Categories of Care: What They Are, and Why They Matter

Using Help to Pinpoint Proper Care Following Brain Injury After a brain injury, many survivors require help in one form or another. Some people require extensive support, while others need only a limited amount of services. This is often reduced with time and rehabilitation, but chronic complications with some injuries may create an increased need for assistance years after a diagnosis is made. Identifying the help that is needed is often a fluid, unfolding process; but being aware of the different categories of caregiving options can provide guidance when searching for the correct level of support. In persons with brain injury, the amount of outside assistance required to carry out essential functions in everyday life is formally known as acuity. An interdisciplinary team of neurological professionals can help determine a person’s acuity by identifying what, if any, supports are needed. By reviewing documentation and collaborating with caregivers who provide supporting information about behaviors they observe from their clients or loved ones, risks, and care needs are identified relating to three specific areas:

  • Tasks of Self-Care: Personal care activities like dressing and bathing are often referred to as basic activities of daily living (BADL). More advanced tasks that require deeper thinking elements, such as scheduling or budgeting, are considered independent activities of daily living (IADL). If an individual needs assistance when carrying out either — or both — of these categories of self-care tasks, they are in need of what’s called attendant care. Attendant care provides hands-on assistance with physically managing daily routines that may be limited by weakness, fatigue, or thinking problems like memory or attention. Generally, attendant care is hands-on care provided to make up for physical limitations of an injury.
  • Replacement Services: Some survivors struggle with effectively carrying out typical responsibilities around the home, such as yard work, childcare, or home repairs. In these cases, they may need to assign or purchase these services for others to do. These needs are called replacement services, and are considered another category of caregiver support.
  • Protective Supervision: Brain injury can create an inability for individuals to recognize problems or advocate for help. Protective supervision is care that stands in reserve, monitoring for emerging risks, and stepping in with support when an injured person demonstrates behaviors that might lead to harm if left unchecked. Protecting a person from fall risk when he or she is unaware of poor motor skills, monitoring a meal for choking risks, or providing orientation support for a person with confusion are examples of why protective supervision is often necessary.
Acuity isn’t only about identifying the type of help an individual needs, however. Acuity also determines the coverage and intensity of this assistance. In other words, it identifies how much and how demanding the support can be. Coverage refers to the portion of the day or specific times when help is needed. This may be expressed as supervision hours (e.g. up to six hours daily), or for specific events or portions of the day, like during mealtimes or supervision during waking hours only. Intensity considers the demand of a caregiver’s attention. In hospitals and rehab facilities alike, this is often referred to as a ratio of supporting persons to the number of people they are helping. People with severe injuries may need someone to provide assistance exclusively to them (1:1 support), while others may be safe with an assistant who helps them along with two others at the same time (3:1 support). Intensity also factors in the distance these caregivers can be from their patients; whether that be to stay within an arm’s length at all times, or simply making sure an individual is within their line of sight. Being familiar with each category of care — and identifying exactly where a patient falls within them — can greatly help when advocating for the correct and necessary support an individual needs. Professional assessments that pinpoint the precise what, when, and how much help a person requires, as well as careful documentation by healthcare providers and caregivers that support these findings, not only improves opportunities for ongoing coverage from funders, but also allows a person the best chance at success and fulfillment in their lifestyle following brain injury. Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Director of Neuro Rehabilitation
Licensed Psychologist

Hope Network Neuro Rehabilitation

Look Twice, Save A Life! Loud Pipes Save Lives!

Many are familiar with the motorcycle safety public service announcements that resurface each year. With the beautiful Michigan summer in full swing, motorcyclists are eager to hit the roads, making these safety reminders especially important. Whether you are in a vehicle or on a motorcycle, taking extra precautions can keep everyone safe on the roads. For a refresher on safely sharing the roads with motorcyclists this summer, view this article from Michigan.gov. For anyone who prefers a motorcycle to a car this time of year, here are few simple, but important reminders to keep you safe this season.
  • Ride defensively: Always be aware of the vehicles in your surrounding area. At stop signs, take caution and never assume the other drivers will stop! Car drivers are often the cause of motorcycle accidents. With distracted driving on the rise, being defensive and aware while on a motorcycle is more important than ever.
  • Select the Right Ride: Purchasing a motorcycle that is properly suited for your height and size is essential. When selecting a motorcycle, ensure your feet are easily resting on the ground and the handlebars and controls are within easy reach.
  • Make Time for a Tune Up: In addition to tuning up your motorcycle, see if your riding skills are in need of a tune up as well. If your riding skills are a little rusty, sign up to take the Motorcycle Safety Foundation (MSF) riding course. This course covers the basics as well as some advanced riding techniques. As an added bonus, taking this course may qualify you for an insurance discount.
  • Dress for Success: Wear clothing that will protect you from wind, flying bugs, debris, and road rash. Avoid clothing items such as shorts, tank tops, and t-shirts.
  • Protect Your Head: Riders who do not wear helmets have a much higher risk of fatality. If you are injured in a motorcycle accident, you are also three times more likely to sustain a head injury if you do not have your helmet on. Helmets save lives; grab yours before hitting the road.
  • Protect Your Eyes: If you do not wear a full-face helmet, make sure you have the proper eye protection. You never know what you may encounter on the roads; take this small precaution to ensure your eyes are safe.
  • Avoid bad weather: Rain makes the pavement slippery, reduces your margins for error and decreases your overall visibility. Watch for road hazards including potholes, sand, gravel, wet leaves, and grass.
Following these simple, but important, safety tips can make the roads safer for everyone this riding season. April Toivonen, MA, CCC-SLP, CBIS
Language Pathologist (and avid motorcyclist)
Origami Brain Injury Rehabilitation Center

Being Mindful on Independence Day

Independence Day can be a time to celebrate for many. It is a time to spend with family, enjoy rest and relaxation, and even revel in the excitement of fireworks. For those with a brain injury, though, this holiday may look and feel very different. Brain injury can bring many unpleasant symptoms, including physical changes (fatigue, pain), photophobia (light sensitivity), overstimulation to noises and crowds, and many emotional changes like anxiety and depression. Despite all of the changes that survivors feel on the inside, brain injury is often referred to as “an invisible injury” because others may not recognize the individual has sustained a brain injury. Many of the cognitive, emotional, and physical changes are unnoticeable to others on the outside. What used to be pleasant holidays and get-togethers, like Independence Day, may pose a variety of challenges for those with brain injury. Some individuals with brain injury may even be living with a mental health condition known as Post-Traumatic Stress Disorder (PTSD). PTSD can develop after exposure to a traumatic or life-threatening event, such as a car accident, a fall, or combat-related incident in the military. PTSD may mean that someone experiences flashbacks, nightmares, or is overly aware of their surroundings. For Independence Day, fireworks may be an unpleasant reminder of the trauma they experienced. The good news is there is hope for those with brain injury to endure and enjoy the holidays once again, with small changes to their usual traditions. Here are a few tips for individuals with brain injury, as well as their support system, for navigating this upcoming holiday. Tips for Individuals with Brain Injury
  • Plan ahead: speak with family and friends to identify a safe and enjoyable way to enjoy the holiday
  • Manage fatigue: be well-rested leading up to the celebration and take breaks when needed
  • Reduce sensory overstimulation: taking noise-cancelling earphones, sunglasses, or hats may reduce the sensory input during fireworks and around large crowds
  • Choose your location carefully: if you choose to enjoy a live celebration of fireworks, choose a seat furthest away from the action
  • Explore your options: forego the live fireworks and watch them from the comfort (and quietness) of your home
Communication Tips for Brain Injury Supporters
  • Ask first: ask the person with brain injury their preference for activities for the holiday
  • Offer support: if they choose to sit out on certain activities, join them and provide company
  • Find a balance: compromise on traditions and swap out events with new activities your loved one is most comfortable with
  • Have a back-up plan: identify alternative activities if your loved one is not feeling up to the festivities at that time
  • Plan your escape: in the event that your loved one is triggered by something during the activity, have a plan for minimizing distress and moving to a more comfortable place
These are just a few ways for everyone to show their understanding and support for individuals with brain injury during this holiday season. Dr. Amanda Lopez PhD, LP, CBIS
Psychology Supervisor
Origami Brain Injury Rehabilitation Center

To Drive or Not to Drive? Getting Behind the Wheel after a Traumatic Brain Injury

Driving is the ultimate symbol of independence and control. Losing the ability to drive after a traumatic brain injury (TBI) may feel devastating and can greatly affect a person’s quality of life during recovery. But considering that driving is one of the most dangerous activities we do on a daily basis, the decision of if and when to return to driving can be complex. Safe driving requires a number of skills which may be altered after a TBI including:
  • Visual acuity and perception
  • Memory to recall directions or destination
  • Hand-eye coordination
  • Reaction time
  • Safety awareness and judgment
  • Sustained and alternating attention
  • Range of motion and strength of arms, legs and neck
  • Confidence behind the wheel
  • Anxiety level
Research indicates that 50-70% of people with moderate to severe TBI will return to driving regardless of recommendations from their healthcare team or safety concerns (Schultheis & Whipple, 2014) (Classen, 2009). That’s why it’s important for TBI survivors to discuss and address return to driving with their healthcare team openly and honestly. As a first step in the path towards returning to drive, therapists are able to incorporate pre-driving skills into therapy sessions. These pre-driving therapy sessions focus on remediating, refining and strengthening any of the above skills that may impact driving ability or safety. Many rehabilitation providers offer pre-driving screenings or programming to jumpstart the process. After pre-driving skills are mastered, TBI survivors can benefit from working with a Certified Driving Rehabilitation Specialists (CDRS) for on-the-road training. These experts also assist in obtaining and practicing the use of adaptive equipment. Various types of equipment such as hand controls and adaptive steering wheels can be used if traditional foot pedals or wheels are not optimal. A CDRS can even help coordinate securing an adaptive vehicle with ramp access and modified seating if necessary. Safe return to driving after a traumatic brain injury is possible with the right training and resources. The first step toward safely getting behind the wheel after a traumatic brain injury is starting a conversation with the rehabilitation team.

References:

  • Classen, S. e. (2009). Traumatic brain injury and driving assessment; and evidence-based literature review. American Journal of Occupational Therapy, 580-591.
  • Schultheis, M. T., & Whipple, E. (2014). Driving after traumatic brain injury:evaluation and rehabilitation interventions. Current Physical Medicine and Rehabilitation Reports, 176-183.
Angela West, MSOT, OTRL
Occupational Therapist + Therapy Best Practices Coordinator
Special Tree Rehabilitation System

Brain Injury Association of Michigan: One-Sided No-Fault Reform Bill Doesn’t Go the Distance

Association joins Gov. Whitmer and House Democrats in calling for strong consumer protection, permanent rate relief, and long-term solutions

FOR IMMEDIATE RELEASE For more information:
Janna Wilson
(248) 810.229.5880 LANSING, Mich. (May 9, 2019) – The passage of SB1 and HB 4397 may now be a reality, but those who protect consumers want more. In response, President and CEO of Brain Injury Association of Michigan (BIAMI) Tom Constand issued the following statement: “We thank Gov. Whitmer and House Democrats for standing up for Michigan consumers in rejecting the bill as written. Although it addresses the basic tenets of reform, it does little to ensure a permanent solution. Moreover, instead of allowing for constructive committee discussion and debate, this 82-page bill was railroaded through the House in the middle of the night with no opportunity for thoughtful deliberation.” “We are looking for fair, reasonable and sustainable legislation that provides strong consumer protections, offers immediate rate relief and protects benefits for the insured. This bill provides weak concessions that don’t ensure ongoing rate relief, provides a pittance of coverage options, and will leave survivors and their families even more exposed to the unethical and predatory practices of the insurance industry. We must do better than this.” About the Brain Injury Association of Michigan
The Brain Injury Association of Michigan is dedicated to enhancing the lives of those affected by brain injury through education, advocacy, research and local support groups, and to reducing the incidence of brain injury through prevention. Founded in 1981, Brighton, Michigan-based BIAMI is a national leader in its efforts on behalf of the approximately 200,000 Michigan residents who live with disabilities as a result of a brain injury.

###

Brain Injury Association of Michigan
7305 Grand River, Suite 100
Brighton, MI 48114-7379
BIAMI.ORG

If you support Governor Whitmer, please add your name to our petition on Change.org.

What Is A Concussion and How Do We Treat It?

One of the hot topics right now in the world of brain injury is Concussion Prevention and Treatment. In order to fully be able to discuss this topic, we first have to understand and answer this question: What is a Concussion? Newer research has shown that a concussion happens from acceleration or deceleration of the brain inside of the skull. This can happen from activities such as a hit directly to the head or body as in contact sports, falls, military activity, or motor vehicle accidents. This acceleration/deceleration of the brain causes stretching of the brain tissue and creates an excitatory response that places the brain in an energy deficit resulting in any of the below symptoms. Symptoms are typically temporary and usually dissipate by 8-10 days. What are some signs and symptoms of a concussion?
  • Loss of Consciousness (only occurs in ~10% of all concussions!)
  • Seizures
  • Delayed verbal/motor responses
  • Confusion/Disorientation/Memory deficits
  • Lack of focus/Concentration
  • Speech disturbances such as slurred speech
  • Balance/Incoordination
Sports are one of the leading causes of concussion resulting in approximately 3.8 million concussions per year in the United States. Rugby, ice hockey, football, and soccer are the top high-risk sports for both men and women due to the amount of contact. The large number of concussions sustained from sports has led to a push for prevention measures such as advancements to helmets. Research has shown that the use of a properly fitting helmet may reduce the risk of the severity of the symptoms of a concussion; however, there is lack of evidence supporting the use actually reducing the number of concussions sustained. Since concussions cannot be completely prevented, we now need to look at treatment! Due to the wide variation of symptoms that can present following a concussion, a comprehensive treatment plan should be utilized. The brain accounts for approximately 2% of our body weight and it takes approximately 20% of our blood supply! Why is this important? A concussion can temporarily reduce blood flow to the brain by up to 50%! This makes exercise one of the most crucial treatment options for an individual following a concussion. Treatment will be based on the presentation of symptoms and following Return-to-School and Return-to-Play guidelines and only moving to the next stage if they are symptom-free for 24 hours. What kind of treatments should be used?
  • Rest
  • Nutrition
  • Physical Exercise
  • Visual and Vestibular Retraining
  • Cervical Spine-Alignment and Musculature Issues
  • Balance Retraining
What does the Return-to-School and Return-to-Play Guideline look like?
  • Rest Initially 24 hours
  • Light Cognitive Activity
  • Half Day of School
  • Full Day of School
  • Clearance for Physical Activity
  • Light Non-Contact Sport Specific Activity
  • Higher Intensity Non-Contact Sport Specific Activity
  • Full Contact Sport
  • Return to Competition
An important fact to remember is that typical concussion symptoms dissipate in 8-10 days; however, the brain metabolic state (no longer being in an energy deficit) does not return to its own baseline until 22-30 days after an injury. Why is this important? Three words: Second Impact Syndrome. If there were to be another concussion prior to the brain reaching its metabolic baseline, the effects of the first concussion can now be compounded, thus placing the individual at an increased risk for permanent deficits or even death. Comprehensive Baseline Testing can assist with not only making sure all aspects of the individual's brain function, including both physical and cognitive aspects, have returned to their baseline. The testing also significantly assist clinicians in the Return-to-Play decision. Early comprehensive treatment of concussion can also decrease the time that symptoms are experienced thus reducing the likelihood of Post-Concussion Syndrome (where the concussive symptoms last greater than 2 weeks). In summary, a concussion can and should be treated with a comprehensive approach and in a collaborative effort between the individual and their family, a trained rehabilitation professional, a physician, school administrators, and coaches. This collaborative approach will help minimize the possible long-term effects of a concussion.

References:

  • Prien, Et al. “Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review” Sports Med. 2018 Apr:48(4):953-969.
  • Langlois Et al. “The epidemiology and Impact of Traumatic Brain Injury: A Brief Overview” Journal of Head Trauma Rehabilitation: September-October 2006: Vol21. Issue 5. Pg 375-378.
  • Patel, Et Al. “Aerobic vs anaerobic exercise training effects of the cardiovascular system” World J Cardiol. 2017 Feb 26:9(2):1324-138.
  • Viano Et al. “Concussion in professional football: biomechanics of the struck player part 14” Neurosurgery. 2007 Aug:61(2):313-327.
Karley Glashauser, PT, DPT, CBIS, CF-L1 Physical Therapist, The Lighthouse Neurological Rehabilitation Center

Karley graduated with her Doctorate of Physical Therapy from Central Michigan University in May of 2009. She has been employed at The Lighthouse Neurological Rehabilitation Center, Caro location, since July of 2009. Karley has continued education in the areas of Hippotherapy, NDT, and Concussion Management. Karley is also a CrossFit Level 1 Trainer at Davison CrossFit and Flint CrossFit with a special certification in Adaptive CrossFit.

Dignitas
Eisenhower Center
Special Tree
Community Connections
rainbow_logo
Lightouse Neurological Rehabilitation Center