THEN GGIN - Brain Injury Alliance of Arizona

THE N
GGIN
November 2015
Vol. 1 Issue 6
Brain Injury Alliance of Arizona Newsletter
The Care Partner’s
Perspective
Allison Marshall on life after her husband’s skull fracture
November is National Family Caregiver Month, a time when we spotlight
the contributions of those who provide unpaid care
for a relative, friend, or neighbor, enhancing their
quality of life. Often when we hear the term caregiver
or care partner we associate it with care being given
In this Issue to an elder member of society. Time and time again
the tribe of traumatic brain injury has thrust the title
of care partner upon those who then find themselves
 Still a doctor:
in the position of caring for someone who is most
Dr. Geoffrey
definitely not a senior citizen.
Goldsmith on
returning to
medicine postTBI
Allison and Evan Marshall with
their dog, Butters.
Allison Marshall experienced that first-hand when a
105 mile-per-hour baseball hit her husband, Evan Marshall, with arterial bleeding on his
brain. Allison found herself the care partner and advocate of her college sweetheart, who
is only in his twenties. Allison recently sat down with BIAAZ Executive Director Carrie
Collins-Fadell to talk about life after a TBI.

Interview with a
Survivor: Dan
Mannon

Members
wanted: BIAAZ
Advisory
Council
Q: August 4th must have started out to be like any other day. What do you remember
about it?

Meet Abigail
Wagoner:
BIAAZ’s new
Marketing &
Outreach intern
This is extremely cliché, but I remember that day like it happened yesterday. That day is
absolutely a part of me. It's a part of Evan. It's a day we absolutely hate but it's a day that
we became so grateful for each other, our family and friends.

The Gavel: Part
two of Obtaining care posthospitalization

ADA Matters:
Sexual harassment rights
In Reno we lived with another baseball couple. Becca and I had spent the day packing our
bags for ourselves and our dogs to travel to Tacoma, Washington. The Reno team was
playing in El Paso, Texas for four days and then were heading to Tacoma for a four-game
series and then back to Reno. That evening Becca, myself and our two pups had a lazy
evening of watching Bachelor in Paradise, Jeopardy, and Wheel of Fortune (glamorous, I
know). During these shows, we each were following the baseball game on our phones —
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The Brain Injury Alliance of Arizona (BIAAZ) is a nonprofit organization dedicated to preventing brain
injuries and to improving the lives of individuals with brain injuries through prevention, education,
information, and community support.
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From Executive Director
Carrie Collins-Fadell
November is a special time of year. Growing up in the Midwest, November is the calm before it is time to batten down
the hatches for winter storms and dark, often dreary, snowy
days. As I experience my first fall in Arizona, I realize that
November is really a time when things are just getting started. The weather is beautiful, the sun is out, and our team at
BIAAZ is, more than ever, ready to serve you.
This is also a big month for BIAAZ members as it’s when
two of our signature annual events are held. If you are a professional, don’t forget to mark November 13th on you’re
your calendar for our Third Annual Conference for Professionals! New this year, we will be offering
eight Continuing Education Units (CEUs) for assisted living home managers. Take advantage of
this affordable opportunity to learn how to better serve your clientele who have been touched by brain
injury.
Dr. Alex Hishaw, the Director of Polytrauma at the Tucson Veterans Administration, will open the conference with the keynote speech. On the personal side of brain injury, Allison and Evan Marshall will
close the session and discuss Evan’s August 2015 injury. Get a sneak peak of Allison’s story on the cover of this month’s Noggin. They are an amazing couple who do so much to help brain injury survivors.
Then join us for the ever-popular Rehab Without Walls Farmers Market on November 19th where we
will be selling craft items made by brain injury survivors and more to fund Camp Can Do. It’s a fun way
to enjoy Arizona’s beautiful fall weather, so don’t miss it. If you are a survivor who has crafts or art
items that you have made to donate to the market, call Dee in the office today at 602-508-8024 and
help us raise money to support Camp Can Do.
Just like Oprah has her list of favorite things, this edition of The Noggin is filled with some of my favorite people. BIAAZ member Dan Mannon, who I met at Camp Can Do this year, gives advice and tips on
physical fitness after brain injury. Dan is an amazing advocate for survivors all over the state. Also in
this edition, Brenda Hamilton concludes her two-part article on how to get care for brain injury survivors once they’ve been released from the hospital. And, you’ll meet our new Resource Facilitation Assistant, Emma, who is working hard to keep the contacts and information in our database fresh and up to
date. You’ll also get a chance to see what our new Marketing Specialist is up to and why she wants people seeing the movie Concussion to get something more than just popcorn and candy at the theater!
Thank you for being a part of our BIAAZ team! I can’t wait to see some of you this fall.
Carrie Collins-Fadell
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neither of us listening to the game.
It was during that last show that I saw Evan was pitching and had gotten three quick outs. Inning over. I exited
out of the game and began to watch TV again. It was after I put down my phone that Becca said, "Now don't
freak out, but Matt’s mom just texted me and said Evan got hit.” My heart instantly stopped.
Q: Where were you when the phone rang?
I was in Reno, Nevada. My husband was in El Paso, Texas. I was trying to do everything I could to get ahold of
Evan. When his name finally popped up on my phone 10
minutes after he was hit, it was the clubby from the locker room to tell me that Evan was showing signs of a concussion and throwing up but that he remembered he was
married and his phone password and to call me. Thank
goodness! They told me he was going to the hospital
across the street to get protocol x-rays and would keep
me updated.
“I didn't understand what Evan’s
injury meant. When I was told he
had a head injury, I didn't know
if that meant seizures, memory
loss, or anything. I've never been
around anyone who has or had a
TBI.”
~ Allison Marshall, whose husband,
A little over an hour later I get a phone call that sent me
Diamondbacks pitcher Evan
into shock. All this time never being able to talk to Evan.
Marshall, was hit in the head by a
I was now being told that my husband was in critical con105-mile-per-hour fastball
dition. His brain was bleeding, but they didn't know
where from, and that he had a fracture on the right side of
his skull. I was being told that the Diamondbacks were
trying to get me a plane to fly out that night because the
doctors didn't know if Evan was going to make it through the night.
Q: What was Evan’s injury?
Evan took a 105 mph hit to the right side of his head. Evan’s official injury title was that he had multiple skull
fractures and an arterial bleed on the brain.
Q: Like anyone who has been by the side of a loved one during major surgery, you likely had both positive
and negative experiences. What was one of the most unexpected thing for you?
I didn't understand what Evan’s injury meant. When I was told he had a head injury, I didn't know if that meant
seizures, memory loss, or anything. I've never been around anyone who has or had a TBI.
There were two things that really stuck out to me with all of this.
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The first was it amazed me how many doctors/nurses would come into Evan’s hospital room- whether he was in
the ICU, CCU, or another hospital floor- and the majority would have no idea what had happened to Evan and
were not up to date with what medication he should be on, his diet, etc. that was being instructed from his neurosurgeon (who was absolutely brilliant and extremely humble).
The second was that when he came out of surgery we were told he showed no signs of a seizure and had not had
one but to be aware he could and that he would be put on seizure medication for five to seven days. The day before we were supposed to leave for Phoenix a doctor we had never seen burst through Evan’s door like a scene
out of a movie and told us that he had examined Evan the day before and thought he had suffered a silent seizure.
We had never heard of that or been told of what that was. It was terrifying and my husband was mortified knowing he had not had a seizure in the middle of the night and didn't understand what was going on. Thankfully,
Evan has not suffered a seizure but not knowing that something like a silent seizure could happen was very scary,
on top of how this doctor was giving us this information. It was extremely unexpected and could have been handled very differently.
Q: There were moments after Evan’s injury that were really touch and go. You were told everything from
he might have a concussion to he might not make it through surgery. Was there a moment when you knew
in your heart that things were going to be alright and you let yourself relax a little?
Thankfully, the Diamondbacks had some how gotten me a
plane and got me into El Paso at four in the morning. I was
originally being told that Evan’s surgery could last a lot longer than usual due to the bleeding in his brain, so I potentially
could be in the air when he gets out. Driving to the airport, I
received a phone call that Evan made it through surgery
beautifully. The neurosurgeon and nurses were saying that
they found the bleed right away, which is what helped surgery time, and that the swelling in the brain was already going down. That was the first time I was able to breathe and
thank God for answering our prayers. I knew that whatever
happened after we would handle and deal with but the most
important thing was that my husband was alive.
Q: Sadly, some relationships do not survive the changes
in personality, routine, career, and life that a traumatic
brain injury often brings. You and Evan are college
sweethearts. How did you weather the storms of change (in big or silly little ways) to keep yourselves solid as a couple?
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else's beliefs, personality traits, and their life goals. That's what also makes relationships so wonderful, you have
someone to motivate and support you, to love you at your best and worst times, and to be your best friend. To
then add TBI or any other type of injury into the mix can make things a little bumpy. You now have your daily
routines changed or goals you have set for yourself or as a couple might be put on hold or changed. It's not easyfor either of you. One person now becomes the caregiver, the other has to become okay with relying on someone
else. You have to have respect for one another.
Even though it was difficult at times, I knew that when Evan got frustrated at me it was because his brain was
telling him that he didn't have anything wrong with him. Now, that doesn't take the hurt feelings away and it did
Communication and respect, I feel like,
are the two things that kept us grounded
with each other through all of this — and
still to this day. I don't treat Evan like he
had a head injury, and he respects me
knowing how I have taken care of him. At
the end of the day that feels really good
knowing you each have each other's back
through thick and thin.
~ Allison Marshall on relationship
challenges brought on by brain injury
take time for me to understand. It also took me vocalizing these issues to him for him to see that it had an impact
on me because he had no idea what he was saying or how he was acting towards me.
Communication and respect I feel like are the two things that kept us grounded with each other through all of this
- and still to this day. I don't treat Evan like he had a head injury, and he respects me knowing how I have taken
care of him. At the end of the day that feels really good knowing you each have each other's back through thick
and thin.
Q: Is there anything that you did for yourself during his intense period of recovery that kept you grounded, refueled, or going so that you could be there for him?
Evan and I are truly blessed that we have two amazing sets of parents who dropped work and their own lives to
fly/drive to be with us. Something that absolutely refueled me and kept me going was taking walks around the
hospital with my mom and/or dad. Being able to talk to them and stretch our legs was definitely something that
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helped me be able to clear my head so that when I got back to
Evan’s room I could focus my attention on him and our lives together. It also helped that I was able to keep our dog, Butters, with
me in El Paso. He was a motivation for Evan but he was also a happy distraction for me.
Q: What advice would you give to other care partners who
put their own self-care last on their to-do list?
I've been there. I get it. We were truly blessed to have both sets of
parents there with us for the first eight to nine days so that I could
sleep and either myself or a parent would drive back and forth to
the hotel to take care of our dog.
The Marshalls’ dog, Butters, was a significant factor in Evan’s recovery. Evan
awoke after being told Butters was in the
hospital room and later he was integrated
into Evan’s physical therapy.
However, I did spend many nights at the hospital because I didn't
want to leave Evan’s side and I felt like I constantly was having to
be my husband’s advocate on care. I didn't want him to wake up
and not see me. I felt guilty anytime I left or took time for myself.
But in reality, I needed those moments to myself; it was in benefit
for myself and my husband. I needed to take care of myself so that
I could have my A-game ready to take care of him.
Even when he became an outpatient he couldn't drive to his appointments so I became his chauffeur to everything. I can see how that can be frustrating and tiring, but at the end
of the day I get to spend time with my husband driving to those appointments and seeing his progress each and
every time. Do whatever you can just to take 15-20 minutes in each day for yourself. Taking walks or a bath is a
great stress reliever but if you're not able to leave the room or whatever then something you can do is read for a
while or do a crossword puzzle (something to distract your mind).
Q: Being a caregiver, particularly a young caregiver, can be an isolating experience since your friends and
peers are not going through the same things as you. Did you experience that and if so how did you handle
that?
Sadly, I have. A dear friend of mine from college got married in September. Evan’s accident happened in August
and by time her wedding rolled around we just weren't going to be able to go due to therapies, doctor appointments and I didn't know how Evan would do traveling and I couldn't leave him by himself, nor did I want to. A
few weeks before my friends wedding, she sent me a text message that never asked how Evan was, or even how I
was. All it said was that she knew we had a lot going on but her and her fiancé needed to know if we would be
able to make it now.
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As a past bride, I understand that type of question. However, as a friend, that question absolutely destroyed me. People — some of them our friends — have absolutely no idea what Evan, myself and our
family went through, and I hope they never do. After giving some time to cool off — I knew she didn't
mean it in a bad way — I texted her back apologizing that we would not be there due to everything that I
listed above.
Q: What would you say to a caregiver who needs support, but is afraid to reach out?
It is extremely difficult for everyone to admit that they need help, especially when you are the one supplying help to another. You have to put that aside and realize that it is in your best interest and in the best
interest of the person you are caring for that you take care of yourself and reach out for support and help.
Everyone needs help throughout life; do not be ashamed of this. If we weren't meant to help others
throughout life there would be no such things as police officers, the fire department, doctors, or even an
amazing organization like BIAAZ.
I had to finally admit this to myself when Evan was
in the hospital. I thought I had everything together,
but it got to the point where I finally just broke
down and I thankfully had my parents with me to
be my support and talk through what was going on
in my head. This helped so much and I was able to
talk through my fears and frustrations and then go
back to focusing on my husband and his recovery
process.
Q: When a TBI occurs, the loved ones of those
injured are thrust often dramatically into the
role of caregiver. Overnight life changes for the
whole family. Was there an “Aaaah…” moment
this fall when you suddenly realized life was getting back to normal?
It is extremely difficult for everyone to
admit that they need help, especially
when you are the one supplying help to
another. You have to put that aside and
realize that it is in your best interest
and in the best interest of the person
you are caring for that you take care of
yourself and reach out for support and
help.
Allison Marshall, a young care partner
for her husband, Evan.
We feel truly blessed and are extremely humbled thinking about what could have happened with Evans
injury. We were being told by doctors, therapists, etc. anything and everything that could happen to him
when he woke up after surgery. Short term memory loss, his left side of his body wasn't responding, hearing loss, blurry vision, seizures, and even the potential of him not returning to baseball (even though this
was the last thing on our mind). His recovery process was absolutely amazing and was shocking the
medical world left and right. We were in El Paso for a week (even though it felt like a lifetime) and when
we arrived in Phoenix, Evan was an in-patient for 6 days and then discharged to out-patient therapy for
five to six weeks. When he was discharged as an out-patient and able to come home here in Arizona, that
is when we had our “aaahhh” moment of "no matter happens in life, we will be okay because we are fiContinued on next page...
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nally together.” Seeing Evan’s face light up when he saw our dog and vice-versa is something I pray I
never forget in life. It's the smallest things in life that make you step back and appreciate and love what
you have.
Q: What don’t people know/understand about Evan’s injury and recovery that you wish they did?
The thing about Evan’s injury that I had to come to grips with is that people, unless they've been through
it, will not understand. And I don't want them to. I don't ever want someone to experience what he or I
went through and are still going through.
The one thing I feel like most don't understand is that my husband was minutes away from dying. He was
minutes away from maybe not remembering who he was, or I was, or who our parents are. My husband
walked off the baseball field after he was hit, with support of his teammates and coaches, and never
lost consciousness. Which is absolutely crazy because after surgery, his left side of his body was non responsive. He had to build back his strength for his entire left side.
That morning after his surgery, they wanted to remove the breathing tube from Evan (the breathing tube
can do a lot more harm over time if left in) but were scared that he was slipping into a coma. It took his
neurosurgeon to tell the hospital to allow me to bring in our dog (he flew with me from Reno) to see if
maybe having him in the room would spark something for Evan. They needed Evan to stay awake long
enough for them to see that he could breathe on his own before removing the breathing tube. Butters was
our miracle for Evan because within just a few minutes of him being in the room Evan woke up after being told Butters was right in front of him. Needless to say our dog spent the majority of our stay in El
Paso in the hospital room and the therapists even used Butters in physical therapy.
There is SO much more that our family was a part of, that the Diamondbacks did for our family, and that
Evan has accomplished in his therapies and exams. I would love to share every single one of them, but
then you would be reading a book and not a questionnaire. We are just so grateful for the prayers and
help to our family and to my husband.
Q: What is next for you?
I feel like with all Evan and I went through we have a brand new life ahead of us. Currently, Evan is
working with the Arizona Diamondbacks making sure he will be ready for the 2016 season. We have our
wonderful dog that takes up our everyday. This is our first off season in Phoenix and Evan and I are making the very most of it. Trying to get involved with
the Phoenix community and explore this beautiful place we feel like more and
more is becoming home.
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BIAAZ Advisory Council
to meet in 2016
Fresh ideas, a new perspective and constructive feedback are crucial
to any organization, and the Brain Injury Alliance of Arizona is no exception. That’s one reason BIAAZ is resurrecting its nonbinding advisory council.
The council’s 14 members will meet on a monthly basis to discuss BIAAZ’s community involvement and keep BIAAZ attuned to the needs of
the brain injury community. Ultimately, the group will advise the board
of directors on ways to achieve the strategic plan the board devised this
year.
Tara Staley is one of the BIAAZ’s advisory council’s new
members.
“This is an exciting time to be putting a new advisory council together
again,” said Carrie Collins-Fadell, BIAAZ’s executive director. “We rely
on our volunteers to connect us and help vet pivotal opportunities in the
community.”
The committee aims to be a grass-roots organization, ideally with people who have a perspective from
both inside and outside of the brain injury community.
Tara Staley, a sales and marketing liaison for Physiotherapy Associates, is eager to use her experience
in health and wellness marketing to help other brain injury survivors like herself.
Tara sustained a traumatic brain injury in an accident during the late-1990s. Although she recovered
well, Tara knew she wasn’t the same as before the accident.
“I felt like people that didn’t understand it couldn’t understand that struggle,” Tara said. “And I felt placated a lot.”
Tara found she now needed some time to process information after meetings and experiencing “that
frustration, that as you get better, you’re still not where you want to be.”
“That’s the reason that compelled me more than anything else,” Tara said. “I can understand things and I
know from the other side of the fence how hard it is to feel frustrated like that.”
Another survivor on the committee is Austin Duncan. Currently a PhD student for medical anthropology,
Austin said he hopes to “bring a little bit of the social science angle to what [BIAAZ] is trying to do.”
Austin deeply believes that approaching health problems through the lens of anthropology, which takes
into account how brain injuries impact not only the survivor, but everyone around them, is crucial to
making the world easier for survivors to navigate through policy changes.
“I would like to bring some of that perspective to the committee,” Austin said.
Advisory Council members are invited to join the panel by BIAAZ. If you’re interested in becoming a
member call (602) 508-8024.
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THE GAVEL
BRAIN INJURY SURVIVOR LEGAL ISSUES
Obtaining Care Post-Injury
Part Two: Mild TBIs and Legal Claimants
By Brenda Hamilton
Brenda Hamilton is a personal injury and wrongful death paralegal with more
than 35 years experience who works for Warnock, MacKinlay & Carman in their
Scottsdale office. Her interest in TBIs was peaked when she had an immediate
family member who sustained a “mild TBI” and had to battle with worker’s compensation and automobile insurers to establish the seriousness of injuries that
caused 100% disability. She works closely with the catastrophic injury team at
WMC to assist families with TBI issues and is well-versed in helping attorneys
and insurers understand the seriousness and long-term consequences of a mild
TBI.
Worker’s Compensation (“W/C”). For on-the-job injuries, W/C insurance should be used to the fullest extent possible. It is very important in a W/C setting with a TBI that the patient have legal representation. There may be frequent attempts to cut back on treatment, or send the patient to “Independent
Medical Evaluations” with doctors who are often not independent at all. This is a very specific area of
injury law. Obtaining adequate care for the full duration of recovery goes hand-in-hand with good legal
representation.
Legal Claimant, Not W/C. For the Legal Claimant, if health insur ance is available, including
Medicare or AHCCCS, the general rule is that it should always be used to the fullest extent available.
Using health insurance allows care to be paid as care is provided, gives broader access to care providers, and ordinarily allows for a better financial resolution when the Legal Claim is resolved. If there is
a Legal Claim and no health insurance, the care will be more difficult to arrange, and a good legal team
is essential to assist in gaining access to care.
Mild TBI. Typical car e for a mild TBI patient may be limited to neur opsychology evaluations and
outpatient cognitive therapies. Most insurers cover neuropsych testing and recommended therapy. Unfortunately, the therapy often has copayments, and a TBI patient may have limited ability to pay. The
patient and his family should contact therapists and providers, work with the primary doctor’s office
and health insurer, to explore all avenues to obtain the care. Ordinarily, some arrangement can be made
so the TBI patient does not go untreated due to financial concerns.
HealthCare Lien with Legal Claim. If ther e is a Legal Claim pending, it may open additional avenues to arrange for payment of amounts not covered by health insurance, i.e., with payment or
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deductibles being deferred until the Legal Claim is settled, through a “HealthCare Lien.” A
HealthCare Lien provides for payment of services when the Legal Claim is resolved, but lien services should generally be used only after health insurance avenues are exhausted or for items not
covered by health insurance, with some exceptions for care that helps support the Legal Claim.
Amounts paid for care on a lien will come out of the funds available for the injured person at the
time of recovery through settlement or a lawsuit, so the financial impact of use of these lien services
should be carefully considered with the Legal Claimant’s attorney.
“There are a few exceptions to the
Health Insurance v. Payment from Claim.
general rule to, ‘Always use health
There are a few exceptions to the general
insurance.’ Examples include
rule to, “Always use health insurance.” Exsituations such as the need for a
amples include situations such as the need
neuropsychologist who is familiar
for a neuropsychologist who is familiar with
with the legal processes and able and
the legal processes and able and willing to
willing to testify, with appropriate
testify, with appropriate background to stand
up against a defense expert. Some providers
background to stand up against a
can be hired as experts and thus paid by the
defense expert.
law firm; others will provide services on a
lien basis, waiting for payment until the
claim is resolved. Likewise, if the needed rehabilitative care is not covered by insurance and the
family has been unable to arrange for qualification under AHCCCS or other available programs, care
can be obtained though a provider or lien service who waits for payment, usually at a premium rate,
until the case is resolved. These lien services, and accessibility to experts for evaluation and treatment, are generally subject to confirmation of sufficient insurance coverage limits. If there is sufficient insurance coverage from the negligent party causing the injury, i.e., the vehicle insurance for
the at-fault driver, then these other options for care are much broader. At the risk of sounding like a
broken record, the recommendation for good legal representation is critical not only for access to the
correct care for the TBI patient’s recovery, in a manner that will prove the injury, care and treatment
for the Legal Claim, but also to best navigate payment for that care; while endeavoring not to exhaust all available funds and leave the injured person with no recovery after payment of bills, or even
worse, owing more than is recovered.
Mild TBI Survivors. Mild TBI survivors
often have more difficulty obtaining care as
they tend to be moderately functional, appear
normal, and have less apparent urgency in
need for care. Those mild TBI survivors benefit greatly, and often return to a full productive life, if their doctors’ recommended care
is obtained. With health insurance, the mild
TBI survivor may lack the skills to understand and schedule needed evaluations, or
may self-terminate the treatment without appropriate insight into the continuing deficits
and long-term consequences of premature
cessation of care. Family participation, or assistance of a TBI-versed Rehabilitation Specialist, is critical to return to the best level of function. If health insurance is not in place and cannot
be obtained, and there is no Legal Claim, these mild TBI survivors are the persons who are most
likely to fall through the cracks and not receive necessary care.
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Marketing and Outreach intern takes on
Concussion movie outreach
Abigail Wagoner joined the Brain Injury Alliance of Arizona (BIAAZ) team in October as the organization’s Marketing and Outreach Specialist. A recent graduate of Purdue University with a Bachelor of Arts in Public Relations, Abigail served as a group coordinator for the National Student Advertising Competition and Social Media
Manager for The Black Sheep during her time in Indiana.
After returning to the Valley, Abigail wasted no time
jumping right into marketing projects that are in line with
the BIAAZ mission. This fall Abigail spearheaded outreach to 48 theaters and offered brain injury awareness
information to the theaters in time for the holiday release
of the Will Smith biographical dramatic thriller Concussion. In the movie Will Smith portrays Dr. Bennet Omalu, a real-life forensic pathologist who fought against
efforts by National Football League to suppress his research on the brain damage suffered by professional football players.
The film is reportedly based on the 2009 GQ expose Game Brain by Jeanne Marie Laskas.
“While we have not viewed the (still unreleased) movie Concussion, it is reasonable to assume that movie goers may want information about safe participation in sports for themselves or their children,” said Carrie Collins-Fadell, executive director of the Brain Injury Alliance of Arizona. “They will also want information on
how to recognize possible symptoms of a concussion, which is a blow or jolt to the head that can change the
way your brain normally works. That’s why Abigail’s outreach work in this area is an important piece in our
work to offer education around brain injury prevention and awareness.”
Abigail’s next project this fall is to spur BIAAZ supporter participation in the Birdies for Charity program
ahead of the 2016 Waste Management Phoenix Open. The Arizona Charity Pledge Drive component of Birdies
for Charity, which Abigail is promoting on behalf of BIAAZ, invites the community to participate in a pledgedrive program based on the total number of birdies made during the 2016 Waste Management Phoenix Open.
“Working with the Thunderbirds organization on the Birdies for Charity program is an amazing opportunity to
interact with the passionate and dedicated supporters of the Brain Injury Alliance of Arizona,” said Abigail.
Abigail finds working for the Brain Injury Alliance of Arizona rewarding. She is looking for full-time work
and loves being back in Arizona. When she is not working and increasing her public relations professional
knowledge, Abigail can be found hanging out with her rescue dog, Max.
We will revisit the movie Concussion next month when Tamara Valovich McLeod of A.T. Still University
pens an article for The Noggin on the Facts and Fallacies of Chronic Traumatic Encephalopathy (CTE). CTE
which will likely be discussed in the movie is a form of encephalopathy that is a progressive degenerative disease, which can currently only be definitively diagnosed postmortem.
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A M E R I CA N S W I TH D I SA B I L I T I E S A C T
ADA Matters
By Milchele Stokes, ADA compliance
specialist for the City of Tempe
Michele Stokes, deaf/oral/lip reader, is currently the ADA Compliance Specialist for the City of Tempe. She has been in the accessibility field for over 25
years. She also serves as the CEO for Behold Charities International, a new
non-profit, whose mission is to facilitate universal design in accessible affordable housing. She has a brother who has had a traumatic brain injury since age
five. Michele is married to Bill Stokes, has four adult children, 11 grandchildren, one great grandson, three dogs, five cats, and a dozen fish. She reports
there might be a gecko or two in the house, as well.
Sex assault, stalking, domestic or dating violence affecting
work? Exercise your Title VII and ADA protections.
No one likes to talk about violent discrimination, but you have protections. Exercise them.
Q: Do you have Civil Rights Act of 1964 (Title VII) protections in these situations below?
Your employer terminates you after learning you were subjected to domestic violence, saying he fears
the "drama battered women bring to the workplace."
Your employer allows a male co-worker to use unpaid leave for a court appearance in the prosecution of
an assault, but does not allow you, a female, to use equivalent leave to testify in the prosecution of domestic violence you experienced. Your employer says that the assault by a stranger is a "real crime,"
whereas domestic violence is "just a marital problem" and "women think everything is domestic violence."
A hiring manager, believing that only women can be true victims of domestic violence because men
should be able to protect themselves, does not select you, a male applicant when he learns that you obtained a restraining order against a male domestic partner.
A: Yes, Title VII enforced by Equal Employment Opportunity Commission protects you.
Title VII prohibits disparate treatment based on sex, which includes sex-based stereotypes, as well
as discrimination based on race, color, sex, religion, or national origin. The Amer icans with Disabilities Act (ADA) prohibits discrimination on the basis of disability. However, these laws are not precise regarding discrimination involving domestic or dating violence, sexual assault or stalking. So it’s
easy to overlook this protection.
Whether discrimination has occurred is determined in an investigation.
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Title VII prohibits sexual or sex-based harassment if it is sufficiently frequent or severe to create a hostile work environment,
or if it results in a "tangible employment action," such as refusal to hire or promote, firing, or demotion. Is the har assment
below resulting in a tangible employment action?

Your co-worker sits uncomfortably close to you in
meetings, and has made suggestive comments. He
waits for you outside the women's bathroom and the
work parking lot. He blocks you in the hallway in a
threatening manner. He phones you after hours, sends
personal e-mails, and shows up outside your apartment at night. You report this to management saying
you feel unsafe and afraid working near him. In response, management transfers him to another area of
the building, but he continues his sexual advances and
stalking. You notify management but no further action is taken.
Yes, this inaction is considered a “tangible employment action.”

A supervisor learns you have recently been subject to domestic abuse, and are now living
in a shelter. Viewing you as vulnerable, he makes sexual advances, and when you refuse,
he terminates you.
Yes, this action or retaliation is a tangible employment action.
Title VII prohibits retaliation for filing a charge of discrimination; complaining to your employer
about harassment; requesting accommodation under the ADA; participating in an investigation,
or opposing discrimination.
For example:
You file a complaint with your employer's human resources department alleging you were raped by a
prominent company manager while on a business trip. In response, other managers reassign you to less
favorable projects, stop including you in meetings, and tell co-workers not to speak with you.
The ADA prohibits different treatment or harassment at work based on an actual or perceived
impairment, which include impairments resulting from domestic or dating violence, sexual assault
or stalking.
For example:

An employer searches your name online and learns that you were a complaining witness in a rape
prosecution and received counseling for depression. The employer decides not to hire you based on
a concern that you may require future time off for continuing symptoms or further treatment of depression.

You have facial scarring from skin grafts, which were necessary after you were badly burned by a
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For more information on your
protections, see below.
former domestic partner. When you return to work after
a lengthy hospitalization, co-workers subject you to frequent abusive comments about the skin graft scars, and
your manager fails to take action to stop the harassment.
The ADA may require employers to provide reasonable accommodation requested for an actual disability
or a "record of" a disability. An actual disability is a
physical or mental impairment that substantially limits
one or more major life activities, including major bodily
functions. A "record of" a disability is a history of a substantially limiting impairment. An impairment does not
need to result
in a high degree of functional limitation in order to be
"substantially limiting." A reasonable accommodation is a
change in the workplace or in the way things are done that
an individual needs because of a disability, and may include time off for treatment, modified work schedules,
and reassignment to a vacant position.
For example:


You have no sick leave and your employer is not covered by FMLA, You request a schedule change or unpaid leave to get treatment for anxiety following a
sexual assault by an intruder in your home. Your employer denies the request because it "applies leave
and attendance policies the same way to all employees."
In the aftermath of stalking by an ex-boyfriend who
works in the same building, you develop depression
that your doctor states is exacerbated by continuing to
work in the same location as the ex-boyfriend. As a
reasonable accommodation for major depression, you
request reassignment to an available vacant position
for which you are qualified, at a different location.
The employer denies the request, citing its "no transfer" policy.
The ADA prohibits disclosure of confidential medical
information.
You are being treated for post-traumatic stress disorder
(PTSD) resulting from incest and you request reasonable
accommodation. Your male supervisor then tells your coworkers about your medical condition.
Definitions of Domestic violence
www.ovw.usdoj.gov/
domviolence.htm
Questions and Answers for Small
Employers on Employer
Liability for Harassment by
Supervisors
www.eeoc.gov/policy/docs/
harassment-facts.html
Policy Guidance on Current
Issues of Sexual Harassment,
www.eeoc.gov/policy/docs/
currentissues.html
EILEEN CROWLEY v. L.L.
BEAN, INC.
www.eeoc.gov/eeoc/litigation/
briefs/crowle.txt.
Enforcement Guidance on
Reasonable Accommodation
and Undue Hardship Under
the ADA
www.eeoc.gov/policy/docs/
accommodation.html
Small Employers and
Reasonable Accommodation
www.eeoc.gov/facts/
accommodation.html
Questions and Answers for Small
Businesses: The Final Rule
Implementing the ADA
Amendments Act of 2008,
www.eeoc.gov/laws/
regulationsadaaa_qa_small_
business.cfm
Enforcement Guidance:
Disability-Related Inquiries
& Medical Examinations of
Employees Under the ADA
(7/27/00),
www.eeoc.gov/policy/docs/
guidance-inquiries.html
www.eeoc.gov/laws/types/
disability.cfm
www.eeoc.gov/eeoc/
publications/
qa_domestic_violence.cfm
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The ADA prohibits retaliation and interference with an employee's rights.
In the prior example, you tell the supervisor you intend to complain to human resources about his disclosure of confidential medical information. The supervisor warns that if you complain, he will deny
you the pay raise you are due to receive later that year.
These are instances of discrimination covered by the ADA and Title VII. If you are experiencing anything similar, please don’t suffer in silence. Exercise your rights!
The process for filing claims of discrimination is different depending on the type of employer:
Private Sector Employers and State and Local Government Employers - An applicant or employee who
believes their Title VII or ADA employment rights have been violated and wants to make a claim
against an employer must file a "charge of discrimination" with the EEOC. Instructions are at
www.eeoc.gov/employees/howtofile.cfm or call 1-800-669-4000/ 1-800-669-6820 (TTY).
Federal Government Employers
An applicant or employee who believes their employment rights have been violated under Title VII or
the ADA and wants to make a claim against a federal agency must file an "EEO complaint" with that
agency. For more information go to: www.eeoc.gov/federal/fed_employees/index.cfm.
Have an extra or old camera? Donate it to the Brain
Injury Alliance of Arizona today!
The Brain Injury Alliance of Arizona is in
dire need of a digital camera with zoom
capability to use at BIAAZ events . A
charitable donation receipt can be provided upon request. The camera does not
need to be in pristine condition but it
does need to consistently work. If possible,
please include any model-specific batteries, battery chargers, charging cords and
lenses. For more information, call (602)
508-8024.
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Gifts Traumatic Brain Injury Brought Me
By Geoff Goldsmith MD, MPH
The following article first appeared in the scholarly journal Family Medicine (Vol. 43 No. 5) in May 2011 and is reprinted here
with the permission of The Society of Teachers of Family Medicine ( www.stfm.org). It has been grammatically edited to conform with The Noggin’s style guidelines, but all content is the author’s.
In June 2008, after 5 years of effort, I had just received a major
research award from the National Cancer Institute (NCI) to study
cancer prevention in the primary care setting. After 30 years of an
(at times a turbulent) academic career in family medicine, I sensed
that my career was almost complete and would eventually lead me
to a most pleasant smooth "glide" path as I prepared for landing
into retirement in about 10 years. But my career as the chair of a
university-based department of family medicine and a practicing
family physician was to change abruptly in several days.
Dr. Geoff Goldsmith found his
way back to medicine after sustaining a TBI. It didn’t look like
what he thought it would, but is
fulfilling nonetheless.
Rather than the smooth glide path I was envisioning, my personal
and professional life went into a crash landing mode when a car ran
over me as I was walking through a parking lot on my way to a
meeting. In addition to 11 broken bones, I suffered a traumatic brain
injury (TBI), joining more than 5 million Americans who suffer from this condition. Unconscious, I
was soon in an ambulance on my way to the hospital.
After a one-week stay in the ICU, I was transferred to the local acute rehabilitation hospital for a sixweek inpatient stay. When discharged, while medically stable, I was far from healed.
Confused, dizzy, unable to walk without help, barely able to read, not able to provide self-care, and
with a number of open wounds and cognitive problems, I still needed intensive rehabilitation. Because I did not feel I was ready to go home, I felt betrayed and abandoned by the same health care
system that I worked tirelessly for over the prior three decades.
Thanks to my wife’s diligent research, I was able to continue my recovery at a comprehensive outpatient rehabilitation center, 2,000 miles from my home at the University of Washington (UW) that
specialized in TBI.
After I learned that my rehabilitation at the UW would last at least nine months and that I could not
go back to my work activities for a year or more, I sank into a deep depression. Like many health professionals, I felt that my purpose for being was to help others through my work. My sense of isolation
and low self-esteem was profound. I lacked a meaning for my life. My psychotherapist recommended
talking therapy, diary keeping, relaxation exercises, and reading inspirational books to guide me back
to finding meaning in my life. My physiatrist added an antidepressant that also increased my energy.
At first, I could read only a page or two per hour with very poor comprehension. But, over time, with
the assistance of the speech therapist and natural brain healing, my comprehension and reading speed
improved. Being able to read again was a mixed blessing. I voraciously read about TBIs. Because I
was still quite depressed, I thought I would develop every negative sequel of a TBI. With 11 broken
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bones and multiple joints involved, I was sure I would develop avascular necrosis. My heavy pain medications, I thought, would lead to addiction. But what alarmed me most was when I read about the 50%
divorce rate post TBI. I felt worthless and broken so I anticipated that my wife would ask for a divorce
at any time.
In addition to learning how to walk, not losing my balance, regaining my energy level, and coping with
the psychosocial effects of the TBI, I had a plan to get my clinical reasoning skills back so I
could return to patient care. I got simulated patient case histories from medical case study work books I
used as part of my medical student teaching. I asked my speech therapist to be a simulated patient for
me. She was so kind to do so as I was pressing her role far beyond her usual speech rehabilitation duties. The approach had an unexpected negative consequence. When my decisions how to treat the simulated patients resulted in an error or "death" of the simulated patient, I became increasingly unsure that I
should return to patient
care. My rehabilitation team thought I
overreacted to
my poor performance
with simulated
“My accident and its sequelae
patients. They felt that I
should care for
produced their full share of dark
real patients in the UW
rehabilitation
emotions, such as sadness, anger,
clinic under the supervision of a rehabilgrief, loss, pain, and fear about my
itation faculty member.
As full professor
and a family physician
who had won
future and marriage. The
recognition for my clinical excellence, I
rehabilitation process has been
was again being treated
like a third-year
exhausting, frustrating, inspiring,
medical student. It was
a humbling but
and at times boring. Yet the entire
important experience.
experience has also given me many
insights about my everyday life
and my ability to survive as a
happily married, retired family
physician and former chair of
family medicine.”
Although I slowly befortable with patient
prised that my clinical
problem solving skills
quickly. I had to work
at even a simple diff
effort was mentally exme several hours to
patient. My therapist
ability to differentiate important from unimportant medical data was not "online" yet.
came more comcare, I was surreasoning and
didn't come back
hard at arriving
diagnosis. This
hausting. It took
evaluate each
said that my
However, after months of trying, I was unable to improve my information processing speed. I knew that
I could no longer be a productive family physician. I couldn't be a residency preceptor either because I
was unable to quickly process a large amount of clinical information. As my therapy came to an end,
I understood that I could not manage the long hours of my chair duties, the many deadlines, conflict
and the intense institutional competition for resources. Regretfully; I told my dean I was unable to work
full-time or return as a clinician.
It is now three years and one month after my accident. Most aspects of my post-accident abilities, such
as alertness, mobility; balance, and executive function, have improved. My mood has stabilized, and I
am out of psycho- therapy and off antidepressants. My analytic thinking has returned. Writing articles
and reports are much slower but definitely coming back. My marriage has survived, and this remains
my biggest asset. My creativity, which had "flatlined” after the accident, returned. Finances are not as
favorable, but we can learn to live on less.
I was offered a part-time academic position by the university's Area Health Educational Center (AHEC)
to foster family medicine research. I combined this assignment with my NCI grant. My new part-time
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job is an excellent fit. Conducting re- search in the AHEC is ideal for me as it allows me to plan, be
creative, write, engage in work-related social activities, and complete assignments largely at my own
pace. The medical school department of family medicine appointed me as an endowed professor
(without salary). My fear and confusion in social settings has disappeared. I have more time to spend
with my wife, the biggest benefit of working part-time.
I am no longer concerned about having a smooth glide path to retirement. Given what my wife and I
had to handle over the last several years, we both feel able to manage even a category-five storm
should we face one in our plan through the remainder of our lives.
My accident and its sequelae produced their full share of dark emotions, such as sadness, anger, grief,
loss, pain, and fear about my future and marriage. The rehabilitation process has been exhausting, frustrating, inspiring, and at times boring. Yet the entire experience has also given me many insights about
my everyday life and my ability to survive as a happily married, retired family physician and former
chair of family medicine.
I learn something the Buddhists call "loving kindness" or mantra toward myself, even toward my new
weaknesses and slowness. Most importantly, all that I endured has rekindled my spiritual prospective.
As noted in the Bible, "Man is born to sorrow, as surely as the sparks fly upward" (Job 5:7), but one
does not have to be consumed by the fire
Join the Purple
Committee!
Looking to advocate for brain injury survivors and caregivers?
The Brain Injury Alliance of
Arizona is extending an open
invitation to join our Purple
Committee. Members will meet
monthly to brainstorm fundraising and outreach efforts for
Brain Injury Awareness Month
in March of 2016.
Meetings can be attended in
person or over the phone. For
more information, call (602)
508-8024.
PURPLE COMMITTEE
METTINGS
Meetings may be attended over the
phone or in person and take place from
4:30-6 p.m.

Monday, November 9th

Monday, December 14th

Monday, January 11th

Monday, February 8th
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Interview with a survivor:
Dan Mannon on fitness, Camp Can Do and his
lifelong recovery
Tell us about yourself. Where are you from?
My name is Dan Mannon, I am a survivor of a traumatic
brain injury caused from a car crash in October of 2000.
Originally I am from Seattle, Washington.
I moved down here by myself in the Spring of 2000 to pursue an education in aircraft maintenance. When I got all settled in and started school, 6 months after I moved down
here, I had a very bad situation occur. Currently I am writing an autobiography that includes my story in detail.
Brain Injury Alliance of Arizona member
Dan Mannon.
We’re told you enjoy Camp Can Do and you’re even featured in a BIAAZ YouTube video about camp. What activities do you like to do there? Are you friends with other
"regulars"?
I enjoy Camp Can Do very much because it gives me a great
deal of independence. I like to go on a hike every morning that the camp provides. I also like to do the
horseback riding and the campfire on Saturday night. I am friendly with all the other campers and I associate with all the volunteers. However, I don't have any outside friendships with anybody outside the
camp. When we play board games I always bring some decks of cards and teach other campers and volunteers how to play a game that I know and like very much.
In your letter, you discuss how you're grateful for your caregivers but also like to have a bit of a
break from them. Some people might find it a bit scary to leave their caregivers for a week. Do
you ever get nervous about taking care of yourself? What helps you not be nervous?
Currently I don't have any caregivers, in my letter I was referring to my parents. I just really like the
break from them and I don't get nervous at all about taking care of myself.
What are you are passionate about?
I am passionate about the outdoors and any form of exercise one can do outside.
If you could make everyone in the world understand one thing about TBI, what would that one
thing be?
If I was to say one thing about living with a TBI it would be to never give up and push your brain as
much as you can. It is very common to have short term memory loss, so you should constantly work
your memory.
What's your favorite movie, song, book or video/board game?
My favorite movie is The Peacefull W arrior, I don't have a favorite song, and my favorite board game is
Scrabble.
I hear you’re interested in fitness? How so?
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I am very interested in fitness, currently I go to LA Fitness like five days a week or so. Exercise is a
really good way to oxygenate your brain so you can work it more.
What is the most challenging thing about living with TBI for you?
The most challenging thing about my TBI is my speech. I have Dysarthria [a motor speech disorder] so
I sound much less educated than I am.
Do you still consider yourself recovering?
Yes I think I am still recovering I will until the day I die.
What kind of physical therapy have you participated or do you still do?
I like to participate in this freestyle rock climbing event at the SpoFit [now Ability360] gym where the
BIAAZ is located.
What is your best advice for other brain injury survivors who may just be starting their recovery
journey?
If there is one thing I can tell people with a TBI it would be to be patient and work your brain as hard as
you can daily.
What do you like about the Brain Injury Alliance of Arizona?
I like the BIAZZ because they don't talk to me condescendingly because they are used to talking to individuals with brain injuries.
Who is that new voice on the phone at the Brain Injury Alliance of Arizona office? It's Emma!
Emma is helping us keep our database of providers updated and fresh. When you call our office or go online to access our hundreds of neuro-resources, we want to get you to the right
place the first call, not the tenth call. And we want you to talk to service providers that understand brain injury. BIAAZ is there for you for every step of the journey after a brain injury.
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WITH HEARTS FULL OF GRATITUDE, THE BRAIN
INJURY ALLIANCE OF ARIZONA THANKS ITS
SPONSORS FOR THEIR SUPPORT.
Diamond Sponsors
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Silver Sponsor
Bronze Sponsors
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Board of Directors
President
Dr. Robert Djergaian
Banner Good Samaritan
Rehabilitation Institute
Past President
Rebecca Armendariz
Banner Health
Vice President
Tom Nielsen
Retired Executive
Directors
Kim Covington
The Covington Companies, LLC
Dr. Christina Kwasnica
Valley Physical Medicine &
Rehabilitation
Ray Norris, Esq.
Gallagher & Kennedy
Sharon Phillips
Secretary
Dr. Alex Hishaw
University of Arizona Medical Center
Treasurer
Sean Badding
Everlasting Services
Matt Riegel
The Northern Trust Company
Amanda Wigal-Schlosser
Brandables
Kay Wing
SWAN Rehab
Carrie Collins-Fadell
Executive Director
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