal of this program is to transition individuals to the most independent and appropriate environment possible while giving them the tools to manage their behaviors.

� Designed especially for adults with neuro-behavioral needs

� Six private bedrooms

� Three fully accessible bathrooms

� Open floorplan featuring barrier-free living areas, TV room, bedrooms and kitchen

� Private therapy room on site

� Alarm system to promote personal safety

� Full laundry facilities

To learn more about availability or to schedule a tour, call Rainbow’s Admissions Department at:

800.968.6644

You may never know the positive impact you have on someone until years later. Just ask Carole MacQueen, OTR/L, NDTC at Rainbow. A few years ago, Carole was a mentor to then-intern Rosanne DiZazzo-Miller, an occupational therapy student at Eastern Michigan University working on her master’s degree in OT.

Since that time, Rosanne has gone on to become an Assistant Professor at Wayne State University in Detroit and has earned a doctoral degree in occupational therapy.

In October of last year, Dr. DiZazzo-Miller asked Carole if she would deliver a lecture series to her OT students on Neuro-Developmental Treatment (NDT), an ad-vanced therapeutic approach practiced by OTs.

Carole was honored by the invitation and jumped at the chance. She developed a lecture series that included a one-hour lecture on theory and two, two-hour labs, where the students were on mats working on handling techniques. The student’s loved Carole’s interesting lecture and interactive labs.

Carole recalls Dr. DiZazzo-Miller as being one of “the best students I ever had!”

Rainbow therapist develops lecture series

Congratulations, Carole, on a fantastic lecture series!Carole MacQueen, OTR/L, NDTC



New program at Rainbow creates opportunities for employees

Regain confidence

Develop skills

Reinforce positive habits

Work toward employment goals

Earn a paycheck

Vocational training and rehabilitation are vital after a traumatic brain injury because cognitive skills—which impact problem solving, concentration and abstract thinking—are often altered.

Rainbow Industries provides a safe, supportive environment where people work toward employment goals while earning a paycheck.

Vocational Experience after a Traumatic Brain Injury

Located in Ypsilanti, Michigan

734-480-4277

Late last year, the Executive Committee at Rainbow Rehabilitation Centers an-nounced a new director-in-training program to support our growth and ensure con-sistent, quality care to our clients no matter where they receive treatment.

Because of this program, there exists an unprecedented opportunity for our em-ployees to advance to roles of increasing responsibility. This new program calls for additional directors to help us expand our services beyond existing boundaries. As the company grows, there will be more opportunities for our employees who have the necessary skills to develop into these leadership roles.

To kick off this program, four people have been selected to participate in the initial year-long training program that will culminate with two of them being promoted to a Divisional Director, while potentially leaving two others available to fulfill future op-portunities. They are: Anne Ulrich, Bob Wancha, Dr. Mary Newton, and Joe Welch.

Join us in congratulating them and encourage them as they take this step in their careers at Rainbow!


News @

Congratulations to Rainbow’s newest CRRNs!Rainbow Rehabilitation Centers is proud to recognize three new Certified Rehabilitation Registered Nurses on its staff.

Kathleen Sobczak Kim PhelpsJill Coval

Congratulations to our colleagues on this significant accomplishment!Congratulations to our colleagues on this significant accomplishment!

Congratulations Dr. Mary NewtonRainbow is pleased to recognize Case Manager and Mental Health Specialist, Mary Newton on earning her doctorate in Industrial Organizational Psychology (I/O) from Capella University in Minnesota. I/O uses evidence-based testing to assess workplace functionality and improve productivity. It is also helpful in assisting individuals to adapt to the greater community and world of work, an important component of Dr. Newton’s responsibilities at Rainbow. We congratulate her on this significant accomplishment!

Rainbow Employees of the SeasonAnn Arbor Apartments: Quanda MercedAfter School/Summer Program: Erin ChatmanArbor: Marybeth ElderBell Creek: Katherine Coon-JohnsonBelleville: Vanessa ViewBirchwood: Alyssa CooperCarpenter: Melissa PottersElwell: Kendra BlackwellFarmington: An’Twoin DowellGarden City Apartments: Cecil NewlinGill: Diane MarshallGlenmuer: Nicole LefebvreGolfside: Denise GenereauxHillside: Kathy Boraggina Highmeadow: Nicholas Mascaro

Home Health: Sandra Smith Maple: Riad AlhakimNRC North: Keisha OliverNRC South: Terrell MitchellPage: Tina MilliganPaint Creek: Angeleec AndronParkview: Carrie FarmerRehab Transportation: Gary DevineShady Lane 1: Chenoa MaysSouthbrook: Krystle RichardsonSpring Valley: Kelly GoodmanTextile: Cheryl HinkleOakland Townhouse: Cynthia Lindberg Whittaker: Sarah PorterWoodside 1& 2: Samantha Bass & Kristi Vaupel

Rehabilitation Assistants

ResidentialProgram ManagersMichelle Smith

Administrative StaffKeith SchenkelPamela BradenCheryl Helber

Professional / Therapy StaffLillian Durecki, Randy Green, Anne Ulrich, Marty Humphrey, Amanda MiuccioMaintenance Staff

Jeff Schmitt and Bob Adams

Fall 2010

For Spring and Summer 2010 Employees of the Season, go to www.rainbowrehab.com

Please join us in congratulating these outstanding staff members!



New Professionals at RainbowMelissa Miller, BSN Clinical Nurse Manager

Melissa joins the team at Rainbow’s NeuroRehab Campus®. She has worked for St. Joseph Mercy Health and Oakwood Annapolis. Melissa holds a Bachelor of Science in Nursing from Eastern Michigan University.

Jocelyn Kubert, PT, DPT Physical Therapist

Jocelyn joins the staff at the NeuroRehab Campus® as a physical therapist. She has clinical experience working with the TBI population and earned a Doctor of Physical Therapy degree from Central Michigan University.

Elina Gorelkin, PT, DPT Physical Therapist

Elina comes to Rainbow with clinical experience in inpatient and outpatient settings and joins our team in Ypsilanti. Elina earned a bachelor's degree from the University of Michigan and a Doctor of Physical Therapy from the University of Colorado-Denver.

Lillian Durecki, RN Nurse Case Manager

Lillian holds a Bachelor of Science in Nursing from Madonna University and joins Rainbow’s staff at the NeuroRehab Campus®. She has over nine years of experience working as a Registered Nurse in home care. Lillian has also worked as a Clinical Instructor at Eastern Michigan University.

Felina Swasey Co-receptionist

Felina joined Rainbow as a Rehabilitation Assistant (RA) in July 2010 and the Clerical team as co-Receptionist in January 2011. She is currently attending Wayne County Community College where she is working toward her degree in Nursing. Felina continues to serve as a RA at the residential homes several shifts per month.

Angeline Kimrey, BBA

Corporate Recruiter

Angeline joins Rainbow's administrative team at the Livonia Corporate Center. She is a graduate of Baker College with a bachelor's degree in Business Administration. Angeline comes to Rainbow with three years of recruitment experience.

Erin Erickson, OTR Occupational Therapist — Functional Recovery

Erin holds a Bachelor of Science degree from

Southern Illinois University and recently

received a master’s degree from Baker College

in Flint, MI. Erin joins the team at Rainbow's

Functional Recovery division in the Flint area.

Katherine Bink, OTR Occupational Therapist

Katherine holds a Bachelor of Business from

Michigan State University and a master's in

Occupational Therapy from Rush University.

She joins the staff at Rainbow's NeuroRehab

Campus® in Farmington Hills, MI.

Isabelle Pattarozzi, PT, DPT Physical Therapist

Isabelle joins the staff at Rainbow's Oakland

Center in Farmington, MI. Isabelle received

her undergraduate education at Loras College

in Dubuque, IA and earned a Doctorate of

Physical Therapy from Rosalind Franklin

University in Chicago, IL.

Sue Arney

Human Resource Assistant

Sue joins out team with 5 years of experience in the field of private investigations, assisting in background investigation and information. Her organization specialized in Workers Compensation. Sue is wonderfully organized addition to our team.


injury rehabilitation to ensure that the saf-est, best tolerated medications are used for improvement in self-control.

Safety FirstCrisis prevention and intervention train-ing is also used by health care profes-sionals to provide for the safety and security of their patients1. At Rainbow,

employees are required to maintain certification with the International Association of Non-violent Crisis Intervention (IANCI), attending classes every year with mandatory competency tests. When interventions are conducted by professionals using proven and safe strategies, people learn how to control

their behaviors, enjoy life, and reach their potential. When plans of care are person-centered and adjusted for individ-ual needs, most people who are initially challenged with profound frustrations can learn over time to defeat these ob-stacles and progress safely, productively, and happily. v

One Thousand Words

Reducing agitation Continued from page 13

Insisting on using our own clients in most of our photo shoots can prove to be challenging, but the outcomes are worth it. Take the case of this photo. We wanted to capture some of the activities at Rainbow’s Summer Fun! program in Genesee County. This young client was playing shy even after all of our efforts to get her to smile. Our tenacity finally paid off as she gave us a smile that only a six year old could. Rainbow’s Summer Fun! Program is gearing up for a new season which begins June 20, 2011. Call 800.968.6644 for information.



Home- and community-based rehabilitation services for adults, teens and children

Functional Recovery is a division of

800.968.6644 www.rainbowrehab.com

Physical, Occupational and Speech Therapy Home and community therapeutic intervention for individuals with brain and spinal cord injuries

Functional Home AssessmentsAssistance in determining durable medical equipment and attendant care needs

Home Modification AssessmentsRecommendations for home modifications in order to create a barrier free or wheel-chair accessible home/living environment

Work Site Assessments On-site modification recommendations

For more information call:

E-mail: [email protected]

www.functionalrecovery.com

Presorted StandardU.S. Postage

PAIDPermit 991

Ypsilanti, MI

Do you have a story idea or comment? We’d love to hear from you! Email: [email protected]

38777 Six Mile Road, Suite 101Livonia, Michigan 48152

GENESEE COUNTYFunctional Recovery / Home and Community-Based Rehabilitation8245 Holly Rd, Suite 102A Grand Blanc, MI 48439810.603.0040

WAYNE COUNTYRainbow Corporate Headquarters38777 Six Mile Rd. Livonia, MI 48152734.482.1200Home Care Program Headquarters38777 Six Mile Rd. Livonia, MI 48152734.482.1200

OAKLAND COUNTYOakland Treatment Center32715 Grand River Ave. Farmington, MI 48336 248.427.1310RIPROC Vocational Center32619 Grand River Ave. Farmington, MI 48336 248.471.9580NeuroRehab Campus®25911 Middlebelt Road Farmington Hills, MI 48336248.471.9580

WASHTENAW COUNTYYpsilanti Treatment Center5570 Whittaker Rd., Ypsilanti, MI 48197734.482.1200RIPCO Vocational Center834 Railroad St. Ypsilanti, MI 48197 734.480.4277

Residential LocationsTHROUGHOUT MICHIGANHome Care & Home and Community-Based Rehabilitation 734.482.1200

MAPDETAIL AREA

Rainbow Facility Locations

For information call toll free: 800.968.6644

E-mail: [email protected]

Visit: www.rainbowrehab.com

InSIde:Reducing Agitation and Aggression after Traumatic Brain Injury Page 10

RainbowVisions - Brain Injury Rehabilitation Centers · Winter 2011 Volume VIII No. 1 A TBI can...

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