Fall 2012 - Rainbow Rehabilitation Centers

Transcription

RainbowVisions
A Magazine for Brain and Spinal Cord Injury Professionals, Survivors and Families
Rainbow Rehabilitation Centers Inc.
Fall 2012
www.rai nb owrehab.com
Volume IX No. 3
Serial Casting
What it is, how it works,
and how it can be useful
for patients with TBI.
Storing and
Disposing of Medications
What is safe to keep? Where should
you keep it? We clear up the confusion.
Substance Abuse
Treatment and TBI
How assessment, residential
treatment, community programs
and pain management all play a role
in a successful recovery.
,
A Patient s
Perspective
An eye-opening interview with
author and brain injury survivor,
Julia Fox Garrison
G
XCITIN
OW'S E RAM!
B
IN
A
G
R
RO
NEW P Page 22
President's
Corner
Employees fuel our growth
By Bill
Buccalo, President
Rainbow Rehabilitation Centers
Creative, Talented, Dedicated, Loyal, Caring,
Hardworking, Family—these are just a few of the words
that I can easily think of to describe Rainbow employees. We
opened our doors nearly 30 years ago with one house set up
to care for people with brain injury. Over the years, we have
prided ourselves in maintaining that small family company feel
while at the same time constantly pushing to become
better at what we do.
A couple of weeks ago, I was working at our Ypsilanti
Treatment Center when the Clerical Team there called for a
mid-afternoon break to cut some cake and celebrate with Jenny
Auty who has been a kinesiologist with us for 25 years. It lasted
only a short time, but we laughed, talked of years gone by, and
recognized Jenny’s dedication. It felt good.
The Clerical Team does this kind of stuff all of the time. They
just think of nice ways to recognize people or make someone’s
life a little simpler and do it. Last year, the Clerical Team started
recognizing one therapist each month by spending a day to
shower them with extra support to get ahead (or catch up as
the case may be).
In August, we held our Annual Family Picnic. At Rainbow,
“family” means employees and their families, clients and their
families and some friends. We hosted over 800 people at the
picnic this year. This is by far the biggest and best-run picnic I
have ever attended—and it was entirely run by the employees
of Rainbow and their families. It has grown bigger and better with each passing year. There was tremendous help from
the Human Resources Dept., Maintenance Team, the cooking
crew from the NeuroRehab Campus, our Residential Program
Managers and the Admissions Team, just to name a few. One
client family member told me that the picnic says so much
about Rainbow. All of the employees and volunteers were
clearly having a good time and so were the guests. Executive
Vice President of Human Resources Sherri McDaniel has organized this picnic for about the past 17 years and has done a
tremendous job. She is going to be passing the picnic torch on
to a new team of employees for 2013. I want to thank Sherri
and her family for all they have done for the picnic over the
years.
While we work to maintain the family feel, we have also
changed to meet the needs of our clients. Rainbow was one
of the earlier programs established to serve people with brain
injury. Since then, the field has become significantly more sophisticated. We know more about recovery and what works.
Families and patients know more about brain injury and what
they want during the recovery process. And the options available for treatment have expanded. For Rainbow to provide the
very best for clients, we are constantly pushing for improvement and growth. We desire to lead.
Over the recent past, we have made great strides in program
development. We have not only expanded our continuum of
care—we have taken significant steps to improve it along the
way.
In June, we added a new outpatient and day treatment center
in Genesee County. We have been providing services in this
region for the past three years through Rainbow’s Home and
Community Services program, largely known as Functional
Recovery. However, we saw a need for outpatient services as
well. Char Combs and the team in Genesee County worked
tirelessly to put the program and facility together. The ability to
work in an outpatient setting is a nice complement to the option of providing services in the home and community where
the patient actually lives. Both have their advantages and challenges, so having the choice is ideal.
For people with disabilities, we know that finding employment or meaningful participation in activities can be very
difficult. Our Vocational Department, led by Lynn Brouwers,
has been working to expand the variety of work and volunteer
opportunities available to our clients and has done a great
job over the past couple of years. In July, we opened our new
Vocational Rehab Campus. This new and expanded site will
Continued on page 13
2 RainbowVisions
www.rainbowrehab.com
Features
8
Clinical News – Substance Abuse Treatment in
Brain Injury Rehabilitation Programs
FALL 2012
On the
Cover
Joe Welch, LLP, CBIS, CAADC
14 Survivor Perspective – Julia Fox Garrison,
author of Don't Leave Me This Way (or when I
get back on my feet you’ll be sorry)
Barry E. Marshall
In each issue
2
President's Corner – Employees fuel our growth
4
16
Medical Corner – Storing and Disposing of Medications
20
Industry Conference & Event Calendar
Bill Buccalo, President, Rainbow Rehabilitation Centers
Therapy Corner – Serial Casting
Julie Ladwig, PT, CBIS, CKTP
Page 14
4
News at Rainbow
22
23
24
Introducing Rainbow U!
8
Summer Open Houses at Rainbow
New Professionals
800.968.6644
Our mission is to inspire the people we serve to realize their greatest potential SM
Editor—Barry Marshall
Associate Editor & Designer—Celine DeMeyer
Contributor—Amanda Benjamin
E-mail questions or comments to:
[email protected]
Copyright September 2012 – 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].
RainbowVisions 3
Medical
Corner
Protect your family as well as the water supply by following these simple guidelines.
C
ontrary to popular belief, the bathroom medicine cabinet is not the
best place to store medications.
The medication, even in a closed cabinet, can be exposed to humidity every
time you shower or bathe. In addition,
the temperature in the bathroom may be
higher than recommended for storage.
Both of these conditions can cause
medications to degrade and become
less effective. This is especially true for
tablets and capsules where unnecessary
exposure to heat and moisture can cause
loss of potency before they expire. If you
must keep medications in the bathroom,
keep the containers tightly closed and
don’t repackage them.
The information sheet you receive
from the pharmacy has storing requirements for each medication. Follow the
storage information carefully and make
sure to refrigerate those medications that
need it.
Where are some good
places to store medications?
Instead of the bathroom medicine
cabinet, store medications in a cool, dry
place away from bright sunlight coming
through windows or rooms affected by
outside weather. Find a place you are
in at the same time every day so it will
become part of your daily routine to take
your medications as prescribed. A childsafe dresser drawer or kitchen cabinet
often works well. If medicines are stored
4 RainbowVisions
FALL 2012
Safely Storing and
Disposing of Medications
in the kitchen, make sure they are away
from the stove, sink and any heat-releasing appliances.
Here are some additional tips for
proper and safe medication storage:
• Store all drugs out of harm’s way.
That includes keeping them out of
reach of children or anyone else
who might misuse them.
• As a safety precaution, post a note
by your phone with the phone number for poison control, your health
care provider and pharmacy.
• Don’t leave the cotton plug in a
medication vial. Doing so can draw
moisture from the pills or capsules,
causing a chemical change in the
medication and possibly reducing
its effectiveness.
What is the best
container for pills?
For most of us, medications should be
stored in the labeled container that
comes from the pharmacy. Unless you
have physical issues that do not allow
you to open a childproof container, they
are the safest. The label on the original
container also allows you to identify the
medication, the way you should take it,
and when it expires.
If there are ever children in your
home, medications should be kept up
high and out of sight. This includes vitamins and supplements. The bright colors
can be very attractive to a child.
When should
medications be disposed of?
Check the expiration date, and if it
has passed, properly dispose of it (see
below). Also look for medications that
have been discontinued, antibiotics that
have not been completed, or any medication that is obliviously discolored,
crumbly or has an odor. Never use a
medication that has changed color, consistency or odor regardless of the expiration date, and dispose of any medication
if you can't read the label.
Dispose of medications that have not
been stored according to recommendations, like something that should have
been refrigerated. It’s also important
to take care when disposing of unused
medication. Keep them out of reach of
children, animals and others who may
be hurt by leftover drugs.
Proper disposal of medications
Properly disposing of medications can
protect you and the environment:
• Prevents poisoning.
• Deters misuse.
• Avoids health problems from acci-
dentally taking the wrong medicine,
too much of the same medicine, or a
medicine that is too old to work well.
• Keeps medicines from entering
streams and rivers when poured down
the drain or flushed down the toilet.
According to the Environmental
Protection Agency, the best way to
properly dispose of medications is to
participate in a “drug take-back event.”
The Drug Enforcement Administration
(DEA) has scheduled a National
Prescription Drug Take-Back Day, which
takes place on Sept. 29, 2012, from
10 a.m. to 2 p.m. You can find out if
there is one being held in your area by
calling 800-882-9539.
If there is no event in your area or you
want to immediately dispose of a medication, you can follow these household
disposal steps:
1. Take your prescription drugs out
of their original containers.
2. Mix drugs with an undesirable
substance, such as cat litter or
used coffee grounds.
Continued on page 6
GotDrugs?
Participate in
Drug Take-Back Day
Sept 29, 2012
To find out about a
collection in your area,
call 800-882-9539.
RainbowVisions 5
Medical
Corner
Continued from page 5
3. Put the mixture into a disposable container with a lid,
such as an empty margarine tub, or into a sealable bag.
provider to write a letter describing your medical regimen
and any devices you use.
4. Conceal or remove any personal information, including
Rx number, on the empty containers by covering it with
permanent marker or duct tape, or by scratching it off.
• Carry a copy of your prescriptions with you along with
5. The sealed container with the drug mixture and the
empty drug containers can now be placed in the trash.
Or check to see if the empty drug containers can be
recycled.
• Try to carry enough medication for the entire trip, and if
possible bring a little extra in case your return is delayed.
• Keep a current medication list in your purse or wallet
along with how you take the meds. You’ll want to include
any allergies you have and your health care provider's
phone number and address.
Are there special considerations
for taking medications when traveling?
Yes. If you are driving, do not store medications in your glove
compartment. The temperature and humidity could cause
damage.
When flying, the following tips on medication storage will
help:
• Keep your medications in your carry-on bag or purse.
• Always take your health insurance card with you.
• If you are changing time zones, ask your health care
provider how to adjust your medication schedule.
• Bring them in their original labeled containers so airport
security will know they are prescribed for you.
• Diabetics are allowed to carry insulin, lancets and syringes
on to the plane, but you may want to ask your health care
We get you Ready
get you Set
your pharmacist’s name and number in case you need to
get more medication while on your trip.
More information on travel tips and safe storage and disposal
of medicines is available through the American Society of
Health Systems Pharmacists at: www.safemedication.com.
Your pharmacist can be a very useful resource for information on storing medications. Using common sense and caution
when storing and traveling with medications will help keep
you and your loved ones safe. v
Expanded service
enesee
in Macomb and G
Counties!
so you can
GO!
The most challenging part of the journey can be getting out the door!
Rehab Transportation drivers know this and are trained in caring for
individuals with special needs. We get you safely from door to door. If
you like, we can also give you expert personal care assistance before,
during and after transportation.
Personalized, attentive services 24/7, 365 days a year.
Ready, Set, GO!
Call 800.306.6406
6 RainbowVisions
FALL 2012
Home- and community-based
rehabilitation services
for adults, teens and children
Physical, Occupational
and Speech Therapy
Home and community therapeutic
intervention for individuals with brain
and spinal cord injuries
Functional Home Assessments
Assistance in determining durable medical
equipment and attendant care needs
Home Modification Assessments
Recommendations for home modifications
in order to create a barrier free or wheelchair accessible home/living environment
Work Site Assessments
On-site modification recommendations
For more information call:
E-mail: [email protected]
www.functionalrecovery.com
Functional Recovery
is a division of
800.968.6644
RainbowVisions 7
Clinical News
By Joseph Welch, LLP, CBIS, CAADC
M
any people recovering from traumatic brain injuries
face the additional tasks required to recover from
substance addiction.
Research by Dr. John Corrigan et al. (1995) of Ohio State
University found that 30-50 percent of people hospitalized
with a traumatic brain injury (TBI) had a blood alcohol level of
.10 at the time of their accident, which is above the legal limit
in all states. This research also found that 66 percent of adolescents and adults admitted into TBI rehabilitation programs have
a history of substance abuse.
The TBI Model Systems National database* also showed
that 43 percent of people with a TBI had problem alcohol use
and 29 percent had illicit drug use. Drug abuse problems have
shown to worsen in two to five years after a person discharges
from substance abuse rehabilitation services. It is not encouraging news that 10-20 percent of people with brain injuries
develop substance abuse problems for the first time after their
injury.
To treat people with substance use disorders (SUD), the
National Institute on Drug Abuse (NIDA) recommends detoxification, medication (when appropriate), behavioral therapy and
developing a formal relapse prevention plan.
A thorough assessment is a must
Appropriate assessment of the person entering treatment is required to develop an individualized plan of care. This assessment
must include information from all available medical records.
Details of the person’s history should be evaluated by an experienced professional who recognizes cultural sensitivity which,
over time, helps to develop a complete picture of the person.
Mandatory details include age at first use of drugs and/or
alcohol, a complete list of all drugs used over time, and consequences associated with their use. Any previous diagnosis of
mood disorder (such as depression and social phobia) and a
history of learning disabilities or attention deficit challenges in
childhood can significantly affect how treatment is planned.
It is also important to know any history of substance abuse
treatments and their experience in utilizing community supports
such as Alcoholics Anonymous and Narcotics Anonymous.
Individuals recovering from both TBI and SUD encounter
unique challenges that clinicians and case managers should be
prepared for. Behavioral issues such as treatment refusal, verbal
aggression, disinhibition and poor initiation can make traditional treatment unrealistic.
These behaviors, even for professionals, may be seen as “intentionally disruptive” when there are no visible signs of disability, and cognitive impairments are misinterpreted as resistance.
Dependence vs. abuse
A person may be diagnosed as being either physiologically
dependent (addiction) to substance(s) or as having abused
substances.
* The Traumatic Brain Injury Model Systems National Data and Statistical Center (TBINDSC) located at Craig Hospital in Englewood, CO, is a central resource for researchers and data collectors within the Traumatic Brain Injury Model Systems (TBIMS) program. The primary purpose of the
TBINDSC is to advance medical rehabilitation by increasing the rigor and efficiency of scientific efforts to longitudinally assess the experience of
individuals with TBI. The TBINDSC provides technical assistance, training and methodological consultation to 16 TBIMS centers as they collect and
analyze longitudinal data from people with TBI in their communities, and conduct research toward evidence-based TBI rehabilitation interventions.
8 RainbowVisions
Addiction is defined as a chronic progressive disease characterized by physical and psychological symptoms such as
craving, compulsive use, loss of control, continued use despite
consequence and chronic use.
Abuse is defined as a maladaptive pattern of alcohol use
leading to clinically significant impairment or distress resulting in actions such as failure to fulfill major role obligations at
work, school or home. This also includes alcohol use in situations in which it is physically hazardous and alcohol-related
activities that result in legal problems.
Knowing whether a person meets the criteria for dependence
or abuse is important in prescribing the appropriate level of
care.
Levels of care in substance abuse treatment
Structured advancement programs within TBI and SUD treatment should have increasing levels of independence that support people with more abilities or who have demonstrated the
necessary responsibilities of recovery. The first level of care
takes the form of structured, supervised residences, which
graduates to moderate support residences and ultimately semiindependent apartment settings or home.
Additionally, persons in a substance abuse treatment program may need a higher level of care or even residential placement when there are legal problems, chronic relapses, medical
issues related to substance use or when there is any type of
violence involved.
Dr. Corrigan has studied treatment of TBI and SUD and
has identified the following components as best practices for
FALL 2012
Community Programs
Alcoholics Anonymous and
Narcotics Anonymous
Both programs are similar in that they describe themselves
as a “fellowship of men and women” who are trying to
overcome and recover from abuse of alcohol and other
substances. Both boast a global, multicultural membership
with numbers reaching into the millions. And both use the
principles of the 12-step program, founded in 1935 by Bill
Wilson and Dr. Bob Smith in Akron, OH.
The programs are available to anyone who needs them
at a low cost or free to those who can’t afford the program.
Participation in Alcoholics Anonymous is mandatory or
highly encouraged in most contemporary substance use
disorder recovery settings.
People who do recover have positive relationships with
Alcoholics Anonymous and Narcotics Anonymous and have
greater involvement with these organizations over time.
See www.aa.org and www.na.org for more information
on these organizations.
substance abuse treatment programs:
Detoxification Physiological dependence that requires medical
oversight to prevent seizures or serious health complications.
Inpatient Treatment Residential treatment in a supervised,
well-controlled environment to prevent impulsive relapse and
provide very close supervision.
RainbowVisions 9
Clinical News
Substance abuse treatment
Residential Treatment Typically a “safe
house” where people in recovery share
group responsibilities and are supported
by peers.
both TBI and SUD to frequently consult
with additional professionals and coordinate care with all available community
resources (Corrigan et al. 1995).
Day Treatment Individuals live independently in the community but attend
facilitated groups, individual therapies
and medical services eight hours a day
in specialized treatment settings.
A person’s readiness to change
Readiness to change is a theoretical model of recovery developed by
Prochaska and DiClemente (1984) and
is used to identify the specific level of
willingness and readiness a person has
in the recovery process. A person’s readiness has been broken down into stages
or levels.
Process of treatment
with relapse prevention
Simple things that could lead to a relapse could be additional discretionary
income, spending too much time on the
Internet, playing video games or using
the cellphone in a way that detracts from
recovery-based activities or working.
The following is the process of treatment
when a person has relapsed:
1. Identify high-risk situations, enhance coping skills and increase
self-efficacy
Stages of Change
Pre-contemplation Where a person does
not think there is a problem with their
use of drugs or alcohol.
3. Management of lapses – restructuring
clients' perceptions of relapse process
Intensive Outpatient Treatment
Individuals live independently in the
community but attend facilitated groups,
individual therapies and medical services four to eight hours a day in specialized treatment settings.
Outpatient Treatment Individuals live
independently in the community but attend facilitated groups, individual therapies and medical services one or more
days a week in specialized treatment
settings.
Additional elements
of treatment
Dr. Corrigan recognized that negative
outcomes have been largely due to the
neurobehavioral consequences of TBI,
which undermine a person’s ability to
participate in conventional treatment.
There are greater co-occurring psychiatric disorders that have not been properly
recognized or treated for people with
TBI. Those with TBI may also have less
ability to sustain improvements without
the support of external structure.
It is recommended that accommodations be made in treatment programs
that take advantage of a person’s neurobehavioral strengths. Motivational
counseling and the general avoidance
of confrontation with patients seems to
be effective in most cases. The diagnosis
and treatment of any additional mood
disorders or psychiatric problems should
be a priority of treatment.
It is recommended that specialized
case managers be assigned in cases with
10 RainbowVisions
Contemplation A person becomes aware
that they have a substance abuse problem but are unwilling, unable or not
educated on how to take action.
Preparation Where a person has taken
steps to enter treatment or acquire information on how to quit.
Action A person commits or enters treatment and follows through on treatment
providers’ recommendations.
Maintenance A period of successful
recovery and participation in recoverybased activities with little or no additional monitoring.
Relapse A potential level of change that
can occur during any level but can be
used as a landmark for learning instead
of an opportunity to resume active addiction or to leave treatment. The importance of this model lies in the fact that a
person cannot be “made to advance” in
readiness —treatment focuses on helping a person at one level to achieve the
next level through education, treatment,
introduction to multiple supports and
practice.
2. Eliminate myths regarding drug and
alcohol effects through education
Relapse Prevention
Relapse prevention planning, developed
by Marlatt and Gordon (1985), is a systematic approach to help a person who
has achieved some abstinence providing
prophylactic treatment and planning to
prevent return to active addiction. This
process typically takes place in the Action
or Maintenance levels in the Stages of
Change.
Relapse prevention teaches the person
how to:
• Recognize and avoid triggers and
high-risk situations
• Pre-plan and rehearse coping strategies
for stress and peer influences
• Nullify myths about drug use and
relapse
• Develop strong support systems
• Acquire a balanced lifestyle
When utilized in the treatment for those
who are living in residential treatment
programs, this process requires constant
vigilance and attention from the treatment team. It also begins the life-long
effort by the person in recovery to be
successful in the long term.
4. Balance lifestyle – develop positive
addictions, stimulus control and
avoidance techniques. Development
of relapse roadmaps.
Motivational interviewing
Motivational interviewing (MI) is the
evidenced-based counseling style developed by William Miller and Steve
Rollnick (1991) that allows the therapist
to respect the external motivators for a
person’s entry into counseling.
This style utilizes a person’s “readiness
to change” as a model for goal setting
and direction. The goals of therapy are:
to educate, to create a therapeutic relationship and to reach the next stage of
change towards recovery.
Motivational interviewing is a semi-directive, client-centered counseling style
for eliciting behavior change by helping
clients explore and resolve ambivalence.
It utilizes an understanding of a person’s
current readiness to change to guide
treatment.
It allows the therapist to express empathy, show discrepancies between the
person’s behavior and their values and
to absorb the patient’s resistance to treatment. The therapist will then be nonconfrontational, and support the person
who is striving to achieve self-efficacy.
FALL 2012
Vocational training
Dr. Corrigan and his colleagues found
that people with both TBI and SUD are
less likely to have gainful employment.
They also found that people who terminate their treatment services before
plan of care objectives are met had less
success maintaining their alcohol and
drug abstinence, were less likely to be
working and reported less overall life
satisfaction.
The integration of vocational retraining into the rehabilitation program is
essential.
Working is an ongoing educational
process in coping skill development and
utilization. Working provides a balanced
lifestyle —it can be a positive addiction.
Working improves self-efficacy, teaches
higher level social skills, promotes selfesteem and has built-in motivational
incentives.
Lynn Brouwers, CBIST, director of
Program Development and Vocational
Therapy at Rainbow Rehabilitation
Centers, says that in today’s economy,
finding employment can be difficult for
people with disabling conditions. A vocational specialist is often needed to engage the individual in developing a personalized vocational plan that will result
in meaningful work and participation.
Best outcomes are achieved when the
person with the dual diagnosis is supported by a rehabilitation team, including a qualified SUD therapist, and has
opportunities for vocational training or
work trials. While performing real work,
which has a wage as a built-in motivational incentive, the team can promote
positive coping skills.
Brouwers states that evaluating the
outcomes of rehabilitation activities
requires measuring whether the person
served meaningfully improved their
lives, especially with regard to community and vocational participation, which
are strongly linked to perceived quality
of life. Most people feel that their life has
quality when it includes meaningful relationships and a purpose.
Professional staff:
Substance abuse counselors
and specialized case managers
The front line of providers treating the
person in recovery are mental health
therapists. These social workers, counselors and psychologists must provide
proven therapy techniques within the
treatment program to assist with the
person’s recovery.
Best practices indicate that these
professionals should acquire specialty
About the author
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 from
Eastern Michigan University.
Joe has been a mental health therapist at Rainbow Rehabilitation Centers since 2005.
RainbowVisions 11
The role of pain management
and addictionist services
Many people recovering from brain injuries also suffer from
pain disorders associated with their initial accident. Proper
assessment and treatment of pain and differentiating pain
complaints from addiction-related disorders is the role of an
addicitionist. Addicitionology is a branch of medicine that
is concerned with the prevention, detection, treatment and
rehabilitation of persons with substance abuse disorders.
Addictionists are board-certified in their state of practice and
are capable of prescribing certain medications that can assist
in a person’s recovery from active addiction.
Dr. Carl Christensen, associate professor of Psychiatry at
Wayne State University in Detroit and medical director of
Addiction Medicine at Detroit Medical Center, states that a
competent addictionist keeps asking themselves if they have
made the right diagnosis. They have to determine if it’s a true
pain disorder, or if it’s malingering and “pseudo addiction,”
in which a patient is prescribed drugs and sells them to others. Dr. Christensen shares several “red flags” of addiction for
people who are reporting chronic pain.
Warning signs of addiction in patients
presenting with chronic pain:
• Tobacco addiction
• Legal history (especially driving under the influence)
• Marijuana use
• Family history
• Non-prescribed/prescribed sedative use
According to Dr. Christensen, benzodiazepines are
frequently prescribed with opiates with the purpose of
decreasing anxiety as well as pain perception. However,
there is a high risk of side effects when these two drug types
are used in combination. Benzodiazepines may also paradoxically lower pain threshold and are highly addictive.
According to Dr. Christensen, drug testing is an extremely
important part of substance abuse treatment for people with
TBI and pain disorders. Clinicians must check for medications that have been prescribed and also for drugs that indicate abuse. Many powerful drugs like methadone and fentanyl do not show up on most drug screens. Everyone should
be tested for their own safety.
Dr. Christensen also utilizes the Michigan Automated
Prescription System (MAPS), which is a service that physicians use to check whether or not the patient has been
receiving controlled substances from other providers.
Anyone with a Drug Enforcement Agency number can enroll. This service is confidential and cannot be used for legal
proceedings.
How to treat co-occurring chronic
pain, substance addiction and TBI
The best practice is to avoid an emphasis on medication
when helping people recover from addiction and traumatic
brain injury. Dr. Christensen recommends avoiding short-acting opioids and is very careful when prescribing stimulants.
He says that stimulants decrease pain in the short-term but
during withdrawal will increase pain.
Sedatives and stimulants individually or in combination
can be dangerous because they change behavior, are addictive and have side effects.
Become a Certified Brain Injury Specialist
Join more than 1,500 Certified Michigan Professionals
Training sessions will be held every Thursday from 8:00 a.m. – 9:30 a.m.
January 17 – March 21, 2013
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]
12 RainbowVisions
FALL 2012
Substance abuse treatment
certifications, such as Certified Advanced Addictions
Counselor (CAADC) and Certified Brain Injury Specialist
(CBIS), to provide better service for the individuals in recovery. Therapists with these sub-specialties are more apt to be
trained in and utilize empirically based treatment models in
therapy, such as motivational interviewing and cognitive behavior therapy.
Strong programs that value their employees and support an
environment of quality care, relationship development and
trust, are better able to assist persons in recovery. Low staff
turnover is a feature of high quality rehabilitation programs.
Also, when rehabilitation staff respects the patients in the
program, the support necessary for success is provided.
Putting it all together
When considering treatment for your client, a family member or yourself, remember that people can and do recover
from substance dependence, form healthier relationships and
return to work. The provider you choose may give treatment
recommendations that seem difficult for the person in recovery to understand and accept at first, but experience and research has shown the efforts are well worth the reward. v
References
Corrigan, J., Sparadeo, F., & Ferris, R. TBI and Substance Abuse.
http://learning.mchb.hrsa.gov/archivedWebcastDetail.asp?aeid=219
Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the
treatment of addictive behavior. New York: Guilford Press.
Miller, W. R., &Rollnick, S. (1991). Motivational interviewing: Preparing people for change.
New York: Guilford Press.
Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: Crossing the
traditional boundaries of therapy. Melbourne, Florida: Krieger Publishing Company.
Substance Abuse and Mental Health Services Administration. (2010). Recovery oriented systems ofcare
(ROSC) resource guide. http://partnersforrecovery.samhsa.gov/docs/rosc_resource_guide_book.pdf
Substance Abuse and Mental Health Services Administration. (2009). Guiding principles and
elements of recovery-oriented systems of care: What do we know from the research?
http://partnersforrecovery.samhsa.gov/docs/guiding_principles_Whitepaper.pdf
State Associations of Addiction Services. Implementing healthcare reform:
First steps to transforming your organization.
http://www.saasnet.org/PDF/Implementing_Healthcare_Reform-First_Steps.pdf
President's Corner
allow for a greater variety of on-site work
trials, work opportunities and vocational
training that will complement the work
going on in the community.
And lastly, I want to briefly introduce
you to Rainbow U. This exciting new
program offers a wide variety of new
treatment options and activities for clients focused on addressing therapeutic
needs in the areas of physical, cognitive, emotional, social and independent
living. The program will complement
traditional clinical therapy and provide
clients with greater variety and input into
their plan of care and daily activities.
Program development has been over a
year in the making and has involved the
input of employees from every corner of
the company. Vice President of Clinical
Administration Heidi Reyst has done an
exceptional job in leading this process,
and the efforts of the whole team have
been tremendous. The program is being
rolled out in phases over the next several months. Rainbow U is clearly an
example of creativity, talent, dedication,
loyalty, caring, hard work and family—
all in one.
Keeping a balance between that small
family feel and being a leader can be
tough, but I think we are doing pretty
well. That’s all for now—I am off to celebrate a co-worker’s 60th birthday. 
RainbowVisions 13
Survivor
Perspective
An unlikely
Julia Fox Garrison suffered a massive hemorrhage that resulted in a
paralyzing stroke 15 years ago while at work. Today, she is a best-selling author, motivational speaker and a loving mother and wife. She speaks to doctors’ groups and
other health care audiences around the country.
Julia is the author of Don’t Leave Me This Way (or when I get back on my feet
you’ll be sorry), published by HarperCollins Publisher in June 2005.
“
I am not my stroke.
Does it define me? In some
ways, perhaps, but it is only
one side of the multifaceted
person I am.
The book chronicles her struggle to regain control over her life and body after the
stroke. Julia was never one to proclaim that she would write a book one day, but in
the aftermath of her stroke, dealing with the medical community and insurance companies while rehabilitating, she realized she had a story to tell. Her experience was
a blueprint for how not to let the system dictate the direction, pace and objectives of
one’s recovery.
“I never had a fire in my belly to write a book,” said Julie, “but I had a lot to say
after having gone through rehab. I wrote it as a resource from a patient perspective.
The book is really about facing something hard—it’s not just about stroke.”
She refers to the hemorrhage as her “stroke of luck” because she has come to realize that her true purpose in life is to be a “Messenger of Hope” to those facing adversity. To show by example how someone can persevere with a positive attitude, a
sense of humor and an unbending belief in yourself.
“I tried to convey those things in the book, which starts out in the third person because I want the reader to observe my daily routine,” said Julia. “In the first chapter,
I'm thanking God for all the obvious blessings—home, family, job. Once the hemorrhagic stroke occurs in the book, I end that chapter in the book with 'she is gone.'”
Julia continues, “I then shift to second person so that the reader feels as though
they are on the gurney with me. I then switch to the first person for the last few chapters to reflect on how much I've learned on my journey back.”
The book is a great read with short vignettes about singular events that make up a
whole chapter. Julia explains that prior to her stroke she was “all about multitasking.”
Today, with Attention Deficit Disorder, she focuses on one thing at a time, and the organization and flow of the book reflects that—some chapters are barely a page long.
There are times when Julia is brutally honest about what she went through. She
wanted to be sure the story she told was complete. She changed the names of the
medical professionals who treated her, which provides perfect insight into how she
felt about them. “Dr. Jerk” is an example of one of her not-so-likeable doctors who
she felt misdiagnosed her. And she told him so at every opportunity.
“I now take nothing for granted and am thankful for what I have and for what I do,
14 RainbowVisions
FALL 2012
By Barry
Marshall
Editor, RainbowVisions Magazine
especially those things you might not even think about, like my
face being symmetrical again, that I can feed and dress myself,
and go to the bathroom without assistance,” Julia explains.
Julia is a graduate of Katharine Gibbs School in Boston and
Champlain College in Burlington, VT, where she majored in
retail marketing. She began her career in the computer industry as a composition editor, then became a technical writer,
and eventually settled on a career path in software customer
support.
Starting out as a phone representative, she demonstrated
a knack for problem-solving. This, coupled with her unquestioned people skills, led to rapid advancement through the
ranks to manager of Software Support, with three reporting
first-level managers and an overall group of 75.
A directorship at her company was within her grasp when
she suffered the debilitating injury, effectively ending her career in the corporate world. And thus began her journey of
rediscovery.
Julia was born in Natick, MA, and raised in Andover, MA, in
a loving if chaotic household with eight brothers, an upbringing that no doubt made her battle ready for the literal fight for
her life. She currently resides with her husband Jim, young son
Rory and dog Shaggy in a suburb outside Boston, where she is
researching her next writing project as she continues to overcome the effects of stroke.
“Fifteen years ago today, I narrowly escaped the Grim
Reaper’s scythe. Every year since, I have marked this day as a
“Homage to my Hemorrhage,” celebrating the gift of more time
here on earth. Originally, I thought of this year’s anniversary as
a milestone, but in reflection, I realize that every day is a milestone, an extra opportunity to make a positive difference.
“I am not my stroke. Does it define me? In some ways, perhaps, but it is only one side of the multifaceted person I am. I
am the victor of my stroke; I conquered the beast. Yes, it raises
its ugly head daily, but I am battle ready. This enemy did not
defeat me, it only made me stronger, wiser, grateful, happier,
yes, happier. I know up-close-and-personal that every day I get
out of bed is a gift. Limping for joy!”
She plans on writing another book— a memoir of growing up
in her family of eight brothers and no sisters.
“I find that I can only write about what is familiar to me, and
it must be something that has comedic elements,” explains
Julie. “And with the dynamics at play in my family, believe me,
I have a treasure trove [to work with].” v
People need to hear about this book and the message it
conveys, says her publisher, not just stroke survivors and their
families, but people from all walks of life. People with health
issues. People with stress in their lives. People who are depressed or overwhelmed or challenged. In other words, all of
us. The message is clear: you hold the key to overcoming the
obstacles put before you. Humor, positive attitude and inner
strength will help you prevail.
Julia recognized the anniversary of her injury, which she
calls an “Homage to my Hemorrhage,” this past July with a
blog post. The following is an excerpt:
RainbowVisions 15
Therapy
Corner
S
Serial Casting
Serial casting is a clinical intervention that is used when a
person has limited range of motion (ROM) due to increased
muscle tone or spasticity. Spasticity is a frequent problem in
persons who sustain a traumatic brain injury (TBI) or other
neurological insult, such as stroke, spinal cord injury, muscular
dystrophy and cerebral palsy.
Spasticity is clinically defined as a muscular hypertonicity
characterized by a velocity-dependent increased resistance to
stretch, which is known to interfere with voluntary movement.
It is usually caused by damage to the motor cortex that controls
voluntary movement (Cincinnati Children’s Hospital, 2009).
During an assessment, a manual passive stretch is applied
at different rates. A joint is passively moved while the muscles
corresponding to that joint are lengthened and shortened.
In cases of mild spasticity, the muscles will only resist when
stretched at a high rate (velocity-dependent), whereas in cases
of moderate spasticity, resistance is noticed at a slower rate and
the clasp-knife phenomenon may be exhibited (Dimitrijevic,
1991).
Serial casting is a process in which a series of casts are periodically used to stretch soft tissues for an extended length of
time (Cincinnati Children’s Hospital, 2009). As an example,
to elongate a rubber band or a balloon, it takes a prolonged
stretch and hold for that to occur. Muscles work in a similar
fashion.
A prolonged stretch in a lengthened position at low impact
will yield better results and functional ROM gains as well as
a reduction in spasticity. This was seen in a study that demonstrated at least six hours of stretch was necessary for effectiveness (Cincinnati Children’s Hospital, 2009).
Serial casting can be done on both the upper extremity and
the lower extremity to reduce spasticity. It is most effective
when it is used within the first six months after injury and with
patients who are demonstrating ongoing recovery neurologically (Booth, Boyle & Montgomery, 1983).
When to use serial casting
There are several clinical indications for casting and precautions to take into consideration prior to casting.
The indications include: improve ROM, improve positioning of the extremity to allow better management of activities
16 RainbowVisions
By Julie
Ladwig, PT, CBIS, CKTP
of daily living, prevent contractures, normalize muscle tone
and reduce spasticity, and ultimately maximize the patient’s
function.
There are precautions to be aware of prior to casting someone, which include: impaired sensation of the extremity to be
casted, poor skin integrity, poor circulation and hard end feel
(which could be heterotopic ossification). If the person has
heterotopic ossification, serial casting is not indicated as ROM
will not be gained due to the fixed end feel caused by the bone
growth.
These precautions require close monitoring prior to and during casting. The patient’s cognitive status and family/caregiver
compliance and understanding of the process are factors in
yielding positive outcomes as well.
Patient/caregiver education
After a cast is applied, it’s important to provide frequent inspections of the cast and surrounding areas. It is also important for
the professional who installed the cast to communicate to the
client and their caregivers on what to expect while the cast is
in place. They should further explain that mild discomfort is
expected as the patient’s extremity is in a stretched position. If
discomfort persists, under the direction/orders of the patient’s
physician Tylenol® or Motrin® can be given for some relief.
The patient or caregiver should contact the therapist if there
are cracks or dents in the cast or an unusual odor in the cast;
if something has been dropped inside the cast; if the client
complains of itching or dampness or if the client simply refuses
to bear weight while the cast is on. If the extremity begins
to slip inside the cast, the therapist needs to know that, too.
(Cincinnati Children’s Hospital, 2009)
If the client is experiencing severe pain, a skin reaction or
poor circulation from the cast, it should be removed.
If the client is being fitted with their first cast, it should be
removed within five to seven days to make sure the client’s skin
and the extremity is tolerating it. Subsequent casts can be removed between seven and 14 days.
When the cast is removed, the skin should be checked for
signs of breakdown, blisters, rash, etc. The therapist should also
reassess ROM (active and passive), functional gains and spasticity reduction.
FALL 2012
Applying a series of casts to an extremity can be an effective clinical
intervention to increase range of motion by slowly stretching the soft tissue.
The casting process
EDITORS NOTE: The casting process is completed by
a professional therapist with training. This is intended
to give the reader a basic understanding of the process.
It is not intended to be instructional.
Pre-casting process
1. Take measurements of the patient’s
extremity in the resting position.
2. Take passive and active range
of motion measurements.
3. Assess functional skills
with the extremity to be casted.
4. Assess spasticity in the involved extremity.
5. Assess skin integrity.
Casting process
1. Make sure the skin is clean and dry.
2. Apply stockinette to the extremity above
and below the joint that will be casted.
3. Apply padding to any bony prominences
to reduce the risk of skin breakdown.
4. Wrap the extremity with cast padding.
5. Fold up the ends of the stockinette on the
cast padding prior to applying the casting
material.
6. Position the extremity in a stretched
position that is greater than the resting
position and less than the full passive
range of motion (PROM) position.
7. Wrap the casting material over the extremity
while it is held in the stretched position.
8. Maintain the extremity in this position
until the casting material dries.
9. Check for proper circulation on the distal
(open end) of the cast.
(Novita Children’s Services, 2012)
RainbowVisions 17
Therapy
Corner
Serial Casting
At this point, the therapist should
decide whether or not to continue with
the casting based on the client’s tolerance and functional gains made from the
above assessment.
If it has been determined to proceed
with serial casting, the therapist should
re-cast the extremity in approximately
five more degrees of ROM. Repeat the
same steps as previous. The second cast
can be kept on for a longer duration
if the first cast went well with respect
to skin integrity, patient comfort and
circulation.
The challenge when using this clinical
intervention in the TBI population can
be a lack of understanding of the process
by patients who may have a cognitive
impairment.
A study concluded that casting is more
effective than traditional techniques in
reducing contractures (increasing ROM)
and decreasing spasticity. Interestingly,
in this study, the difference between the
effects of serial casting and traditional
therapy on functional improvement of
the extremity did not yield a significant
difference. However, it can be concluded that with a reduction in spasticity and
improvement in ROM that functional
gains will be made overall (Hill, 1994).
Another study, in which a systematic
review was completed of the research
on serial casting following a brain injury, concluded that only the outcome
of improved passive ROM has sufficient
evidence to support the use of casts as
current best practice.
This study demonstrates the need for
continued research in the area of serial
casting intervention in persons with a TBI
(Mortensen & Eng, 2003). Further research can establish better best practice
guidelines for therapists in the areas of
reduction in hypertonicity or spasticity as
well as change in functional ability.
18 RainbowVisions
At Rainbow, we have found success in
serial casting with our clients who have
sustained a TBI.
We have found improvements in our
clients’ ROM and can follow up with
appropriate resting splints after the serial
casting is complete. These splints are
more comfortable for the patient and
fit better because of the gains made in
ROM with serial casting. Most of our
patients treated with serial casting are
treated with Botox® prior to the casting
The role of Botox® in serial casting
Botulinum toxin, or Botox®, injections into the tight muscle can
provide relaxation of the contractile tissue of the muscle and make
serial casting more successful.
This medication will block the release of acetylcholine, a neurotransmitter, at the neuromuscular junction, which results in weakness or
paralysis in the muscle (Cincinnati Children’s Hospital, 2009) and a reduction in spasticity.
This effect usually takes 10 to 14 days, and it is best to wait until the
injection is fully effective before putting on the cast. Serial casting is
much more comfortable for a patient when the muscle is weakened
and stretched out versus a muscle that is still fully contracting. This
will increase the tolerance and the outcome when incorporated with
the serial casting.
References:
Booth, J. B., Doyle, M., & Montgomery, J. (1983). Serial casting for the
management of spasticity in the head-injured adult. Physical Therapy – Journal of
the American Physical Therapy Association, 63, 1960-1966.
http://ptjournal.apta.org/content/63/12/1960.full.pdf+html
Cincinnati Children’s Hospital Medical Center. (2009). Evidence-based care
guideline for management of serial casting in children.
http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemI
D=87961&libID=87649
Novita Children’s Services. (2012). Information for parents: Serial casting at
Novita. http://www.novita.org.au/library/Factsheet-Serial_Casting.pdf
Mortenson, P. A., & Eng, J. J. (2003). The use of casts in the management of joint
mobility and hypertonia following brain injury in adults: A systematic review.
Physical Therapy – Journal of the American Physical Therapy Association, 83, 648658. http://ptjournal.apta.org/content/83/7/648.full.pdf+html
Hill, J. (1994). The effects of casting on upper extremity motor disorders after
brain injury. The American Journal of Occupational Therapy, 48(3), 219-224.
http://ajot.aotapress.net/content/48/3/219.full.pdf
as it is more comfortable for them and the outcomes are better.
In summary, serial casting is a conservative clinical intervention that can be used to manage the effects of increased spasticity following a TBI. It can improve a patient’s ROM and appears
to be more effective when combined with Botox®.
Several clinicians at Rainbow have completed the training
FALL 2012
in-service on this intervention. They continue to use serial casting in conjunction with traditional therapy techniques and appropriate splinting. While serial casting is not the answer for
all patients, it is another “tool” in our toolbox that can make a
difference in the quality of life for our clients. v
ENTER
The OAKLAND TREATMENT C
After School
& Saturday Day
Programs
NEW!
After School Program now also at
the Genesee Treatment Center!
Therapies and skill building for
children and teens with brain injuries
Specifically designed for academic and social
success, our programs integrate structure, group
and individual therapies, recreational activities
and social skills training. Programs also feature:
•Tutoring and classroom readiness
•Early childhood services
•A school liaison staff member
to facilitate success in public school
To register or for more information call...
800.968.6644
E-mail: [email protected]
RainbowVisions 19
2012
Conference & Event Schedule
Fall
September
September 18, 2012
October 25-27, 2012
CMSA Greater Grand Rapids Kalamazoo Chapter
IARP International Conference
Grand Rapids, MI
For info, please email: [email protected]
Caribe Hilton, San Juan, PR
For info, please visit: www.rehabpro.org
September 20-21, 2012
October 30, 2012
Michigan Association of Justice No-Fault Institute
MSU 2012 Case Management Conference
Westin Hotel, Southfield, MI
For info, please visit: www.michiganjustice.org
Lexington Lansing Hotel, Lansing, MI
For info, please visit: www.nursing.msu.edu
Denver Marriott City Center, Denver, CO
For info, please visit: www.islcp.org
November
September 26, 2012
November 6-9, 2012
International Symposium on Life Care Planning
2nd Annual Veterans TBI Summit
National Workers' Comp & Disability Conference
Lansing Center, Lansing, MI
For info, please visit: www.biami.org
Las Vegas Convention Center, Las Vegas, NV
For info, please visit: www.wcconference.com
November 7-9, 2012
BIAMI Annual Conference
Lansing Center, Lansing, MI
For info, please visit: www.biami.org
October
RE:CON (formerly Michigan Rehab Conference)
Grand Traverse Resort, Traverse City, MI
For info, please visit: www.mi-recon.org
November 13, 2012
MSU College of Nursing Conference on Pain
Marriott Eaglecrest Resort, Ypsilanti, MI
For info, please visit: www.nursing.msu.edu/continuing.asp
October 2, 2012
November 13, 2012
6th Annual Great Lakes Chapter ACMA
Case Management Conference
CMSA Greater Grand Rapids Kalamazoo Chapter
Laurel Manor, Livonia, MI
For info, please visit: www.acmaweb.org
Kalamazoo, MI
October 3-6, 2012
Contemporary Forums Brain Injury Conference
Flamingo Hotel, Las Vegas, NV
For info, please visit: www.contemporaryforums.com
October 3-6, 2012
2013 Event Preview
Save the date!
ARN Annual Educational Conference
Renaissance Nashville, Nashville, TN
For info, please visit: www.rehabnurse.org
October 12-15, 2012
AANLCP Life Care Planning Conference
Albuquerque, NM
For info, please visit: www.aanlcp.org
October 18, 2012
Michigan Self-Insurers' Association Fall Conference
Suburban Collection Showplace, Novi, MI
For info, please visit: www.michselfinsurers.org
October 18, 2012
Capitol Area Case Management Council Vendor Fair
University Club of MSU, Lansing, MI
20 RainbowVisions
January 28-30, 2013
BIAA Brain Injury Business Practice College
Chaparral Suites Resort—Scottsdale, AZ
For info, please visit: www.biausa.org
June 25-28, 2013
CMSA National Conference
Morial Convention Center, New Orleans, LA
For info, please visit: www.cmsa.org
MBIPC
Michigan Brain Injury Provider Council
FALL
FALL2012
2012
RINC
Rehabilitation &
Insurance Nursing
Council meetings
MEMBERS ONLY
Registration at 11:30 a.m. / Lunch at Noon
Presentation begins at 12:45 p.m.
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, contact Mary Mitchell
734-482-1200 or [email protected]
October 9, 2012
Topic: Seizures and TBI
Speaker: Brien Smith, M.D.
Dept. Chief, Neurology, Spectrum Health
Location: Prince Conf. Center at Calvin College, Grand Rapids, MI
November 13, 2012
Topic: Vestibular Rehabilitation
Speaker: Julie Ladwig, PT, CKTP
Clinical Director – Rehabilitation Services, Rainbow Rehabilitation Centers
Location: Holiday Inn West, Livonia, MI
December 11, 2012
Topic: Vision Training Following Brain Injury
Speaker: Dr. Robert Hohendorf, O.D.
September 21, 2012
Topic: No-Fault Coverage: What Next?
Speaker: Ed Turfe, Attorney
Location: Ford Yacht Club,
29500 South Pointe, Grosse Ile, MI
RSVP to: Shannon Higdon
313-745-6902 / 734-341-7879 (cell)
[email protected]
October 19, 2012
Topic: Unraveling the Mystery of People
Speaker: James (Jay) Hawreluk, Managment Consultant
Location: Maggiano's Restaurant,
2089 W. Big Beaver Rd., Troy, MI (complimentary valet parking)
RSVP by Oct. 12 to: Sandy Hensley 586-493-7677 or 586-246-5993
[email protected]
November 16, 2012
Topic: Cognitive Treatment: Review and Analysis from the American
Rehabilitation Medicine Cognitive Rehabilitation Training
Speaker: Michael Dodman, MA, CCC-SLP CBIS
Location: Andiamo's Restaurant, Bloomfield Township, MI
RSVP to: Rebecca Penchette 734-732-0212
RINC meetings are presented the third Friday of each month.
January 8, 2013
Topic: Real Time Measures of Brain Functioning
Using Advanced Electrophysiology
Speaker: Terry Braciszewski, Ph.D.
Location: Holiday Inn West, Livonia, MI
February 12, 2013
Topic: Practical Management of Balance and Dizziness
Speakers: Kerri Bryhof, OTR and Gina Watkins, MA
For updates on meetings, visit www.rainbowrehab.com
For more information on meetings and membership contact
Adrienne Shepperd: 248-953-4079
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.
RainbowVisions 21
News @
Introducing
This fall, Rainbow introduced an exciting new way to deliver treatment services:
Rainbow U. This program provides our clients with more choices, more treatment
options and more sustained achievement. Participants in Rainbow U explore an
array of interesting and entertaining activities while they work on clear treatment
objectives.
Residential and outpatient clients have the opportunity to participate in Rainbow
U according to their individual abilities and interests, and courses are offered at a
variety of Rainbow’s treatment locations.
Rehab Techs are specially trained to lead many
of the elective classes at Rainbow U. Pictured
are (clockwise from back left) Chuck Bernard,
Amy Chesney, Sabrina Miles-Bentley, Kirk
Howard, Darryl Hartman, Kendra Jaynes and
Jeff Brozoski.
When home
is the only place
you want to be
How it Works
In addition to the traditional individual and
group therapy that Rainbow offers, Rainbow U
adds two types of therapeutic groups; core and
elective. Core courses are prescribed based on
the client’s therapeutic needs in Physical, Cognitive, Emotional, Social and Independent Living
areas.
Elective courses are the activities that clients
choose for themselves. Each quarter they’ll
select from a variety of courses such as
Photography, Book Club, Pet Therapy, Drama
Club, Journalism, Yoga, Music Appreciation and
Dealing with Loss.
Rewarding Success, Measuring Results
At a Rainbow U kick-off event, staff and
clients had the opportunity to "test
drive" several of the elective courses.
Here, recreational therapist, Michelle
Kroll shows off her hand-felted creation
from the Fibre Arts course.
Rainbow U's success is measured using a variety of tools, however, client clinical
outcomes are the primary way that the program is evaluated. Tools like the MayoPortland Adaptability Inventory and the Satisfaction with Life scales are used to
examine both client and program level success.
Participants receive an achievement report at the end of each quarter to help them
stay in touch with their goals. Achievement reports include:
• Total percentage of courses attended
HOME CARE
from
• Daily and quarterly U-Points earned
• Scores based on citizenship, participation,
instruction acceptance and skill utilization
U-Points are earned for participation and achievement, and can be redeemed for
tangible rewards such as concert tickets or gift cards.
More Choices, More Success
The high-quality programming that we're known for has been built into
Rainbow U giving clients more choices, more results and more fun!
800.968.6644
22 RainbowVisions
For more information about
Rainbow U, call 800.968.6644.
FALL 2012
Rainbow proudly celebrateS
the opening of two new facilities
Genesee treatment Center
Char Combs, clinical director of the Genesee Treatment
Center, cuts the ceremonial ribbon to officially launch
the new center.
This summer, Rainbow Rehabilitation Centers hosted open
houses for its newest facilities: the Genesee Treatment Center
and Vocational Rehab Campus.
Formerly the RM Auctions building in Ypsilanti, the Vocational
Rehab Campus is the center of Rainbow’s growing vocational
rehabilitation program for its clients.
Attendees at both events had the opportunity to tour the
facilities, meet staff and learn about the services provided at
each location.
At the Vocational Rehab Campus Open House on July 19, Rep.
David Rutledge, Paul Schreiber, mayor of Ypsilanti, and Diane
Keller, president of A2Y Chamber, were in attendance, along
with representatives from the brain injury professional community, clients who will be working at the center and their
families.
The Genesee Treatment Center offers outpatient neurorehabilitation services and is the home to Functional Recovery, the home- and community-based rehabilitation division
of Rainbow.
This center is located at 5402 Gateway Centre Drive, in Flint, MI.
Rainbow’s new vocational center is located at 5 West Forest
Ave. in Ypsilanti, MI.
vocational rehab campus
[ABOVE] From left: Diane Keller; Joe Morgan from Rep. John Dingell's office;
Paul Schreiber; Rep. David Rutledge; Nerico Johnson, one of Rainbow's
longest-participating vocational clients; Lynn Brouwers, director of
program development; Dawn Harbach, vocational program manager;
Vocational Specialists Don Daniels, Chris Roberts and Laurie Cooke; and
Nicole Korbecki, occupational therapist at the Oakland Treatment Center.
RainbowVisions 23
News @
New Professionals
Jon Dunkerley, MS, LLP, BCBA
Behavioral Analyst
Jon has a Master of Science degree in clinical
behavioral psychology from Eastern Michigan
University and is a board certified behavioral
analyst. He has over 10 years of experience as
a behavioral psychologist and will be serving
our clients from the Ypsilanti Treatment Center.
Stacy Hunter, BSW
Residential Program Manager
Stacy holds a bachelor’s degree in social work
from Keuka College in Keuka Park, New York.
She has several years of experience working
with clients of all behavior levels as well as
with persons with TBI. Stacy will begin the
Manager in Training Program and will work
with clients in the Ypsilanti area.
Summer 2012
Albert Brown Jr.
Executive Chef
Albert joins Rainbow's NeuroRehab Campus
as the executive chef and is looking forward to
treating clients to some really special dishes!
Al has over 20 years of experience including
cooking for the Atlanta Falcons. He is a Certified
Executive Chef.
Debbie Powell, MSW
Social Worker
Debbie joins our team at the NeuroRehab
Campus. She earned a Master of Social Work
degree from Wayne State University and has
over 20 years of experience as a clinical social
worker.
Veronica Thomas, RN
Danyell Solomon
Nurse Case Manager
Human Resource Assistant
Veronica received her nursing degree from
Henry Ford School of Nursing. Veronica has
held previous case manager positions working
for Blue Cross Blue Shield as well as Feinberg
Consulting and Oakwood Hospital. She joins
the staff at Rainbow's NeuroRehab Campus.
Jennifer Warrow, MSW, LMSW
Case Manager – Mental Health
Danyell holds a certificate from Dorsey Business
School and is currently pursuing a bachelor's
degree in business administration at Baker
College. She has 13 years of business experience
in career services.
Payal Bhagat, PT
Community Physical Therapist
Jennifer earned a Master of Social Work degree
from Wayne State University. She previously
worked at University Psychiatric Centers as
a Case Manager. She joins our staff at the
Ypsilanti Treatment Center.
Payal has worked 10 years as a physical therapist
and has experience working with individuals
with serious injuries. She holds a bachelor's
degree in physical therapy from the College of
Physiotherapy in Anand, India. Payal will be
serving clients in Macomb County as part of our
home- and community-based therapy team.
Michelle Bitgood, BS
Amanda Benjamin, BA
Vocational Program Manager
Michelle holds a bachelor's degree in
recreation management and outdoor
leadership from Springfield College and
is working toward a Master of Science in
Rehabilitation Counseling and Casework.
She has experience as a program coordinator
with the Fowler Center for Outdoor Learning
and joins Rainbow as our vocational program
manager.
24 RainbowVisions
Digital Marketing Specialist
Amanda is a graduate of Oakland University
with a bachelor’s degree in journalism. She is
currently working on her master’s degree in
communication. Amanda comes with a wealth
of writing, web and social media experience.
Most recently, Amanda worked at the Oakland
University Pawley Lean Institute, where she
created and implemented the Institute's public
relations strategy.
Samantha Nall, OTR/L MS
Occupational Therapist
Samantha joins our therapy team as an
occupational therapist at the Ypsilanti
Treatment Center after serving an internship
with Rainbow last summer. She received a
master’s degree in Occupational Therapy from
Eastern Michigan University.
Yolanda Rountree, BBA
Corporate Recruiter
Yolanda holds a Bachelor of Business
Administration from Davenport University and
is currently working toward an MBA. She joins
Rainbow with over seven years of recruiting
experience which included recruiting for
medical positions. She will be joining the
human resources team at Rainbow's Livonia
Corporate Center.
FALL 2012
Kate Sobbry, MS, RD
Dietitian
Kate will be monitoring the dietary needs of Rainbow
clients primarily at the NeuroRehab Campus. She has
a master’s degree in Dietetics from D’Youville College
in Buffalo, New York and has experience working as
a clinical dietitian manager at a skilled nursing and
rehabilitation facility.
Work with Us
Interested in a career with Rainbow?
We welcome applications from qualified
candidates for a variety of positions.
To learn more, just visit www.rainbowrehab.com
and click on the Employment tab at the top of the page.
Vocational Opportunities after a Traumatic Brain or Spinal Cord Injury
Regain work habits
and behaviors
Develop occupational skills
Reinforce functional
independence
Work toward employment goals
Vocational training and rehabilitation are vital after a traumatic
neurological 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. When work
is performed as part of the rehabilitation program, Rainbow
Industries pays clients in accordance with Dept. of Labor rules.
800-968-6644
RainbowVisions 25
One Thousand Words
Hungry goats capture the attention of these two Summer Fun! participants during a late summer outing to a local riding
stable and petting farm. The fun and friendships continue into the school year with Rainbow’s therapeutic After School and
Saturday Program, now in both Oakland and Genesee counties. Call 800.968.6644 to learn more about Rainbow's Pediatric
and Young Adult programs.
It's about reaching your potential!
Young Adult Program
Vocational programming Designed to assist young adults in gaining meaningful
employment and developing the skills necessary
Therapeutic services
to initiate and maintain long-term relationships.
Residential services
Flexible scheduling
800.968.6644 E-mail: [email protected]
26 RainbowVisions
FALL 2012
no greater hope of recovery…
A full Continuum of Care including
active therapy, community outings
and supported living for individuals
with medical needs.
FEATURING
Two 20-bed facilities
Private rooms and baths
Physician visits on-site
Nursing services available
on-site 24/7
Interdisciplinary
treatment team
fo
om
c
.
b
ha
tion or
a
m
r
o
r inf
to schedule a tour.
Email ad
miss
io
ns @
rai
nb
ow
re
Executive chef
800.968.6644
RainbowVisions 27
Presorted Standard
U.S. Postage
PAID
Permit 991
Ypsilanti, MI
38777 Six Mile Road, Suite 101
Livonia, Michigan 48152
INSIDE:
Substance Abuse Treatment & TBI What treatment provides the best
possible outcomes? See Page 8
Do you have a story idea or comment? We’d love to hear from you! Email: [email protected]
Locations

SAGINAW
MIDLAND
BAY CITY
GENESEE COUNTY
Genesee Treatment Center
5402 Gateway Centre Drive
Flint, Michigan 48507
T: 810.603.0040 F: 810.603.0044
OAKLAND COUNTY
Oakland Treatment Center
32715 Grand River Ave.
Farmington, Michigan 48336
T: 248.427.1310 F: 248.427.1309
L
G
SIN
AN
NeuroRehab Campus®
25911 Middlebelt Rd.
Farmington Hills, Michigan 48336
T: 248.471.9580 F: 248.471.9540
WASHTENAW COUNTY
Ypsilanti Treatment Center
P.O. Box 970230, 5570 Whittaker Rd.
Ypsilanti, Michigan 48197
T: 734.482.1200 F: 734.482.5212
WAYNE COUNTY
Rainbow Corporate Headquarters
38777 Six Mile Rd., Suite 101
Livonia, Michigan 48152-2660
T: 734.482.1200 F: 734.482.3202
LANSIN
G
JA
CKSO
N
THROUGHOUT MICHIGAN
Home Care
800.968.6644
Functional Recovery / Home and
Community -Based Rehabilitation
T: 810.603.0040 F: 810.603.0044
Rehab Transportation®
A wholly-owned subsidiary of
800.306.6406
For information call toll free: 800.968.6644
E-mail: [email protected] Visit: www.rainbowrehab.com

Fall 2012 - Rainbow Rehabilitation Centers

Transcription

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