OBIA Review Volume 22, Issue 2 - Ontario Brain Injury Association

JUNE 2015 • VOLUME 22 • ISSUE 2
Brain Injury
Awareness Month
EDUCATION:
AWARENESS:
SUPPORT:
How Brain Injuries
Affect Men and Women
Differently
pg 41
Provincial Acquired
Brain Injury System
Navigators
pg 23
I am the Face of
Brain Injury - Two
Perspectives
pg 11
OBIA REVIEW
2
JUNE 2015
BOARD OF DIRECTORS
President
Barbara Claiman
Treasurer
Brad Borkwood
Corporate Secretary
Dr. Debby Vigoda
Directors
Alice Bellavance
Dr. Sheila Bennett
Sabrina Chagani
Maria Hundeck
Nancy Nicholson
Veronica Pepper
Hazel Wood
OBIA Advisory Council
Representatives
Wendy Charbonneau
Mary Lou Dalaire
Tim Slykhuis
Dr. Mary-Ellen Thompson
INSIDE THIS ISSUE
Awareness:
The Provincial
Acquired Brain
Injury System
Navigators
23
Education:
How Brain
Injuries
Affect Men
and Women
Differently
41
Support:
I am the Face of
Brain Injury - Two
Perspectives
11
OBIA STAFF
905-641-8877
1-855-642-8877
Toll-Free Support Line:
1-800-263-5404
Executive Director
Ruth Wilcock ...#238
Associate Director
Tammy Dumas ...#240
Financial Controller
Ad Lewis ...#230
Advocacy Specialist
Katie Muirhead ...#229
North Eastern Ontario
Advocacy Specialist
Tanya Jewell
(705) 471-7610
Support Services Specialist
Carla Thoms ...#227
Admin. Services Coordinator
Terry (Wilcox) Bartol ...#234
Training & Admin. Assistant
Diane Dakiv ...#231
Communications & Program
Assistant
Kimberly Butcher ...#224
I.T. Consultant
Steve Noyes ...#232
Special Projects Assistant/
OBIA Review Editor
Jennifer Norquay ...#242
Also Inside
Ruth’s Desk .............................................................................4
Gail’s Retirement ......................................................................7
In the News:
Community Transportation Pilot Grant Program ......................... 10
Survivor Stories:
Brain Injury Survival - In the Beginning ....................................16
OBIA’s Provincial Peer Support Program....................................19
Expanding Support Services ....................................................21
Across the Province ................................................................27
New at the Bookstore ..............................................................31
Survivor Stories:
Lori White - Riding Away Stigma ..............................................33
Coping - Getting Back in the Saddle Again ................................38
Events Calendar .....................................................................44
Community Associations ..........................................................46
Provincial Associations ............................................................50
OBIA Training:
Children and Youth with Acquired Brain Injury...........................52
VISIT
www.obia.ca
Connect with us!
EMAIL
[email protected]
Copyright 2015, PUBLICATIONS MAIL AGREEMENT NO. 40005485
RETURN UNDELIVERABLE CANADIAN ADDRESSES TO:
Ontario Brain Injury Association, PO Box 2338 St. Catharines, ON L2R 7R9
Ph: 1-800-263-5404 (support) 1-855-642-8877 or 905-641-8877
Fax: 905-641-0323, E-mail: [email protected]
Registered as a Canadian Charitable Organization Reg. #10779 7904RR0001
3
OBIA REVIEW
AWARENESS
During Brain Injury
Awareness Month,
I would encourage
you to contact your
MPP’s to educate
them about the
needs of those
who sustain brain
injuries. These needs
include timely access
to expert trauma
care, specialized
rehabilitation and
individualized
services and
supports.
By Ruth Wilcock
Executive Director, OBIA
4
RUTH S DESK
Why the Need for Brain
Injury Awareness Month
According to Health Canada,
there are dozens of health-related
awareness days, weeks and months.
This includes: mental health, breast
cancer, Alzheimer’s, lupus, arthritis,
autism, Huntington disease, heart
and liver disease and the list goes on
and on. Although these are extremely
important, we must ask ourselves is
there place and need for Brain Injury
Awareness Month? The short answer is
a resounding yes!
Some of the more obvious and
imperative reasons include: educating
the general public about the incidence
of brain injury, the needs of people
with brain injuries and their families
and reducing the stigma of brain injury
while at the same time empowering
those who have survived. Also, we know
that we can be at risk for sustaining
brain injuries by participating in
everyday activities such as driving
our cars, riding our bikes or using a
ladder that can lead to a fall. This is
where awareness and prevention come
together. OBIA’s Provincial D.O.N.T.
(Drive Only Never Text) campaign is
a prime and powerful example of why
there is such a compelling need for
Brain Injury Awareness Month.
Another very important reason why we
need to bring awareness and education
about brain injury to the forefront is
the recently proposed changes to the
Standard Auto Insurance Benefits
(SABS). These changes are very
troubling as they will greatly impact
65,000 Ontarians who may be injured
in a motor vehicle collision this year*.
Some of the proposed changes include:
• Rehab and Attendant Care for
Serious Injuries, $65,000 combined
(a $21,000 or 25% cut) *
• Rehab and Attendant Care for
Catastrophic Injuries, $1,000,000
combined (a $1,000,000 or 50%
cut) *
• The budget also suggests changing
the criteria for “catastrophic”
The Ministry of Finance states that
“working with the auto insurance
industry, the government will ensure
that consumers are aware of the changes
to the standard auto insurance policy
and can make an informed decision
should they choose to take advantage
of enhanced optional coverages to suit
their needs”.
In 2010, the government introduced
Politics: runoff election likely a
JUNE 2015
“optional benefits” to allow consumers
to buy better coverage. Less than 2% of
policy holders bought optional coverage
(according to the Financial Commission
Services of Ontario-FSCO). This indicates
that a great deal of work will have to
be done with insurance agents and
brokers to ensure that consumers are
well informed. (see chart below for changes
to accident benefits since 1996)
This brings us back to the issue of
why there is a need for brain injury
awareness. In my experience, most of
those who represent us in government
are well intentioned. However, they may
not be as well informed about specific
issues including brain injury and the
devastating impact that it has upon
those living with brain injury and their
families. During Brain Injury Awareness
Month, I would encourage you to contact
your MPP’s to educate them about
the needs of those who sustain brain
injuries. These needs include timely
access to expert trauma care, specialized
rehabilitation and individualized services
and supports. With the proposed changes
to auto insurance there is no question
that access to services will be reduced.
This will lead to a further burden on our
health care system. Our vision is that all
persons living with brain injury are able to
live healthy, independent and satisfying
lives. We must make our friends, families,
coworkers and our elected officials aware
of how these changes to insurance will
lead to further devastation for those who
have survived trauma and are now living
with brain injuries. ◊◊◊
*Source – The Ontario Rehab Alliance
Summary of Changes to Accident Benefits Since 1996
MEDICAL-REHABILITATION & ATTENDANT CARE – SUMMARY OF CUTS TO ACCIDENT BENEFITS
• Rehabilitation (“rehab”) benefits cover a range of medically necessary goods and services that aren’t funded in the public
system such as physiotherapy, speech therapy, psychology, medications, accessibility renovations, nursing, wheelchairs,
artificial limbs, etc.
• Attendant care (“AC”) benefits cover the services of personal support workers to assist with bathing, dressing, toileting,
etc.
• All goods and services are always subject to the insurer’s determination of what is “reasonable and necessary”, so insurers
can deny any request for rehab or AC services even if funds are available.
• There are approximately 65,000 people injured in motor vehicle accidents in Ontario each year: minor injuries account for
about 80% of all injuries, serious injuries account for about 19% and catastrophic injuries account for just 1%; insurers
have strong controls over which individuals get classified into which severity category.
5
OBIA REVIEW
Providing direct therapy, transitional
support and community integration to
children, youth, adults and seniors
recovering from an acquired brain injury
and/or serious trauma.
www.bartimaeusrehab.com
1-877-542-9990
Setting the standard of excellence in
Rehabilitation Support Workers since 1988
Memory Loss
When you need support to
EHZKR\RXDUH3DWKZD\V
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“
I love being a
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I’ve met some of
my very best friends
here
”
—“K. B.” Supported Client in
Pathways Family Home
program
“
to Independence
Acquired Brain Injury Services
Accredited by the Commission
for the Accreditation of
Rehabilitation Facilities (CARF),
Pathways to Independence
specializes in providing
community based living
services and programs to
people living with an ABI.
Pathways ABI programs and
services are tailored to
accommodate client needs
and provide a continuum of
care. Pathways works closely
with every client to develop a
Depending upon the nature of the
brain injury, these supports may include:
I like that I
have a place to go
where I feel safe and
comfortable
”
— “B. B.” Supported Client at
Pathways Club ABI
™ 24 hour Supported Homes
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6
service plan that supports a
person’s rehabilitation and
reintegration to the community
following a brain injury. In
addition to assisting with
activities of daily living,
Pathways employees actively
work with the client to access
social networks and community
partners to develop and
support the
implementation
of a person’s
individualized
service plan.
™ Psychological & Psychiatric
Services
™ Legal Services
™ Medical and Wellness Support
such as Physiotherapy,
Speech Therapy,
Occupational Therapy,
Nursing, Dietician
www.pathwaysind.com
JUNE 2015
Happy Retirement Gail!
By Ruth Wilcock, Executive Director, OBIA
After over 21 years of dedicated service
to OBIA and those living with brain
injury, Gail Coupland is entering into
a new and exciting phase in her life.
As we know, the Financial Controller is
paramount to any charity. Gail’s wisdom
and guidance through the years has
assisted OBIA in being the organization
it is today. Her presence, loyalty, devotion
and her wonderful sense of humour will
be missed by all.
OBIA’s Online
Bookstore
A great selection of Books,
DVDs, and Manuals for
professionals, survivors
and family
members.
Share your expertise...
On behalf of the Board of Directors and
the staff at OBIA it is my honour to
wish Gail much happiness and deserved
relaxation in her retirement. ◊◊◊
#SaveYourBrain
Visit www.obia.ca
OBIA’s Concussion Booklets
Information includes:
Be an
OBIA Review
Guest Author
Upcoming themes:
•
•
•
•
•
•
•
What is a Concussion?
Anatomy of a Concussion.
Symptoms.
What Should I do?
How Long Will it Take to Feel
Better?
When Can I Go Back to Work,
School, Play, Activity?
What is Second Impact
Syndrome?
Where Can I Get Help?
Resources.
September 2015
Education
December 2015
Relationships
March 2016
Innovation
To receive a copy of this brochure, or if you need further information
on concussion, contact:
Contact the Editor:
[email protected]
1.800.263.5404
[email protected]
•
•
7
OBIA REVIEW
8
OBIA REVIEW
AWARENESS
IN THE NEWS
Community Transportation Pilot Grant Program
By Katie Muirhead, OBIA Support Services
Consistently, one of the most often identified barriers to
accessing services across the province is transportation.
Whether you live in the Northern parts of Ontario where there
is a vast geography to navigate or in smaller communities
sprinkled throughout Ontario where there are limited services,
transportation services have often been the missing link.
The Ministry of Transportation established the Community
Transportation Pilot Grant Program in November 2014 to
attempt to bridge that gap.
This is a $1 million pilot program aimed at providing financial
assistance to municipalities across the province to improve
community transportation services for seniors, persons living
with disabilities, youth and other members of the community
who need transportation.
Applications for the program were accepted until January 30,
2015 and the Ministry has now announced the successful
applicants.
Eleven municipalities have been selected to receive up to
$100,000 to provide better transportation services through
the sharing and coordination of community transportation
resources. The Community Transportation Pilot Grant
Program provides funds to municipalities to partner with
community organizations, such as health and community
agencies, transit agencies, school-bus operators and private
transit operators, to co-ordinate local transportation services,
Region
Municipality
10
so more rides can be provided to more people and to more
destinations.
This program is part of the Ontario government’s commitment
to provide support to help seniors stay healthy and stay at
home longer. It will also improve transportation services,
options and resources for everyone in the community, such
as students and youth who need to get to school, persons living
with disabilities, or those in rural areas where amenities and
services are too far to reach without a car.
Quick Facts
• The Community Transportation Pilot Grant Program
launched on Nov. 25, 2014, and closed on Jan. 30, 2015,
with a total of 54 applications submitted across Ontario.
• Up to $1 million in funding will be provided from April 1,
2015, to March 31, 2017, with a maximum grant amount
per eligible project of $100,000.
• After March 31, 2017, the funded community transportation
services will be evaluated to determine the effectiveness of
coordinated community transportation as a service delivery
model.
Below are the 11 selected municipalities who have been
successful in their application and a short description of their
project. For more information on how these services might
assist you, contact your local municipality. ◊◊◊
Project
Grant
Funding
Northwest
Atikokan
New coordinated service to share vehicles and drivers, and centralize trip booking and dispatch for nine
organizations.
$91,586
Northwest
Terrace Bay
New service to connect five communities to Thunder Bay for medical appointments.
$95,847
Northeast
Papineau-Cameron
New service to connect eight municipalities and 23 organizations with maximized taxi service with
centralized intake, booking and scheduling.
Northeast
Haliburton
Enhanced service through one contact, integrated website and mobility manager to refer trip requests to nine
organizations and multi-modal options, including ride-share.
$77,540
Northeast
Black River-Matheson
New service using school buses to transport seniors to medical appointments, shop and/or visit friends within
community and to Timmins and Iroquois Falls.
$30,500
Southwest
Grey
New coordination of existing service using software for centralized access, scheduling and dispatch.
$100,000
Southwest
Tillsonburg
New coordination of existing service through a phased approach: hiring of coordinator, acquiring software/
technologies and purchasing new accessible van.
$100,000
Central
Georgina
New coordination of existing services to phase-in a centrally coordinated service: taking an inventory of local
transportation services/resources, assessing mobility needs and integrating available services.
$99,866
Central
Simcoe
New coordination of existing service to implement a transportation service/resource web portal to enable
online intake, booking and referral.
$97,000
Central
Pelham
New coordinated service to provide inter-municipal and volunteer service to surrounding municipalities,
Niagara College, Niagara Regional Transit and GO Transit.
$100,000
East
Prescott & Russell
Enhanced coordination of existing service to increase capacity (i.e., patients with high needs) by purchasing
van and GPS technology and hiring a driver.
$100,000
$100,000
JUNE 2015
SUPPORT
I am the Face of Brain Injury
Two Perspectives
ABI and knowledge of what it takes to help you get your life
back is priceless.
I have now adopted a much slower pace of life to cope with
my injury—switching between tough cognitive tasks and rest.
Early in the process, the fog lifted just enough to make it
clear that life would never be the same for me. Don’t get me
wrong, I am grateful for my life. It is just that at times the list
of things I can’t do or will never be able to do again piles high
like a threatening Jenga stack. It’s tough to imagine a future
where you can’t fully depend on your brain.
One of the most therapeutic benefits was meeting others with ABI,
seeing people suffering with the same things I am. It was these
relationships that first started to form what action was possible.
I watched how much some struggle with letting go of their old
lives and how much anger can be built up because of the injury.
Stephanie’s Story
One of my favorite quotes has always been “Life is 10% what
happens to me and 90% of how I react to it.”
For my first 29 years, I faced life challenges with hard work and
a positive attitude. However, when acquired brain injury (ABI)
put the brakes on my life four years ago, I faced a situation
where my usual hard work reaction was the least helpful and
sometimes not even possible.
It was July 2011. I was working in Ottawa launching a radio
station when a bicycle accident left me with a broken rib and
finger, a black eye and an mTBI, also known as a concussion.
The emergency room doctor told me about a website I could
look at to learn about concussion but provided no clue that
this could be a life changing moment. I went home convinced
I could figure out how to recover and be back to normal as
quickly as possible. As the days went by it became less and
less clear what my reaction should be.
Not understanding the implications of a concussion, I
floundered for 1-1/2 years, trying to work. I thought I was
losing my mind—I didn’t connect my headaches, brain fog
and dizziness to the accident—so in March of 2012 I moved
back to London, where I was from originally. On the very day I
was to start receiving concussion care at Parkwood Institute’s
Acquired Brain Injury (ABI) program, a sign fell on my head
resulting in a second concussion.
My ABI therapists are helping me as I learn to cope with my
mTBI. When the rest of the world feels cold and harsh, the
ABI team is like a cocoon. Their thorough understanding of
When I heard about the OBIA Peer Support Program, I knew
the healing part of my therapy could finally begin. The program
matches persons with lived experience with an individual who
is living with the effects of acquired brain injury and is looking
for support. The matches are based on similar experiences,
needs and personal interests. As a Peer Mentor, I provided
weekly phone support for a woman recently diagnosed with
ABI. She was so confused and fed up with not feeling like
herself. She felt that some of her family and friends didn’t even
believe that anything was wrong with her. I could hear myself
in her words. Being a Mentor was like therapy for myself, as I
was able to bring some comfort to another person in this very
confusing time.
That was the root of what is now my personal mission—to raise
awareness about brain injury. Even if ABI can’t be seen, it is
very real. Without visible symptoms, sometimes it’s difficult
for people to understand. It’s so frustrating when people say
“But you look great!” after I tell them I have a brain injury.
I will admit, before my bike crash, I assumed persons with
brain injuries were too ill to be out. I assumed they would be
in a wheelchair. I’m ashamed of my lack of empathy now.
I drew on my pre-ABI life to help me raise awareness about
the “face” of brain injury. Having worked in radio and TV for
10 years, I approached colleagues at Rogers TV who helped
me create a public service announcement in the form of a 30
second video. The purpose of the video is to create a broader
understanding of brain injury and to let people know that not
all brain injuries are visible. Through Parkwood Hospital and
the Brain Injury Association of London and Region, I recruited
other people living with ABI to bravely represent the face of
brain injury in the video.
11
OBIA REVIEW
“I am the face of brain injury.” As my peers announced this
tag line, I felt a shift. It was so inspiring to experience my
peers owning their injury. I was on the verge of tears during
the entire taping. Deep inside it was clear that just saying the
words gave them, us, a sense of control in this uncontrollable
time. Powerful. “I can only dream that this video will help at
least one other person on this confusing brain healing journey.”
To view the video “I am the face of brain injury” go to
http://youtu.be/SPlxSEFFblw
Nancy and Shawn’s Story
It has been almost 7 years to the date since Shawn’s motor
vehicle collision and it has been a challenging journey, but the
struggles have been worth it. After 5 years of intense rehab
therapy, we decided to make the move from Cambridge back
to Shawn’s hometown of Kingston. It seemed like the most
natural progression to return to the city he loves and where
most of his family and friends still live.
One of the biggest components of his recovery that was missing
was the social element and just being around people that know
and love him and see past the deficits from his brain injury. We
both couldn’t be happier since we moved because we felt so
isolated and alone in Cambridge and it took a toll on both of
us. The lack of social life in Cambridge was the missing piece
in our lives so we knew it was time to take the plunge and give
up the fantastic professional support we had. We needed to
look to the future and decide how we wanted to live our lives
in the real world.
We built a beautiful fully accessible home and moved our
family to Kingston in the summer of 2013. We have had many
ups and downs trying to put together a new rehab and support
team in a smaller city with fewer resources, but we have never
regretted the decision. We couldn’t be happier with our new
home and how things have worked out and seeing our friends
on a regular basis and just having fun.
As Shawn would tell anyone, there is more to life than just
doing rehab all the time. Life needs to be lived.
Nancy’s Blog - The New Us...Life After a Brain Injury
(http://lifeafterabraininjury.blogspot.ca/)
A coma is nothing like you would imagine or how they play it
out on TV. There’s no sudden arousal, there’s no talking to you
and completely comprehending everything going on.
I think the coma was the worst part, even though early on the
doctors said that Shawn would wake up from his coma, they
had no idea when.
The initial Neurosurgeon was the one that had told us on
the 2nd day that due to the locations of the brain bleeds, in
his opinion, Shawn would wake up. However, he would have
deficits in motor function and memory. Sounded pretty simple
but that was really before they knew the full extent that the
Diffuse Axonal injury and the Hypoxia (lack of oxygen to the
brain) would affect Shawn long term. That particular doctor
I was very impressed with, probably because his news was
leaning more on the positive side.
The next Neurosurgeon that came on the rotation reviewed
Shawn’s CAT scan and believed that his deficits would be
extremely severe and placed him on the low level of outcome—
hated that guy! It seemed every time you started to feel good
about how things were going, someone would come along and
just pull the blanket right out from underneath you.
Living with a constant knot in your stomach definitely takes
such a huge toll on you both emotionally and physically. I am
amazed that our baby survived and my pregnancy continued
because the amount of stress was overwhelming. My doctor
had told me that the body has an incredible way of protecting
babies from outside stresses and she was right.
It was right after my first prenatal visit with her, just 6 days
after Shawn’s accident that I learned of my first real life coma
story. It’s kind of amazing the way it happened, but after that
appointment I asked Shawn’s sisters to take me to Chapters
book store so that I could find a book on brain injury. We walked
in and there was a poster advertising a new author that had
just written a book about his experience recovering from a brain
injury!! What were the odds that this book would have this
author coming to this book store in 2 days to sign copies of his
new book?? I bought a copy and started reading and couldn’t
believe it because this man had been in a car accident about 10
years earlier and had been in a coma and here he was writing
a book. It gave me such hope and the more I read I learned
that he was in a very serious car accident and his coma lasted
about 3 weeks and he had to learn how to walk and talk again.
Meeting that man in person and hearing his story gave me such
inspiration when I needed it the most.
That was not the last time I heard about a coma story from
someone I met; it seemed like they started popping up out of
nowhere. The priest that came to give Shawn a blessing was
also in a coma when he was child for about 3 weeks from a
bicycle accident. The clerk at a retail store told us about her
relative being in a coma and they all seemed to be around the
3 week mark when things turned around.
Well, it was a little over 3 weeks before Shawn officially was
considered “out of the coma.” There was no “hey, how’s it
going” or “what happened” from him like you see in the movies,
it was a simple eye opening that lasted just a split second and
12
JUNE 2015
that was him coming out of the coma. It started off so slow
with his eyes opening for a second until weeks later he had
them open for 45 minutes straight and that was very exciting.
His eyes may have been open but there was no recognition
and he was never tracking or following anything, he just looked
straight ahead. He never opened his eyes when you would ask
but just spontaneously for a short time, sometimes only once
a day and sometimes more. Regardless, I sat by his side and
talked to him and told him about what was happening and
who had visited or I would read him a book or put his iPod on
for him. Whenever his eyes would open, I would get right in
his line of sight and even though he didn’t seem to see me, I
knew he did and I knew he knew I was there. Once in awhile
he would squeeze my hand and even though I was told it was
not “purposeful” I felt like it was and that he was letting me
know that he was there and just to give him time.
Most people don’t remember their coma so it’s hard to say
what exactly they hear but in Shawn’s case we knew he was
listening and trying to show us that he was. In one situation,
a doctor ignorantly spoke to us in Shawn’s presence about his
lack of any real recovery and to expect the worse, his heart rate
raced as he was listening to everything that man was saying.
Other than the times he would squeeze my hand, he actually
showed some movement when an old friend that he knew from
childhood visited. It was within that first week and his good
friend Roy was speaking to him and Shawn actually lifted his
right hand up in response to Roy’s voice. Roy was ecstatic and
he came back in the waiting room saying, “He’s in there, my
boy is in there!!” None of this was ever given any regard by
the medical staff, as they felt it was all reflex, they just didn’t
know who they were dealing with. Shawn is/was a fighter and
it was him trying to let us know he was coming back to us.
I had read so many brain injury stories trying to get an idea of
what to expect but none of them ever really addressed the coma.
I think that was largely due to the survivors writing those stories
so that wasn’t a time they remembered and could only recount
what they were told. I remember so that is why I want to share
this with everyone and also share with Shawn, who follows this
closely because he too wants to gain more insight into what
happened back in 2008. So as I mentioned, he came out of
the coma after 3 weeks and it was a long long process before
he was able to look at me, I mean really look at me and see me
and show he knew who I was.
The first time he actually watched me walk across his hospital
room, we had long left the trauma hospital and he was repatriated
back to our local community hospital, which was 6 weeks after
his accident. Some of the great ideas we had been told or read
about back during the coma were to not only talk to him but also
heighten his other senses with smell and touch. I would find
things that I knew had stronger smells, like cinnamon, and also
smells that were familiar to him, my body lotion for example.
To this day the smell of Bath and Body Works White Tea and
Ginger body lotion reminds me of the ICU and that hospital,
whereas before that it was my favourite smell. ◊◊◊
13
The 2015 Awards of Excellence
in Brain Injury Rehabilitation
The Ontario Brain Injury Association, along with the lawyers from The Personal Injury Alliance,
are pleased to announce the 2015 Awards of Excellence in Brain Injury Rehabilitation.
These awards are meant to recognize exceptional service to the brain injury community
in the following categories:
Hospital Social Worker
Case Management
Health Care Provider
Community Brain Injury Association
Rehabilitation Company
Insurance Company
Nominations for the Awards of Excellence can be made online
between June 1st and July 17th, 2015.
Voting for the selected nominees will take place online
between August 4th and August 28th, 2015.
The 2015 Awards of Excellence will be presented by the Ontario Brain Injury Association
at the Back to School Conference on September 10th, 2015
at the Four Seasons Hotel in Toronto.
To nominate, vote or for more information about the Awards of Excellence, visit:
F EXCELL
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AR
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NC
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NI
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IN B
AI
N J U RY E H A BIL
R
MCLEISH ORLANDO
OATLEY VIGMOND
2015
TA
TIO
AW
OBIA.ca
I
PRESENTED BY
ONTARIO BRAIN INJURY ASSOCIATION
THOMSON ROGERS
PERSONAL INJURY LAWYERS
JUNE 2015
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OBIA REVIEW
SUPPORT
SURVIVOR STORIES
Brain Injury Survival - In the Beginning
By Mary Lou Dalaire
Mary Lou and her dad on BIAN’s canvas, used at community diplays.
I, like many others, live my life with some of the many
challenges of brain injury and have so for the past 21 years.
It all began around Christmas 1993 with what I thought
was a cold that accelerated to pneumonia, meningitis and
encephalitis and, lucky for me and thanks to my ex-husband
who had come to visit, ended with me being rushed to hospital
unconscious and in critical condition on January 14, 1994.
I was not expected to survive but I did, thanks to the excellent
medical care (the head neurologist was just coming out of an
operation and was called to see me shortly after I arrived) and
encouraging, determination-driven rehabilitation staff (both
at the old Royal Victoria Hospital in Barrie and at Shaver
Rehabilitation Hospital in St. Catharines).
My wonderful supportive family (my parents moved into my
apartment in Barrie instead of their condo in Florida for the
coldest winter on record) made a big difference in my recovery
by encouraging me every step of the way. My sister and her
family were there every weekend. My ex-husband was there every
day. My special friends were pulling together for me, visiting
me often, talking to me, bringing pictures and sharing special
memories hoping to help me to regain some of my memory. All
these special things helped me to survive and thrive.
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I am so thankful! It’s not often one gets a second chance at
life, even if I did have to struggle to get it and even if I have a
lot of daily struggles to face. I definitely think it was/is worth it.
I was in intensive care for about a month in fairly rough,
sometimes critical shape, then moved to the rehab floor, where
I was encouraged to try to stand and walk a few steps and
eventually got well enough to be moved to Shaver Hospital in
St. Catharines for further rehab, where my family were close
by and able to keep a watchful eye on me.
Following my 3-month residential rehab, I was invited to
stay with my parents and was bussed to Shaver on a daily
basis. Rehab was not easy, but the staff was very patient and
understanding and encouraged and helped me. I tired very
easily and found I was always very frustrated at not being able
to do some of the simple, daily activities.
I had a special challenge and that was to learn how to do
everything that I had been doing as a right handed person as
a left-handed person.
I learned how to walk again, but needed to wear a brace for
my foot and had difficulty bending my knee and keeping my
JUNE 2015
balance. I felt so very awkward. I learned how to write with my
left hand and type with my left hand only (slowly, but I could
do it!). I had to learn how to talk again too, which presented
some difficulty (I thought I talked funny). One of the ways I
practiced talking was to read out loud. This helped my speech
but also helped me concentrate on what I was reading and not
lose my spot. It works!
I learned how to do things in the kitchen: use an electric
can opener, cut vegetables (making sure to miss my fingers),
mash potatoes, use a timer so that I wouldn’t forget and burn
something, take something out of the fridge, use it and then
put it back (so it would stay fresh). I was soon able to make a
meal by/for myself because my goal for rehab was to be able
to survive on my own. The whole rehab process took a lot of
work. My brain was often tired and would turn off and not allow
me to do things. I would need afternoon naps. I would need
times of solitude to rejuvenate. There were a lot of failures but
soon there was a growing list of successes and it was worth it!
When I finished my term in rehab, I knew it was time to start
my life. I was able to find my own apartment in Welland (with
the help of my sister) and soon I was living in the upstairs
of a house close to her. My dad was very afraid that I would
fall down the stairs, but I promised him I wouldn’t. Two days
after moving day we visited the Humane Society and Oliver
came home with me. He was a lovely orange tabby cat, who
was fairly wild at first, but when he calmed down he became
my buddy, always there with me/for me. Having a cat was very
important to my recovery. He would wrap himself around my
head to soothe me, cuddle to comfort me and never gave up
on me.
Living on my own presented many challenges. I had to do my
own cooking, my own cleaning, make my own bed, wash, dry
and put away my own dishes (without breaking them) and I
was determined to do it right. My personal goal was to keep my
place, my home neat and clean—a place of comfort. Having to
walk up a full flight of stairs presented a challenge, as my right
side was not fully active and my landlord helped by putting a
railing on both sides of the steps. I lived there for 4 years and
never fell down the stairs.
Living with brain injury doesn’t mean you can give up on
resuming your life. There are always going to be “special”
challenges but there are ways to help yourself. With me it was
becoming involved with Brain Injury Association of Niagara
(BIAN). I began attending peer support (Friends Helping
Friends) meetings and BIAN family support meetings with
my family where we got to know other families and how having
a survivor as part of the family affects everyone’s lives.
My family and I made many good friends at these meetings—
everyone sharing special experiences and challenges, making
life easier to understand. We attended family picnics, family
Christmas parties; I even acted in plays at the Valentine Day
survivor party. I was encouraged to write for the newsletter
(and still do) and was a contributor to BIAN’s book “Winds
“Sister” Mary Lou performing at one of BIAN’s
Valentine’s Day plays.
of Change”, a book of 32 BIAN survivor stories. I helped
with painting what would be the trademark for the two BIAN
conferences. I was invited to attend BIAN’s Moving Ahead
with Brain Injury Group, a group of dynamic, energetic and
caring survivors. Our group members helped BIAN with
fundraising—with 2 garage sales, volunteered at conferences,
Food for Thought celebrations, brain injury prevention events,
concussion prevention and recognition events.
I became a client at BICR (Brain Injury Community Re-Entry)
in 1998. The programs at BICR opened a lot of doors for me,
giving me an opportunity to participate and attend different
group programs, writing, reading, oil painting, gardening,
a special women’s group that covered many topics. As a
volunteer, I was able to assist the Social Worker and together
we developed a staff and family training program “Walk in My
Shoes” , that was presented in-house and to other agencies.
A few years ago my volunteering got a boost with the addition
of my husband, Pierre. Now we both volunteer regularly at
BIAN and at OBIA Conferences together.
Meetings with other survivors through BIAN and BICR enabled
me to learn from others and share with them in discovering
ways to ACCEPT, to CHALLENGE, to CHANGE life. ◊◊◊
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OBIA REVIEW
Funding for the Peer Support
Program is provided by:
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JUNE 2015
SUPPORT
OBIA’s Provincial Peer Support Program
Making Peer Connections from Niagara Falls to Thunder Bay
By Carla Thoms, OBIA Peer Support Services and Tammy Dumas, OBIA Associate Director
One of the most important benefits of peer-to-peer support is
the sense of hope that comes from talking to other people with
similar lived experiences. In talking and listening to others
like us, there is a belief in a better future that comes from
being with or talking to people who have worked through their
difficulties. (Davidson et al, 2006). Recognizing the inherent
value and effectiveness of peer to peer support, in 2006 OBIA
established the Peer Support Mentoring Program for people
living with the effects of acquired brain injury. In 2012, for
simplicity, the name officially changed to Peer Support Program.
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OBIA’s program was developed based on the TBI Mentorship
Program, a joint venture of the Research and Training Center (RTC)
and the Brain Injury Association of New York State (BIANYS).
It was launched in Ontario nine years ago and has been rapidly
evolving since its inception. In 2011, an independent three
year evaluation of the program concluded and the following key
messages for OBIA emerged: there is a life-long need for support
following brain injury (for individuals and family members) and
OBIA’s Peer Support Program is meeting that need.
How Can I Get Involved?
Is This For Me?
Through our Peer Support Program, Ontarians living with brain injury
are matched with one another in a supportive peer mentoring
relationship. An individual with lived experience (the Mentor)
is connected to an individual who is seeking peer support (the
Partner) to assist them in understanding their experience with
ABI. Through weekly telephone or video calls they engage in a
mutually supportive peer relationship for up to one year. The
value of this type of support is that individuals can schedule the
calls at a time that is convenient to both of them and they can
participate in the call from the comfort and privacy of their own
home. Mentors and Partners are matched based on similarities
in background, injury, life experience, personal interests and
hobbies. The program is available to people living with a brain
injury and to their family members and unpaid caregivers.
Where Do I Go?
Our program is delivered in communities across Ontario
through our affiliated community Brain Injury Associations.
In each location, a Peer Support Coordinator is responsible
for promoting the program and for the recruitment of new
Mentors and Partners. Coordinators work collaboratively to
thoughtfully ‘match’ Mentors and Partners around the province.
The following 14 Associations are currently coordinating the
program in their local area:
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Brain
Brain
Brain
Brain
Brain
Injury
Injury
Injury
Injury
Injury
Association
Association
Association
Association
Association
of
of
of
of
of
London and Region
Niagara
North Bay & Area
Ottawa Valley
Peel Halton
Brain Injury
Brain Injury
Brain Injury
Brain Injury
Brain Injury
Brain Injury
Seizure and
Brain Injury
Brain Injury
Association Peterborough Region
Association of Quinte District
Association of Sarnia & Lambton
Association Sault Ste. Marie and District
Association of Sudbury and District
Association of Thunder Bay and Area
Brain Injury Centre (Timmins)
Society of Toronto
Association of Windsor and Essex County
To Be a Partner:
For those who are currently looking for support through the
Peer Support Program (to be a Partner) you can contact your
local brain injury association. If your local association does
not offer the program please contact OBIA and we will assist
you directly. Once an initial intake interview is complete, you
will receive information about the program and the process of
finding you a Peer Mentor will begin, taking into account your
background, experiences, interests and goals for the program.
“Wonderful service. I live in remote northwestern Ontario and
was blessed to have a very understanding and caring person
to support me. I hope to become a Mentor as well. She has
inspired me…” OBIA Peer Support Partner
To Be a Mentor:
There is a mandatory screening and training process for
individuals who are interested in becoming Mentors. This
includes, but is not limited to, one full day of Mentor training
and a completed criminal background check. Please contact
your local brain injury association for more information, or
OBIA directly if not offered in your community.
“I find it extremely rewarding giving my time and sharing my
personal experiences with others who are now going through
the same thing.” OBIA Peer Support Mentor
For more information about the Peer Support Program please
contact [email protected]
Resources:
Davidson, L., Chinman, M., Sells, D, & Rowe, M. (2006) Peer Support Among
Adults With Serious Mental Illness: A Report From the Field. Schizophrenia
Bulletin. Vol 32, 3, 443–45 ◊◊◊
Funding for the Peer Support
Program is provided by:
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OBIA REVIEW
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JUNE 2015
SUPPORT
Expanding Support Services
North Eastern Ontario Advocacy Specialist
By Tammy Dumas, OBIA Associate Director
OBIA is pleased to announce the expansion of our Support
Services program into North Eastern Ontario and the launch
of a new two year pilot project. Through this project, OBIA
will bring enhanced advocacy and support services to people
living with the effects of acquired brain injury in North Eastern
Ontario. We are delighted to welcome Tanya Jewell of North Bay
to our team and to the role of North Eastern Ontario Advocacy
Specialist.
to people living with acquired brain injury.
If you would like to make a referral or would like more
information about the NEO Advocacy Specialist Project please
contact Tanya Jewell:
Self-referrals to the program can also be made through
contacting the OBIA Support Line at 1.800.263.5404. ◊◊◊
This project was developed by OBIA in collaboration with
community agencies in North Bay to address the increasing
need for individual advocacy and holistic transitional support
for people with brain injury. Program services are available
to both children and adults living with brain injury and also
extend to their family and caregivers. Accordingly, Tanya brings
a wealth of knowledge to this role and is well suited to provide
this much needed direct and ongoing support. In addition to a
very well developed background in advocacy and community
engagement, Tanya also brings a very important perspective
to the role: lived experience.
Notice of OBIA’s Annual General Meeting
1p.m. - 3p.m., Saturday June 20, 2015
Room 318, Miles Nadal Jewish Community Centre
750 Spadina Avenue, Toronto
Tanya is currently orienting herself to the role and reaching
out to community agencies to raise awareness about her role
and to ensure that individuals and families know how to gain
access to this program. The program, while located in North
Bay, does extend services to people living in the entire North
Eastern Ontario Region.
We are very pleased to be partnered with the Brain Injury
Association of North Bay on this project and we are grateful for
the support of the North Bay Regional Health Centre (NBRHC)
and the many agencies in the NEO area who provide assistance
Please R.S.V.P. to Diane Dakiv: [email protected]
by June 15, 2015
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OBIA REVIEW
podemos ayudarle. pwede kaming
~ giúp.
tumulong. chúng tôi se
As Toronto’s largest ethnic personal injury law firm, speaking 24 languages, we are dedicated to ensuring
our clients receive the rehabilitation and fair compensation they deserve, in a language they understand.
At Carranza, many of us are first or second generation Canadians who are able to provide expert legal
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assist with many of the cultural issues that may arise throughout treatment and recovery.
No matter how you say it, “we can help.”
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London: 519-266-6715
Toll Free: 1-877-633-1065
www.carranza.on.ca
22
JUNE 2015
AWARENESS
The Provincial Acquired Brain Injury
System Navigators
By Veronica Pepper, HNHB ABI Network & System Navigator
In 2010 the Ministry of Health and Long Term Care provided
each of Ontario’s 14 Local Health Integration Networks
(LHINs) with funding to obtain an Acquired Brain Injury
System Navigator. This was in response to the Ministry’s
recognition that the ABI system in Ontario was fragmented,
uncoordinated and inconsistent throughout the province
and it was not meeting the needs of many individuals who
sustained an ABI in an effective and efficient way. As a result,
many ABI individuals were ‘falling through the cracks’, being
misdiagnosed or undiagnosed and consequently they were not
receiving appropriate supports or services in a timely manner.
These problems were often leading to blocked hospital beds
and/or mental health beds, specialized rehabilitation beds,
repeated visits to Emergency Departments and many ABI
individuals and/or their families and caregivers were going
into crisis, some to the point of conflicts with the law or
incarceration and homelessness.
A first step for the ABI System Navigator, therefore, was to
complete an ABI clinical pathway analysis in their LHIN
area that would identify the gaps, barriers and challenges
experienced by their ABI system. Then the ABI System
Navigator identified potential solutions that would address
the issues relating to the problems.
The overarching goal of the ABI System Navigator’s role is to
develop a well-coordinated and consistent service pathway that
will provide increased service capacity of and efficient access
to, services for adults living in Ontario who have sustained
an ABI. This also includes individuals who not only have
suffered an ABI but who can also have other diagnoses such
as a mental illness, addictions problems and an intellectual/
developmental delay. However, this goal needs to be achieved
with no additional funding from the LHINs and/or the Ministry
of Health. It must be achieved by using and coordinating
already existing resources, both ABI and non-ABI resources.
Addressing barriers in the system required first identifying what
was causing the barrier and then breaking down the barrier
by changing current protocols or practices and improving
communication.
To address gaps in the ABI service pathway it often
meant facilitating relationships between and among ABI
and non-ABI service providers including mental health,
addictions, developmental services, geriatrics, corrections
and social services such as housing, meals on wheels, public
transportation, financial supports (i.e., ODSP and OW), etc.
These new partnerships often included co-consultations, crosstraining and education and shared support. It is also important
for the ABI System Navigator to maintain the relationships and
keep them in place for any future ABI cases.
For very complicated or complex cases which usually involve
individuals with an ABI, significant behavioural problems,
mental illness, addictions, homelessness and conflict with
the law the ABI System Navigator often facilitates ‘complex
case resolution meetings’. These special meetings include
every service provider or professional that has had involvement
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OBIA REVIEW
Online Concussion/mTBI
Support Group
Do you have a Concussion or
Mild Traumatic Brain Injury (mTBI)?
OBIA is pleased to announce the launch of our ONLINE
SUPPORT GROUP FOR ADULTS (18 and over) living with
Concussion or mTBI:
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Providing support and sharing information about brain injury and
concussion
Delivered online and available throughout Ontario
Free and confidential
For more information or to register for
the group, contact:
1.800.263.5404 or [email protected].
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JUNE 2015
A very important role of the ABI System Navigators is to raise awareness with their respective
LHINs regarding the incidence and prevalence of ABI and the difficulties the healthcare system
experiences when providing support to them, the professionals who support them and their families
and caregivers.
with the individual in the past or are currently involved with
them as well as those who have not had involvement but
likely should be involved. These meetings provide the forum
for much needed problem solving, creative thinking and more
importantly, the opportunity to develop an effective plan
that will ultimately resolve the case and avert further crisis.
The Navigator then follows the case to monitor the progress
and organize additional complex case resolution meetings if
required.
Another role of the ABI System Navigator is to be a resource
to any professionals who are working with individuals with a
diagnosed ABI. This can include Social Workers, Personal
Support Workers, Nurses, Physiotherapists, Occupational
Therapists, Speech-Language Pathologists, Doctors,
Psychiatrists, Psychologists, Case Managers, etc. The job of
the Navigator is to link these professionals to the appropriate
ABI resources available to them in their LHIN area. However,
it is also the Navigator’s job to know all of the other 13 ABI
Navigators in the event that they receive contact from a
professional in a LHIN area other than their own.
A very important role of the ABI System Navigators is to
raise awareness with their respective LHINs regarding the
incidence and prevalence of ABI and the difficulties the
healthcare system experiences when providing support to
them, the professionals who support them and their families
and caregivers. The Navigators, along with their ABI service
providers, identify the pressures on the system and provide
potential solutions to the LHINs for consideration and possible
funds to address the problems.
Although all 14 ABI System Navigators have some common
goals and roles, they also have differences amongst their
responsibilities and duties.
Some of the Navigators’ main focus is on the ‘higher systems
level’ where they look at the bigger ABI system as a whole. They
address the problems within the larger system and therefore
they have no direct clinical involvement with the person with
the ABI and their family/caregivers. That is they do not have
a role in direct case management. They are involved in cases
at more of a distance by getting information about the cases
from the service providers or professionals who are involved
with them. That information is then used by the Navigator as
a way to identify where the problems are within the system.
However, other Navigators do have a more active role in
case management where they are directly involved in the
assessment and clinical aspect of every case that is brought
to their attention. Therefore they will assess the individual with
the ABI to identify their needs and then coordinate the care,
rehabilitation and supports they require. They will monitor the
progress of the individual and provide further support when
required. They also provide support directly to any professional,
service provider or family and caregiver who is involved in the
case.
Another area of the Navigator job that varies from Navigatorto-Navigator is the role of referrals, admissions and wait list
management. That is, some Navigators are the ‘gate keepers’
to the ABI services in their LHIN area. All referrals go through
them. Then the Navigator assesses the referred ABI individual
to determine appropriateness and suitability for admission to
their ABI services and if they are approved for service, their
names are placed on a wait list. For some Navigators, it is
also their role to monitor the wait list, provide support where
necessary and determine who receives services next when a
vacancy becomes available. For other Navigators their role is
simply to facilitate a referral directly to the appropriate ABI
services in their LHIN area. The admission assessment and
wait list management is provided by the ABI service provider,
not the Navigator.
Education and training for non-ABI service providers also
differs between Navigators. As written earlier, the role of the
ABI System Navigator is to ‘link’ service providers who are
working with ABI individuals to the appropriate ABI supports
in their LHIN area. This often includes linking the non-ABI
service providers with the ABI resources in that area that will
provide staff education and training on ABI.
For some Navigators it is their job to provide direct education
to professionals on acquired brain injury and the problems that
can occur as a result of an ABI. They may also provide training
to various front line staff that are supporting persons with an
ABI on how to better manage their cognitive, behavioural and
communication problems.
Since the roles and responsibilities of the ABI System Navigators
varies across the 14 LHIN areas it is best to contact your local
Navigator directly and clarify what their role is specifically and
how they can best support the service provider, the individual
with the ABI and their families and caregivers.
The Acquired Brain Injury System Navigator has proven to be
a very useful and effective role. Currently the Navigators are
collecting common and individual data that will allow them to
monitor the effectiveness of their role in helping individuals
with an ABI specifically and also their impact on the ABI
systems within their respective LHIN areas. ◊◊◊
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OBIA REVIEW
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26
JUNE 2015
AWARENESS
Across the Province
The View from the OAC
The OBIA Advisory Council met in
Toronto on March 14, 2015 and was
treated to a wonderful presentation by
Linda Marshall of Marshall Connects
Inc., entitled “25 Fundraising Habits
of Successful Boards.” Throughout her
talk, Linda stressed the importance of
the saying “It’s all about how you make
people feel.” (Maya Angelou).
Linda encouraged our organizations to
practice excellence and integrity at all
levels; the office level, the Board level
and in our encounters with the public.
She challenged Board members to be
passionate about their Mission statements
and to advocate for their associations.
Linda encouraged us by stating that
“Giving leads to giving if donors are
treated respectfully and believe in the
organization’s mission.” Hopefully,
members will be able to use Linda’s
advice as we continue to strive to raise
funds for the work of our Associations.
The afternoon was a lively sharing of
information and ideas from across
the province. The OAC provides the
opportunity for a unified provincial
approach to the challenges of ABI with
professionals, caregivers and survivors
working towards a common goal.
Community Programs & Events
As always, we are delighted to be able
to showcase many of the wonderful
programs and events happening around
Ontario.
BIA Ottawa Valley
The Brain Injury Association of the
Ottawa Valley partnered with OBIA to
provide Brain Basics and Peer Mentor
Training. Hélène Richardson will be the
new Peer Support Co-ordinator for the
association. Congratulations to all the
graduates from both trainings.
Members of our volunteer team were
Linda’s presentation can be viewed at: celebrated at a breakfast in their honour
https://vimeo.com/123359171.
OBIA is pleased to support the Brain Injury Association of London and Region,
along with Brain Tumour Foundation of Canada and
Dale Brain Injury Services, in launching the Year of the Brain 2015
in London & surrounding area.
The focus of Year of the Brain is to provide a platform for all neurological and
mental health based organizations in the area to come together to support
people living with brain-related conditions.
With a monthly webinar series, Brain Fair and other events‒it s bound to be an
exciting and busy year ahead!
Visit www.YearOfTheBrain2015.com to find out more.
held on April 23rd at the Bay Bistro.
(pictured above)
The members of the Step Up Work Centre
have once again partnered with the City
of Ottawa and Tim Hortons to participate
in the “Cleaning the Capital Campaign.”
This is the 4th year that the membership
has been involved in this project. Hats
off to the members who participate.
June is Brain Injury Awareness month
and plans are well underway. We have
partnered with the law firm of Burn,
Tucker Lachaîne LLP in the Helmets
on Kids Program. Approximately 800
helmets will be given out in three
schools in the City of Ottawa. Thank
you to the members of OTLA that will be
participating in this program. Members
will be conducting a bicycle survey
along the bicycle pathways to see if
there has been an increase in the use
of helmets by both children and adults.
The survey will also include the use of
helmets with respect to inline skating
and skateboarding.
Some of the members of the Running
Group will be taking part in the “Spring
Spring” sponsored by the Brain Tumour
Foundation on June 7th, 2015 at Andrew
Haydon Park.
Don’t forget to stop by our booth at Brain
Injury Awareness Day sponsored by Vista
Centre Brain Injury Services being held
at the Hampton Inn on June 12th.
The 2 nd Annual Fleming Fitness golf
tournament will be held on June 18th at
Loch March. For more information please
contact Pat Fleming, R.Kin, CSCS at
patrick@flemingfitness.ca. (see ad on page 29)
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OBIA REVIEW
Our Annual General Meeting will be held
at the Bronson Centre on June 16th at
6:00 pm.
For information about any of the
programs offered by the association
please telephone Wendy Charbonneau
at (613) 233-8303 or email
[email protected]
BIA Windsor-Essex County
The Brain Injury Association of Windsor
& Essex County hosted its 2nd annual
Sports & Sparkle: The Main Event gala
on April 11th, 2015. Over 250 people
attended to raise funds for BIAWE. It
was a wonderful evening with great food,
music, entertainment and celebrities who
came out to support BIAWE and brain
injury survivors and their caregivers.
Brain Fast Facts
DID YOU
KNOW?
• 86% of those employed for
pay at the time of injury are
currently not employed
Athletes and event speaker from left to right, Tarrence Crawford of the Windsor
Lancers, Daryl Townsend of the Montreal Alouettes, Ernie Soulliere and Tyrone
Crawford of the Dallas Cowboys attend the second annual Sports and Sparkle gala,
Saturday, April 11, 2015, at the Caboto Club. (Photo: Rick Dawes: The Windsor Star)
Brain injury survivors from left to right, Cathy Polidori, Kathy Worotny, Bev Fortier
and Caterina Pintus attend the second annual Sports and Sparkle gala, Saturday,
April 11, 2015, at the Caboto Club. (Photo: Rick Dawes The Windsor Star)
HIA Fort Erie
Annual family picnic will be held at the
HIAFE Centre Thursday June 25. This
will be an excellent opportunity for the
community to engage with clients who
participate at the Centre.
Throughout the month of June, HIAFE
will display information about brain
injury and articles about who we are and
what programs we deliver.
HIAFE participants will conduct a pledge
survey within the Community pledging to
Drive Only...Never Text.
• 69% state there has been
a change in relationship with
other members of the family
• 52% of caregivers admit
they have concerns about the
behaviour of their friend/relative
since sustaining an ABI which
may put her/him at risk.
- 2012 OBIA Impact Report
28
Members of HIAFE made a one-of-a-kind mural that adorns the hall of the HIAFE
Centre. Pictures (left to right) are a few of the mural’s creators: Roger, Elizabeth,
Heather, Michael, Fred and Mike.
JUNE 2015
BIA Niagara
We have some exciting news to share!
Brain Injury Association of Niagara is
pleased to share that our association
has received a three-year grant from
The Ontario Trillium Foundation to
commence a member-driven Clubhouse
for people living with the effects of brain
injury in the Niagara region.
Our annual Kerry’s Head for the Hills
Race/Corporate challenge event and 1k
survivor walk was held on April 25, 2015
in St. Catharines, with special thanks to
our sponsors, corporate challenge teams
and participants. This event is held in
association with the St. Catharines
Roadrunners and Walkers.
As part of our Brain Injury Awareness
Month activities, we are gearing up for our
Annual Summer Prevention/Awareness
Campaign, “We Caught You Using Your
Head,” together with our community
Policing partners, individuals “caught”
JUNE
18
wearing their helmets while engaged in
muscle powered, sportsrelated activities
will be awarded a “Surf’s Up Day Pass”
for the indoor Wave Park, courtesy of
Americana Conference Resort & Spa.
Our 3rd Annual Fundraising “Meet Me
in Niagara” Food for Thought Gala
will be held at Club Roma on June 4,
2015. The Gala committee is once
again working to develop an exciting and
enjoyable evening with excellent food
and entertainment. The goal with this
event continues to be to raise funds in
support of the operations of BIAN. Just
over $30,000 was raised at the 2014
Food For Thought Gala, thanks to all who
participated!
with eight successful Mentors including
parents, survivors and a spouse. Since
the training, three of the eight mentors
have been matched with a Partner. Two
more matches are presently in the works.
The program has one Partner matched
and is presently looking at recruiting new
Mentors and Partners to the program.
Contact has also been made with
local support groups and Brain Injury
Community Re-entry, which highlighted
this invaluable program in its “learning
and Leisure Guide.
BIAN participants continue to enjoy
themed-based horticultural craft
activities in association with Karin
Vermeer. (Shown right is Andrea.)
The Peer Support Program for BIAN
held its first Mentor Training in February,
SAVE THE DATE…
For the 2nd annual…
Golf Tournament
All proceeds benefiting the Brain Injury Association of the Ottawa Valley
…at Loch March Golf & Country Club
FEATURING DR. DONALD CHOW AS HONORARY GUEST & SPEAKER, AND
DERICK FAGE, DAYTIME HOST OF ROGERS TV, AS THE M.C.
CONTACT PAT FLEMING
FOR SPONSORSHIP
OPPORTUNITIES
(2 PLATINUM, 1 GOLD,
1 SILVER, 1 BRONZE)
Patrick Fleming, R.Kin, CSCS
Fleming Fitness
613-882-8434
[email protected]
29
OBIA REVIEW
BIA Sudbury & District
The Brain Injury Association Sudbury &
District in partnership with the March
of Dimes Canada hosted its first St.
Patrick’s Day themed Porketta Bingo
on March 13th from 1-3 pm at 2750
Bancroft Drive for their survivors and
caregivers. The event was a great success
due to the awesome turnout and support.
There were lots of porketta bingo winners
who either chose to eat a yummy porketta
sandwich or could replace the sandwich
by placing their name in a draw for one of
five prizes! Prizes included Tim Horton’s
and MacDonald’s gift cards, as well as
a grand prize for two to view a movie
at Silver City Cinemas! Everybody went
home a winner that afternoon with either
a full belly or a smile on their face.
A special thanks to Jan Oystrick and
her team at Subway for donating the
delicious deli buns and for all who
volunteered their time to put on this
great event. Due to the success of this
Porketta Bingo more events shall be
planned in the near future! ◊◊◊
30
JUNE 2015
New at the OBIA Bookstore
BRAINLASH: Maximize your recovery
from Mild Brain Injury $56
TIP Cards (various) $3
Slow Dance: A Story of Stroke, Love and
Disability. $20
Author (various)
Author: Gail L. Denton, PhD
Author, Bonnie Klein
Book on concussion helps families,
individuals
and caregivers
understand the
consequences of
mild traumatic brain
injury. Written by a
psychotherapist
who coped over
many years with the
effects of several
mild brain injuries, it provides clear
and practical information with many
tools and strategies that can be applied
to daily life.
Brain injury affects children and adults
differently, so we offer over 50 different
cards on different topics related to
acquired brain injury. They are called
“Tip Cards” because of the emphasis
on checklists and suggestions for what
to do. All are written in clear language
for families, educators and advocates,
as well as clinicians.
In 1987, filmmaker
Bonnie
Klein
suffered
two
catastrophic strokes.
“Slow
Dance”
presents her candid,
moving account
of adapting to life
with a disability. An
inspirational book
with the pace of a
thriller that brings
disability to centre stage.
For a list of available resources, visit OBIA’s Online Bookstore:
www.obia.ca/bookstore/
31
OBIA REVIEW
32
JUNE 2015
SUPPORT
Survivor Stories
Riding Away Stigma
By Lori White
walked around dealing with shame, hopelessness, loss, fear,
abandonment and feeling as though there was quite literally
a piece of me missing. I attended summer school every year
after repeatedly failing so many classes. I finally graduated
high school after six long years, when I turned twenty! Although
I struggled and felt insanely lost, I never lost sight of what I
wanted to do. I wanted to be a teacher.
I believed teaching would bring me great joy. Little did I know
that the road to becoming a teacher would prove to be even
more difficult than the struggles I had faced in high school!
The summer of 2015 marks a new journey for me. I will be
riding my bike 1,340km from Montreal, Quebec, to Halifax,
Nova Scotia, solo! A challenging commitment for anyone;
being a brain injury survivor makes this personal journey even
more arduous and rewarding. My intention is to help enhance
awareness for all people impacted from brain injury, and/or,
mental health issues and raise donations for their respective
agencies. Infused with personal stories, this campaign’s focus
is to emphasize educating those who silently suffer and those
who stand alongside them. Only with perseverance, inner
strength and your support, will this task reach fruition. By
working together, we will be Riding Away Stigma!
I have come to understand the magnitude of courage and
vulnerability required to complete this endeavor and I wish to
share my experience with as many people as possible. My ride
is inspired by two things; brain injury awareness and mental
health awareness. This is my story:
At the young age of fourteen, my life changed and I no longer
saw it through the same eyes. I sustained a moderate traumatic
brain injury after a very severe car crash. High school was an
incredible struggle and I felt very alone throughout the entire
experience. I didn’t want to get out of bed in the morning
and I couldn’t sit still in class. In grade nine I failed Math,
Science, Geography and English! My struggles were academic,
emotional and social. I did not have the confidence to even
get a job or my driver’s licence. At 18, I applied for my first
job with the help of my both my basketball coach and friend
Karen. Their support and assistance ensured that I would have
the patience and skill set to fill out a simple job application. I
got the job, but I remember feeling so stupid since the process
was so incredibly difficult and I felt like no one understood
that. During this time my brain injury was undiagnosed and I
After graduation and having only 3 of the 6 mandatory OAC’s
and an academic average of 53% I enrolled in part-time studies
at Wilfred Laurier University (WLU). Having been successful
in the two classes, I then applied for full-time studies in
Physical Education at Brock University for the fall of 1999.
I was accepted and also played Varsity Soccer my freshman
year! That year was an enormous learning experience. Since I
had one full credit from WLU, I was only required to take four
full credits my first year.
The second year, I enrolled in five classes and it felt like I was
drowning. I was studying my heart out and only getting 70-75%.
I strongly believed I was capable of better. Some may feel like
that would have been a success, which in many respects it
was, but I cannot stress enough that my effort exerted and the
70-75% grades were not cohesive. I watched my peers study
habits and couldn’t comprehend how they would seemingly
apply only half of the effort I was, yet achieve higher grades.
It left me dumbfounded. I went to a Doctor at Brock’s Medical
Centre and for the first time the history of my accident was
taken into account. She referred me for a neuropsychological
assessment which, once completed, determined that I suffer
from a moderate traumatic brain injury. This assessment
came ten years after my accident. I lived not knowing that I
sustained a brain injury for those ten years but I also knew that
something within my being was gravely wrong and I had NO
idea what it was or, what to do about it. The details of my injury
are irrelevant, but what is paramount is from that moment
on I began receiving the necessary support and education in
order to be successful in life. It also validated that I am not
crazy, there is legitimate reason for my overwhelming difficult
feelings of loss throughout high school. I cannot get the ten
years back without a diagnosis, nor do I want to, as those lost
years are a part of my journey. What I do want, is to bring
education and awareness surrounding the issues of brain injury
in order to decrease the possibility of someone suffering as
long as I did.
33
OBIA REVIEW
Restoring Hope.
Building Futures.
Comprehensive rehabilitation services
from providers you can trust.
physiotherapy | case management | discharge planning | occupational therapy
speech-language pathology | rehabilitation therapy | home assessments
vocational counselling | personal counselling | life care planning/future costs
medical & psychological assessments | employer services | insurer services
34
www.rehabfirst.ca
1-888-REHAB-90 | [email protected]
JUNE 2015
In May of 2004, I graduated from Teacher’s College with a
Bachelor of Education degree and have been employed with
the District School Board of Niagara as an occasional teacher
for the past 10 years. My struggles with my brain injury did
not end once I obtained a career. My consistent perseverance
and dedication to developing my self-awareness is my greatest
strength and that is shaping the person and educator I have
become.
Further to Brain Injury Awareness, another cause I am passionate
about is Mental Health Awareness. I believe that frequently these
two issues overlap and symptoms mirror one another in persons
afflicted. There is much evidence to support that persons with
brain injuries are also suffering from some form of mental
illness. Mental health on its own affects a large percentage
of the population. In particular, as a dedicated teacher for 10
years now, I see first-hand how the impact of mental health
issues can weigh upon the youth, their struggles and the stigma
surrounding it. They wrestle with similar overwhelming feelings
that I encountered as a brain injury survivor: hopelessness,
loneliness, sense of abandonment, shame and depression—the
list can go on. The importance of early educational awareness
and a proper diagnosis is crucial.
This summer’s ride will test my perseverance, dedication,
courage and ability to be vulnerable and overcome adversity in
order to accomplish my goal. I want to draw more awareness
to brain injury and mental health issues, to the educators,
healthcare personnel, brain injury survivors and their families.
I can’t stress enough the significance of early diagnosis of
brain injury and proper diagnosis of mental health issues,
as it provides the effected person and their family with the
knowledge and tools needed to aid them in life. Education
is vital and I hope this journey helps shed some light on the
importance of increased awareness in our communities, homes
and schools.
The cause of my ride is to strengthen awareness for
brain injury and mental health sufferers and their
families and to raise money for the Ontario Brain
Injury Association and Pathstone Mental Health. This
1,340 km adventure can be tracked via social media every
kilometre of the way and I have enlisted the support of many
to help organize this trip. I am extremely excited to share this
experience with those who follow, for what this ride means
personally and the potential it has to empower everyone to
make positive changes in one another’s lives. ◊◊◊
Follow Lori’s ride:
www.ridingawaystigma.com
@LoriRide
35
CANA
D
I
LAWYER M
A
INE
AZ
G
AN
JUNE 2015
Canada-wide serious injury
care with a local “touch”
Bayshore HealthCare delivers a wide range of nursing and attendant
care to people with serious injuries, helping them regain their daily lives
and maintain quality living within their community.
Our nurses are specially trained to care for clients who need advanced
clinical care, while our personal support workers perform many
delegated tasks for individuals with catastrophic and non-catastrophic
injures. They are supported by internal clinical experts and our
Managed Care Team – a convenient, central contact point for workers’
compensation boards, insurers and government care programs,
providing individualized care plans, standardized client reporting and
timely service.
With 60-plus offices across Canada, we also offer a local “touch” when
it comes to professional care for people with serious wounds, fractures,
amputations and spinal cord/acquired brain injuries.
To learn more, please call
1.877.289.3997
www.bayshore.ca
ISO
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HealthCare
Quality
Management
System
Registered Company
37
OBIA REVIEW
SUPPORT
Survivor Stories
Coping: Getting Back in the Saddle Again
By Barrie Faulkner
etc. To an ABI survivor this can be
overwhelming and fatiguing. Although
brain injury supposedly does not affect
an individual’s I.Q., it definitely slows
the decision making process which can
result in bad decision making. Best allaround to trust in a guide.
Most modern multi speed bikes have
two gear levers. There are good and bad
combinations of gears. Bad combinations
are inefficient and can have safety
issues, for example, it is possible to
drop the chain resulting in the loss of
all power in the bike. The chain drop
problem became much more acute as
weather conditions deteriorate or as the
driver becomes fatigued.
I really love riding a bicycle.
Two years ago my son and I rode our
bicycles from our home in Bracebridge
to Istanbul, Turkey and back. OK, we
cheated by putting our bikes on the
Queen Mary to cross the Atlantic Ocean
each way but that was all part of the fun.
As an ABI survivor I’m aware that I have
problems in addition to those faced by
most bike riders and these problems get
more acute as I get tired.
Logically it might seem that I should
“give up” bike riding, however, for all
ABI survivors it is essential that we do
not “give up.” Instead, taking steps to
make it easier for us to cope and make
life safer is of the utmost importance.
38
(carbon-fibre reinforcement) and temple
protection. It is not the lightest, best
ventilated, most pony-tail friendly or
most fashionable helmet on the market.
My research shows it to be the SAFEST.
I wear a helmet for safety…period.
I no longer ride in groups. Riding with
others is distracting and with brain injury
I have trouble multi-tasking. Watching
traffic, road surfaces, conversing with
others, maneuvering around other bikers
is multi-tasking. The consequence can
be dangerous. Best I avoid this.
Here are some of the steps I’ve taken to
cope with bike riding:
This seems a total contradiction to
#2, but when I ride somewhere new
I’ve learned to never ride alone. The
person riding with me must be very
knowledgeable about brain injury. Riding
with me means either being quite a bit
ahead, leading me or quite a bit behind,
watching for possible problems.
I try to stay current with the latest helmet
safety technology. My present helmet
has MIPS (Multi-directional Impact
Protection System), Aramid bridging
In addition to the normal challenges
facing a rider, really new situations
present problems with navigation,
sights, customs, maybe even language
Gear changing is a constant task and for
most riders it becomes largely automatic.
For ABI survivors the constant decision
making can be quite fatiguing and can
become extreme if inattention and/
or lack of ability to learn automatic
response is a factor.
Also with combination gearing systems,
gear changing must occur while the rider
is pedalling the bike. If a rider forgets to
gear down while braking (gearing down
and braking at the same time is multitasking), the bike is in too high a gear
and starting up is quite difficult and can
be dangerous as it is easy for the bike to
wobble when starting in the wrong gear.
My bike is equipped with a fourteen
speed internal gear hub. Only one
shifter, no bad combinations. The chain
is always in a straight line and tensioned,
making it almost impossible to “drop the
chain.” Any gear change can occur either
in motion or at a stop.
Way less for me to worry about, way fewer
problems, way safer!
Almost all serious cyclists use pedals
that the shoes clip into and these have a
JUNE 2015
number of advantages. To disengage the
shoe from the pedal simply requires the
rider to flick his/her heel away from the
bike. Fine while the bike is in motion,
physics keeps the bike upright. When
the bike is stopped, the outward flick
of the heel causes the bike and rider to
unceremoniously fall sideways onto the
road. The rider is unable to break the
fall, quite dangerous when in traffic.
Again most riders quickly learn to
automatically clip out when slowing
down. For an ABI survivor, slowing down
at a traffic light, gearing down, signally a
turn, watching the light, watching where
the curb is, watching what the car beside
you is doing and clipping out all at the
same time is multi-tasking. Dangerous
if you get it wrong and suddenly tumble
over sideways onto the road.
The simplest solution is to use platform
type pedals but those eliminate some
safety features of clip-ins such as your
foot cannot accidently slip off the clip
in pedal.
toes. When disengaging the foot moves
backwards out of the cage, an action
which does not cause the bike to topple
over (care must be taken to ensure the
shoe treads do not catch in the pedals).
My bike’s taillight has a sensor mode
which automatically turns on if it gets
dark and the bicycle is in motion. The
light stays on for four minutes after the
bike has stopped, keeping me visible at
a traffic light or stop sign.
I no longer have to remember to turn my
light on at dusk or when entering a long
bridge or tunnel, or turn off to save the
batteries. A safety feature that I do not
have to waste my energy worrying about.
We all have different problems. These
are some of the ways I cope in claiming
back an activity that I love. They at least
help me to feel safer as I ride along.
We’re all in this together and need to
share what we have learned. Please write
and share something that has helped you
cope in your ABI recovery. ◊◊◊
My solution is to use the old rat trap
type pedal where there is a cage over the
We want to hear from you.
Do you have a story of survival? Do you have coping strategies to share?
Are you a caregiver to someone with ABI?
Have you dedicated your life
to helping those with brain injuries?
To help spread the awareness of how brain injury impacts our lives, OBIA is pleased
to share stories from our readership.
The goal is simple:
Share • Inspire • Support
To share your stories with our readers, email us at
[email protected]
39
OBIA REVIEW
Support Services for Brain Injury
Helping individuals living
with the effects of brain
injury achieve a better
quality of life
Serving East Central Ontario
MindWorks Group
312 Rubidge Street
Peterborough, Ontario K9J 3P4
Phone: 705-741-3412
Fax: 705-741-4098
Toll Free: 1-800-559-8323
www.mindworksgroup.ca
40
OUR SERVICES
s
s
s
s
s
Rehabilitation Assistants
Community Support Staff
School Support Staff
Recreational Programming
Vocational Planning, Programming and Coaching
JUNE 2015
EDUCATION
How Brain Injuries Affect Men and
Women Differently
By Alison, BIST Blog Contributor
Traumatic brain injuries (TBIs), concussions in particular, have
been getting some much-needed attention from the media.
Despite recent evidence that females are more susceptible
to concussions and have greater difficulties with recovery
than men, the media reports mainly on male athletes. For
example, hockey fan or not, most people heard about NHL
player, Sidney Crosby’s struggle with concussions from 2011
to 2012. However, around that time, far fewer people heard
about award-winning, female hockey Olympian, Meghan
Duggan’s struggle with her concussion. Even fewer learned of
Katie Weatherston’s lost chance at the 2010 Olympics due to
concussion symptoms. This disparity concerns the unreported
statistics of female athletes that have retired from professional
sports due to TBI. Focus of attention should be shared between
men and women equally, so that female athletes may be better
protected and female survivors better supported. This article
discusses some of the ways that brain injuries are known to
affect men and women differently.
The brain is the most complex organ in the human body.
It controls our bodily functions, movements, thoughts,
and feelings. Although no two brains are alike, men’s and
women’s brains are remarkably different, so trauma to the
brain can affect the sexes differently. Given that TBI has a
multi-factorial pathophysiology and a symptom profile that is
unique to each person, it is very difficult to develop treatments
that are effective in most TBI survivors. Factoring gender
into the standard of care is a much-needed approach to the
management of acquired brain injuries. Further research is
required to understand how men and women respond to and
recover from TBIs differently.
neuronal densities, connections, and activity. Male brains have
a higher proportion of gray matter whereas female brains have
a higher proportion of white matter. Gray matter is made up
of more active neurons that process information where white
matter networks information between different areas of the
brain. White matter allows people to integrate thoughts from
gray matter, which helps with complex skills such as language
(Jung and Haier, 2007). This suggests that women’s brains
are more complex, even though men and women are equally
intelligent. Evidence also suggests that the percentage of gray
and white matter regions involved in cognition that are located
in the frontal lobes is drastically larger in women than that in
men. Taking into account the specific location of trauma to
the brain, these differences could explain some of the genderspecific variations of TBI symptoms. For instance, injury to the
frontal lobes could be more devastating to females than males.
Concussion Rates for Men and Women
Although the majority of people that sustain a TBI are
male, recent studies indicate that females are actually more
susceptible to concussions and poorer outcomes. Despite the
fact that more males play contact sports than females, females
suffer significantly higher rates of concussions than males
playing the same sports. Where males have a higher percentage
of concussions resulting from player-player contact, females
have a higher percentage of concussions resulting from playersurface contact and player-equipment contact (Dick, 2009).
A higher incidence rate of sports-related concussions (SRCs)
has been documented in females in high school sports (soccer
and basketball) (Powell JW and Barber-Foss KD, 1999) and
How Male and Female Brains Differ
The anatomy of the male and female brains differ in many
ways. In general, men’s brains are larger than women’s brains,
and women’s brains have thicker, more convoluted cortexes
with more tightly packed neurons (brain cells). The following
parts of the brain are, on average, larger in male brains than
female brains: the hippocampus, which is involved in memory
formation; the amygdala, which is involved in emotion and
memories; and the third interstitial nucleus of the anterior
hypothalamus, which is believed to play a role in sexual
orientation and gender identity. Functionally, male and female
brains rely more heavily on different sides of their brains
when performing various tasks. Most interestingly, there is a
substantial difference in ratios of gray to white brain tissue
matter between the two sexes. This translates to different
41
OBIA REVIEW
college-level sports (soccer, basketball, and ice hockey)
(Hootman et al., 2007; Covassin et al., 2013). Furthermore,
high school girls are more likely to have recurrent concussions
than boys (Castile et al., 2012).
The gender-specific rates of SRCs have been explained by
the fact that women have less neck strength than men. Neck
strength is crucial for protecting the brain from sudden
acceleration-deceleration forces. In fact, it is already welldocumented that women are more susceptible to whiplash
injuries, which are cervical spine injuries due to sudden
acceleration-deceleration. TBI and whiplash are often
experienced concurrently and can cause similar symptoms.
Besides having stronger neck and back muscles, men also
have more cartilage in the facet joints of the spine, resulting
in better protection from injury.
Another theory behind the discrepant SRC rates between men
and women is that a person’s body mass index (BMI) may
play a role in transmitting force and, hence, contribute to the
severity of an injury. Young girls tend to have higher BMIs
than boys their age. Also, the women that were analyzed in
a study that showed worse outcomes in females after TBI
had a slightly higher average BMI than the men in that study
(Covassin et al., 2013).
Concussion Morbidity in Men and Women
Besides being a factor in the rate of concussions, gender is also
a risk factor for morbidity. An analysis of 8 different studies
demonstrated that TBI outcomes were worse, in general, for
women than men in 85% of the physical symptoms, including
memory, concentration, dizziness, fatigue, sensitivity to light
and/or noise, headache, anxiety and depression (Farace and
Alves, 2000). One study looked at 1425 subjects with mild TBI
to compare the acute symptoms of post-concussion syndrome
(PCS) between men and women. The subjects were assessed
at the initial emergency department visit and then 3 months
later. The results showed a significant correlation between
female gender and worse symptoms that was especially strong
for females in their childbearing years (Bazarian et al., 2010).
A different study focused on the long-term consequences of
mild TBIs and found that 3 years after their injuries, women
had worse outcomes than men in terms of symptoms and
disability. Of 163 patients, approximately 50% of the women
had PCS, whereas only 30% of the men had PCS after 3 years
(Styrke, 2012).
Additional variances can be seen when comparing the ability
of concussed men and women to demonstrate specific skills.
For example, studies have shown that post-concussion female
soccer athletes have significantly slower reaction times than
their male equivalents (Colvin et al., 2009). Concussed female
soccer players have also been shown to perform more poorly
than concussed male soccer players on visual image memory
tests (Covassin et al., 2007). In contrast, female TBI survivors
tend to outperform male survivors on tests of verbal memory
(Bengston et al., 2000) and executive functions, including
42
planning, initiating, and problem solving (Barr, 2003; Bounds
et al., 2003, Putukian et al., 2000; Schopp et al, 2001).
The psychosocial consequences of TBI appear to be harder
for women than they are for men. One study reported that
women are less likely to have a caregiver and are particularly
vulnerable to isolation, disempowerment, and abuse (Alston
et al., 2012). For some reason, males with TBI are more likely
to be successfully employed, more likely to receive vocational
rehabilitation services, and less likely to have vocational
services prematurely terminated than woman (Jensen and
Thulstrup, 2001; McCauley et al., 2001; Bounds et al., 2003).
Hormonal Changes After TBI
Although the mechanism is not yet fully understood, it is clear
that sex and stress hormones play a major role in protecting
the brain and/or damaging it further after trauma. The sex
hormones include estradiol, progesterone, and testosterone,
and the main stress hormone of interest is cortisol. The
pituitary hormones, follicle-stimulating hormone (FSH) and
luteinizing hormone (LH), stimulate the production of the sex
hormones. Brain injuries have been shown to disrupt hormone
production. Immediately after severe TBI, the following
hormones become acutely elevated: estradiol and progesterone
in men; testosterone, FSH, and LH in women; and cortisol in
both men and women. These hormone levels then plummet
below normal within the first six days following the injury,
resulting in hypogonadism (a reduction in sex hormone
secretion) (Wagner et al., 2011). Another study documented
hypogonadism between 7 and 20 days after moderate to severe
TBI in up to 80% of males and 90% of females (Agha et al.,
2004). Severe and/or chronic disruptions to sex hormones
have been correlated with worse outcomes. There is ongoing
research on understanding how these hormones repair and/
or damage male and female brains differently in hopes of
developing new hormone therapies for TBI.
Hormones fluctuate more drastically in women, making
women particularly susceptible to migraines and reproductive
changes after a TBI. Fluctuations in estradiol are a cause of
migraines in women of childbearing ages. Concussed female
JUNE 2015
Barr, W.B. (2003). Neuropsychological testing of high school athletes. Preliminary norms
soccer players report double the rate of migraines compared
to the males (Covassin et al., 2013). One study followed 104
women with moderate to severe TBI and observed that 46%
of those women had amenorrhea lasting up to 60 months and
68% of them developed irregular menstrual cycles including
more skipped menses. The women also reported worsened
premenstrual syndrome (PMS) and menopausal symptoms
after TBI. Although the study did not see an effect of TBI on
fertility, it noted that fewer female TBI survivors gave birth to
children than the controls and that those that did had more
difficulties in the postpartum period. (Colantonio et al., 2010).
and test-rested indices. Achieves of Clinical Neuropsychology, 18, 91-101.
Bazarian, J.J., Blyth, B., Mookerjee, S., He, H., McDermott, M.P. (2010). Sex Differences
in Outcome after Mild Traumatic Brain Injury. Journal of Neurotrauma, 27(3): 527-539.
Bengtson, M., Martin, R., Sawrie, S., Gilliam, F., Faught, E., Morawetz, R., Kuzniecky,
R. (2000). Gender, memory, and hippocampal volumes: Relationships in temporal lobe
epilepsy. Epilepsy Behavior, 1, 112-119.
Bounds, T.A., Schopp, L., Johnstone, B., Unger, C., Goldman, H. (2003). Gender
differences in a sample of vocational rehabilitation clients with TBI. NeuroRehabilitation,
18, 189-196.
Castile, L., Collins, C.L., McIlvain, N.M., et al. (2012). The epidemiology of new versus
recurrent concussions among high school athletes, 2005-2010. British Journal of Sports
Medicine, 46:603-610.
Colantonio, A., Mar, W., Yoshida, K., Escobar, M., Velikonja, D., Rizoli, S., Cusimano,
Conclusions
M., & Cullen, N. (2010). Women’s health outcomes after traumatic brain injury. Journal
of Women’s Health, 19(6), 1109-1116.
This review of the scientific literature concludes that gender
has a significant effect on TBI outcomes. The conditions that
determine when and how women or men might fare better or
worse are multi-factorial and include age, severity of injury,
timing of the assessments, and affected area(s) of the brain.
In general, females, particularly young girls and women of
childbearing potential, are more susceptible to sustaining new
and recurrent TBIs. Women deal with increased incidences of
migraines and reproductive changes after TBI. Trend analyses
indicate that post-TBI, women fare worse with visual memory
whereas men fare worse with verbal memory and executive
functions. Moreover, evidence suggests that psychosocial
effects of TBI are more detrimental to women than men.
Colvin, A.C., Mullen, J., Lovell, M.R., Vereeke West, R., Collins, M.W., Groh, M. (2009).
The Role of Concussion History and Gender in Recovery From Soccer-Related Concussion.
American Journal of Sports Medicine, 37:1699.
Covassin, T., Schatz, P., Buz Swanik, C. (2007). Sex Differences in Neuropsychological
function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery,
61:345-351.
Covassin, T., Elbin, R.J., Harris, W., Parker, T., Kontos, A. (2012). The role of age and
sex in symptoms, neurocognitive performance, and postural stability in athletes after
concussion. American Journal of Sports Medicine, 40(6):1303-12.
Covassin, T., Elbin, R.J., Bleecker, A., Lipchik, A., Kontos, A.P. (2013). Are there
differences in neurocognitive function and symptoms between male and female soccer
players after concussions? American Journal of Sports Medicine, 41(12):2890-2895.
Dick, R.W. (2009). Is there a gender difference in concussion incidence and outcomes?
British Journal of Sports Medicine, 43:i46-i50.
Other studies have published findings that are controversial to
the ones presented in this article. The discrepant results can
likely be explained by variations in the sample populations. In
other words, the contradicting studies did not use the same
criteria for selecting participants and/or performing analyses
as the studies discussed in this article. Given the inherent
difficulties surrounding the study of brain injuries, it is very
difficult for researchers to design trials that control for all of
the factors that could potentially affect the results. Some of
those factors include, but are not limited to, equal number
of male and female subjects, baseline test scores, timing
of post-injury testing, BMI, age, severity of injury, cause of
injury/specific sport, education level, concussion history, and
medical history, etc.
Farace, E. and Alves, W.M. (2000). Do women fare worse: a metaanalysis of gender
differences in traumatic brain injury outcome. Journal of Neurosurgery, 93:539–545.
Hootman, J.M., Dick, R., Agel, J. (2007). Epidemiology of collegiate injuries for 15
sports: summary and recommendations for injury prevention initiatives. Journal of Athletic
Training, 42:311–319.
Jensen, O.K. and Thulstrup, A.M. (2001). Gender differences of post-traumatic headache
and other post-commotio symptoms. A follow-up study after a period of 9-12 months.
Ugeskr Laeger, 164, 5029-5033.
Johan Styrke. Traumatic brain injuries and whiplash injuries: epidemiology and longterm consequences. Doctoral thesis, 2012.
Jung, R.E. and Haier, R.J. (2007). The Parieto-Frontal Integartion Theory (P-FIT) of
intelligence: Converging neuroimaging evidence. Behavioural and Brain Sciences, 30,
135-187.
McCauley, S.R., Boake, C., Levin, H.S., Contant, C.F., Song, J.X. (2001). Postconcussional
disorder following mild to moderate traumatic brain injury: Anxiety, depression, and
Given the anatomical, hormonal, and psychosocial differences
between men and women, it would be beneficial to consider
gender a factor when planning treatment, support, and return to
school/sports/work for TBI survivors. However, further research
is needed before gender-specific treatments can be developed
and new medical management guidelines established.
social support as risk factors and comorbidities. Journal of Clinical Experimental
Neuropsychology, 23, 792-808.
Powell, J.W. and Barber-Foss, K.D. (1999). Traumatic brain injury in high school
athletes. JAMA, 282:958–963.
Putukian, M., Echemendia, R.J., Mackin, S. (2000). The acute neuropsychological effects
of heading in soccer: A pilot study. Clinical Journal of Sport Medicine, 10, 104-109.
Schopp, L., Shigaki, C., Johnstone, B., Kirkpatrick, H. (2001). Gender differences
in cognitive and emotional adjustment to traumatic brain injury. Journal of Clinical
References
Psychology in Medical Settings, 8, 181-188.
Wagner, A.K., McCullough, E.H., Niyonkuru, C., Ozawa, H., Loucks, T.L., Dobos,
Agha, A., Rogers, B., Mylotte, D., Taleb, F., Tommy, W., Phillips, J., Thompson, C.J.
J.A., Brett, C.A., Santarsieri, M., Dixon, C.E., Berga, S.L., Fabio, A. (2011). Acute
(2004). Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clinical
serum hormone levels: characterization and prognosis after severe traumatic brain injury.
Endocrinology (Oxford), 60(5), 584-591.
Journal of Neurotrauma, 28(6):871-88. ◊◊◊
Alston, M., Jones, J., Curtin, M. (2012). Women and Traumatic Brain Injury: “It’s not
visible damage”. Australian Social Work, 65(1):39-53.
43
OBIA REVIEW
EDUCATION
Events Calendar
For more listings, check: www.obia.ca/events
Location: Four Seasons Hotel, Toronto, ON
Contact: Elisa O’Neill, Client Services Coordinator
Phone: 416-868-3195
Fax: 416-868-3134
Email: [email protected]
September 28, 2015
BIA Quinte District presents:
Empowering Your Rehabilitation: Today, Tomorrow and Yesterday
(originally scheduled for May 14, 2015)
Location: Core Centre, 2nd Floor, 223 Pinnacle Street,
Belleville, ON
Contact: BIAQD office
Phone: 613-967-2756
Email: [email protected]
October 6, 2015
June 10, 2015
BIST/OBIA presents:
11th Annual Mix and Mingle
Location: Steamwhistle Brewery, Toronto, ON
Contact: Terry Bartol
Phone: 905-641-8877 ext. 234
Fax: 905-641-0323
Email: [email protected]
June 20, 2015
Dale Brain Injury Services presents:
7th Annual HEADS UP Walk-a-thon for Brain Injury Awareness
Location: Springbank Gardens, London, ON
Contact: Lisa McIntyre
Phone: 519-668-0023 ext. 102
Email: [email protected]
Website: www.daleservices.on.ca
June 20, 2015
OBIA presents:
Annual General Meeting
Location: Room 318, Miles Nadal JCC, 750 Spadina Avenue,
Toronto, ON
Contact: Diane Dakiv
Phone: 905-641-8877 ext. 231
Fax: 905-641-0323
Email: [email protected]
September 10, 2015
The Personal Injury Alliance (PIA) presents:
Back to School Conference/2015 Awards of Excellence in Brain Injury
Rehabilitation
44
MRI Appointments presents:
Brain Injury Disagnostics Half Day Conference - What’s New and What You
Need to Know
Location: Windsor, ON
Contact: Deborah Crowe
Phone: 519-878-5839
Email: [email protected]
October 14-15, 2015
OBIA and Headwaters ABI Group (HABI) present:
Brain Basics
Location: Dufferin Child and Family Services, 655 Riddell
Road, Orangeville, ON
Contact: Diane Dakiv
Phone: 905-641-8877 ext. 231
Email: [email protected]
Website: www.obia.ca/brain-basics/
October 23-24, 2015
OBIA and Brock University present:
Children and Youth with Acquired Brain Injury
Location: Holiday Inn & Suites Conference Centre,
St. Catharines, ON
Contact: Diane Dakiv
Phone: 905-641-8877 ext. 231
Email: [email protected]
Website: www.obia.ca/brock-university-certificate-courses
November 11-13 2015
OBIA and participating Community Associations present:
2015 ABI Provincial Conference - Innovate Integrate Motivate
Location: Sheraton on the Falls Hotel, Niagara Falls, ON
Contact: Terry Bartol
Phone: 905-641-8877 ext. 234
Fax: 905-641-0323
Email: [email protected]
Website: www.ontarioabiconference.ca ◊◊◊
JUNE 2015
2015
Acquired Brain Injury
Provincial Conference
PRESENTED BY
INNOVATE
INTEGRATE
MOTIVATE
and PARTICIPATING
COMMUNITY ASSOCIATIONS
Register Now!
For more information
www.ontarioabiconference.ca
November 11 -13, 2015
Sheraton on the Falls Hotel
Niagara Falls, Ontario
Brain Injury Diagnostics
Half Day Conference
“What’s New and What You
Need to Know”
Tuesday, October 6, 2015 • 8 a.m. - 12 noon
Holiday Inn Hotel & Suites, 1855 Huron Church Road, Windsor, ON
Speakers
DR. YIN-HUI SIOW
DR. WILLIAM PAVLOSKY
Radiologist and Director of Nuclear Medicine,
Southlake Regional Health Center
Associate Professor, Schulich School of Medicine & Dentistry,
University of Western Ontario, Department of Medical Imaging
DR. DONALD LEE
DR. SAADIA AHMAD
Neuroradiologist,
London Health Sciences Centre
Clinical Neuropsychologist,
Faculty, Hotel Dieu Grace Healthcare
Program approved for 4 Substantive CEU’s through the Law Society of Upper Canada
All proceeds to be donated to:
Contact: Deborah Crowe • Telephone: 1-519-878-5839 • Email: [email protected]
45
OBIA REVIEW
SUPPORT
Community Associations
All recent changes to information marked in orange.
Call OBIA
1-855-642-8877
Toll Free
Support Line
1-800-263-5404
(HELPLINE)
Ontario Brain Injury Association
Dufferin County
(Mail) PO Box 2338,
St. Catharines, ON L2R 7R9
(Courier) 3550 Schmon Parkway, 2nd Floor,
Thorold, ON L2V 4Y6
Phone: 905-641-8877 or 1-855-642-8877
Toll-free support 1-800-263-5404
Fax: 905-641-0323
Email: [email protected]
Web Site: www.obia.ca
Headwaters ABI Group (HABI)
Belleville
BIA of Quinte District
223 Pinnacle Street, Core Centre
Belleville, ON K8N 3A7
Phone: 613-967-2756 or toll free:
1-866-894-8884
Fax: 613-967-1108
Email: [email protected]
Website: www.biaqd.ca
Chatham-Kent
New Beginnings ABI & Stroke Recovery Association
(2 Locations - Chatham and Sarnia)
9 Maple Leaf Drive
Chatham, ON N7M 6H2
Phone: 519-351-0297
Fax: 519-351-7600
Email: [email protected]
Website: www.newbeginnings-cksl.com
Contact: Bob Rawlinson
46
Orangeville, ON
Phone: 519-215-1519
Contact: Volunteer Intake Coordinator
Durham
BIA of Durham
#24 - 850 King Street West
Oshawa, ON L1J 8N5
Phone: 905-723-2732 or toll free:
1-866-354-4464
Fax: 905-723-4936
Email: [email protected]
Website: www.biad.ca
Contact: Frank Murphy, Exec. Director
Fort Erie
HIA of Fort Erie and District
649 Niagara Boulevard
Fort Erie, ON L2A 3H7
Phone: 905-871-7789
Fax: 905-871-7832
Email: [email protected]
Contact: Donna Summerville
Hamilton-Wentworth
Hamilton BIA
822 Main Street E.
Hamilton, ON L8M 1L6
Phone: 905-538-5251
Fax: 905-390-3649
Email: [email protected]
Website: www.hbia.ca
Contact: Adria Repp
JUNE 2015
London and Region
Peterborough Area
BIA of London and Region
Brain Injury Association Peterborough Region
560 Wellington St., Lower Level
London, ON N6A 3R4
Phone: 519-642-4539
Fax: 519-642-4124
Email: [email protected]
Website: www.braininjurylondon.on.ca
Contact: Donna Thomson
158 Charlotte St.
Peterborough, ON K9J 2T8
Phone: 705-741-1172
or 1-800-854-9738
Fax: 705-741-5129
Email: [email protected]
Website: www.biapr.ca
Contact: Cheryl Ann Hassan
Niagara Area
BIA of Niagara
Office: #10 - 261 Martindale Road,
St. Catharines, ON
Mail: PO Box 20019
Thorold, ON L2V 5B3
Phone: 905-984-5058
Fax: 905-984-5354
Email: [email protected]
Website: www.bianiagara.org
Contact: Pat Dracup
North Bay Area
BIA of North Bay and Area
c/o PHARA
280 Oakwood Ave.
North Bay, ON P1B 9G2
Phone: 705-840-8882
Fax: n/a
Email: [email protected]
Website: www.bianba.ca
Sarnia-Lambton
BIA of Sarnia-Lambton
#1032 - 1705 London Line,
Sarnia, ON N7W 1B2
Phone: 519-337-5657
Fax: 519-337-1024
Email: [email protected]
Website: www.sarniabiasl.ca
New Beginnings ABI & Stroke Recovery Association
Lochiel Centre
180 College Avenue North, 2nd Floor
Sarnia, ON N7T 7X2
Phone: 519-491-2668
Fax: 519-491-2632
Email: [email protected]
Website: www.newbeginnings-cksl.com
Contact: Bob Rawlinson
Sault Ste. Marie
BIA of Sault Ste. Marie & District
Ottawa Area
BIA of Ottawa Valley
211 Bronson Avenue, 3rd Floor
Ottawa, ON K1R 6H5
Phone: 613-233-8303
Fax: 613-233-8422
Email: [email protected]
Website: www.biaov.org
Contact: Wendy Charbonneau
PO Box 272
Richards Landing, ON P0R 1J0
Phone: 705-943-0424
Fax: n/a
Email: [email protected]
Website: www.braininjuryssm.ca
Contact: Elizabeth Eddy
Sudbury and District
BIA of Sudbury & District Branch
Peel-Halton
BIA of Peel & Halton
PO Box 47038
Sheridan Mall PO
Mississauga, ON L5K 2R2
Phone: 905-823-2221
or 1-800-565-8594
Fax: 905-823-9960
Email: [email protected]
Website: www.biaph.com
Contact: Jorun Rucels
2750 Bancroft Drive
Sudbury, ON P3B 1T9
Phone: 705-670-0200
Fax: 705-222-2427
Email: [email protected]
Website: www.biasd.ca
Contact: Sean Parsons
47
OBIA REVIEW
Thunder Bay
Waterloo-Wellington
BIA Thunder Bay & Area
BIA of Waterloo-Wellington
#217 - 1100 Memorial Ave.
Thunder Bay, ON P7B 4A3
Phone: 807-621-4164
Email: [email protected]
Website:
www.bisno.org/brain-injury-association-of-thunder-bay
#1-31 McBrine Drive
Kitchener, ON N2R 1J1
Phone: 519-579-5300
Fax: 519-579-0118
Email: [email protected]
Website: www.biaww.com
Contact: Patti Lehman, Exec. Director
Timmins
48
Seizure & Brain Injury Centre
Windsor-Essex
733 Ross Ave. E.
Timmins, ON P4N 8S8
Phone: 705-264-2933
Fax: 705-264-0350
Email: [email protected]
Website: www.seizurebraininjurycentre.com
Contact: Rhonda Latendresse
BIA of Windsor and Essex County
Toronto (GTA)
York Region
Brain Injury Society of Toronto
Brain Injury Association of York Region
#205-40 St. Clair Ave. East
Toronto, ON M4T 1M9
Phone: 416-830-1485
Email: [email protected]
Website: www.bist.ca
Contact: Michelle McDonald
11181 Yonge St., 3rd Floor
Richmond Hill, ON L4S 1L2
Office Voicemail: 905-780-1236
Fax: 905-780-1524
Email: [email protected]
Website: www.biayr.org
Contact: Bev Bristow
#200 - 201 West Grand Blvd.
Windsor, ON N9E 3W7
Phone: 519-981-1329
Email: [email protected]
Website: www.biawe.com
Contact: Mary-Ann Fuduric
JUNE 2015
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49
OBIA REVIEW
SUPPORT
Provincial Associations
Brain Injury Canada/Lésion Cérébrale Canada
200 - 440 Laurier Ave. West
Ottawa, ON K1R 7X6
Phone: 613-762-1222, Toll Free Line: 1-866-977-2492
Fax: 613-782-2228
Website: www.braininjurycanada.ca
Email: [email protected]
British Columbia Brain Injury Association
Newfoundland and Labrador Brain Injury Association
Sea to Sky Meeting Management Inc.
Suite 206, 201 Bewicke Avenue
North Vancouver, BC V7M 3M7
Phone: 604-984-1212
Fax: 604-984-6434
Website: www.brainstreams.ca
Email: [email protected]
PO Box 21063
St. John’s, NF A1A 5B8
Phone: 709-579-3070
Fax: n/a
Website: www.nlbia.ca/index.php
Email: [email protected]
Central Alberta Brain Injury Society (CABIS)
Regroupement des associations de personnes
traumatisées cranio-cérébrales du Québec
#202, 4805 - 48 Street
Red Deer, AB T4N 1S6
Phone: 403-341-3463
Fax: 403-346-1035
Website: www.cabis.info
Email: [email protected]
220, avenue de Parc
Laval, QC H7N 3X4
Phone: 450-575-8227
Fax: 514-274-1717
Website: www.raptccq.com
Email: [email protected]
Saskatchewan Brain Injury Association
Brain Injury Association of Nova Scotia
Mail: P.O. Box 3843
Regina, SK S4P 3Y3
Office: #322 - 310 Main St. N.
Moose Jaw, SK S6H 3K1
Phone: 306-373-1555 or
Toll Free (in Sask) 866-373-1555
Fax: 306-373-5655
Website: www.sbia.ca
Email: [email protected]
PO Box 8804
Halifax, NS B3K 5M4
Phone: 902-473-7301
Fax: 902-473-7302
Website: http://braininjuryns.com/
Email: [email protected]
Manitoba Brain Injury Association
50
Brain Injury Association of Canada (New Brunswick)
Phone: 506-721-8003
Website: www.biacnb.org
Email: [email protected]
204 - 825 Sherbrook St.
Winnipeg, MB R3A 1M5
Phone: 204-975-3280 or
Toll Free: 866-327-1998
Fax: 204-975-3027
Website: www.mbia.ca
Email: [email protected]
#5 - 81 Prince Street
Charlottetown, PE C1A 4R3
Phone: 902-314-4228 or 902-367-3216
Website: www.biapei.com
Email: [email protected]
Ontario Brain Injury Association
Alberta Brain Injury Association
PO Box 2338
St. Catharines, ON L2R 7R9
Phone: 905-641-8877 or 800-263-5404 (support)
855-642-8877 (admin)
Fax: 905-641-0323
Website: www.obia.ca
Email: [email protected]
Website: www.biaa.ca
Brain Injury Association of PEI
JUNE 2015
51
OBIA REVIEW
EDUCATION
OBIA Training
The Ontario Brain Injury Association in conjunction with Brock University has developed a Certificate Training Program to
provide professionals with the tools and knowledge to assist clients with recovery and function in everyday life following
acquired brain injury.
Brock Certificate Training Programs: The program is currently composed of two separate levels and feature guest faculty.
Both levels are directed primarily at personnel working in community and home based rehabilitation programs that serve
individuals with acquired brain injury.
Featured course
Children and Youth with Acquired Brain Injury
Approved by VRA Canada for 11.75 Continuing Education Hours
This Certificate Training Program will focus on providing
information about behaviours after ABI that relate to learning
and
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assessing and treating educational and social challenges
for these individuals from a functional perspective.
Details
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Hotels:
Professors:
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October 23 to October 24,
24 2015
Holiday Inn & Suites - 905.688.2324
Roberta DePompei, Ph.D
Some topics covered during this training program include:
52
•
Characteristics that impact learning and behaviour
•
Environmental scans and communication partners and
treatment strategies
•
Transitions, functional outcomes and collaborations
For more information about this and/or other
Certificate Training Programs
visit: www.obia.ca
905.641.8877
1.855.642.8877
[email protected]
JUNE 2015
DISCLAIMER:
Articles may be reproduced from
the OBIA Review provided credit
is given to the authors wherever
possible. Note: the opinions
expressed herein are those
of the respective authors and
advertisers and not necessarily
those of the Ontario Brain Injury
Association (OBIA). OBIA will
not be liable for any damages or
losses howsoever sustained, as a
result of the reliance on or use
by a reader or any other person
of the information, opinion, or
products expressed, advertised or
otherwise contained herein. Where
appropriate, professional advice
should be sought.
53
OBIA REVIEW
Advertiser Index
Bartimaeus Rehabilitation Services Inc. - 6
Bayshore - 37
Bergeron Clifford LLP - 24
Brainworks Rehabilitation - 54
Carranza Barristers & Solicitors - 22
Champaigne Klassen - 31
Community Solutions - 30
Dale Brain Injury Services - 53
Gluckstein Personal Injury Lawyers - 55
Henderson Structured Settlements LP - 26
Hill Program - 39
Himelfarb Proszanski LLP - 51
Inter-Action Rehabilitation Inc. - 54
Judith Hull & Associates - 8
Lawlor Therapy Support Services Inc. - 53
Mazin Associates - 20
McKellar Structured Settlements - 2
McLeish Orlando - back cover
Melamed, Beverlee C. - 54
Mindworks - 40
NHI Health Care - 37
NRIO - 40
Oatley, Vigmond LLP - 9
Pathways to Independence - 6
Rehab First - 34
ResCare Premier - 22
Shekter, Dychtenberg - 35
Singer, Kwinter - 36
Step Up! ABI Recovery - 49
Thomson Rogers Lawyers - 15
Wallbridge Wallbridge - 32
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JUNE 2015
55