RAINBOWVISIONS - Brain Injury Rehabilitation Centers · 2019-03-16 · Understanding DISORDERS of...

RAINBOWVISIONSFor and about the brain injury and spinal cord injury community. Rainbow Rehabilitation Centers, Inc.

FALL 2018 Volume XV No. 3

rainbowrehab.com

• PRESIDENT'S CORNER

A Look Back in Time–Buzz was ‘all in.’ By Bill Buccalo, President & CEORainbow Rehabilitation Centers

It was April 1988. I was wrapping up my first busy season as an auditor with the then accounting firm

Arthur Andersen. I was to head out and join a team working on a brand-new account, Rainbow Tree Center.Upon my arrival, the audit team was gathered in a large conference room combing through multiple check registers. Nothing was making sense. They were trying to reconstruct history, as the company Controller had walked off the job the night before, noting the company had severe cash flow problems. It was a bad scene.

Buzz Wilson, Rainbow’s long-time leader, had just taken over as President the year before. However, he was still running his employee benefits law practice in west Michigan while trying to take the reins of a relatively new start up. Rainbow had opened its doors in the summer of 1983 and had expanded rapidly to meet the demand for individuals surviving significant brain injuries.

Joyce Doele, nurse case manager, along with Buzz’s law partner, Roger Bird, nurse Judy Whiteside, started Rainbow Tree Center. Joyce had worked with several catastrophically injured clients and had a vision for how strong clinically supported community integrated care should be done. The fledgling company brought Buzz on to the board in 1985 to provide some business acumen. Over the course of the next couple of years, Buzz saw the tremendous potential in Rainbow’s clinical services and wonderfully caring employees. But he still was only half in at Rainbow and half in his law practice.

I imagine while I was getting my first glimpse into Rainbow and the audit team was updating Buzz on an hourly basis of the mounting scale of the company’s problems, Buzz was facing one of the biggest decisions of his life. Does he retreat to the law practice and let the Rainbow experiment end? Or does he jump in with both feet and fight his way out of the situation?

Fortunately, for the thousands of individuals Rainbow has served over these past 35 years, and for the many employees and families that have been touched by Rainbow, Buzz was all in. He wrapped up the law

practice, turned around the finances, and dedicated the next 20 years of his life to building Rainbow. He saw the potential for Rainbow to ‘do good’ very early on.

Below is a portion of a letter co-founder Joyce Doele wrote to Buzz in June of 2005 after seeing a copy of our new newsletter (Rainbow Visions).

Hey Buzz…[I was given a copy] of your newest newsletter...

and I must say I was VERY impressed!I can’t tell you how pleased I was to see what direction

you have taken the company from a clinical standpoint... it is so nice to see the professionalism and clinical expertise that is now a part of your ever expanding company. The nursing and therapy staff/programs you have put in place appear to meet—and maybe even exceed—the industry best practice.

You have gathered a group of clinical professionals that I am sure have been very helpful in making the appropriate recommendations to bring the infantile RTC into a strong player in the marketplace and a place that has helped many, many folks to achieve their rehab potential. You have completed the vision I always hoped would become a reality, and you have done it so very well that I just had to write and let you know how happy I am that Rainbow has survived in such a wonderful way! You have done an excellent job, and I know it couldn’t have been easy—so thanks for fulfilling all the promise of a simple concept that came out of my work with the cat [catastrophic] cases of old and the help of a devoted friend who agreed to move to Michigan from Indiana and come and work with me to get that vision started. You have done us proud, and I am grateful! Thanks so much! — Joyce

Rainbow has evolved through the years due to the efforts of so many employees past and present. From these humble beginnings 35 years ago, we have become a leader in the industry. Thank you employees, friends and vendors for your contribution to who we are today! ❚

10

• ON THE COVERRainbow is celebrating 35 of years of inspiring the people we serve to reach their greatest potential!

Our anniversary theme is INSPIRE! so we asked our wonderful clients to create artwork based on this message. On the cover is a collage of some of their unique creations.

We hope that this issue inspires you as well!

Page 20

35Inspiring the people we serve for

Copyright September 2018—Rainbow Rehabilitation Centers, Inc. All rights reserved. Published in the United States of America. No part of this publication may be reproduced in any manner whatsoever without written permission from Rainbow Rehabilitation Centers, Inc. Contact the editor: [email protected].

Our mission is to inspire the people we serve

to realize their greatest potential

Features 2 Clinical News Understanding Disorders of Consciousness Lynn Brouwers, MS, CRC, CBIST

10 Success Story For the Love of Animals Kalyn Sanderfer, LLMSW

14 Medical Corner Diabetes and TBI: Fact or Fiction? Kim Phelps, RN, CRRN, CBIS

18 Therapy Corner Reaching Casey’s Goals Jason Dusza, OTR-L, CBIS and Alissa Humes, PT, DPT, NCS, CBIS

24 Medical Corner Unique Nutritional Needs Blake Avery, RD and Brandi Jed, RD

28 Technology Corner Walking Again Andrea Sweet, PT, DPT, CBIS

News at Rainbow32 Conferences & Events

34 Summer Fun! | 2018 BIAMI | NRC Renovation | Cutest Pet Contest

36 Pillar of Excellence Awards | Employees of the Season

38 New Professionals at Rainbow

Editor Barry Marshall

Associate Editor/Designer Jill Hamilton-Krawczyk

Contributor Valerie Kolesar

Email questions or comments to: [email protected]

14

800.968.6644rainbowrehab.com

18

• CLINICAL NEWS

2 | RAINBOWVISIONS • FALL 2018

Understanding

DISORDERS of CONSCIOUSNESS

By Lynn Brouwers, MS, CRC, CBIST Rainbow Rehabilitation Centers

Loren, a 25-year-old graduate student, was injured when he lost control of his car on a snowy Michigan winter morning. Loren’s injury occurred two years ago. He spent nearly three months at a trauma hospital and was then transferred to a subacute brain injury program. Since that time, he has not been able to establish any way to reliably communicate his needs to his family or caregivers. He does get restless when his therapists walk in the door to provide passive range of motion which they perceive is uncomfortable but needed to preserve his physical functioning. He also seems to be more attentive when his mom is in the room. He has laughed spontaneously at inappropriate jokes. Is Loren in a coma? A vegetative state? A minimally conscious state?

New guidelines released for managing disorders of consciousness in persons with brain injury

Continued on page 4

RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 3

• CLINICAL NEWS DISORDERS OF CONSCIOUSNESS

Continued from page 3

Disorders of consciousness (DoC) are a set of disorders that affect wakefulness or consciousness in a person after illness or injury. DoC includes three phases; coma, vegetative state (VS) and minimally conscious state (MCS). These disorders have been called some of the most misunderstood conditions in medicine and are an important challenge for scientific research.1

Published estimates of diagnostic error among people with disorders of consciousness range from 35-40 percent.2 This means that they are conscious but unable to respond and are mistaken for being in a vegetative state. “Misdiagnosis may result in premature or inappropriate treatment withdrawal, failure to recommend beneficial rehabilitation treatments, and worse outcome,” said lead guideline author, Joseph Giacino Ph.D. at Harvard Medical School and Spaulding Rehab Hospital in Boston.3

These conclusions are based in part on new technologies in functional neuroimaging and electrophysiologic procedures that have been used to study people with DoC. A landmark study published in 2010 showed that it is not always possible to know who is aware but unable to respond. In this study, functional MRI was used to determine the incidence of “undetected awareness” in a group of people classified as vegetative. Of the 54 patients, five with TBI could modulate their brain activity by generating voluntary, reliable, and repeatable responses in predefined neuroanatomical regions of their brain when prompted to imagine performing a task. It is interesting to note that in this study, people with brain injury from non-traumatic causes were not able to willfully respond in a way that showed awareness on the functional MRI.

A newly published guideline developed by the American Academy of Neurology, American Congress of Rehabilitation Medicine (ACRM), and the National Institute on Disability, Independent Living and Rehabilitation Research released in August 2018 also indicates that there is a moderate amount of evidence that people who injure their brains through trauma have a better chance of recovery than people who injure their brains from other causes.3

Professionals who developed the guideline reviewed the available scientific literature on diagnosing, predicting outcome, and caring for persons with prolonged DoC. There is a recognition that people with DoC need specialized health care managed by clinicians knowledgeable in treating DoC.

The results of these new studies and the well-documented reports of late recovery challenge the old view

that the brain is static, and that restoration of function in people with severe brain injury is not possible. This old view said that once the brain was damaged, repair and recovery were not possible, and that coma was a natural precursor to death.

The contemporary belief is that the brain is plastic, and people with DoC have potential for long term recovery. Well documented cases of late recovery point to the remarkable plasticity of the human brain. Neuroplasticity refers to the brain’s ability to change structurally when stimulated by the environment.1

Professionals who developed the guideline reviewed the available scientific literature on diagnosing, predicting outcome, and caring for persons with prolonged DoC. There is a recognition that people with DoC need specialized health care managed by clinicians knowledgeable in treating this disorder.

THE CHALLENGE OF MAKING AN ACCURATE ASSESSMENT IN PERSONS WITH PROLONGED DISORDERS OF CONSCIOUSNESS

When a person demonstrates functional communication (yes/no response or gestures) or the functional use of objects (puts toothbrush in mouth, hairbrush to head), the person is no longer classified as having a disorder of consciousness. This simple determinant can be complicated by other disabling characteristics like aphasia (loss of ability to understand or produce language), paresis (weakness), or apraxia (inability to perform purposive actions due to damage to certain areas of the brain). In rare instances, the person may be diagnosed with a locked-in syndrome (see sidebar on page 5). Medical complications and some medications can impact arousal and awareness making it difficult to judge the person’s level of consciousness.

The newly published guideline suggests that clinicians use standardized evaluations that have been shown to be valid and reliable in a DoC population and that they assess the individual several times in order to reduce potential diagnostic error due to variability in responsiveness in this population.

THE IMPORTANCE OF SKILLED CLINICIAN OBSERVERS AND THE NEED FOR SPECIALIZED TREATMENT PROGRAMS

To date, research and development of evidence-based treatment for persons with DoC is limited. People with DoC do have unique problems such as autonomic dysfunction syndrome, heterotopic ossification, the need


for augmentative communication devices, and management of severe tone and spasticity which require the skills of a specialized rehabilitation team. Physicians who understand MCS may use medications to affect arousal and awareness. In fact, the guideline suggests that there is a moderate amount of evidence that the drug amantadine can hasten recovery when used within one to four months post injury.3

Specialized team members understand the need to focus in on how best to assess awareness and can focus on which sensory system is most intact for communication. Sensory systems of seeing, hearing, smelling, tasting, moving, and touching are the ways people connect with the environment and others. Rehabilitation goals include improving responses, tolerating stimulation, staying healthy, and caregiver training.

LONG-TERM PLANNING FOR PERSONS WITH PROLONGED DoC

Family members, in the absence of the injured person making a living will, may be asked or may consider on their own what their family member’s wishes would be if confronted with living in a vegetative state. Some may make the decision to take a palliative approach to care and others may seek the most aggressive medical and rehabilitative treatment available. Courts have been involved when there are questions of awareness (VS or MCS?) and when there is family disagreement.

With attentive care, people in VS and MCS can live for years at home, in skilled nursing facilities, and in brain injury residential programs.

A HISTORY OF ADVOCACY, ACRM’s SPECIAL INTEREST GROUP AND EUROPEAN TASKFORCE ON DoC

A report was delivered to Congress in 2011 by an esteemed group of rehabilitation specialists, physicians, and researchers requesting funding and support nationally for a specialized neurorehabilitation center and a structured support network. Their concerns were that the current system of care (acute care followed by

LOCKED-IN SYNDROMELocked-in syndrome is a rare neurological disorder in which there is complete paralysis of all voluntary muscles except for the ones that

control the movements of the eyes. Individuals with locked-in syndrome are conscious and awake, but have no ability to produce movements (outside of eye movement) or to speak (aphonia). Cognitive function is usually unaffected. Communication is possible through eye movements or blinking. Locked-in syndrome is caused by damage to the pons, a part of the brainstem that contains nerve fibers that relay information to other areas of the brain.13 Fred Plum and Jerome Posner coined the term for this disorder in 1966.13

ASSESSMENT OF CONSCIOUSNESS Since consciousness cannot be directly observed, clinicians must observe behavior and draw conclusions about an individual’s underlying

state of consciousness. The Brain Injury-Interdisciplinary Special Interest Group Disorders of Consciousness Task Force, composed of experts from the American Congress of Rehabilitation Medicine, reviewed available scales and made evidence-based recommendations for clinical practice.14

The Coma Recovery Scale Revised, (CRS-R), received the highest recommendation. The scale consists of 23 items that comprise six subscales addressing:

• auditory • visual • motor• oromotor• communication • arousal functions

The scale is free and available at tbims.org/combi/crs/index.html 15

Other scales with acceptable standardization include:• Coma/Near Coma Scale (CNC)• The Disorders of Consciousness Scale (DOCS)• Sensory Stim Assessment Measure (SSAM)• Western Neuro Sensory Stimulation Profile (WNSSP)16

Continued on page 6



transfer to a nonspecialized skilled nursing facility or discharge home) makes long-term research difficult and may be responsible for the poor outcomes of many people with disorders of consciousness.

It is especially important to know how many individuals are in a minimally conscious state and have a “life of the mind” but are misdiagnosed as vegetative state. The prospect of such individuals harboring consciousness but being misidentified or simply ignored because of the perceived futility of additional long-term assessment is an ethical concern. Lack of specialists and specialized care centers also perpetuates the historic disregard of this marginalized population.4

The European Task Force on Disorders of Consciousness has even suggested different names for these states of consciousness; unresponsive wakeful syndrome in place of vegetative state and minimally responsive in place of minimally conscious state. It is hoped that these will infer

a less dismal prognosis and may therefore lead to less cessation of treatment in select patients.

“We find it high time to propose a new, more neutral and descriptive term. By calling it ‘unresponsive wakefulness syndrome,’ we describe what we clinically see but do not judge whether there is consciousness or not,” said Dr. Moonen, a member of the Task Force.

“Overall, we hope that this new wording will help to herald a change in the ethical approach towards patients who need more, not less, attention by their environment, since they are not able to claim on their own their right to human contact,” said Dr. Laureys, a member of the task force.5

UNDERSTANDING DISORDERS OF CONSCIOUSNESS

UNDERSTANDING THE DEFINITION OF COMA, AN INDICATOR OF BRAIN INJURY SEVERITY

A coma is a state of unconsciousness whereby a person cannot be wakened with touch or noise. The inability to waken differentiates coma from sleep. It is the length of time that a person remains in coma that has commonly been used to determine the severity of a person’s brain injury (see Glasgow Coma Scale). A coma or unconsciousness of less than 30 minutes is considered a mild traumatic brain injury or concussion. Less than one day of coma is considered moderate brain injury. Any coma lasting more than a day is considered to be a severe brain injury.

An “induced” coma can make it difficult to use the Glasgow Coma Scale as a predictor of traumatic brain injury (TBI) severity.

WHY COMA OCCURS, THE PHYSIOLOGICAL RESPONSE TO BRAIN TRAUMA

In TBI, coma can occur when there is an injury to the brain, particularly the brain stem. The brain stem processes the automatic, unconscious control systems of the body including heart rate, blood pressure, body temperature, and breathing. The reticular activating system (RAS), located within the brain stem, is the important “on/off ” switch for consciousness and sleep (Fig. 1, pg. 8). To be awake, the RAS and at least one cerebral hemisphere must be functioning. Coma can also occur when both

GLASGOW COMA SCALEBEHAVIOR RESPONSE SCORE

EYE OPENING RESPONSE

(E)

Spontaneously 4To speech 3To pain 2No response 1

VERBAL RESPONSE

(V)

Oriented to time, place and person 5Confused 4Inappropriate words 3Incomprehensible sounds 2No response 1

MOTOR RESPONSE

(M)

Obeys commands 6Moves to localized pain 5Flexion withdrawal from pain 4Abnormal flexion (decorticate) 3Abnormal extension (decerebrate) 2No response 1

E + V + M = TOTAL SCOREA fully conscious patient has a Glasgow Coma Score of 15.

A person in a deep coma has a score of 3 (there is no lower score).



cerebral hemispheres have shut down, for example, with loss of oxygen in situations like near drowning or a TBI followed by a respiratory arrest.

The reticular activating system stops working in two situations:

• Brain stem bleeding or loss of oxygen: Cells in the area of the RAS have lost their blood supply and the oxygen and glucose that the blood supply delivers. This shuts off the reticular activating system.

• Swelling: Increased swelling in the brain pushes down on the brain stem causing it to fail. The skull is a rigid box that protects the brain. Unfortunately, if the brain is injured and begins to swell (edema), there is no room for the additional fluid. Increased intracranial pressure causes compression of the brain tissue against the skull bones. This swelling within the skull can cross the midline of the brain and affect the undamaged hemisphere.

THE IMPORTANCE OF ACUTE MEDICAL CARE WHEN A COMA OCCURS

If the intracranial pressure continues to increase without being treated, the brain will continue to swell until it pushes down through the opening at the base of the skull, thereby damaging the brain stem where the reticular activating system is located. This affects the ability of the brain to stimulate breathing and control blood pressure and can be the reason for death in the hours or days after injury.

When the members of the trauma team are concerned about swelling of the brain, an intracranial pressure monitor may be placed inside the skull to monitor the pressure. Or, a portion of the skull may be temporarily removed to minimize the risk of further injury to the brain due to the swelling. This allows the trauma team to monitor the brain’s pressure and provide treatment to minimize the “secondary brain injury” that can occur from swelling, bleeding, and lack of nutrients and oxygen to the brain tissue.

Doctors may also “induce” a coma to decrease

DIAGNOSTIC CRITERIACOMAAll of the following criteria must be evident on bedside examination:

• No eye opening and absence of sleep-wake cycles on EEG• No evidence of purposeful motor activity• No response to command• No evidence of language comprehension or expression• Inability to discretely localize noxious stimuli

VEGETATIVE STATEAll of the following criteria must be evident on bedside examination:

• No evidence of awareness of self or environment• No evidence of sustained, reproducible, purposeful, or

voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli

• No evidence of language comprehension or expression• Intermittent wakefulness manifested by the presence of

sleep-wake cycles• Sufficiently preserved hypothalamic and brain-stem

autonomic functions to permit survival with medical and nursing care

• Bowel and bladder incontinence• Variably preserved carian-nerve reflexes and spinal reflexes

MINIMALLY CONSCIOUS STATEAt least one of the following criteria must be clearly evident on bedside examination:

• Simple command following• Gestural or verbal yes/no responses• Intelligible verbalization• Movements or affective behaviors that occur in contingent

relation to relevant environmental stimuli and are not attributable to reflexive activity. Any of the following examples provide sufficient evidence for this criterion

• Pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli

• Episodes of crying, smiling, or laughter in response to the linguistic or visual content of emotional but not neutral topics or stimuli

• Vocalizations or gestures that occur in direct response to the linguistic content of comments or questions

• Reaching for objects that demonstrates a clear relationship between object location and direction of reach

• Touching or holding objects in a manner that accommodates the size and shape of the object

Source: The Mohonk Report. (2011)Continued on page 8


intracranial pressure and rest the brain. Barbiturate medications such as Pentothal and pentobarbital can be injected similar to providing a general anesthetic. These medications can decrease the metabolic rate, protecting the brain. Twenty to 40 percent of persons with injuries this severe do not survive, even with the best of medical care.6

THE NORMAL COURSE OF AWAKENING FROM A COMA

For people with days to weeks to months of unresponsiveness, coma usually evolves into the vegetative state or a higher level of consciousness within two to four weeks amongst those who survive.7

Unlike what is seen in fictional portrayals of coma, it is very unusual for a person to move from a coma to full wakefulness without experiencing VS, MCS, and/or the confused state that follows. A person can move through the levels of consciousness (see sidebar on page 7) or remain in a vegetative or minimally conscious state for the duration of their lives.

AWARENESS IS THE IMPORTANT DIFFERENCE BETWEEN VS AND MCS

Although VS and MCS both involve severe alteration in alertness and awareness, there is clear and growing evidence that important clinical differences exist. The prognosis is different for VS and MCS. Estimates are that 315,000 Americans are living with DoC; including 35,000 in VS and 280,000 in MCS.8

Vegetative state can be transient or long-term (persistent) following coma. Persons in VS may move in a non-purposeful manner and may smile, grimace, tear, and moan. Individuals in VS generally do not visually track or fixate on objects. If tracking is seen, it can often mean that the person is transitioning to MCS. Both the terms “persistent” and “permanent” are controversial, with advocates suggesting that the term “permanent” not be used until the VS state has lasted 12 months for persons with TBI and three months for people with non-traumatic brain injury.9

In the TBI population, 35 percent of individuals who remain in VS for three months will recover consciousness by 12 months post-injury. Among this group, 20 percent will be left with severe disability, while the remaining 15 percent will have a moderate to good outcome.1

It is difficult to track the incidence of MCS because there is no International Classification of Diseases (ICD) diagnostic code. Persons in MCS retain large scale cortical networks responsible for language processing despite their inability to communicate reliably.9 The recovery for this population is slow and long. In the MCS group, 50 percent will have moderate to severe disability while 27 percent will have mild to moderate disability.10, 11 ❚

References1. The Mohonk Report. (2011). A Report to Congress. Disorders of

Consciousness: Assessment, Treatment, and Research Needs.

2. Tresch DD, Sims FH, Duthie EH, Goldstein, MD, Lane PS. (1991). Clinical characteristics of patients in the persistent vegetative state. Arch Internal Med,151:930-932.


Figure 1. The Reticular Activating System (RAS)

CEREBRAL HEMISPHERE

CEREBELLUM

HYPOTHALAMUS

THALAMUS

RETICULAR SYSTEM

MIDBRAIN

MEDULLASPINAL CORD

PONS



3. https//acrm.org New Guideline released for Managing Vegetative and Minimally Conscious States

4. Fins JJ. (2003). From Psychosurgery to Neuromodulation and Palliation: History’s Lessons for the Ethical Conduct and Regulation of Neuropsychiatric Research. Neurosurgery Clinics of North America, 14(2): 303-319.

5. European Neurological Society (ENS): Oral abstracts 238, 242, and 267. Presented May 30, 2011

6. Sherer, M, Vaccaro, M, Whyte, J, Giacino, J (2007) Facts about the Minimally Conscious States after Severe Brain Injury, Consciousness Consortium

7. Plum F, Posner J. (1982). The diagnosis of stupor and coma, 3rd Edition Philadelphia: F.A. Davis.

8. Multi-Society Task Force on the Persistent Vegetative State. (1994). Medical aspects of the persistent vegetative state, part I. N Engl J Med, 330:1499-1508.

9. Strauss DJ, Ashwal S, Day SM, Shavelle RM. (2000). Life expectancy of children in vegetative and minimally conscious states. Pediatr Neurol, 23:312-319.

10. American Academy of Neurology. (1995). Practice parameter:

Assessment and management of persons in the persistent vegetative state. Neurol, 45:1015-1018.

11. Giacino JT, Kalmar K. (1997). The vegatative and minimally conscious states: A comparison of clinical features and functional outcome. J Head Trauma Rehabil,12(4):36-51. Giacino, J & Kalmar, K. (2006).

12. Whyte J, Katz D, Long D, DiPasquale M, Polansky M, Kalmar K, Giacino J, Childs N, Mercer W, Novak P, Maurer P, Eifert B. (2005). Predictors of Outcome in Prolonged Posttraumatic Disorders of Consciousness and Assessment of Medication Effects: A Multicenter Study. Arch Phys Med Rehabil, 86:453-462.

13. https://rarediseases.org/rare-diseases/locked-in-syndrome/ (accessed May 28, 2013)

14. Seel, Ph.D., Sherer, Ph.D., Whyte, M.D., Ph.D., Katz, M.D., Gianco Ph.D., Rosenbaum, Ph.D., et al. (2010). Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil, 91:1795-1813.

15. Coma Recovery Scale-Revised. The Center for Outcome Measurement in Brain Injury. http://www.tbims. org/combi/crs/ (accessed May 28, 2013)

16. The Essential Brain Injury Guide Edition 5.0, Brain Injury Association of America

About the author

Lynn Brouwers, MS, CRC, CBIST Director of Program Development

Lynn Brouwers holds a Master of Science in Rehabilitation Services from the University of Wisconsin-Stout in Menomonie, WI. She has more than 35 years of leadership experience in medical rehabilitation with a specialty in programs for persons with traumatic brain injury and other neurologic injury. She has managed neurological rehabilitation programs in hospitals, skilled nursing facilities, residential and outpatient facilities, and in the home and community. She is a Certified Brain Injury Specialist Trainer and a surveyor for CARF International.

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• SUCCESS STORY


During our teenage years, most of us are just trying to figure out what it means to be independent. It is the age of new freedoms, the beginning of adulthood, and a time of joy and transition for

many young people. Unfortunately for Cortez Marcelis, now a 29-year-old dog groomer from Detroit, his coming of age story was cut short at the age of 18 by a drunk driver.

His mother remembers getting a phone call in the middle of the night. “It was 2007… his friends called. They were scared, breathing hard, yelling that Cortez was in the car with a drunk driver.” Cortez was a passenger in a vehicle that hit a wall, and he was ejected out the front window. He was rushed to St. John’s hospital and diagnosed with a traumatic brain injury (TBI). His mother recalls seeing him soon after. “I was shocked… he was unresponsive, and they put a stent in his brain to relieve the pressure.” Of all the dangers she could have foreseen, a traumatic brain injury was nowhere on her list of worries.

The unfortunate reality is that because of the social identities held by Cortez, he was (and still is) at a higher risk of sustaining a traumatic brain injury. Men, African Americans, and children ages 0-19 are among the groups with higher risks of sustaining a TBI. Moreover, African Americans have higher rates of death and hospitalization

from TBI-related incidents.1 While many parents are privy to the dangers of drugs, sex, bullies, and bad grades, most families are woefully unprepared for the very costly consequences of their child sustaining a TBI. Family members average over $130,000 in personal costs for

trauma and rehabilitation care in as quickly as six months.2 With Cortez being so young and inexperienced at the time of his TBI, he

faced a long road that could have resulted in a substantial loss of potential income

and productivity years.Cortez spent the next five years

learning how to walk, talk, eat, and live again. He recalls, “Everything

was a challenge.” Still, he found a way to stay motivated and push through his treatment at a time when he should have

been experiencing his first college course or first real job.

He joined Rainbow’s Vocational Rehab Campus (VRC) in 2012 with the hope of sharpening his work skills and eventually becoming an animal groomer. However, there were some new challenges present because of his traumatic brain injury. Cortez had regained his physical strength and was able to maintain it fairly easily, but he was also dealing with a host of new mental health challenges. Moderate to severe TBI is associated with an increased risk of subsequent psychiatric illness… about 50 percent

By Kalyn Sanderfer, LLMSW Rainbow Rehabilitation Centers

FOR the LOVE of

ANIMALSDedication to the vocational rehabilitation process

helped Cortez to realize his dream

Continued on page 12


• SUCCESS STORY FOR THE LOVE OF ANIMALS

of survivors show symptoms in the first year following injury.3 Although it would not be easy, Cortez pushed ahead with hope that his support system of family and health care professionals would help him to excel.

While employed at the VRC, Cortez had the opportunity to work in a variety of roles related to his interest in animals. At Starry Skies Equine Rescue and Sanctuary, he tended to horses that had been rescued from unsafe conditions. He trained as a groomer and stock person at PetCo and has improved his organizational skills by assisting with various tasks at the VRC including packaging, sorting, and computer tasks.

Alas, none of these roles seemed to be a good fit for Cortez’s particular set of needs and interests. It was difficult to find an environment that allowed him to reach his full potential while being sensitive to the side effects of his injury. Cortez had a new definition of “normal.” He spent a lot of years re-strengthening his mind and body, and didn’t want to rush into a job that could compromise his growth. So it was important to find a work


environment that would help him prosper financially, physically, and mentally. He began working on his own business ideas while looking for a more suitable placement within the VRC.

In the Spring of 2018, Rainbow was able to partner Cortez with a local kennel owner and create a unique job experience for him. He now works as a groomer at Curry Family Pet Care in Romulus, MI, and it seems to be a perfect fit.

Cortez uses his individual vocational time to work on business plans for his dog grooming business, Cortz Tails, and the space at Curry Family Pet Care allows him to practice his craft with an experienced job coach.

When he is not grooming dogs, Cortez is passing out flyers and business cards to local vets and business owners to promote Cortz Tails. He envisions one day having his own mobile dog grooming business. “I want to make it easier for the animals. I’ll come to them,” he says.

So far, Cortez has done an amazing job grooming the kennel dogs and building up his personal clientele. Even his job coach’s dachshund, Gryffindor, stopped by for a bath. His latest project is renovating a van he plans to use for his mobile grooming business. “I work on it almost every day,” he says.

Although his journey has been a long one, Cortez Marcelis is a prime example of what all clients can

achieve through dedication to the vocational rehab process. Like all successful people, Cortez has had

some failures and bad experiences along the way. But he stuck it out, and now he can do what he

loves in a safe environment with the supports he needs. We’re all excited to see what the

future holds for Cortez. ❚

References1. Arango-Lasprilla, J.C. (2010). Racial and ethnic disparities in functional, psychosocial, and neurobehavioral outcomes after brain injury. Journal of Head Trauma & Rehabilitation. 25(2), 128–136.

2. Gary, K.W., Arango-Lasprilla, J.C. & Stevens, L.F. (2009) Do racial/ethnic differences exist in post-injury outcomes after TBI? A comprehensive review of the literature. Brain Injury, 23:10, 775-789,

3. Fann, J., Burington, B., Leonetti, A. (2004) Psychiatric illness following traumatic brain injury

in an adult health maintenance organization population. Arch Gen Psychiatry.61. 53-61. Retrieved

from: https://www.liftcare.org/wp-content/uploads/2013/11/LIFT-Fann-Psychiatric-illness-

following-TBI-adult.pdf


About the author

Kalyn Sanderfer, LLMSW Case Manager

Kalyn works at Rainbow’s Ypsilanti Treatment Center as a case manager. She earned her Master of Social Work and Bachelor of Sociology from the University of Michigan. Previously, she served as a Resource Coordinator/Intake Counselor at the University of Michigan Pediatric Advocacy Clinic and as a Patient Care Assistant.

Don Daniels, Vocational Manager, Cortez Marcelis, Chelsea Lupone, Job Coach, and Gryffindor the dachshund.


DIABETES and TRAUMATIC BRAIN INJURYFACT or FICTION?

By Kim Phelps, RN, CRRN, CBIS Rainbow Rehabilitation Centers

• MEDICAL CORNER

Diabetes is frequently described as a disease that affects the way the body uses glucose. While this statement is true, diabetes is more complicated than that, and when a traumatic

brain injury (TBI) is added into the mix, the management of diabetes and the TBI can be further complicated.

There are several types of diabetes, but Type 1, Type 2, and Diabetes Insipidus are the three types that can impact the management of diabetes due to a traumatic brain injury.

Type 1 is defined as a chronic autoimmune disease in which the immune system kills the insulin producing beta cells in the pancreas. The cause is unknown but can follow a viral infection. Genetics can also be a risk factor for Type 1 diabetes. A person who is diagnosed with Type 1 diabetes will typically be prescribed insulin immediately.

There is no cure for Type 1 diabetes. Diet, exercise, and strict glucose control with insulin are all part of diabetic care to keep glucose levels in an optimal range.

Type 2 diabetes is more often diagnosed in older adults or during middle age. With Type 2 diabetes, your body still produces insulin, but it may not be enough insulin or enough usable insulin to control blood glucose. This is characterized as insulin resistance.

The risk factors for Type 2 diabetes include obesity, sedentary lifestyle, and genetics. For many who are diagnosed with Type 2 diabetes, diet and exercise can significantly improve blood glucose levels and can prevent further issues or improve the associated complications. If these lifestyle changes do not decrease blood glucose levels, then oral medications will be prescribed. If these medications do not provide adequate glucose control, then insulin will be needed.

Diabetes Insipidus (DI) is a condition that leads to frequent urination and excessive thirst. It can be caused by a deficiency of antidiuretic hormone (ADH). Trauma from head injury, tumors, or surgery can damage the pituitary gland or hypothalamus and lead to ADH deficiency. Medication and fluid intake control is needed for management of DI.


Treatment for Type 1, Type 2 and Diabetic Insipidus are the same.FICTION: Though all three forms of diabetes are related to the endocrine system, treatment for Type 1 and Type 2 diabetes are similar, but DI is different. Type 1 and 2 are related to the pancreas and production of insulin which controls blood glucose. DI is related to the hypothalamus and pituitary gland and lack of production of antidiuretic hormone.

Diabetes is caused by eating too much sugar, and DI is caused by drinking too much water.1

FICTION: Sugary foods do not cause diabetes, but can elevate blood glucose if you have diabetes. If you are diagnosed with Type 1 or 2 diabetes, following a healthy diet by consuming a variety of foods is recommended. Your physician or a dietitian can give you guidelines on how to count carbohydrates and suggestions for healthy eating.

You cannot contract diabetes insipidus by drinking too much water. Damage to the hypothalamus by trauma or disease process can be the cause of DI.

Follow up with an endocrinologist is recommended to help you determine a treatment plan.

A traumatic brain injury will impact my treatment for diabetes or vice versa.FACT: Type 1 and 2 diabetes or DI can have an impact on care regarding treatment and outcome. Symptoms of Type 1 and 2 diabetes can be exacerbated after a severe TBI.

Following a TBI, factors such as stress, inflammation, surgery, IVs, diet, decreased mobility, change in metabolism, and infection can all lead to hyperglycemia. Several classifications of medications can also lead to hyperglycemia, especially antipsychotics which may cause unwanted weight gain. Hyperglycemia is also a known cause of cognitive deterioration.

Regardless of the cause of hyperglycemia following a TBI, the course of treatment will focus on returning glucose to normal parameters and prevent hypoglycemia.

FACT or FICTION?



• MEDICAL CORNER DIABETES

A person will not be able to manage their diabetes independently following a TBI.FICTION: Factors such as decreased cognition, visual and/or physical changes may cause challenges following a TBI, but there is a variety of adaptive equipment and techniques available that can assist with managing diabetes as independently as possible.

For those with impaired cognition, there are alarm watches and phones to remind you to take your medication or insulin, continual glucose monitors that alert family members if your glucose is too high or too low, insulin pumps that read your glucose and administer insulin, and memory insulin pens.

For those with physical limitations, there are larger meters, lancet devices you can use with one hand, lancet drums with multiple needles, larger syringes, cozies for insulin bottles, safety shields for bottles, and vial safe bottles for better gripping.

Many of these devices can also be used by the visually impaired.

There is a wealth of adaptive supplies available. See your endocrinologist or diabetic specialist for a complete guide that can assist you with your specific needs.

Just as each brain injury is different, each course of diabetes is different. When these two worlds collide, a new set of problems can arise. By following recommendations from your physician and treatment team, developing skills and techniques to manage your brain injury and diabetes can help you reach your optimal level of independence and health. ❚

References1. Myths and Facts: Stop Diabetes” website: http://www.stopdiabetes.com/

get-the-facts/myths-and-facts.html (accessed July 6, 2018


RESIDENTIAL Rainbow Rehabilitation Centers provides specialized residential and therapy services for individuals recovering from spinal cord injury. Residential services include beautiful wheelchair accessible homes with 24-hour supervision and assistance available. The living environment can be equipped with voice-activated environmental control systems. Our goal is to facilitate the independence of our clients and design individualized treatment plans to meet their specific needs. Services can range from assisted living level of care through intense rehabilitation services.

OUTPATIENT We have comprehensive outpatient therapies with special emphasis on recreation and community re-entry. Our facilities are equipped with all necessary equipment to meet the rehabilitation needs of the individual with a spinal cord injury and the family.

No finer promise of achievement

800.968.6644

SPINAL CORD INJURY PROGRAM


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Residential Programs • Outpatient Services • Day Treatment • Spinal Cord Rehabilitation Home & Community-Based Rehabilitation • Home Care • Vocational Programs

Comprehensive Rehabilitation • Medical Care • NeuroBehavioral Programs

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With multiple residential programs, five treatment centers, a NeuroRehab Campus® and two vocational centers, Rainbow Rehabilitation Centers offers services that span nearly every aspect of brain injury rehabilitation and spinal cord injury rehabilitation. From hospital discharge to community re-entry, Rainbow Rehabilitation Centers has programs to treat each client with optimal care at every stage of their rehabilitation. There’s no better place to heal!

Brain and Spinal Cord Injury Rehabilitation Programs for People of all Ages

There’s no better place to heal!


• THERAPY CORNER


By Jason Dusza, OTR-L, CBIS and Alissa Humes, PT, DPT, NCS, CBIS Rainbow Rehabilitation Centers

REACHING CASEY’S GOALS

A Collaborative Approach to Therapy in a Home Setting

WHAT IS HOME OT AND PT?Occupational therapy (OT) and physical therapy (PT)

have an important role to play in the home and community environment. These roles are very different than those in inpatient and outpatient settings. Providing therapy within the home environment is unique in that it allows the client to practice activities within a familiar setting.

Research has shown that home rehabilitation services can help clients improve or maintain their physical level of function, improve their quality of life, and increase their overall independence.1 Additionally, home care services can also address home- and community-related issues with caregivers in real life settings. This can improve caregiver involvement and allow family to cope with their family member’s new level of function, which may lead to the client being able to stay in their home longer.2

OT and PT each have their own unique approach to home- and community-based therapy that, when combined, can work synergistically to meet the client’s goals in a more holistic and well-rounded manner.

The American Occupational Therapy Association states that OT helps people across their lifespan perform the activities they need and want to do to in order to live life to its fullest. Occupational therapy can help promote better health and prevent or manage injury, illness, or disability through the therapeutic use of daily activities (occupations).3 This can be accomplished in the home by analyzing the environment, recommending changes to better support the client’s needs, goals, and safety, and performing an analysis of the demands of various tasks and activities that are important to the client. Activities such as home management tasks, cooking and medication management can be directly addressed in the setting they are accustomed to instead of being simulated, as they often are in the clinic.

The American Physical Therapy Association describes PTs as health care professionals who work toward reducing pain and improving mobility by examining each individual to develop a plan and start a treatment program. Through

Simple tasks such as getting up from the sofa, walking up and down the stairs, and even taking a shower are activities that most of us take for granted. But when you are severely injured, these simple endeavors become extremely difficult. Parts of your own home may become inaccessible, and simple actions are now daunting and can induce anxiety.


RAINBOWREHAB.COM FALL 2018 • RAINBOWVISIONS | 19RAINBOWREHAB.COM

RAINBOW THEN & NOWIn 1983, Rainbow Rehabilitation Centers (originally Rainbow Tree Center) opened the doors to its first residential home, Elwell, in Belleville, MI. The vision was to build comprehensive rehabilitation programs for individuals who have sustained traumatic brain injury—something that was severely lacking at the time.

Today, Rainbow has grown to include five comprehensive treatment centers, a NeuroRehab Campus®, three vocational centers and more than 38 community-based residential program locations. To this day, Rainbow holds true to our mission:

REMEMBERING LAURIE SHIPLEYThis past June, Rainbow lost a very dear friend and colleague, Laurie Shipley. Laurie started her career at Rainbow 35 years ago. She was Rainbow’s first hired employee. She was pure Rainbow— looking out for clients and employees every step of the way. Laurie’s impact on clients and employees as a Residential Program Manager was remarkable. She was a great leader, honest, compassionate and above all else, was incredibly kind. In Laurie’s own words, “It is all about the clients. They are the ones who have taught me compassion, heroism and stick-to-itness. The older I get the more I get it.”

As Rainbow moves forward, we will continue to serve our clients the way that Laurie had so beautifully displayed for 35 years.

Elwell, Rainbow’s first residential home in Belleville, MI.

Rainbow was originally named Rainbow Tree Center.


Rainbow began as such a tiny company with just a few clients and staff, and it has grown into something amazing now. What I love is that back then it was like a family, and now we are just a big family! I am proud to be a part of the Rainbow family.”

Barb Wilson, Owner & Board Member

When Rainbow’s first residential home, Elwell, opened its doors in July of 1983, Rainbow had a total of 9 EMPLOYEES

Rainbow currently has over

900 EMPLOYEES all with the same goal of improving the lives of individuals who have sustained traumatic brain and spinal cord injuries

2 pediatric treatment centers

3 vocational rehab centers

104

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Rainbow now has over residential program facilities across central and southeast Michigan

38

Do Good, Do Well,

Have Fun.Buzz Wilson

2005. Buzz Wilson cuts the ribbon for the opening of the renovated PT gym at Rainbow’s Ypsilanti Treatment Center

Every year Rainbow celebrate those employees celebrating milestone employment anniversaries (5, 10, 15, 20, 25, 30+ years) with a fun outing such as a sports game, a riverboat tour, museum exhibits, a day at the zoo or a performance at a comedy club.


this, PTs “promote the ability to move, reduce pain, restore function, and prevent disability” as well as educate individuals on healthier lifestyles.4

A physical therapist is typically brought into the home when a person is unable to leave their house for various reasons such as transportation issues, not having the strength or endurance to leave the home or being unable to enter or exit the home independently. In the home, the PT assists with improving mobility to increase overall independence, whether that be with various assistive devices (walker, knee scooter, wheelchair, cane), strengthening exercises, or improving overall activity tolerance.

A TEAMWORK APPROACHBoth the OT and PT have the common goal of meeting

the individualized needs of the client, and it has been proven that “working in teams and sharing skills eliminates confusing and exasperating duplication of tasks for the patient.”5 Research and the first-hand experiences of clients has concluded that OTs and PTs working together is a more effective method of delivering care.5 Each therapist will have discipline specific goals on which they are working during each session.

When OTs and PTs work together with a client within his or her home, the therapists are able to combine their skills to truly maximize the client’s independence in an efficient and meaningful way.

CASEY’S BACKGROUND Recently, one Rainbow client benefited from a successful

OT and PT collaboration. Prior to being involved in a car accident on August 20, 2017, Casey was independent and active at home and in the community. He and his wife were hit head on by another vehicle resulting in Casey sustaining multiple contusions, abrasions, and a Lisfranc fracture in his right foot. Casey was unable to bear weight through his right leg for nine weeks due to an open reduction internal fixation surgery and therefore needed various assistive devices to help him move, including a knee scooter, a walker, and a wheelchair. Casey also had a

history of Parkinson’s disease. Slowed cognitive processing, memory impairments, anxiety, decreased coordination, and difficulty with motor movements became exacerbated following his surgery, which added additional challenges to his recovery.

CASEY’S THERAPY GOALSRainbow’s OT and PT team worked with Casey to

identify and develop goals that were meaningful and important to Casey and his spouse. It was quickly evident that Casey’s main goal was to access and use his basement bathroom, as it was the only shower in the home he could utilize. At the time of the initial evaluation, Casey was unable to manage a full flight of stairs due to his physical and cognitive impairments. As a result, he was limited to a sponge bath at his kitchen sink with assistance from his

wife.Once Casey’s

main goals were identified, the team discussed how each discipline would address, prioritize, and organize therapy in order to meet Casey’s overall goal. Both OT and PT complemented

each other throughout the therapy process by targeting different aspects of the goal unique to their discipline.

For example, the OT evaluated Casey’s upper body strength and range of motion to assess whether there would be any physical barriers to complete showering tasks. They assessed the bathroom for fall risks, provided recommendations on adaptive equipment to utilize, and completed a simulated shower for practice.

The PT focused on improving Casey’s independence with his walker, scooter, and managing stairs, as this was a main barrier to accessing the lower level basement. Throughout this process, OT and PT remained in communication by frequently updating each other on progress, concerns, and successful techniques that were working for Casey so that each therapist could implement the same strategies in a consistent manner.

Remaining consistent in the therapeutic strategies used with Casey was important due to the cognitive deficits present such as memory impairments, difficulty with complex commands, following instructions, and increased

• THERAPY CORNER REACHING CASEY’S GOALS

When OTs and PTs work together they are able to combine their skills to truly

maximize the client’s independence in an efficient and meaningful way.



anxiety, especially with new tasks. All these deficits made it challenging for Casey to carry over new techniques. Therefore, OT and PT attempted to utilize the same cueing and education techniques as well as overall physical instruction during each discipline’s session.

In addition to individual sessions, the OT and PT also completed multiple co-treatment sessions in which both therapists worked with Casey at the same time. This allowed the therapists to problem solve together, improve patient safety, and decrease Casey’s anxiety during tasks that were more difficult for him.

For example, during one of the co-treatment sessions, Casey worked with both therapists to simulate the process of transferring from his knee scooter to the floor prior to trialing this complicated task at the stairwell. Casey had reported significant anxiety over practicing on the stairs, but this simulation allowed him to master the skill needed in a safe and comfortable setting prior to completing the move on the actual staircase. This strategy was developed after both therapists worked closely with Casey’s spouse who helped by locating items within their home that could be utilized as well as helping to problem solve through various barriers that they came across. Casey’s spouse had also previously received PT following the same accident and was able to offer many helpful suggestions based on her experiences in therapy.

During individual sessions, PT continued to work with Casey on improving techniques to manage the staircases and practiced transferring from his scooter to the steps. Once Casey completed the entire process of transferring from his scooter to the staircase and going up and down the stairs, OT began the next step towards meeting his goal by working with Casey on using the bathroom.

The OT team first worked with Casey on completing transfers from his wheelchair into and out of his shower while maintaining his weight-bearing precautions. He

was educated on the proper use of his shower chair, grab bars, and the hand-held shower to improve safety and independence. He then completed a simulated shower to improve carryover and reduce anxiety prior to completing a real shower. Once Casey demonstrated safe techniques and reported confidence with these tasks, he was able to meet his main goal of taking a full shower after many months. He continued to complete showers successfully with his spouse’s supervision.

REACHING CASEY’S GOALSCasey is an excellent example of how OT and PT teams

can work together in the home, utilizing their individual skill sets to maximize a client’s function as well as help the client meet the most challenging goals they have at home. Ultimately, Casey could put weight on his foot without having to wear a boot, which resulted in him being able to go up and down stairs without any issue. However, during the months he was unable to do this, occupational therapy and physical therapy helped him regain his ability to perform an everyday activity that most would take for granted—taking a shower. ❚

References1. Armstrong J, Sims-Gould J, Stolee P. Allocation of rehabilitation services

for older adults in the Ontario home care system. Physiotherapy Canada. 2016; 68(4); 346-354; doi:10.3138/ptc.2014-66.

2. Warner G, Stadnyk R. What is the evidence and context for implementing family-centered care for older adults? Physical and Occupational Therapy in Geriatrics. 2014; 32(3); 255-270.

3. American Occupational Therapy Association. 2018. About Occupational Therapy. https://www.aota.org/About-Occupational-Therapy.aspx

4. American Physical Therapy Association. 2015. Who Are Physical Therapists? http://www.apta.org/AboutPTs/.

5. Smith S, Roberts P. An investigation of occupational and physiotherapy roles in a community setting. International Journal of Therapy and Rehabilitation. 2005; 12(1).

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• MEDICAL CORNER


THE

UNIQUE NUTRITIONAL NEEDSof those receiving enteral nutrition

By Blake Avery, RD and Brandi Jed, RD Rainbow Rehabilitation Centers

For many people, nutrition is no more complicated than choosing what to eat. However, for individuals with a traumatic brain injury (TBI), getting adequate

nutrition can be extremely difficult. Due to the complex nature of brain injuries, pinpointing one specific cause of altered nutritional status is nearly impossible. Contributing factors can include a decreased appetite, lack of motor skills, increased metabolism, dysphagia (trouble with swallowing), and more. As a result of these complications, many people will require enteral nutrition support, also referred to as tube feeding, at some point in their recovery process.

Enteral nutrition therapy involves placing a tube along the patient’s digestive tract and infusing a specialized liquid formula that provides the individual with fat, protein, carbohydrates, water, vitamins and minerals.

Registered Dietitians (RDs) are professionally trained to assess each person’s unique nutritional needs in order to provide the correct tube feeding formula, amount, and rate. Specially trained RDs at Rainbow assist and monitor clients requiring tube feeding to ensure they are receiving the best nutrition therapy for their individual needs.

Information to consider when choosing the right enteral nutrition formula include time since injury, client age, pre-existing health conditions, and post-injury complications.

Immediately following a severe brain injury, metabolic rate can increase up to as high as 240 percent1 greater than those without TBI. An increase in metabolic rate and catabolism can increase protein breakdown which can lead to malnutrition. More often than not, persons in the hospital following a TBI cannot consume an adequate amount of oral nutrition required to meet the body’s increased demands. Thus, calorie and fluid intake is often supplemented or entirely provided via enteral nutrition.

Early initiation of tube feeding is often the preferred protocol to prevent malnutrition, speed recovery, and reduce overall length of stay. Almost every patient will require a high protein and/or high calorie formula to meet these increased needs.

As individuals transition out of the acute care setting, they may no longer need tube feeding support. However, those who cannot meet their daily nutritional requirements through oral intake may still require total or partial enteral support as they continue their recovery.

Clients requiring long-term tube feeding support may need even more individualized nutritional plans which take into account pre-existing medical conditions and post-injury complications. Chronic health conditions to consider include diabetes, heart disease, obesity, and renal disease, all of which have corresponding therapeutic


• MEDICAL CORNER ENTERAL NUTRITION

formulas. For example, a formula with a special balance of protein and electrolytes can be provided for individuals with chronic kidney diseases, and a formula with low-glycemic carbohydrates will help support clients with altered blood sugar control.

Some formulas contain immune enhancing vitamins, minerals and other additions to help combat metabolic and gastrointestinal stress. Prebiotics and probiotics may be added to a formula for “good” bacteria growth in the colon. Increased amounts of antioxidants, vitamin C and E may be added to reduce free radical damage. The addition of EPA and DHA omega-3 fatty acids can help fight inflammation and support immune function. Arginine and glutamine support immune function and can assist with wound healing, while hydrolyzed proteins are often included for optimal absorption.

Once a formula has been carefully selected and initiated, close observation for any potential intolerances is required. Common long-term complications that can arise are constipation, diarrhea, and malabsorption. RDs will continually assess and closely monitor tube feeding

tolerance to provide evidence-based interventions in order to reduce these symptoms as much as possible. One example may be a high fiber tube feeding formula or a fiber supplement to help alleviate constipation.

Clients with traumatic brain injury will have an evolving nutritional status on their road to recovery. In the acute care setting, nutritional status is at its most critical point with malnutrition prevention being the number one priority. As they transition to post-acute settings, their needs shift to preventing exacerbation of pre-existing conditions and preventing long-term complications. No matter where a client is in their tube feeding journey, a Registered Dietitian will be there to help them along the way. ❚

References1. Horn, Susan et. Al. Enteral Nutrition for Patients with Traumatic Brain

Injury in the RehabilitationSetting: Associations with Patient Pre-Injury and Injury characteristics and outcomes. ___Archives of Physical Medicine and Rehabilitation. 2015: 96(8suppl3):S245-55.https://www.archives-pmr.org/article/S0003-9993(15)00321-4/pdf

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• SUCCESS STORY

By Andrea Sweet, PT, DPT, CBISRainbow Rehabilitation Centers

WALKING AGAINClient and Therapist Perspectives

• THERAPY CORNER

THERAPIST PERSPECTIVEWhen a therapist meets a client who is going to trial a

ReWalk device for the first time, there is a lot of learning that must occur for both the therapist and the client. Clinicians who use the ReWalk undergo specialized training which includes identification and understanding of all parts and components of the device, how to identify appropriate candidates for ReWalk use, how to assess and fit a client for the device, understanding and using the software, how to operate and adjust the device, and understanding the skills inventories. Therapists who are being educated on using the ReWalk must also complete hands-on training with the device and the client.

Learning the rhythm of the device and gauging how much assistance to provide were the main challenges I experienced as a therapist working with the ReWalk for the first time. When a client first starts out on the ReWalk, the therapist must provide hands-on assistance as the client is operating the device. It is essential that the therapist move in sync with the device and the user in order to maximize the effectiveness of the training.

As always, safety is at the forefront of the therapist’s mind when guarding or assisting the client. While safety is critical, the therapist must be cautious to not assist too much, especially as the client progresses. Assisting too much, whether intentional or not, can inhibit progress. If the therapist is making all the error corrections, the client will never be able to truly feel the errors (such as loss of balance or inadequate or too much weight shift in a particular direction) and learn how to correct them. As with most skills, this improves with experience, both with the device and when working with that specific client.

The overall experience of learning the ReWalk and working with a client to use the device has been wonderful. It is always helpful to learn different treatment approaches and expand my treatment toolbox as a clinician, and it is exciting to have the opportunity to use sophisticated technology. It has also been rewarding to watch my client progress and be on this journey with him as he gets closer to reaching the goal of using the ReWalk device in the community and interacting with his family and peers in ways he thought would never again be possible.

In our Fall 2017 issue of Rainbow Visions, readers were introduced to the ReWalk exoskeleton. The ReWalkTM is a robotic device that integrates the user’s movements with a system of motors at key joints to externally control gait.1 The ReWalk device has helped many individuals with spinal

cord injury around the world to stand and walk again. In this article we will explore therapist and client experiences with training on the ReWalk for the first time.



• THERAPY CORNER WALKING AGAIN

CLIENT PERSPECTIVETommie McMullen began ReWalk training in June

of 2017 at Rainbow Rehabilitation Centers. Since then, Tommie has worked hard to train and improve his skills. He has noticed several physical improvements and has been able to experience some of the emotional and social benefits of the ReWalk. As he continues to train, he is looking forward to the ongoing physical benefits and the potential for more social and emotional opportunities.

There are many physical changes that a ReWalk user may undergo with training. Research has demonstrated improvements in strength, (based on ASIA motor scores. Developed by the American Spinal Injury Association [ASIA], the scores are a way to measure and classify muscle function in individuals with spinal cord injury) resting and training heart rate, and improvement in bowel and bladder regulation.2 Tommie’s experience has aligned with the research. Specifically, he has noticed changes in muscle definition and strength in his legs, and his core strength and posture has also improved. Outside of the ReWalk, not only does he have better posture when seated in his wheelchair, he also is able to maintain that posture longer. Tommie’s physical endurance and tolerance has also improved significantly with training.

Using the ReWalk has many social implications and can improve one’s quality of life.2 The ReWalk allows him to stand without overexertion and feel safe while doing so. Others who have trialed the ReWalk have also reported significantly reduced fatigue and feeling safe in the device.1 This provides an opportunity for social interaction by standing and is one aspect to which Tommie is most looking forward. He has spent several years unable to interact with family and peers at eye level, and he feels that being able to look someone in the eye gives him more confidence in his interactions.

Additionally, the ReWalk gives Tommie an opportunity for functional walking, whereas other methods he attempted only offered walking for therapeutic purposes.1 The energy and effort required to ambulate with the ReWalk has been found to be acceptable and practical for everyday use.3 This will allow him to go for walks with his family and friends while still having enough energy and focus left to converse and better attend to the environment

while in motion. Recently, Tommie was able to experience taking a walk alongside his grandson for the very first time.

Realizing the benefits of using the ReWalk does require some learning, hard work and commitment. Tommie reported that learning the rhythm of the machine was one of the most difficult parts for him at first, but with practice and repetition he quickly caught on. Once he had the rhythm down, Tommie had to work to improve his endurance to allow him to tolerate increased distances and to progress to more challenging skills. He has also had to further improve his core strength and posture to optimize his balance in the device and has been working on this in

conjunction with occupational therapy.

Despite how tiring some of the training sessions with the ReWalk have been for him, Tommie feels that out of all the walking methods he has tried, the ReWalk is easiest to use, the most functional, and is still less tiring

than other methods. This is because other methods tend to require high energy cost or result in rapid muscle fatigue in those with spinal cord injury or lower-limb paralysis.3

Although the ReWalk is not for everyone, Tommie recommends that anyone who is a good candidate give it a try. It may seem intimidating and challenging initially, but it gets easier with practice. A list of indications and contraindications for ReWalk use can be found on the ReWalk website (rewalk.com), and any interested individual would need to be assessed for appropriateness.

To those just starting out using the ReWalk, Tommie offers encouragement to keep going and not give up. The experience of being able to walk again is definitely worth the time and effort! ❚

References1. Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi

A. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study. J Spinal Cord Med. 2012; 35(2): 96–101. doi: 10.1179/2045772312Y.0000000003

2. Raab K, Krakow K, Tripp F, Jung M. Effects of training with the ReWalk exoskeleton on quality of life in incomplete spinal cord injury: a single case study. Spinal Cord Series and Cases. 2016;3,15025. doi:10.1038/scsandc.2015.25

3. Asselin P, Knezevic S, Kornfeld S, Cirnigliaro C, Agranova-Breyter I, Bauman W, M Spungen A. Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. The Journal of Rehabilitation Research and Development. 2015;52(2):147-158. doi: 10.1682/JRRD.2014.02.0060

The experience of being able to walk again

is definitely worth the time and effort!


Rainbow Rehabilitation Centers’ Young Adult Program is specially designed to assist individuals

with traumatic brain or spinal cord injury in gaining meaningful employment, developing the skills

necessary to initiate and maintain long-term relationships and solidify their identity.

To register or for more information, call

800.968.6644

It’s about reaching your potential

PEDIATRIC • ADOLESCENT • YOUNG ADULT • ADULTRainbow provides outpatient and day treatment services to clients living in their own homes who wish to participate in rehabilitation programs at one of our state-of-the-art treatment centers. Our in-house staff of highly trained and experienced professionals provide individual and group therapies at all of our centers. Programs feature individualized care plans and treatment, regularly scheduled progress meetings and peer grouping to promote socialization and skill building.

Outpatient and Day Treatment Programs

No better place to heal

800.968.6644

Discover Specialized Residential

Programming in Genesee CountyIntroducing a safe, supportive environment for

the last critical steps toward independence

• Graduated program allows for greater levels of independence

• Vocational and educational focus• Graduated medication management• Program fosters independent

financial management • Coordination of driving

evaluations/training• Discharge planning and community

care follow-up services• Community outings • Professional staff available 24/7• Individual therapies and

therapeutic groups

Facility Features• Furnished and unfurnished living

environments• Accessible one- and two-bedroom

units on the ground floor• Laundry facilities in the unit• Cable/Internet-ready• Transportation available

For more information, call

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• 2018-19 CONFERENCES & EVENTS

SeptemberSeptember 13-14 BIAMI Annual Fall Conference Lansing Center – Lansing, MI biami.org

September 25 ACMA Great Lakes Conference & Expo Suburban Showplace Diamond Center - Novi MI acmaweb.org

September 27 Mary Free Bed Spinal Cord Injury Conference Prince Con. Ctr. at Calvin College – Grand Rapids, MI maryfreebed.com

OctoberOctober 4-5 Comprehensive Brain Injury Rehabilitation Training Rainbow Rehabilitation Centers – Livonia, MI rainbowrehab.com

October 4-5 MAJ No-Fault Institute Sheraton Detroit - Novi, MI michiganjustice.org

October 5 Michigan Adjuster’s Association Bavarian Inn, Frankenmuth, MI [email protected]

October 9-10 Michigan Self Insurers’ Association Fall Conference Mariott Ypsilanti at Eagle Crest - Ypsilanti, MI michiganselfinsurers.org

October 17-20 ARN National Conference Palm Beach County Con. Ctr. – West Palm Beach, FL rehabnurse.org

October 19 CMSA Detroit Day Long Conference Burton Manor – Livonia, MI cmsadetroit.org

October 26 Michigan Guardianship Fall Conference Amway Grand – Grand Rapids, MI michiganguardianship.org/conference

October 27 CPAN Auto No-Fault Gala Eagle Eye Banquet Center – Bath Township, MI ProtectNoFault.org

NovemberNovember 1 MSU Case Management Conference Kellogg Center - East Lansing, MI nursing.msu.edu

November 5 BIAMI Quality of Life Conference Crowne Plaza Lansing West - Lansing, MI biami.org

DecemberDecember 5-7 National Workers’ Comp Conference Mandalay Bay – Las Vegas, NV wcconference.com

2019Feb. 28 - March 2 CCMC New World Symposium Gaylord National Resort - Washington, DC ccmcertification.org

March 7-8 Comprehensive Brain Injury Rehabilitation Training Rainbow Rehabilitation Centers – Livonia, MI see page 39 for details

March TBD MBIPC Annual Executive Lunch Lansing, MI mbicp.or

March 13-16 IBIA World Congress on Brain Injury Sheraton Centre Hotel - Toronto, Ont Canada ibia2019.org

March 13-16 NABIS Conference on Legal Issues in Brain Injury Sheraton Centre Hotel - Toronto, Ont Canada nabis.org

May 2-3 ICLE Annual No Fault Summit The Inn at St John’s - Plymouth, MI icle.org

June 10-14 CMSA National Conference & Expo Mirage Event Center - Las Vegas, NV cmsa.org

July 16 BIAMI East Golf Outing The Inn at St John’s - Plymouth, MI biami.org


NOTICE: The conferences and events information listed on these pages is dated information. For the most up-to-date information on industry-related conferences and events, please visit: rainbowrehab.com/calendar.

Registration at 11:30 a.m. • Lunch at Noon Presentation 12:30–2 p.m.

Learn Over LunchMeeting times are noon – 1:30 p.m.

(Registration at 11:30 a.m.)Cost: MBIPC Member $25 / Non-member $60

For information call 810.229.5880

October 9, 2018Location: Calvin College, Prince Conference Center, Grand Rapids, MI

November 13, 2018Location: Schoolcraft College, VisTaTech Center, Livonia, MI

December 11, 2018Location: Calvin College, Prince Conference Center, Grand Rapids, MI

January 8, 2019Location: Schoolcraft College, VisTaTech Center, Livonia, MI

February 12, 2019Location: Calvin College, Prince Conference Center, Grand Rapids, MI

April 9, 2019Location: Schoolcraft College, VisTaTech Center, Livonia, MI

May 14, 2019Location: Calvin College, Prince Conference Center, Grand Rapids, MI

June 11, 2019Location: Schoolcraft College, VisTaTech Center, Livonia, MI

RINC meetings are generally presented the third Friday of each month except July, August and December

For location of meeting or more information, please email [email protected]

UPCOMING MEETINGSLocation and Topics TBD

September 21, 2018

October 12, 2018TOPIC: Ethics

Sponsored by Rainbow Rehabilitation CentersLocation: The Inn at St. John’s, Plymouth, MI

November 16, 2018

January 18, 2019

February 15, 2019

March 15, 2019

April 19, 2019

May 17, 2019

Rehabilitation Insurance Nurses Council

For updates on meetings, visit rainbowrehab.com or mbipc.org


This summer, Rainbow’s pediatric and young adult clients at our Oakland Treatment Center and Genesee Treatment Center learned, socialized and explored during the Summer Fun! Program. The theme of this year’s program was Road Trip – a virtual drive across America.

Created by Rainbow’s pediatric rehabilitation specialists, this therapeutic program provides structure, support and fun for children ages four through young adult who have sustained traumatic brain and spinal cord injuries.

The Summer Fun! program schedule was packed with a variety of classes and activities including Crafty USA, Road Trip Games, Reading Across the USA, Going the Extra Mile and more. These classes challenged our clients to reach their therapeutic goals, all while having fun with their friends!

Summer Fun! program participants also went on weekly outings including, Greenfield Village in Dearborn, MI, water parks, an overnight camping trip, arcades and a talent show. Community outings are used as “therapy in disguise” to assist with rehabilitation goals such as socialization, mobility, endurance and combating anxiety and depression.

With school now back in session, Rainbow’s Oakland Treatment Center and Genesee Treatment Center offer After School and Saturday programs for children and young adults. If you are interested in learning more about this program, visit rainbowrehab.com/after-school-saturday.

Summer Fun! Road Trip 2018 Pediatric clients enjoy a virtual drive across America

Rainbow encourages all of our employees to attend and present at conferences locally, nationally and internationally. This fall, Rainbow is humbled to have eight Rainbow employees presenting at the Fall 2018 Brain Injury Association of Michigan (BIAMI) conference in Lansing, MI. The presentations include: Lynn Brouwers – The Lesser of Two Evils: Ethical Challenges for Clinicians, Kirk Howard – An Exploration into Tai Chi and Ai Chi, Mariann Young – Grief, Loss and Hope, Carolyn Scott and Lynn Brouwers – An Introduction to Brain Injury, Marissa Cruz and Payal Desai – Balance After Brain Injury, and Aurelia Wiltshire and Sabrina Bentley – Cultural Awareness; Let’s Talk!

Presenting at this conference is a great opportunity for these employees to share their expertise and best practices with conference attendees including brain injury professionals, clinicians, individuals who have sustained brain injury and their families.

In addition to presenting at conferences, several of Rainbow’s professional staff are available to present on a number of topics including Post-Traumatic Confusion and Behavior: Understanding the School Reintegration Process Following a TBI, Balance After Brain Injury: Vestibular Disorders–Anatomy, Assessment and Treatment, and Traumatic Brain Injury and the African American Male: How Identity Can Effect Post-Injury Outcomes.

To learn more about Rainbow’s in-service presentations, contact a member of our admissions team at 800.968.6644 or email [email protected].

Rainbow Presentations at the Annual Brain Injury Association of Michigan Conference in Lansing


• NEWS AT

This summer, Rainbow’s Employee Activities Committee organized a company-wide fundraiser for the Michigan Humane Society to support homeless and mistreated animals in our community.

To raise money for the Humane Society, employees participated in a Cutest Pet Contest. Employees submitted pictures of their pet, and for $1 per vote employees could cast a ballot for who they thought was the cutest pet.

The committee received over 60 submissions which included dogs, cats, a bunny and a gecko! In total, the cutest pet contest raised $627 for the Michigan Humane Society.

The winning pet was Dolce, the Shih Tzu! Dolce enjoys being pampered by her mom, Jennifer Griewahn, Human Resource Generalist. Dolce also loves belly rubs and car rides. She is very demanding and sassy and is a picky eater. She will only eat a specific kind of dog treat and will turn her nose away from anything else. Dolce is spoiled rotten!

Congratulations Dolce! This contest helped provide food and care for many other cute animals just like her.

Rainbow holds Cutest Pet Contest to support the Michigan Humane Society

Exciting things are happening at Rainbow! Construction is underway for the NeuroRehab Campus® expansion and renovation project. Located in Farmington Hills, MI, the NeuroRehab Campus® is our facility that is specially equipped for individuals who require intensive post-acute rehab and care.

The renovation project includes the construction of a new therapy gym. This space will feature state-of-the-art equipment and technology that will provide even more opportunities for success and recovery for our clients.

In addition to the therapy gym, there will also be a renovated lobby and common areas and remodeled client rooms and bathrooms. The new design will be based on the calming color palette and diverse textures used at Rainbow’s newest facility, The Southfield Center.

This project will significantly improve the flow and feeling of this 40-bed residential and rehabilitation facility. Every detail of the design has been selected by a team of experts to increase the satisfaction of our clients, guests and NeuroRehab Campus® employees!

Rainbow breaks ground on NeuroRehab Campus® expansion and renovation project

On June 14, 2018, a groundbreaking ceremony was attended by Rainbow’s executive team, board of directors, employees and clients, plus key individuals who have been supportive in the launch of this project including, State Representative Christine Greig, Andy Martin of FH Martin Constructors, Jason Altman of Hooker Dejong Architects, Mary Martin, Executive Director of Farmington Area Chamber, and Terry Solomon of Fifth Third Bank.


• NEWS AT

Employees of the Season Winter 2018

Pillars of Excellence AwardsAt the luncheon honoring the Winter 2018 Employees of the Season, Rainbow presented the Growth Pillar Award and Safety Pillar Award to two distinguished employees.

The Growth Pillar Award recognizes an employee who has contributed significantly to areas that promote this pillar including business diversification and increasing or executing key projects that facilitate growth. The Safety Pillar Award recognizes an employee who has contributed significantly to decreasing employee injury rate, or any other activity that contributes to the safety of our clients and employees.

Marisa Cruz, Division Director, was chosen as the recipient of the Growth Pillar Award for her tremendous work that she has done to promote growth in her division. In the few years that Marissa has been with Rainbow, she has helped expand and enhance many areas including home care, outpatient services and more. She is always thinking of new and innovative ways to improve the quality of service for our clients and is a supportive leader for everyone working in her division.

Bill Carlton, Director of Facilities and Construction Management, was the recipient of the Safety Pillar Award for his above and beyond

efforts at Rainbow helping to improve efficiency and safety for our clients and employees. Every day, Bill’s number one priority is the safety and well-being of our clients and employees, and Rainbow is a better place because of it. Congratulations to Marissa and Bill! Rainbow is honored to have employees like you!

Pillar of Excellence Award winners Marissa Cruz and Bill Carlton.

Each season, Rainbow employees are recognized for the amazing things they do every day, such as helping with extra shifts, taking care of our client’s needs, and keeping our facilities sparkling clean. The following are the employees recognized for Winter of 2018:

Clinical and Therapy StaffDaria Goodman-SmithAngelica LanningSara ComerAngela AspergerAnn Moncrieff Lillian DureckiKim WagenknechtTimothea McBeeCereste Duprat-FabreJill Coval

Stephanie LighteSusan MatsonLeslie McIntyreKayla BeachKerri TorzewskiPaige CicchiniAlison BrinkmanKirk HowardAngie McCalla

RPMsChayla TurmanDebbie TrumbullCindy TreharneJoann ArpinoDebbie MayPorsha MooreMichelle SmithJulie Mooring

Rehabilitation Assistants Arbor: Pamela DagostinoAnn Arbor Apts: Brian Poma, Daniel ShaferBemis: Juanita Washington, Sarah CarusoBirchwood: Ashli Terrell, Heather Vitale, Jessica Reid, Dawn Eichenberg, Jillian Zamenski, Cheylon Schneider, Tara Paris, John AntoniottiBriarhill: Glen KurzCarpenter: Chalaha BegumGarden City Apts: Kenyatta Young, Marocca Davis, Emonda Burroughs, Debra Parks, Jacquelin Jordan, Danita Whitt, Lashanda Williams, Crystal Carr, LaKendra Bushey, Marketta Crutcher, Hilda BracyGolfside: Elizabeth KerkesHome Care: Roberta Wendt, Veronica Kimble, Debra Kemp

Maple: Autumn LandrumNRC: Kalyd Manville, Antonia Starks, Jacqueline Murray-Bey, Lizzietta Battle, Florence Palmore, Nautica ScottOakland Townhouses: Deirdre Brown, Whitney PerrySpring Valley: Sierra StoneShady Lanes: Toya Moore, Lynn Vaughn, Angel Hudson, Brandon Schubert, Nicole McClainSouthfield: Latesianna ThrowerTalladay: Alyssa Adams, Kelli PinderVRC: Chelsea LuponeWhittaker: Jennifer LynchWoodsides: Kathryn Sobaszko, Amanda Thornton, Judy HartmanYpsilanti Center: Millie Staton, Brandy Antoniotti, Tuesday CritesRehab Trans: Juanita Jones, Ted Higginbotham

Professional/Administrative StaffCrystal BajosNickole BurnhamTresa EllisSusan Zaitounh

Kristian PowellAmy GelsoStephanie HuhnKathleen Sobczak

Maintenance TeamDennis DauphinaisCharlie AllenJason RosentreterRon Keen Derek Bennett


Please join us in congratulating these outstanding employees!

View open positions at rainbowrehab.com/employment

Rainbow Rehabilitation Centers has provided quality care and therapeutic

rehabilitation services for individuals with brain injuries, spinal cord injuries and

other neurological disorders. It is our mission to inspire the people we serve

to realize their greatest potential.


New Professionals• NEWS AT

Teresa Austreng, RN, BSNNurse Case ManagerTeresa joins Rainbow as a Nurse Case Manager at the Genesee Treatment Center in Flint, MI. She earned her degrees at Oakland University in Rochester, MI. Teresa has been a nurse for 25 years. She has worked in critical intensive care units and an internal medicine clinic, and was also a Director of Nursing at an ambulatory surgery center.

Sarah Pozza, DPTPhysical TherapistSarah joins Rainbow as a Physical Therapist at the Ypsilanti Treatment Center in Ypsilanti, MI. She earned a Bachelor of Science in Kinesiology from Michigan State University in East Lansing, MI and a Doctor of Physical Therapy from Central Michigan University in Mt. Pleasant, MI. Sarah has previous experience with skilled nursing care and home care/assisted living.

Lauren Snyder, OTR/LCommunity Occupational TherapistLauren comes to Rainbow as a Community Occupational Therapist at the Genesee Treatment Center. She earned a Master of Occupational Therapy from the University of Findlay in Findlay, OH. Lauren’s previous experience includes two years serving inpatient and outpatient populations in a critical access hospital and 13 years with a neurological population.

Dina Marsh, RRTRespiratory TherapistDina joins Rainbow as a Respiratory Therapist at the NeuroRehab Campus® in Farmington Hills, MI. She earned an Associate in Applied Science from Macomb Community College in Warren, MI and is working toward a Bachelor of Science degree in Health Care Administration. Dina spent 15 years working at a level 1 trauma center.

Earl Jenkins, MBATalent Acquisition ManagerEarl joins Rainbow as a Talent Acquisition Manager in the Human Resources Department at the Corporate Center in Livonia, MI. He earned a Bachelor of Arts from Arizona State University in Tempe, AZ and earned a Master of Business Administration at Saint Xavier University in Chicago, IL. Most recently, Earl managed talent acquisition for Common Ground in Bloomfield Hills, MI.

Lauren Wu, DPTPhysical TherapistLauren joins Rainbow as a Physical Therapist at the Farmington Hills Treatment Center in Farmington Hills, MI. She earned her degree from Central Michigan University in Mt. Pleasant, MI. Though she’s a new graduate, she does have previous experience working with brain and spinal cord injuries.

Sue Turner, BSSenior Business AnalystSue joins Rainbow as a Senior Business Analyst in the Information Technology department at the Livonia Corporate Center. She earned a Bachelor of Science in Computer Science from the University of Michigan in Dearborn, MI. Previously, Sue worked at one of the largest health systems in southeast Michigan.

Melissa Rayburn, MPTPhysical TherapistMelissa joins Rainbow as a Physical Therapist working at the NeuroRehab Campus® in Farmington Hills, MI. Melissa earned her degree from Wayne State University in Detroit. She has been a physical therapist for 12 years—six of those years with a neurological focus including traumatic brain injury, spinal cord injury and cerebrovascular accident (stroke).

Rainbow is looking for exceptional people who

want to make a difference!

Work With Us!

Learn why you should consider joining our team at: rainbowrehab.com/employment


Email [email protected] ASAP to reserve your spot!

Join more than 1,500 Certified

Michigan Professionals

Become a

CERTIFIED BRAIN INJURY

SPECIALIST

Earn 14 CCM and/or RN CEs

The Academy of Certified Brain Injury Specialists (ACBIS) offers a national certification program for experienced professionals working in the field of brain injury. ACBIS provides an opportunity to learn about brain injury, to demonstrate learning with a written examination, and to earn a nationally recognized credential.

As a service to our brain injury community, Rainbow is offering a free training course to prepare for the CBIS exam. Receive a discounted exam fee of $200 ($100 less than the individual application cost) when you take the exam with Rainbow’s group.

Nurses, case managers and other professionals who partner with Rainbow and have at least one year of experience working in the field of traumatic brain injury rehabilitation are invited to attend.

FREE CBIS TRAINING

COMPREHENSIVE BRAIN INJURY REHABILITATION TRAINING MARCH 7-8, 2019 • 8:30 a.m.–4:30 p.m.PROCTORED EXAMS Scheduled at your convenience

LOCATION Rainbow Rehabilitation Centers17187 N. Laurel Park Dr., Suite 160, Livonia, MI 48152

2019 SERIES

THIS CLASS IS NOW

2 DAYSAND USES THE

NEW EBIG 5.0

Textbooks will be available for loan with a deposit or purchased

at a discounted price of $80

This activity has been approved by the Ohio Nurses Association. The Ohio Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission. (OBN-001-91). This program has been approved by the Commission for Case Manager Certification to provide board certified case managers with 14.0 clock hour(s). To verify successful completion of this program and 14.0 contact hours, you must sign in and sign out on-site each day, attend the entire presentation and complete an evaluation form after the program concludes. The planners and faculty have declared no conflict of interest. Please call Marianne Knox at 734.482.1200 for more information about contact hours.


One Thousand Words

As we celebrate Rainbow’s 35th anniversary, our thoughts turn to Buzz Wilson who helped establish the company in 1983. Buzz was a great leader. He challenged his employees to make Rainbow a better place for themselves and clients alike. He was a fierce advocate for Rainbow clients and created the culture that everything we do is centered around them. Buzz passed away in 2008, and to this day people still share fond memories about him. The story usually started with, “Remember when Buzz...” He coined the phrase “Do Good, Do Well, Have Fun” and you see this every day in various manifestations throughout the company. Thank you, Buzz, for the opportunities you’ve given so many.

Locations [email protected]

GENESEE COUNTYGenesee Treatment Center5402 Gateway Centre Dr., Suite B, Flint, MI 48507T: 810.603.0040 F: 810.603.0044

OAKLAND COUNTY Farmington Hills Treatment Center 28511 Orchard Lake Rd., Suite A Farmington Hills, MI 48334T: 248.306.3170 F: 248.306.3197

NeuroRehab Campus®25911 Middlebelt Rd., Farmington Hills, MI 48336T: 248.471.9580 F: 248.471.9540

Oakland Treatment Center32715 Grand River Ave., Farmington, MI 48336T: 248.427.1310 F: 734.629.0453

Southfield Center25285 W. Eleven Mile Rd., Southfield, MI 48033

WASHTENAW COUNTY Ypsilanti Treatment Center5570 Whittaker Rd., Ypsilanti, MI 48197T: 734.482.1200 F: 734.482.5212

Vocational Rehab Campus5 West Forest Ave., Ypsilanti, MI 48197T: 734.390.2450 F: 734.217.8174

WAYNE COUNTY Rainbow Corporate Headquarters17187 N. Laurel Park Dr., Suite 160, Livonia, MI 48152T: 734.482.1200 F: 734.482.3202

THROUGHOUT MICHIGAN Home Care T: 800.968.6644

Home and Community-Based RehabilitationT: 810.603.0040 F: 810.603.0044

Rehab Transportation®A wholly owned subsidiary of Rainbow Rehabilitation Centersrehabtransportation.comT: 800.306.6406


Rainbow Rehabilitation Centers

SOUTHFIELD CENTER The new Southfield Center offers comprehensive rehabilitation services provided by

professionals who specialize in caring for individuals who have been injured.

The program focuses on treating medically stable individuals with:Traumatic brain injuries • Spinal cord injuries

Neurologic impairments • Orthopedic injuries • Co-morbidities

The Southfield Center is conveniently located in Southfield, MI, close to medical facilities, community activities and major freeways.

The fully-accessible facility boasts numerous amenities including: Beautifully appointed 14-bed living environment • Fully accessible private rooms and baths

Cable TV, phone and Internet availability in each bedroom • On-site dining servicesTherapy areas on-site • A large patio deck, perfect for outdoor activities

If you would like to tour Rainbow’s newest premier facility, give us a call at

800.968.6644

Presorted StandardU.S. Postage

PAIDPermit 991

Ypsilanti, MI17187 N. Laurel Park Drive, Suite 160Livonia, Michigan 48152

Tell us what you think about RainbowVisions! Do you have a story idea or comment? Email: [email protected]

INSIDE:Understanding Disorders of Consciousness

Now offered in Oakland and Genesee Counties! 800.968.6644

Therapies and skill building for children and teens with brain injuries

Take steps to boost academic and social successRainbow’s After School & Saturday Programs are designed to foster academic and social success in addition to advancing a child’s treatment goals.

Created by pediatric rehabilitation specialistsRainbow’s After School and Saturday Programs provide education and structure for children pre-school age through adolescence, all in a setting that is safe and fun.

Engaging activitiesTutoring provided by certified teachers • School-based groupings • Individual therapies Therapeutic groups • Recreational groups • Swimming and fitness activities Community outings • Meals and snacks

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