RainbowVisions A News Magazine for Acquired Brain Injury Professionals, Survivors and Families Rainbow Rehabilitation Centers Inc.
www.rainbowrehab.com
March 2009 online edition
Volume 1
No. 3
March 2009 is brain injuryAwareness month A look at ...
Robot-Assisted Walking Therapy
Robots can now help people with brain and spinal cord injuries learn to walk again. Read more ...
Occupational Therapy
in Rainbow's Adult Levels Program Covering strategies that assist TBI survivors with the job of living
A Professional Product Review of the
BrainInjury
RecoveryKit SUBSTANCE ABUSE
The 5 Stages of Change
March 2009 is brain injuryAwareness
month.
A Note from the
Editor ...
March is brain injury awareness month, but most of our readers are already well aware of the issues associated with traumatic brain injury (TBI). Individuals with moderate to severe TBIs often suffer with long-term cognitive dysfunctions, physical impairments and behavioral problems. As late as the 1970s, 90 percent of all brain-injured patients died. Thanks to medical advances, improved technology and emergency care, survival rates are up — but the burden of paying for rehabilitation has become a important issue. Without proper rehabilitation many, if not most survivors with moderate to severe injuries, will not reach their full recovery potential. Recovery often requires extensive rehabilitation. Survivors must be retrained and relearn what was commonplace before their injury. This type of rehabilitation requires a high level of expertise, structure, support and plenty of time. According to Richard Senelick, MD, author of Living with Brain Injury, “In a study of severely brain-injured young adults with serious cognitive and emotional disturbances, 50 percent of those who received rehabilitation were found to be production threequarters of the time, as opposed to only 36% of those who did not receive treatment.” Individuals who receive effective rehabilitation often are empowered to rebuild productive and meaningful lives. Dealing with brain injury rehabilitation is a relatively new concept (only about 25-30 years old) and we still have a long way to go in educating the public and providing treatment. Yet, there have been substantial advancements and the picture for survivors is not so bleak. In the coming year I challenge to you to read each issue of RainbowVisions. We will cover topics on medical and therapy advances, bring you inspiring success stories and inform you on industry events. Take the time to be informed. Brain injury recovery is possible — knowledge is key along with the right support and help.
, Editor
Features ... What’s News in the Industry – Rainbow acquires Functional 4 Recovery
On the
Cover
Mental Health Support – A look at substance abuse and 5 the five stages of change
In this online edition of
Robot Assistive Walking Therapy 6
featuring an article on
Product Review – The Brain Injury Recovery Kit 8 Industry Conference & Event Calendar 10
RainbowVisions we are Robot Assistive Walking Therapy. <click here> to read the article
Therapy Corner– A look at Occupational Therapy 12 Adult Levels Program in Ann Arbor 15 NEW ACBIS Training Program 17
E-mail questions or comments to: Rainbowvisions@rainbowrehab.com 2
R ainb owVisions
Editor & designer – Kimberly Paetzold Staff writer & assistant editor – Nicole Bonomini Staff writer & assistant editor – Barry Marshall Staff photographer – Heidi Reyst
June â&#x20AC;&#x201D; August, 2009
Summer Fun! Therapeutic programs for children and teens with brain injuries.
<Click Here> for a brochure and schedule
1.800.968.6644 www.rainbowrehab.com
R ainb owVisions 3
Whatâ&#x20AC;&#x2122;s News in the
Industry RAINBOW ACQUIRES
Functional Recovery Home Health Care
R
By Bill Buccalo, President
ainbow has some exciting plans in
store for 2009. Already this
throughout Genesee, Macomb and
planned growth by expanding our regional
Oakland Counties for more than 12 years.
reach and therapeutic continuum.
year, Rainbow has purchased Functional
This acquisition is a great opportunity for
Recovery, Inc., a home and community-
Rainbow to enter fully into home-and-
based professional therapy services
community based treatment with a known
firm for children, teens and adults. We
and respected industry leader. We are very
are very excited to have Char Combs,
excited to have the opportunity to work
former president and owner of Functional
with Char and her therapy teams.
Recovery, join Rainbow as the new
Functional Recovery will be integrated into
program director of the Functional
Rainbow Rehabilitation Centers as a new
Recovery Division.
division of home care services. Functional
Functional Recovery, based in Grand
Recovery's approach of fully integrating
Blanc, Mich., and its teams of physical,
clients into real life settings matches well
occupational and speech therapists
with Rainbowâ&#x20AC;&#x2122;s philosophy and continuum
has served people with brain injuries
of care. This endeavor will assist with our
Introducing ...
Functional Recovery Home and Community-Based Rehabilitation
Now a division of
With teams of physical, occupational and speech therapists, Functional Recovery has served clients with brain and spinal cord injuries throughout Genesee and Oakland Counties for more than 12 years. We will continue to offer high quality home and community-based professional therapy services to children, teens and adults. For more information on our services, please log on to our Website. 4
RainbowVisions
www.rainbowrehab.com/Functional_Recovery
TBI
Mental Health Support
A LOOK AT SUBSTANCE ABUSE
W
The Five Stages of Change Edited by
Joseph Welch, MS LLP, Rainbow Behavior Analyst
hen treating individuals in a rehabilitation environment, the use
of alcohol and drugs often slows recovery and impedes active
therapy. If a patient has substance abuse issues, their treatment team will need to support and help change their addictive behavior(s). Before attempting to help support someone undertaking a difficult change, I would like to introduce you to a useful theory called the Stages of Change Model (SCM). It takes a look at the stages an individual’s mind and body go through when implementing change. It was originally developed in the late 1970s by James Prochaska and Carlo DiClemente at the University of Rhode Island. SCM can be applied to a broad range of behaviors including losing weight, kicking the smoking habit and overcoming alcohol / drug problems. The idea behind SCM is that
Subst ance Abuse
change does not happen in one step. Instead, people tend to progress through different stages – each individual at his or her own rate.
The Five Stages of Change
to think “Nobody can help me with a
important to prevent relapse. Prochaska
1. Pre-contemplation – Not
drug problem but me” and believe it
and colleagues believe that a person must
acknowledging a problem behavior
only takes willpower to change.
have at least six months of successful
that needs to be changed. In this stage,
4. Action – Changing the behavior.
change in order to be considered in the
people are essentially unaware that a problem exists and have no intention of changing in the foreseeable future. They may be defensive or not want to discuss their bad habit. People with brain injuries typically require a significant intervention by professionals and family members to reach the next stage.
People in this stage make changes in their behavior and alter their environment in order to modify or eliminate an addictive behavior. Willpower is a misnomer. Medical supervision during initial treatment and consistent attendance at community support groups is key. Twelve-step work
Maintenance versus the Action stage. A Note on “Relapse” – When eliminating a bad habit, many people experience relapses. A spiral process in which an individual relapses and recycles through earlier phases is more common than a steady linear progression. People who eventually overcome addictive
2. Contemplation – Acknowledging that
– getting a sponsor, calling others, and
there is a problem but not ready to make
having a full schedule of meetings is
a change. People in this stage are aware
the most successful, cost effective and
that a problem exists and are considering
available treatment there is.
change. Those with brain injuries require
5. Maintenance – Maintaining the
failure, undermining self-confidence.
behavior change. In this stage, success
It is important that, if they do slip, they
3. Preparation – Getting ready to
means filling in the gaps left by the
don’t see themselves as having failed;
change. In this stage, individuals have
absence of substance abuse. Becoming
rather, they should analyze how the slip
the intention to change but have not
friends with a social group of non-users
happened and use it as an opportunity to
established a specific goal. People with
takes time. Constructive alternative
learn how to cope differently. Relapsing
brain injuries require assistance to take
activities to replace the culture of
is like falling off a horse — the best thing
the necessary steps. It is a misconception
substance abuse requires courage and is
you can do is get right back on.
assistance to take effective action.
behaviors show progress over time, with setbacks becoming smaller and shorter. There is a real risk that people who relapse will experience a sense of
RainbowVisions 5
www.rainbowrehab.com
RAINBOWVISIONS O n l i n e M a g a z i n e
ABI
Technology Corner
A LOOK AT
Robot-Assisted Walking Therapy Interview by Kimberly Paetzold, Editor Written by Nicole Bonomini, Staff Writer
obots can now help people R with brain and spinal cord
injuries learn to walk again. With the Lokomat System, a new treadmill technology
created by the Swiss company Hocoma, a computer and robot quickly teach walking movement and corrects gait by moving the patient’s legs in a way that mimics walking. The Lokomat suspends a person in a skeletal, robot frame over a treadmill. The robot is attached by straps to the outside of the person’s legs. The Lokomat then moves the legs in a natural walking pattern, while a computer controls the pace of walking and measures the body’s response to the movements. The Lokomat provides users with a repetitive walking pattern, which helps re-route brain signals that are interrupted due to injury or illness. “Its scientific foundation is really based on animal models,” Dr. Edward Dabrowski explained. “If you sever the spinal cord of a cat, for example, and suspend him on the treadmill, he’ll walk.” Dr. Dabrowski is chief of the Division of Physical Medicine and Rehabilitation Services for Children's Hospital of Michigan and the Medical Director for Pediatric Services at Rainbow. “How could he walk when the brain isn’t connected to the spinal cord?” Dr. Dabrowski asked. “Or the spinal cord isn’t connected to the legs anymore? It’s telling you there are independent generators in the spinal column that generate walking.” The Lokomat helps to reduce the physical strain of therapy for therapists, improves efficiency of gait training for patients, and improves leg movement and lateral balance for the patients. Currently, this type of therapy takes the work of at least two therapists without robotic assistance because they must manually move the patient’s legs in a walking pattern. With the Lokomat, the robot helps patients walk throughout therapy. Therapists only help as needed, thus pushing 6
RainbowVisions
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
About Rainbow's Pediatric Medical Director ... patients to their full potential. “The Lokomat reduces the work of the therapist and allows for consistent therapy. We know exactly how fast the patient is
Dr. Dabrowski,
MD
walking and how much weight they are
Dr. Edward Dabrowski has a medical
bearing. Rehabilitation efforts are consistent,
degree from Wayne State University School
repetitive and precise,” Dabrowski
of Medicine. He is board-certified in
explained. In addition to the spinal cord
physical medicine and rehabilitation.
population, those with brain injury, cerebral palsy, etcetera, can also benefit from this
Experience/Specialty:
technology.
Dr. Dabrowski has extensive faculty and
First approved by the Food and Drug
professional appointments. He currently
Administration in March 2002, the Lokomat
serves as chief of the Division of Physical
may also help to strengthen muscles and
Medicine and Rehabilitation Services for Children's Hospital of Michigan
improve circulation.
and pediatric program medical director at Rainbow Rehabilitation Centers. In
Many health care insurance providers cover robot-assisted walking therapy. This therapy is available at a variety of locations, including hospitals and rehabilitation centers. More information on the Lokomat is
addition, Dr. Dabrowski is program director of the combined pediatric/PM&R residency program and codirector for the Muscular Dystrophy Association of Southeastern Michigan. Dr. Dabrowski specializes in pediatric traumatic brain injury, neuro-muscular conditions and spasticity.
available on Hocoma’s Web site at: www.hocoma.ch/en/products/lokomat
Give a Teen a Chance to
Succeed! Rainbow provides supports to help build
social skills, self-confidence and is a “place to belong” and succeed. For kids with brain injuries.
www.rainbowrehab.com
RainbowVisions 7
www.rainbowrehab.com
RAINBOWVISIONS O n l i n e M a g a z i n e
TBI
Product
REVIEW BrainInjury
RecoveryKit of recovery and how the buddy should assist. • Step Three: Understanding the experience of brain injury. The buddy and user begin to progress through the Four Keys of Recovery – buddy, rest, acceptance and routine. • Step Four: The Day-Timer personal planner and color-coding for success tools are introduced for organization and routine to improve memory, confidence and
R
8
organization. • Step Five: Using repetition and reminders. The Electronic Message Center voice recorder is introduced as a reminder system for users. It includes alarms, a
ainbow’s Lead Speech Language
assisting with recovery) and three DVDs.
The books provide information, exercises,
Pathologist Angie McCalla and a
countdown timer and multiple mailboxes.
client tested The Brain Injury Recovery Kit
review forms and checklists that track
Review Results
(BIRK). Created by Day-Timer, this kit was
progress and reinforce the DVD lessons
Angie and a client went through the
designed by Lisa Keller, a person with a
— helping to identify breakdowns in
system and analyzed its strengths and
brain injury, in conjunction with Sandra
sequencing, recall and initiation. They
weaknesses. Overall, both participants
J. Knutson, CRC, CDMS, CCM — Lisa’s
also provide strategies based on what
had positive results with the BIRK. Based
former caseworker. The tool was created to
Day-Timer calls the Four Keys of Recovery
on their observations, they found the kit to
help TBI survivors recover — and in Angie’s
– Buddy, Rest, Acceptance and Routine.
be an excellent tool. It incorporates a lot
opinion, those with mild to moderate brain
The strategies stress development of step-
of sensory components allowing users to
injuries stand to benefit from the BIRK.
by-step protocols and routine. The planner
exercise all of their modalities — they can
The kit is designed to:
system allows the user to track information
touch the orange cord and see the planner,
• make ‘getting through the day’ more
in one location and uses color-coding for
read the checklists and watch the DVDs.
productive,
organizing and prioritizing tasks. The five-
It provides tools that you create (such as
• help with memory deficits,
step system consists of:
a calendar or schedule), making it very
• promote organization,
• Step One: Learning about brain injury
interactive.
• reduce stress, and
and its complications, emphasizing the
“From day one, she [the client] loved it,”
• support therapy rehabilitation efforts.
importance of professional therapeutic care
Angie explained. “We had very positive
The BIRK is an inclusive five-step
and survivor challenges.
results. Typically she is very resistive to
system that contains two comprehensive
• Step Two: Learning how to support an
programming, but this really gave her
workbooks (one for the person with the
individual with brain injury — with an
a sense of, ‘I can do this.’ It was very
brain injury and another for the buddy
introduction to the workbooks, Four Keys
empowering and she felt that she could
RainbowVisions
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
accomplish things on her own with the
is forgotten,” she discovered.
The client also thought that the
help of the kit.”
However, Angie, her therapist, thought
workbook should include a more thorough
The client said she liked that the kit
the repetition was useful and for many
section on brain injury, such as a diagram
explained brain injury in great detail. “A lot
would be necessary. “It’s what the
explaining which deficits can occur in
of tools in this kit, if mastered, can make
majority of the brain injury population
which section of the brain as a result of an
the user more efficient,” she explained.
needs. Repetition and routine helps them
injury. She thought the workbook would
This sense of empowerment and
to pick up things more quickly. The kit
benefit from having common brain injury
confidence carried over into the client’s
really focuses on over learning, and that
definitions, a list of rehabilitation therapies
other therapies and treatments, such as
is something I’ve tried to carryover to
along with a list of therapy occupations
occupational therapy. “She started using a
my other therapies,” she said. “Often
and professionals.
chalkboard wall in her apartment bedroom
we move on to the next task right after
to become more organized,” Angie said.
one is mastered, saying, ‘OK, we did this
“It was a tool she never utilized before and
successfully one week, now we can add the
it has further improved her attitude and
next one. But it is beneficial to over learn
organization in other therapies as a result.”
the material and do it for several weeks
Our client had positive results with the
before adding the next task.”
following kit components:
The client also found the ID key chain to
• Color-coding: “It takes a lot of strain off
be unfavorable. “I understand the concept,
of me when I can just look at something
but it screams, ‘look at me, I have an
and know it is urgent or it has to do with
impairment.’ Therefore, I am not willing to
my family, money matters, etc.,” she said.
use it.” Angie did not think the key chain
• Going Somewhere Checklist: if the user
was very effective, either. “When an item is
focuses on trip details prior to leaving, then
that large and does not fit nicely in a purse
he or she is able to focus on driving when
or bag, some may not be willing to use it.”
on the road.
While the client liked color-coding, she
• Resting Eye Mask: The client found
found the orange binder to be excessive.
that the resting eye mask helped her to
“Using a planner is something a person
fall asleep even when she was not tired.
should continue to do even after their
“When I put this on, it blocks out all light,
recovery goals have been accomplished.
which quiets my mind and forces me to fall
Why not use something that resembles
asleep,” she explained.
what others have? If a person always puts
• Orange Cord (used as a placeholder):
the planner in the same place, he or she
The orange cord helps users focus on the
will not have a problem finding it,” she
task at hand. When they stop and return
asserted. “The orange color isn’t necessary.”
to a task at a later time, it prompts them to
Angie agreed. “The orange binder was
remember exactly where they left off.
just too large. It really shouts, ‘there is
Weaknesses were found with several
something wrong with me.'”
Want to help TBI survivors?
pieces of the kit as well. The client thought
Our client also made suggestions on how
A non-profit group called the "10 in 10
the DVDs were too repetitive — over
to improve the kit. She thought that the
Project" accepts donations toward the kits
redundancy can cause participants to skim
overall labeling of the workbooks needed
and distributes them to people who cannot
over material and lose attention. The client
to be improved. Angie explained that the
afford the $600 price. And "Ticket of Hope,"
found that the most important information
workbooks needed to provide more detail.
a special campaign launched by 10 in 10,
was presented at the beginning of disc
“The workbooks don’t provide explanation
is working to secure donations specifically
one. “It is recommended that the user
and details — they just tab right to
for veterans' kits. After the estimated 3,000
and buddy watch all three DVDs from
worksheets,” she said. “The kit would
Iraq war veterans with brain injuries receive
beginning to end before moving forward.
benefit from having the workbooks overlap
the help they need, the group will make kits
But by then, a lot of important information
more with the DVD content.”
available to others as well.
How to order a BIRK Overall, both the Rainbow client and lead SLP therapist had positive results with the BIRK and would recommend it to other individuals with TBI, especially those with mild to moderate injuries. The BIRK may be purchased at a retail price of $600 or you can take advantage of a special discount for RainbowVisions Magazine readers. by contacting ...
800.525.5005 www.daytimer.com
RainbowVisions 9
2009
Conference & Event Schedule
MBIPC
Michigan Brain Injury Provider Council
â&#x20AC;&#x201D;National Conferencesâ&#x20AC;&#x201D; March, 2009 March 3 - 5, 2009
2009 Collaborative Practice Summit at the Grand Hyatt in San Antonio, TX For info log on to: www.cmsa.org/cps March 4 - 7, 2009
Contemporary Forums Brain Injuries Conference at the Las Vegas Hilton in Las Vegas, NV For info log on to: www.contemporaryforums.com
Learn over Lunch Meeting 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 Lisha Clevenger lisha.clevenger@rrciweb.com
March 5 - 6, 2009
Illinois Worker's Compensation Forum at the Westin Lombardo
Yorktown Center in Chicago, IL For info log on to: www.ilscforum.com March 5 - 6, 2009
BIA of Iowa's Annual Brain Injury Conference at the Hotel Fort Des Moines in Des Moines, IA For info e-mail: conferences@biaia.org March 12 - 13, 2009
March 10, 2009 Topic: Research and Study on TBI Model Systems Speaker: Robin Hanks, PhD of the Rehabilitation Institute of Michigan/DMC Location: Radisson Hotel, Lansing, MI
First Annual International Conference on Culture Ethnicity and Brain Injury Rehabilitation at the Crystal Gateway Marriott Hotel in Arlington, VA For info e-mail Dr. Juan Carlos Arango-Lasprilla: jcarangolasp@vcu.edu March 18 - 21, 2009
April 14, 2009 Topic & Speaker: TBA Location: Radisson Hotel, Livonia, MI
May 12, 2009 Topic: Management of the Upper Limb in Motor Neuron Syndrome Speaker: Dr. Adam J. Rush of Rehabilitation Medicine Associates Location: Applause Banquest & Catering, Grand Rapids, MI
June 9, 2009 Topic & Speaker: TBA Location: Radisson Hotel, Livonia, MI
For a full list of meetings <CLICK HERE>
Contemporary Forums Psychiatric Nursing Conference at the
Sheraton Society Hill in Philadelphia, PA For info log on to: www.contemporaryforums.com March 18 - 21, 2009
Contemporary Forums Spinal Cord Injuries Conference at the
Hilton in the Disney World Resort in Orlando, FL For info log on to: www.contemporaryforums.com March 21 - 24, 2009
The Young Child with Special Needs Conference at the Las
Vegas Hilton in Las Vegas, NV For info log on to: www.contemporaryforums.com March 28 - 31, 2009
American Association of Neuroscience Nurses 41st Annual Meeting at the all Rio Suites Casino Resort in Las Vegas, NV For info log on to: www.aann.org March 29, 2009 - April 1, 2009
Contemporary Forums Psychiatric Nursing Conference at the
Renaissance Nashville Hotel in Nashville, TN For info log on to: www.contemporaryforums.com
10
RainbowVisions
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
â&#x20AC;&#x201D; NOTICE â&#x20AC;&#x201D;
The conferences and events information listed on these pages is dated information (current as of March 1, 2009). For the most up-to-date information on industry-related conferences and events, please click the link below: www.rainbowrehab.com Conferences & Events
April, 2009 April 18 - 22, 2009
16th NICM Conference and 10th ACMA Meeting at the Westin
Boston Waterfront Hotel in Boston, MA For info log on to: www.acma.org April 21 - 25, 2009
Psychiatric Nursing Conference (West)
at the Hyatt Regency La Jolla in San Diego, CA For info log on to: www.contemporaryforums.com
RINC
Updated biweekly, www.rainbowrehab.com offers the dates, locations and topics of all of the industry's most prominent events. Also included are local Michigan events.
April 21 - 25, 2009
16th NCIM Conference and 10th ACMA Meeting at the Westin Boston Waterfront Hotel in Boston, MA For info log on to: www.acmaweb.org April 30 - May 1, 2009
2009 Brain Injury Litigation Strategies
at the Signature at MGM Grand in Las Vegas, NV For info log on to: www.biausa.org/elements/litigation/
MICHIGAN
Rehabilitation & Insurance Nursing Council
Meetings
Members Only
Registration at 11:30 a.m./ Lunch at 12:45 p.m. March 20, 2009 Topic: Cognitive Language Treatment for Brain Injury Speaker & Location: TBA
May, 2009 May 7 - 9, 2009
9th Annual Adolescent Health Care Conference at the Westin
Boston Waterfront Hotel in Boston, MA For info log on to: www.contemporaryforums.com May 27 - 30, 2009
Forensic Trends: Psychiatric and Behavior Conference at the Las Vegas Hilton in Las Vegas, NV For info log on to: www.contemporaryforums.com
June, 2009 June 7 - 9, 2009
CMSA Annual Conference & Expo at the Phoenix Convention
April 17, 2009 Topic: Home Infusion Speaker & Location: TBA
May 15, 2009 Topic: The Great Masquerade: Sacroiliac Joint Dysfunction Speaker: Dr. Carla Morton Location: TBA
June 19, 2009 Topic: Advanced Home Care Speaker & Location: TBA
For more information <CLICK HERE>
Center in Phoenix, AZ For info log on to: www.cmsa.org
RainbowVisions 1 1
TBI
RAINBOWVISIONS O n l i n e M a g a z i n e
Therapy
Disciplines
A LOOK AT
Occupational Therapy By
Anne Ulrich, OTR, CBIS
Rainbow Occupational Therapist
W
hen someone’s life is
altered after a traumatic brain
injury, many survivors are left to cope with new cognitive deficits, behavioral problems, medical complications and more. A traumatic brain injury may rob a person of his or her independence, leaving the survivor reliant on others for bathing, dressing, feeding and other daily living necessities. Occupational therapists (OTs) provide survivors with the training they need to regain independence in these daily living skills, including activities such as self-care, education, employment and social interaction. OTs help people develop “skills for the job of living.” They increase self-sufficiency to allow patients the ability to lead productive and satisfying lives. Rainbow OTs are skilled professionals in human growth and development with an emphasis on helping individuals overcome the social, emotional and physiological effects of illness and injury. They help individuals with disabilities get on with the “occupation” of living. In rehabilitation hospitals and in adult foster care homes, the primary emphasis of occupational therapy is on regaining basic functions.
12
RainbowVisions
www.rainbowrehab.com
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
Once a person becomes independent
Money Management — Clients benefit
Managing a Home — An OT assesses
in fundamental skills and performs them
from learning to manage a checking
safety and independence with meal
consistently and safely, he or she may
account, which includes balancing a
planning and grocery shopping. Some
be ready to move to a less structured
checkbook, budgeting and bill paying.
people struggle with the larger living space
environment.
An OT can set up a mock bill-paying
of an apartment when they may have
Individuals who have mastered self-care
program — mailing simulated bills to a
been accustomed to maintaining only a
tasks are able to focus on higher-level skills
person with a due date for each payment.
bedroom. Other household tasks such
such as financial transactions, personal
This works in conjunction with a mock
as laundry, vacuuming and cleaning are
organization and money management.
checkbook register, working on accuracy
monitored as well.
Rainbow's Semi-Independent Apartment
of simulated paycheck deposits recorded,
Program offers these opportunities so clients
as well as check writing and timeliness of
Getting Back into the Community —
can practice and master skills of daily living.
bill paying.
People that are new to the area or new to
Following are therapeutic skills that Rainbow
Continued next page
occupational therapists commonly address.
Apartment Groups offered at Rainbow
Facilitated by therapists, mental health counselors and other qualified staff, the groups at Rainbow's Ann Arbor Apartments provide a safe environment for clients to access the community and interact with their peers. The groups assist with time management, community re-entry, problem-solving skills, awareness of deficits, knowledge of current events, social engagement and more. A list of current group offerings will be provided in the March 2009 online edition of RainbowVisions. To subscribe, log on to:
www.RainbowVisionsMagazine.com
Assisting clients with activities of daily living is an important step toward independence. Pictured above: Laura (right), an Occupational Therapist, works with Carole Anne on personal money management skills.
RainbowVisions 1 3
www.rainbowrehab.com
RAINBOWVISIONS O n l i n e M a g a z i n e
Occupational Therapy Continued from page 13 Parenting Skills — An OT can provide
compensatory strategies. For example, if
public transportation benefit from training
guidance and assistance with enrolling
a person’s short-term memory does not
on using the bus schedule, riding the bus,
children in school and arranging childcare.
improve, it is still possible to be successful
transferring buses and arranging taxis. As
Clients and therapists work together to find
in the workplace by using strategies to
part of Rainbow’s interdisciplinary team
affordable childcare resources, including
compensate for the memory problems.
approach to therapy, OTs work closely with
preschool and day care.
Such strategies include using an assistive
recreational therapists to assist clients with
device such as a planner, alarm, watch or
identifying, initiating and following through
Strategies OTs implement
with community leisure activities.
Because traumatic brain injury is often
a PDA.
accompanied by psychosocial dysfunction,
Over Learning — Another strategy to move
Work / School — People living in Rainbow
Rainbow OTs are trained in using
clients forward in the rehabilitation process
apartments often attend school, volunteer,
behavioral and mental health techniques
is to implement over learning. Repeating
and/or work in the community. They may
in the rehabilitation process. The term
the same task is an effective way to learn.
benefit from assistance with enrolling in
psychosocial covers a broad spectrum
Even if a person does not remember being
school, applying for jobs and developing
of mental disorders including substance
instructed on how to do an activity, if it is
strong study skills.
abuse, mood fluctuations, anxiety and
performed regularly, his or her performance
adjustment disorders. Psychosocial
can improve.
Medication Management — Clients
disorders, while not unique to people who
work closely with OTs, nurses and
have brain injuries, tend to be prevalent in
Routine — Maintaining a consistent
rehabilitation assistants to learn to manage
the TBI community.
routine is a good way to work around memory and organization deficits. For
their medication routines with minimal Compensatory Strategies — Deficits
example, some can become increasingly
such as memory and problem-solving may
frustrated when looking for misplaced keys
Building Social Skills — Many clients
not always improve, so the occupational
in their apartment. An OT can work with
benefit from exploring ways to meet new
therapist’s goal is to instruct clients in ways
the person to designate a place for keys,
people. They may need assistance with
of working around these problems using
such as on a hook next to the front door.
assistance.
establishing and maintaining a network of friends, dating, and practicing safe and appropriate methods of sexual expression. Semi-independent living also provides an opportunity to work on appropriate interactions with neighbors and other people in the community. Driving — Some OTs are specially trained to assess driver readiness and provide behind-the-wheel training when necessary. If a person has clearance from a doctor and has a registered, insured vehicle, they may be permitted to drive. NOTE: Generally, driving is not permitted in a group home setting.
14
RainbowVisions
Continued on page 16
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
A Look at Rainbow's Semi-Independent Adult Levels Program ...
(Available in Ann Arbor, Mich.)
Rainbow's Adult Levels Program offers a continuum of semi-independent living options providing care and support as individuals rehabilitate and become self-sufficient.
Level I — Most individuals ready for some independence begin at the
Level 3 — Once there is no longer a need to access staff in
town house level with staff presence in the residence around the clock.
the same building, clients are able to move to an outlying
Each person has his/her own bedroom and is responsible for grocery
apartment in the complex. At this level, individuals begin
shopping, assisting with cleaning the common areas, laundry, and is
budgeting their money for groceries and taking public
introduced to the public transit system. Participants receive assistance
transportation to school, work and medical appointments. In
with their medication programs and supervision or cueing with chores, as
some cases, interaction with staff is limited to signing in and
necessary.
out when accessing the community and/or going on a leave of
Level 2 — After demonstrating successful living at a Level 1 town
absence.
house, clients are ready to move into a two-bedroom apartment staffed
Level 4 — At this level, people take on a portion of their rent
around the clock. They continue to manage the apartment and chores
and utilities to further budgeting and bill-paying skills. The
independently and take on more responsibility with arranging their own
ultimate goal is full independence. When participants graduate
public transportation. Staff is available on the premises to closely monitor
from the program, they are able to live independently without
community access and timeliness of medication administration.
supports and are discharged from Rainbow.
RainbowVisions 1 5
About the Author ... Occupational Therapy
Anne Ulrich,
OTR, CBIS
Continued from page 14 Anne received her Bachelor of Science in Verbal Cueing — Some people benefit from reminders when performing tasks.
occupational therapy from Eastern Michigan University in Ypsilanti, Mich. in 1995.
They may not need hands-on assistance,
Anne currently works at the Ann Arbor Semi-
only a reminder to get started. For
Independent Apartment Program with adults
example, OTs can put a programs in place
who have traumatic brain injuries. She has
where staff visit or call a client to remind
worked at Rainbow Rehabilitation Centers since
that person to do laundry.
2000. She is a Certified Brain Injury Specialist.
Group Therapies — Group sessions can address time management, community re-entry, awareness of deficits, fitness, nutrition and provide education on brain injury. They also provide opportunities for leisure exploration and socialization. Through assisting clients with self-care, education, employment, community integration and social interaction, OTs increase clients self-sufficiency and help
Ap a r t me n t Pr o g r am
Clubhouse
them to carry on with satisfying and productive lives. Occupational therapists allow brain injury survivors to get on with the “job of living.” Whether in the Semi-Independent Apartment Program, outpatient therapy, town house or group home, OTs provide training for the skills clients need for satisfying, independent lives. For outpatient clients, occupational therapy treatments are available at all of our southeastern Michigan treatment centers: the Ypsilanti Treatment Center, Rainbow Oakland Center, NeuroRehab Campus and through our home health care program. Whatever your needs, Rainbow will customize a plan of care designed around you and implement programs necessary to ensure your success. For more information on our programs, log on to www.rainbowrehab.com.
16
RainbowVisions
The Ann Arbor Apartment Clubhouse at Rainbow offers another environment where OTs help clients. The clubhouse provides an area for people to play pool, card games, prepare and eat meals, use the Internet, and socialize with others. The clubhouse is governed by clients who take an active role in choosing and participating in the activities offered.
w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m
MARCH
2009
ACBIS ANNOUNCEMENTS
New Family and Caregiver’s Brain Injury Resource and Training Program Under Development
T
he Academy of Certified Brain Injury
a wide variety of topics, including brain
completed.
• A glossary of difficult or medical terms.
Specialists (ACBIS) Advisory board is
injury anatomy, myths and facts of brain
developing an online reference and training
injury, behavior management, advocacy,
tool geared toward families and support
community reintegration, cognitive issues,
staff working with brain injury survivors.
aging, vocational retraining and more.
There has been a growing need for
These modules will include knowledge
people who do not need or qualify for
checks with immediate feedback, enabling
certification as a Certified Brain Injury
provider organizations to ascertain that
Specialist, but still need information
learners have achieved a certain level of
to understand relevant aspects of care
understanding through the training.
for those with brain injuries. This non-
• Personal account and login information.
certification program plans to meet that need. The planned program design includes: • An online training program. Self-paced and interactive, it provides modules on
• An online resource of additional brain injury sites. Organizations using the program will also receive a complete administrative package to track usage and related demographics. The BIAA office has estimated that the project will be released mid-2009. Cost per user is still to be
• PowerPoint format with graphics and
determined. Look for more information
illustrations.
on this tool in upcoming issues of
• Printed certificates indicating when
RainbowVisions magazie.
a module is successfully passed and
The Academy for the Certification of Brain Injury Specialists (ACBIS) offers a national certification program for entry-level staff and experienced professionals working in the field of brain injury.
The Essential Brain Injury Guide Edition 4.0
As a service to the brain injury community, Rainbow Rehabilitation Centers will be offering a free training course this summer (2009) in Canton, Michigan to prepare for the ACBIS Certified Brain Injury Specialist test. For details <CLICK HERE>
Brain Injury Association
www.aacbis.n of Ame et rica
RainbowVisions 1 7
RainbowVisions Magazine SUBSCRIBE NOW!
Rainbow Treatment Center Locations: Ypsilanti Treatment Center
5570 Whittaker - PO Box 970230 Ypsilanti, MI 48197 734.482.1200
Oakland Treatment Center
32715 Grand River Avenue Farmington, MI 48336 248.427.1310
NeuroRehab Campus
25911 Middlebelt Road Farmington Hills, MI 48336 248.471.9580
For more information call toll free ...
1.800.968.6644
E-mail: Rainbowvisions@rainbowrehab.com
www.rainbowrehab.com
18
R ainb owVisions