What is Therapeutic Recreation?

February is National Therapeutic Recreation Month. If you’re wondering what therapeutic recreation is, you’re not alone. It’s the question recreational therapists get asked the most! Therapeutic recreation uses recreational and leisure activities to promote well-being and overall fitness with the goal of improving, maintaining or restoring physical strength, cognition, and mobility for individuals with a disability or illness. Recreational therapists get to know each patient and what motivates them so they can participate in enjoyable leisure activities to address functional skills for recovery. In a rehabilitation setting, recreational therapists work closely with a patient’s rehabilitation team to help them achieve their therapy goals. Recreational therapy, as it’s also known, encompasses a wide array of activities that focus on community integration, exercise and strength training, sports specific adaptations, and aquatic therapy/aquatic exercise. An activity is considered recreational therapy when it’s used as a treatment modality to maximize skill development and improve quality of life. For example, participating in a leisure activity in the community may increase life satisfaction while also connecting a person to community resources, improving time and money management skills, and increasing confidence in getting from one place to another. Recreational therapy can be very beneficial for a person who has sustained a TBI. After a brain injury, a person may experience various lifestyle changes which may include a decrease in leisure participation, increase in free time, loss of income, decrease in social skills which affects old friendships and establishing new ones, a shift to more sedentary activities, and less social activities. Experiencing these changes can have a negative impact on life satisfaction and quality of life. When an individual is ready to return to leisure interests, recreational therapy can address these changes to help individuals find new ways to enjoy life which also positively impacts the recovery process. Kristin Claerhout, CTRS, CBIS
Certified Therapeutic Recreation Specialist
Special Tree Rehabilitation System
Brain + Spinal Cord Rehabilitation

How to Decrease Your Risk of Falling Following a Brain Injury

Along with ringing in the New Year, January is sure to bring plenty of snow and ice! The onset of slippery conditions can cause an increase in incidences of falls. Though the majority of falls only result in mild injuries such as muscle soreness or bruising, approximately 10% of falls result in a trip to the emergency department. Some falls may be unavoidable, but being informed of the risks and actively making changes can reduce the risk of falling. With 30-65% of people with brain injuries reporting balance deficits at some point during recover, it is especially important for survivors to be aware of the facts that make them more susceptible to falling. Factors to Consider: Are you over 65 years old? Approximately 1 out of 4 people over the age of 65 experience a fall every year, with falls being the leading cause of injuries in this population. Do you take multiple medications? Individual medications or interactions between multiple medications may cause an increase in risk of falling. Researchers have found that certain classes of medications including sedatives and antidepressants may contribute to increased falls risk. If you notice an increase in falls with the start of a new medication, be sure to contact your physician. Have you fallen more than once in the last year? Previous falls are an indicator of an increased likelihood for subsequent falls. If you have previously fallen it is very important to take preventative measures to avoid reoccurring falls. Do you have vision deficits? Vision is an important component of balance, and having vision deficits significantly increase the risk of falls. Blurred vision, double vision, and other visual impairments are common after a brain injury; therefore, it is important to follow up with your optometrist or ophthalmologist if you suspect any changes in your vision. They may make changes to your eye glasses or refer you to an occupational therapist for vision therapy. Do you have impaired sensation in your legs? It is common to experience decreased sensation or proprioception, the perception of movement and positioning of our body, following a brain injury or due to other chronic conditions such as diabetes and peripheral neuropathy. This can cause individuals to trip on objects or lose their balance. Are you depressed? Studies have shown a correlation in increased falls with depression likely due to cognitive, sensory, and motor changes that may occur with brain injuries. Consider talking to your physician, social worker, or counselor if you believe you are experiencing depression. Do you experience dizziness? Dizziness can be a symptom of many conditions including damage to the vestibular system, changes in vision, medication symptoms, or other medical conditions. If you are experiencing dizziness it is advised to consult with your physician. They may refer you to an Ear Nose and Throat Specialist, ophthalmologist or to a vestibular physical therapist depending on the cause. Are you mostly inactive? A decrease in activity can lead to poor cardiovascular endurance and flexibility, as well as weakened muscles, which can increase your risk for falls. Ask your physician if you are able to participate in a regular exercise program, and consider consulting a physical therapist or another expert for a custom exercise program to meet your needs and goals. Do you experience incontinence?Incontinence is associated with an increase in falls due to impulsive and unsafe behavior occurring when a sudden urge to urinate occurs. Depending on the type of incontinence and the severity, different techniques such as utilizing caregiver assistance, bed pans, pads, or Kegels may be appropriate. A pelvic floor specialist can aid with decreasing episodes of incontinence. If you answered yes to any of these questions, you might be at an increased risk for falling. Many brain injury survivors may have answered yes to many of the above questions; because of this, individuals who have experienced a brain injury have a significant increased risk of falling. Although some risk factors such as age are out of our control, many others may be modified to reduce your risk. If you believe you or a loved one is at an increased risk for falling, there are some simple modifications that can be made to decrease the risk:
  • Remove tripping hazards such as rugs or uneven thresholds in your home
  • If you use an assistive device, make sure you are using it correctly
  • Wear supportive shoes with a rubber sole to prevent shuffling feet and slipping.
  • Use night lights in order to increase visibility at night. Alert systems can be used for individuals requiring more assistance.
  • Shovel snow and apply salt to reduce the risk of slippery sidewalks
These tips can reduce your likelihood of falling and incurring an injury. If you have notice any recent changes or have questions regarding your balance, please contact your physician.

Emily Wolf, PT, DPT

Physical Therapist, The Lighthouse Neurological Rehabilitation Center

References

  • Kallin, Kristina, et al. "Predisposing and precipitating factors for falls among older people in residential care." Public health 116.5 (2002): 263-271.
  • Lord, Stephen R., Hylton B. Menz, and Catherine Sherrington. "Home environment risk factors for falls in older people and the efficacy of home modifications." Age and ageing 35.suppl_2 (2006): ii55-ii59.
  • Peterson, Michelle, and Brian D. Greenwald. "Balance problems after traumatic brain injury." Archives of physical medicine and rehabilitation 96.2 (2015): 379-380.
  • Thurman, David J., Judy A. Stevens, and Jaya K. Rao. "Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology 70.6 (2008): 473-479.
  • Woolcott, John C., et al. "Meta-analysis of the impact of 9 medication classes on falls in elderly persons." Archives of internal medicine 169.21 (2009): 1952-1960.

Emily graduated from Arcadia University with a Doctorate of Physical Therapy. Her academic focus was primarily on treatment of adolescents and adults post-concussion. She has been practicing as a physical therapist at The Lighthouse Neurological Rehabilitation Center in Kingsley, Michigan since 2017.

It’s the most wonderful time of the year…or is it?

Some helpful tips for holiday cheer following a TBI

The holidays are fast approaching and are typically associated with excitement, family gatherings, music, delicious food and lights! While all of these aspects of the holidays are wonderful, they can be incredibly challenging for someone with a traumatic brain injury (TBI) to navigate and manage. Various symptoms of TBI can impact how one perceives the holidays: experience of sensitivity to light and sound, increased headaches or migraines, issues with processing information, challenges with energy levels, struggles with accurately interpreting social cues, trouble with controlling emotions, and difficulty with planning or initiation.
There is hope! Many steps can be taken to ensure the holidays are enjoyable for individuals with TBI and their family members. Here are a few identified by Brainline.org’s online community:
  1. Identify in advance - a quiet place to go at gatherings if you are feeling overwhelmed. This gives you a chance to take a break, and lets your loved ones stay involved in the festivities.
  2. Avoid crowded stores and order gifts online instead.
  3. If you are shopping in stores, remember to make a list in advance and plan your trips on week days - either early in the morning or late at night when there are fewer crowds.
  4. Wear a cap with a brim or lightly tinted sunglasses to minimize the glare of bright lights in stores or flashing lights on a tree.
  5. Wear noise-reducing headphones or ear buds. These are also great gift ideas for loved ones with TBI if they don’t already have them.
  6. Ask a friend to go with you to stores or holiday parties. They can help you navigate crowds and anxiety-producing situations.
  7. Plan in advance as much as possible. Ask your hosts what their plans are so you aren’t surprised by anything.
  8. Volunteer to help with the holiday activities that you enjoy the most and are the least stressful for you.
  9. Remember to ask for help and accept help if it is offered to you.
  10. Ask someone you trust to help you with a budget to avoid overspending on gifts.
  11. Take a nap if you need a break.
  12. Remember that it’s okay to skip the big parties and plan to celebrate in a way that makes you comfortable and happy.
  13. Check in advance to see if fireworks are part of outdoor celebrations - and skip them if they make you uncomfortable.
  14. If flashing lights bother you, ask your friends and family to turn off the flashing feature on Christmas tree lights or other decorations when you visit their homes.
  15. You can let your host know in advance that you may need to leave early. It will help you feel comfortable if you need to get home or to a quiet place, and it can also help avoid any hurt feelings.
The more support that family and friends can offer to a loved one when they are struggling or identifying what they may need for relief, the more successful they will be with effective implementation of these strategies. Here are a few tips:
  1. Have this list handy to help remind your loved ones of skills they can engage in, while also increasing your own awareness of what can be done to help.
  2. Keep an eye on them. If you notice they are disengaging, demonstrating signs of pain (i.e., holding their head, closing their eyes, tensing their muscles) or struggling with keeping up in conversation, gently suggest utilizing some strategies for relief.
  3. Be flexible. Often times your loved one may not know exactly how an environment will trigger them until they are there, even if they plan for it. Be open to plans changing a bit.
  4. Be available. As amazing as the holiday season can be, it will most likely pose some of the greatest challenges for your survivor. They may rely on your support to make it through.
  5. Ask for help yourself. You do not have to be the only one providing support. Let others know when you need a break.
Hopefully these tips will promote a safe and happy holiday season! If you need more support, consider reaching out to one of these local resources: https://www.biami.org/ https://www.apa.org/helpcenter/index.aspx https://www.brainline.org/ https://www.origamirehab.org/

Reference:

  • 15 Tips for Surviving - and Enjoying - the Holidays with Brain Injuries. (2013, November 21). Retrieved from https://www.brainline.org/article/15-tips-surviving-and-enjoying-holidays-brain-injury
Dr.Jayde Kennedy, PhD, LP, CBIS
Clinical Psychologist, Origami Brain Injury Rehabilitation Center

Dr. Kennedy graduated from The Chicago School of Professional Psychology in Los Angeles with a PsyD in Clinical Psychology in 2014. Her academic focus was primarily on treatment for children and adolescents. Her practicum, internship, and fellowship experiences allowed her the opportunity to work with a variety of populations including children, adolescents, teens, adults, and geriatrics. Dr. Kennedy has practiced in several settings including, outpatient, inpatient, community mental health, and residential treatment utilizing individual and family therapy modalities. She has been a member of the Origami Brain Injury Rehabilitation team since 2015.

Seizure Disorder and Brain Injury

November is Epilepsy Awareness Month, a time of the year to help promote awareness and educate the general public about epilepsy and seizures. One of the common challenges seen with brain injury is seizure disorder – more commonly known as epilepsy. Epilepsy and seizure disorder are terms often used interchangeably, but there are distinct differences. Seizures are the individual events of a sudden loss of control of functions associated with normal brain activity. They are sudden, temporary episodes of brain dysfunction, caused by the abrupt, non-purposeful discharge of electrical activity in the brain. Typically lasting 1-5 minutes, they are characterized by changes in sensation, emotional experience, motor control, and levels of consciousness. Epilepsy is the general term for a variety of neurological conditions characterized by recurrent unprovoked seizures – it’s the fourth most common neurological disorder in the United States. And, approximately 110,000 people in Michigan are diagnosed with epilepsy. In about 60% of cases, there is no known cause. Among the remaining 40%, brain injury is one of the most frequent causes. Most common with brain injuries are partial seizures, which typically arise from scar tissue from the injury. Partial seizures affect only one portion of the brain and have more limited symptoms such as visual distortions, odd sensations, unexplained emotional experiences, or non-purposeful behaviors or jerking movements. Sometimes, partial seizures spread and become generalized (Grand Mal), before they resolve. Grand Mal seizures involve a loss of consciousness and uncontrolled shaking as all muscle groups receive an overload of messages for movement. If a person has more than one seizure in a short period of time without recovering consciousness, or does not resolve a seizure episode within 5 minutes, it is called Status Epilepticus – and is a medical emergency. There are many types of seizures. Any initial occurrence of a seizure warrants medical attention as it is a sign that something is not right with the brain. Common causes are electrolyte imbalance, dehydration, fever, sleep deprivation or exhaustion, a new neurological injury such as bleeding or hydrocephalus, medication or illicit drug side-effects, or genetic predisposition. Some seizures are idiopathic, not known to be caused by anything in particular. Other times, seizures may have no clear physiological component, thought to be caused by neuropsychiatric features. Careful diagnosis of new-onset seizures is critical to appropriate treatment. Approximately 10% of individuals with brain injuries severe enough to require hospitalization have seizures. Seizures at the time of injury are quite common, but are not always an indicator of later problems with seizures. Seizures associated with the time of injury possibly represent a different type of convulsive phenomena. In later appearing seizures, those with open head injuries are associated with a higher risk. There are relationships between the severity and occurrence of injuries. Individuals with a severe traumatic brain injury are 29 times more likely than the general population to have epilepsy. When seizures appear later in recovery they are often more persistent, with 80% experiencing at least one more seizure. When seizures occur, or where sufficient risk factors are present, medication may be required to prevent or control them. In about 80% of cases, seizures can be controlled with medication. For others, surgery may be used to eliminate the likely source of irritation. Behavioral strategies associated with maintaining a healthy lifestyle such as good sleep, diet, hydration, and appropriate medication use are also critical. The effects of substance misuse, like alcohol withdrawal, and misuse of some types of medicines, can also increase seizure risk. There are many implications associated with seizure disorder including safety risks, loss of driving privileges, mortality risks, mental health vulnerabilities, as well as the social stigma still unfairly endured by persons with epilepsy and brain injury. Accommodations can help minimize these influences on adjustment. Support may include allowing additional time for tasks, pacing activities to limit fatigue, managing stimulation levels from noise or distractions, facilitating transportation or providing safe activity alternatives. Such supports help keep people with brain injury and seizures active and included, participating as part of their communities. First aid for seizures is largely supportive, providing protective monitoring with vigilance to provide assistive resuscitation in extreme events. While sometimes a frightening and challenging symptom to manage, people with epilepsy and brain injury have many resources and treatment options to support the successful management of these symptoms. Web Resources:
Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Licensed Psychologist
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation

Rockin’ for Rehab 2018

While Rockin’ for Rehab has always been a hugely successful event benefiting our Lansing chapter, we’re working hard to re-imagine the evening of food, drink, music, and fun so that it benefits not just Lansing, but our Flint and Tri-Cities (Saginaw/Bay City/Midland) support groups as well! More good news: We’re also exploring how to provide transportation for survivors who wish to attend Rockin’ for Rehab. Details will be shared as soon as possible, but for save-the-date purposes, this year’s Rockin’ for Rehab will be held Friday, December 7, at the Michigan State University Club from 6:30 pm – 11:30 pm. Perennial favorite Dr. Fab and his Off the Couch Band will perform your favorite hits from the 1950’s – 60’s. Admission is $65 per person. For attendees desiring hotel accommodations, a block of rooms has been set aside at the adjacent Candlewood Suites. When making reservations, be sure to use the block name “Rockin’ for Rehab-BIAMI” and enter block code “RFR” to reserve a room. Candlewood Suites reservations can be reached at (517) 351-8181.

Quality of Life Conference 2018

BIAMI is excited to announce we’re expanding this year’s Quality of Life Conference to include four new, informative, and very timely sessions. Here’s a sneak preview:
  • Dealing with Phone, Mail, and E-scams, presented by the Michigan Attorney General’s office
  • Sexuality and Relationships after a Traumatic Brain Injury, presented by Deborah Adams from Eisenhower Center
  • Healthy Eating for a Healthy Brain, with Dr. Sarah Wice and Emily White from Origami Brain Injury Rehabilitation
  • Creating Your Recovery Based on Your Unique Talents, presented by Courtney Wang from Galaxy Brain and Therapy Center and survivor Barbaranne Branca.
As always, one of our major Conference objectives is to ensure all attendees have access to transportation services should they need it, regardless of location. We’ll pass along further transportation information as we line up sponsors. The Quality of Life Conference will be held November 5 at the Crown Plaza in Lansing from 9 AM to 3:00 PM. Registration is open to survivors, caregivers, and professionals, so make plans to join us for a positive and rewarding experience!
Dignitas
Eisenhower Center
Special Tree
Community Connections
rainbow_logo
Lightouse Neurological Rehabilitation Center