RainbowVisionsA News MAgAziNe for Acquired Brain injury Professionals, survivors and Families

Rainbow Rehabilitation CenteRs inC. www.rainbowrehab.com

March 2009 online edition

Robot-Assisted Walking TherapyRobots can now help people with brain and spinal cord injuries learn to walk again. Read more ...

Volume 1 No. 3

A look at ...

The 5 Stages of Change

sUbstanCe abUse

Marchis brain injuryAwareness

2009month

Occupational Therapyin Rainbow's adult levels Program

Covering strategies that assist TBI survivors with the job of living

A Professional Product Review

of the

BrainInjuryRecoveryKit

Marchis brain injuryAwareness

2009month.

2 R a i n b owVisions

CoverOn the

Editor & designer – Kimberly Paetzold

Staff writer & assistant editor – Nicole Bonomini

Staff writer & assistant editor – Barry Marshall

Staff photographer – Heidi Reyst

In this online edition of

RainbowVisions we are

featuring an article on

Robot Assistive Walking

Therapy. <click here> to

read the article

Features ...What’s News in the Industry – Rainbow acquires Functional 4 Recovery

Mental Health Support – A look at substance abuse and 5 the five stages of change

Robot Assistive Walking Therapy 6

Product Review – The Brain Injury Recovery Kit 8

Industry Conference & Event Calendar 10

Therapy Corner– A look at Occupational Therapy 12

Adult Levels Program in Ann Arbor 15

NEW ACBIS Training Program 17

E-mail questions or comments to: Rainbowvisions@rainbowrehab.com

March is brain injury awareness month, but most of our readers are already well aware of the issues

associated with traumatic brain injury (TBI). Individuals with moderate to severe TBIs often suffer with

long-term cognitive dysfunctions, physical impairments and behavioral problems.

As late as the 1970s, 90 percent of all brain-injured patients died. Thanks to medical advances, improved technology and

emergency care, survival rates are up — but the burden of paying for rehabilitation has become a important issue. Without

proper rehabilitation many, if not most survivors with moderate to severe injuries, will not reach their full recovery potential.

Recovery often requires extensive rehabilitation. Survivors must be retrained and relearn what was commonplace before

their injury. This type of rehabilitation requires a high level of expertise, structure, support and plenty of time. According

to Richard Senelick, MD, author of Living with Brain Injury, “In a study of severely brain-injured young adults with serious

cognitive and emotional disturbances, 50 percent of those who received rehabilitation were found to be production three-

quarters of the time, as opposed to only 36% of those who did not receive treatment.” Individuals who receive effective

rehabilitation often are empowered to rebuild productive and meaningful lives.

Dealing with brain injury rehabilitation is a relatively new concept (only about 25-30 years old) and we still have a long

way to go in educating the public and providing treatment. Yet, there have been substantial advancements and the picture for

survivors is not so bleak. In the coming year I challenge to you to read each issue of RainbowVisions. We will cover topics

on medical and therapy advances, bring you inspiring success stories and inform you on industry events. Take the time to be

informed. Brain injury recovery is possible — knowledge is key along with the right support and help.

a note from the editor ...

, Editor

R a i n b owVisions 3

June — August, 2009

Summer Fun!Therapeutic programs for children and teens with brain injuries.

<Click Here> for a brochure and schedule

1.800.968.6644www.rainbowrehab.com

industryWhat’s News in the

R A I N B O W A C Q U I R E S

Functional Recovery Home Health CareBy Bill Buccalo, President

R ainbow has some exciting plans in

store for 2009. Already this

year, Rainbow has purchased Functional

Recovery, Inc., a home and community-

based professional therapy services

firm for children, teens and adults. We

are very excited to have Char Combs,

former president and owner of Functional

Recovery, join Rainbow as the new

program director of the Functional

Recovery Division.

Functional Recovery, based in Grand

Blanc, Mich., and its teams of physical,

occupational and speech therapists

has served people with brain injuries

throughout Genesee, Macomb and

Oakland Counties for more than 12 years.

This acquisition is a great opportunity for

Rainbow to enter fully into home-and-

community based treatment with a known

and respected industry leader. We are very

excited to have the opportunity to work

with Char and her therapy teams.

Functional Recovery will be integrated into

Rainbow Rehabilitation Centers as a new

division of home care services. Functional

Recovery's approach of fully integrating

clients into real life settings matches well

with Rainbow’s philosophy and continuum

of care. This endeavor will assist with our

planned growth by expanding our regional

reach and therapeutic continuum.

Functional RecoveryHome and Community-Based Rehabilitation

With teams of physical, occupational and speech therapists, Functional Recovery has served clients with brain and spinal cord

injuries throughout Genesee and Oakland Counties for more than 12 years. We will continue to offer high quality home and

community-based professional therapy services to children, teens and adults. For more information on our

services, please log on to our Website.

Now a division of

www.rainbowrehab.com/Functional_Recovery

Introducing ...

4 Rainb owVisions

hen treating individuals in a rehabilitation environment, the use

of alcohol and drugs often slows recovery and impedes active

therapy. If a patient has substance abuse issues, their treatment team

will need to support and help change their addictive behavior(s). Before

attempting to help support someone undertaking a difficult change,

I would like to introduce you to a useful theory called the Stages of

Change Model (SCM). It takes a look at the stages an individual’s mind

and body go through when implementing change. It was originally

developed in the late 1970s by James Prochaska and Carlo DiClemente

at the University of Rhode Island. SCM can be applied to a broad

range of behaviors including losing weight, kicking the smoking habit

and overcoming alcohol / drug problems. The idea behind SCM is that

change does not happen in one step. Instead, people tend to progress

through different stages – each individual at his or her own rate.

Substance Abuse

A L O O K A T S U B S T A N C E A B U S E

The Five Stages of ChangeEdited by Joseph Welch, MS LLP, Rainbow Behavior Analyst

Mental healthTBI

Support

The Five Stages of Change

1. Pre-contemplation – Not

acknowledging a problem behavior

that needs to be changed. In this stage,

people are essentially unaware that a

problem exists and have no intention

of changing in the foreseeable future.

They may be defensive or not want to

discuss their bad habit. People with brain

injuries typically require a significant

intervention by professionals and family

members to reach the next stage.

2. Contemplation – Acknowledging that

there is a problem but not ready to make

a change. People in this stage are aware

that a problem exists and are considering

change. Those with brain injuries require

assistance to take effective action.

3. Preparation – Getting ready to

change. In this stage, individuals have

the intention to change but have not

established a specific goal. People with

brain injuries require assistance to take

the necessary steps. It is a misconception

to think “Nobody can help me with a

drug problem but me” and believe it

only takes willpower to change.

4. Action – Changing the behavior.

People in this stage make changes

in their behavior and alter their

environment in order to modify or

eliminate an addictive behavior.

Willpower is a misnomer. Medical

supervision during initial treatment and

consistent attendance at community

support groups is key. Twelve-step work

– getting a sponsor, calling others, and

having a full schedule of meetings is

the most successful, cost effective and

available treatment there is.

5. Maintenance – Maintaining the

behavior change. In this stage, success

means filling in the gaps left by the

absence of substance abuse. Becoming

friends with a social group of non-users

takes time. Constructive alternative

activities to replace the culture of

substance abuse requires courage and is

important to prevent relapse. Prochaska

and colleagues believe that a person must

have at least six months of successful

change in order to be considered in the

Maintenance versus the Action stage.

A Note on “Relapse” – When eliminating

a bad habit, many people experience

relapses. A spiral process in which an

individual relapses and recycles through

earlier phases is more common than

a steady linear progression. People

who eventually overcome addictive

behaviors show progress over time,

with setbacks becoming smaller and

shorter. There is a real risk that people

who relapse will experience a sense of

failure, undermining self-confidence.

It is important that, if they do slip, they

don’t see themselves as having failed;

rather, they should analyze how the slip

happened and use it as an opportunity to

learn how to cope differently. Relapsing

is like falling off a horse — the best thing

you can do is get right back on.

W

Rainb owVisions 5

www.ra inbowrehab.comRainbowViSionS o n l i n e M a g a z i n e

6 Rainb owVisions

R obots can now help people with brain and spinal cord injuries learn to walk again. With

the Lokomat System, a new treadmill technology

A L O O K A T

Robot-Assisted Walking TherapyInterview by Kimberly Paetzold, Editor

Written by Nicole Bonomini, Staff Writer

created by the Swiss company Hocoma, a computer and robot quickly

teach walking movement and corrects gait by moving the patient’s legs

in a way that mimics walking.

The Lokomat suspends a person in a skeletal, robot frame over a

treadmill. The robot is attached by straps to the outside of the person’s

legs. The Lokomat then moves the legs in a natural walking pattern,

while a computer controls the pace of walking and measures the

body’s response to the movements.

The Lokomat provides users with a repetitive walking pattern, which

helps re-route brain signals that are interrupted due to injury or illness.

“Its scientific foundation is really based on animal models,” Dr.

Edward Dabrowski explained. “If you sever the spinal cord of a

cat, for example, and suspend him on the treadmill, he’ll walk.”

Dr. Dabrowski is chief of the Division of Physical Medicine and

Rehabilitation Services for Children's Hospital of Michigan and the

Medical Director for Pediatric Services at Rainbow.

“How could he walk when the brain isn’t connected to the spinal

cord?” Dr. Dabrowski asked. “Or the spinal cord isn’t connected to the

legs anymore? It’s telling you there are independent generators in the

spinal column that generate walking.”

The Lokomat helps to reduce the physical strain of therapy for

therapists, improves efficiency of gait training for patients, and

improves leg movement and lateral balance for the patients. Currently,

this type of therapy takes the work of at least two therapists without

robotic assistance because they must manually move the patient’s

legs in a walking pattern. With the Lokomat, the robot helps patients

walk throughout therapy. Therapists only help as needed, thus pushing

CornertechnologyABI

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

About Rainbow's Pediatric Medical Director ...

Dr. Dabrowski, MD

Dr. Edward Dabrowski has a medical

degree from Wayne State University School

of Medicine. He is board-certified in

physical medicine and rehabilitation.

Experience/Specialty:

Dr. Dabrowski has extensive faculty and

professional appointments. He currently

serves as chief of the Division of Physical

Medicine and Rehabilitation Services for Children's Hospital of Michigan

and pediatric program medical director at Rainbow Rehabilitation Centers. In

addition, Dr. Dabrowski is program director of the combined pediatric/PM&R

residency program and codirector for the Muscular Dystrophy Association of

Southeastern Michigan. Dr. Dabrowski specializes in pediatric traumatic brain

injury, neuro-muscular conditions and spasticity.

patients to their full potential.

“The Lokomat reduces the work of the

therapist and allows for consistent therapy.

We know exactly how fast the patient is

walking and how much weight they are

bearing. Rehabilitation efforts are consistent,

repetitive and precise,” Dabrowski

explained. In addition to the spinal cord

population, those with brain injury, cerebral

palsy, etcetera, can also benefit from this

technology.

First approved by the Food and Drug

Administration in March 2002, the Lokomat

may also help to strengthen muscles and

improve circulation.

Many health care insurance providers

cover robot-assisted walking therapy. This

therapy is available at a variety of locations,

including hospitals and rehabilitation

centers. More information on the Lokomat is

available on Hocoma’s Web site at:

www.hocoma.ch/en/products/lokomat

Rainb owVisions 7

Give a Teen a Chance to

Rainbow provides supports to help build

social skills, self-confidence

and is a “place to belong” and succeed.

Succeed!

For kids with brain injuries.

www.rainbowrehab.com

www.ra inbowrehab.comRainbowViSionS o n l i n e M a g a z i n e

R ainbow’s Lead Speech Language

Pathologist Angie McCalla and a

client tested The Brain Injury Recovery Kit

(BIRK). Created by Day-Timer, this kit was

designed by Lisa Keller, a person with a

brain injury, in conjunction with Sandra

J. Knutson, CRC, CDMS, CCM — Lisa’s

former caseworker. The tool was created to

help TBI survivors recover — and in Angie’s

opinion, those with mild to moderate brain

injuries stand to benefit from the BIRK.

The kit is designed to:

•make‘gettingthroughtheday’more

productive,

•helpwithmemorydeficits,

•promoteorganization,

• reducestress,and

• supporttherapyrehabilitationefforts.

The BIRK is an inclusive five-step

system that contains two comprehensive

workbooks (one for the person with the

brain injury and another for the buddy

assisting with recovery) and three DVDs.

The books provide information, exercises,

review forms and checklists that track

progress and reinforce the DVD lessons

— helping to identify breakdowns in

sequencing, recall and initiation. They

also provide strategies based on what

Day-Timer calls the Four Keys of Recovery

– Buddy, Rest, Acceptance and Routine.

The strategies stress development of step-

by-step protocols and routine. The planner

system allows the user to track information

in one location and uses color-coding for

organizing and prioritizing tasks. The five-

step system consists of:

• StepOne:Learning about brain injury

and its complications, emphasizing the

importance of professional therapeutic care

and survivor challenges.

• StepTwo: Learning how to support an

individual with brain injury — with an

introduction to the workbooks, Four Keys

of recovery and how the buddy should

assist.

• StepThree: Understanding the

experience of brain injury. The buddy and

user begin to progress through the Four

Keys of Recovery – buddy, rest, acceptance

and routine.

• StepFour: The Day-Timer personal

planner and color-coding for success tools

are introduced for organization and routine

to improve memory, confidence and

organization.

• StepFive: Using repetition and

reminders. The Electronic Message Center

voice recorder is introduced as a reminder

system for users. It includes alarms, a

countdown timer and multiple mailboxes.

Review Results

Angie and a client went through the

system and analyzed its strengths and

weaknesses. Overall, both participants

had positive results with the BIRK. Based

on their observations, they found the kit to

be an excellent tool. It incorporates a lot

of sensory components allowing users to

exercise all of their modalities — they can

touch the orange cord and see the planner,

read the checklists and watch the DVDs.

It provides tools that you create (such as

a calendar or schedule), making it very

interactive.

“From day one, she [the client] loved it,”

Angie explained. “We had very positive

results. Typically she is very resistive to

programming, but this really gave her

asenseof,‘Icandothis.’Itwasvery

empowering and she felt that she could

Product REVIEWTBI

BrainInjuryRecoveryKit

8 Rainb owVisions

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

accomplish things on her own with the

help of the kit.”

The client said she liked that the kit

explained brain injury in great detail. “A lot

of tools in this kit, if mastered, can make

the user more efficient,” she explained.

This sense of empowerment and

confidence carried over into the client’s

other therapies and treatments, such as

occupational therapy. “She started using a

chalkboard wall in her apartment bedroom

to become more organized,” Angie said.

“It was a tool she never utilized before and

it has further improved her attitude and

organization in other therapies as a result.”

Our client had positive results with the

following kit components:

•Color-coding:“Ittakesalotofstrainoff

of me when I can just look at something

and know it is urgent or it has to do with

my family, money matters, etc.,” she said.

•GoingSomewhereChecklist:iftheuser

focuses on trip details prior to leaving, then

he or she is able to focus on driving when

on the road.

•RestingEyeMask:Theclientfound

that the resting eye mask helped her to

fall asleep even when she was not tired.

“When I put this on, it blocks out all light,

which quiets my mind and forces me to fall

asleep,” she explained.

•OrangeCord(usedasaplaceholder):

The orange cord helps users focus on the

task at hand. When they stop and return

to a task at a later time, it prompts them to

remember exactly where they left off.

Weaknesses were found with several

pieces of the kit as well. The client thought

the DVDs were too repetitive — over

redundancy can cause participants to skim

over material and lose attention. The client

found that the most important information

was presented at the beginning of disc

one. “It is recommended that the user

and buddy watch all three DVDs from

beginning to end before moving forward.

But by then, a lot of important information

is forgotten,” she discovered.

However, Angie, her therapist, thought

the repetition was useful and for many

would be necessary. “It’s what the

majority of the brain injury population

needs. Repetition and routine helps them

to pick up things more quickly. The kit

really focuses on over learning, and that

is something I’ve tried to carryover to

my other therapies,” she said. “Often

we move on to the next task right after

oneismastered,saying,‘OK,wedidthis

successfully one week, now we can add the

next one. But it is beneficial to over learn

the material and do it for several weeks

before adding the next task.”

The client also found the ID key chain to

be unfavorable. “I understand the concept,

butitscreams,‘lookatme,Ihavean

impairment.’ Therefore, I am not willing to

use it.” Angie did not think the key chain

was very effective, either. “When an item is

that large and does not fit nicely in a purse

or bag, some may not be willing to use it.”

While the client liked color-coding, she

found the orange binder to be excessive.

“Using a planner is something a person

should continue to do even after their

recovery goals have been accomplished.

Why not use something that resembles

what others have? If a person always puts

the planner in the same place, he or she

will not have a problem finding it,” she

asserted. “The orange color isn’t necessary.”

Angie agreed. “The orange binder was

justtoolarge.Itreallyshouts,‘thereis

something wrong with me.'”

Our client also made suggestions on how

to improve the kit. She thought that the

overall labeling of the workbooks needed

to be improved. Angie explained that the

workbooks needed to provide more detail.

“The workbooks don’t provide explanation

and details — they just tab right to

worksheets,” she said. “The kit would

benefit from having the workbooks overlap

more with the DVD content.”

The client also thought that the

workbook should include a more thorough

section on brain injury, such as a diagram

explaining which deficits can occur in

which section of the brain as a result of an

injury. She thought the workbook would

benefit from having common brain injury

definitions, a list of rehabilitation therapies

along with a list of therapy occupations

and professionals.

Want to help TBI survivors?

A non-profit group called the "10 in 10

Project" accepts donations toward the kits

and distributes them to people who cannot

afford the $600 price. And "Ticket of Hope,"

a special campaign launched by 10 in 10,

is working to secure donations specifically

for veterans' kits. After the estimated 3,000

Iraq war veterans with brain injuries receive

the help they need, the group will make kits

available to others as well.

How to order a BIRK

Overall, both the Rainbow client

and lead SLP therapist had positive

results with the BIRK and would

recommend it to other individuals

with TBI, especially those with mild to

moderate injuries.

The BIRK may be purchased at a

retail price of $600 or you can take

advantage of a special discount for

RainbowVisions Magazine readers.

by contacting ...

800.525.5005www.daytimer.com

Rainb owVisions 9

2009Conference & Event Schedule

MBIPC Michigan Brain Injury Provider Council

Learn over LunchMeeting times are noon - 2:00 p.m.

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

For info or RSVP contact Lisha Clevengerlisha.clevenger@rrciweb.com

March 10, 2009 Topic: Research and Study on TBI Model Systems

Speaker: Robin Hanks, PhD of the Rehabilitation Institute of Michigan/DMCLocation: Radisson Hotel, Lansing, MI

April 14, 2009 Topic & Speaker: TBA

Location: Radisson Hotel, Livonia, MI

May 12, 2009 Topic: Management of the Upper Limb in Motor Neuron Syndrome

Speaker: Dr. Adam J. Rush of Rehabilitation Medicine AssociatesLocation: Applause Banquest & Catering, Grand Rapids, MI

June 9, 2009 Topic & Speaker: TBA

Location: Radisson Hotel, Livonia, MI

For a full list of meetings

<CLICK HERE>

—National Conferences—

March, 2009March 3 - 5, 20092009 Collaborative Practice Summit at the Grand Hyatt in San Antonio, TX For info log on to: www.cmsa.org/cps

March 4 - 7, 2009Contemporary Forums Brain Injuries Conference at the Las Vegas Hilton in Las Vegas, NV For info log on to: www.contemporaryforums.com

March 5 - 6, 2009Illinois Worker's Compensation Forum at the Westin Lombardo Yorktown Center in Chicago, IL For info log on to: www.ilscforum.com

March 5 - 6, 2009BIA of Iowa's Annual Brain Injury Conference at the Hotel Fort Des Moines in Des Moines, IAFor info e-mail: conferences@biaia.org

March 12 - 13, 2009First Annual International Conference on Culture Ethnicity and Brain Injury Rehabilitation at the Crystal Gateway Marriott Hotel in Arlington, VA For info e-mail Dr. Juan Carlos Arango-Lasprilla: jcarangolasp@vcu.edu

March 18 - 21, 2009Contemporary Forums Psychiatric Nursing Conference at the Sheraton Society Hill in Philadelphia, PA For info log on to: www.contemporaryforums.com

March 18 - 21, 2009Contemporary Forums Spinal Cord Injuries Conference at the Hilton in the Disney World Resort in Orlando, FL For info log on to: www.contemporaryforums.com

March 21 - 24, 2009The Young Child with Special Needs Conference at the Las Vegas Hilton in Las Vegas, NV For info log on to: www.contemporaryforums.com

March 28 - 31, 2009American Association of Neuroscience Nurses 41st Annual Meeting at the all Rio Suites Casino Resort in Las Vegas, NV For info log on to: www.aann.org

March 29, 2009 - April 1, 2009Contemporary Forums Psychiatric Nursing Conference at the Renaissance Nashville Hotel in Nashville, TN For info log on to: www.contemporaryforums.com

1 0 Rainb owVisions

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

— NOTICE —The conferences and events information listed on these pages is dated information

(current as of March 1, 2009). For the most up-to-date information on industry-related conferences and events, please click the link below:

www.rainbowrehab.com Conferences & Events

Updated biweekly, www.rainbowrehab.com offers the dates, locations and topics of all of the industry's most prominent events. Also included are local Michigan events.

April, 2009April 18 - 22, 200916th NICM Conference and 10th ACMA Meeting at the Westin Boston Waterfront Hotel in Boston, MAFor info log on to: www.acma.org

April 21 - 25, 2009 Psychiatric Nursing Conference (West)at the Hyatt Regency La Jolla in San Diego, CA For info log on to: www.contemporaryforums.com

April 21 - 25, 2009 16th NCIM Conference and 10th ACMA Meetingat the Westin Boston Waterfront Hotel in Boston, MA For info log on to: www.acmaweb.org

April 30 - May 1, 2009 2009 Brain Injury Litigation Strategiesat the Signature at MGM Grand in Las Vegas, NV For info log on to: www.biausa.org/elements/litigation/

May, 2009May 7 - 9, 20099th Annual Adolescent Health Care Conference at the Westin Boston Waterfront Hotel in Boston, MAFor info log on to: www.contemporaryforums.com

May 27 - 30, 2009Forensic Trends: Psychiatric and Behavior Conference at the Las Vegas Hilton in Las Vegas, NVFor info log on to: www.contemporaryforums.com

June, 2009June 7 - 9, 2009CMSA Annual Conference & Expo at the Phoenix Convention Center in Phoenix, AZFor info log on to: www.cmsa.org

RIN

C MICHIGAN

Rehabilitation & Insurance Nursing Council Meetings Members Only

Registration at 11:30 a.m./ Lunch at 12:45 p.m.

March 20, 2009 Topic: Cognitive Language Treatment for Brain Injury

Speaker & Location: TBA

April 17, 2009 Topic: Home Infusion

Speaker & Location: TBA

May 15, 2009 Topic: The Great Masquerade: Sacroiliac Joint Dysfunction

Speaker: Dr. Carla MortonLocation: TBA

June 19, 2009 Topic: Advanced Home Care

Speaker & Location: TBA

For more information <CLICK HERE>

Rainb owVisions 1 1

www.ra inbowrehab.comRainbowViSionS o n l i n e M a g a z i n e

A L O O K A T

Occupational Therapy

By Anne Ulrich, OTR, CBIS Rainbow Occupational Therapist

therapyTBI

Disciplines

hen someone’s life is

altered after a traumatic brain

injury, many survivors are left to cope

with new cognitive deficits, behavioral

problems, medical complications and

more. A traumatic brain injury may rob

a person of his or her independence,

leaving the survivor reliant on others

for bathing, dressing, feeding and other

daily living necessities.

Occupational therapists (OTs) provide

survivors with the training they need

to regain independence in these daily

living skills, including activities such

as self-care, education, employment

and social interaction. OTs help people

develop “skills for the job of living.”

They increase self-sufficiency to allow

patients the ability to lead productive

and satisfying lives. Rainbow OTs are

skilled professionals in human growth

and development with an emphasis on

helping individuals overcome the social,

emotional and physiological effects of

illness and injury. They help individuals

with disabilities get on with the

“occupation” of living.

In rehabilitation

hospitals and in adult

foster care homes,

the primary emphasis

of occupational therapy

is on regaining basic

functions.

W

1 2 Rainb owVisions

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

Once a person becomes independent

in fundamental skills and performs them

consistently and safely, he or she may

be ready to move to a less structured

environment.

Individuals who have mastered self-care

tasks are able to focus on higher-level skills

such as financial transactions, personal

organization and money management.

Rainbow's Semi-Independent Apartment

Program offers these opportunities so clients

can practice and master skills of daily living.

Following are therapeutic skills that Rainbow

occupational therapists commonly address.

Money Management — Clients benefit

from learning to manage a checking

account, which includes balancing a

checkbook, budgeting and bill paying.

An OT can set up a mock bill-paying

program — mailing simulated bills to a

person with a due date for each payment.

This works in conjunction with a mock

checkbook register, working on accuracy

of simulated paycheck deposits recorded,

as well as check writing and timeliness of

bill paying.

Assisting clients with activities of daily living is an important step toward independence.

Pictured above: Laura (right), an Occupational Therapist, works with Carole Anne on

personal money management skills.

Continued next page

Managing a Home — An OT assesses

safety and independence with meal

planning and grocery shopping. Some

people struggle with the larger living space

of an apartment when they may have

been accustomed to maintaining only a

bedroom. Other household tasks such

as laundry, vacuuming and cleaning are

monitored as well.

Getting Back into the Community —

People that are new to the area or new to

Apartment Groups offered at Rainbow

Facilitated by therapists, mental health

counselors and other qualified staff,

the groups at Rainbow's Ann Arbor

Apartments provide a safe environment

for clients to access the community

and interact with their peers. The

groups assist with time management,

community re-entry, problem-solving

skills, awareness of deficits, knowledge

of current events, social engagement

and more. A list of current group

offerings will be provided in the March

2009 online edition of RainbowVisions.

To subscribe, log on to:

www.RainbowVisionsMagazine.com

Rainb owVisions 1 3

www.ra inbowrehab.comRainbowViSionS o n l i n e M a g a z i n e

compensatory strategies. For example, if

a person’s short-term memory does not

improve, it is still possible to be successful

in the workplace by using strategies to

compensate for the memory problems.

Such strategies include using an assistive

device such as a planner, alarm, watch or

a PDA.

OverLearning — Another strategy to move

clients forward in the rehabilitation process

is to implement over learning. Repeating

the same task is an effective way to learn.

Even if a person does not remember being

instructed on how to do an activity, if it is

performed regularly, his or her performance

can improve.

Routine — Maintaining a consistent

routine is a good way to work around

memory and organization deficits. For

example, some can become increasingly

frustrated when looking for misplaced keys

in their apartment. An OT can work with

the person to designate a place for keys,

such as on a hook next to the front door.

public transportation benefit from training

on using the bus schedule, riding the bus,

transferring buses and arranging taxis. As

part of Rainbow’s interdisciplinary team

approach to therapy, OTs work closely with

recreational therapists to assist clients with

identifying, initiating and following through

with community leisure activities.

Work / School — People living in Rainbow

apartments often attend school, volunteer,

and/or work in the community. They may

benefit from assistance with enrolling in

school, applying for jobs and developing

strong study skills.

Medication Management — Clients

work closely with OTs, nurses and

rehabilitation assistants to learn to manage

their medication routines with minimal

assistance.

Building Social Skills — Many clients

benefit from exploring ways to meet new

people. They may need assistance with

establishing and maintaining a network

of friends, dating, and practicing safe and

appropriate methods of sexual expression.

Semi-independent living also provides

an opportunity to work on appropriate

interactions with neighbors and other

people in the community.

Driving — Some OTs are specially trained

to assess driver readiness and provide

behind-the-wheel training when necessary.

If a person has clearance from a doctor and

has a registered, insured vehicle, they may

be permitted to drive.

NOTE: Generally, driving is not permitted in

a group home setting.

Continued on page 16

Occupational TherapyContinued from page 13

Parenting Skills — An OT can provide

guidance and assistance with enrolling

children in school and arranging childcare.

Clients and therapists work together to find

affordable childcare resources, including

preschool and day care.

Strategies OTs implement

Because traumatic brain injury is often

accompanied by psychosocial dysfunction,

Rainbow OTs are trained in using

behavioral and mental health techniques

in the rehabilitation process. The term

psychosocial covers a broad spectrum

of mental disorders including substance

abuse, mood fluctuations, anxiety and

adjustment disorders. Psychosocial

disorders, while not unique to people who

have brain injuries, tend to be prevalent in

the TBI community.

Compensatory Strategies — Deficits

such as memory and problem-solving may

not always improve, so the occupational

therapist’s goal is to instruct clients in ways

of working around these problems using

1 4 Rainb owVisions

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

Level I — Most individuals ready for some independence begin at the

town house level with staff presence in the residence around the clock.

Each person has his/her own bedroom and is responsible for grocery

shopping, assisting with cleaning the common areas, laundry, and is

introduced to the public transit system. Participants receive assistance

with their medication programs and supervision or cueing with chores, as

necessary.

Level 2 — After demonstrating successful living at a Level 1 town

house, clients are ready to move into a two-bedroom apartment staffed

around the clock. They continue to manage the apartment and chores

independently and take on more responsibility with arranging their own

public transportation. Staff is available on the premises to closely monitor

community access and timeliness of medication administration.

A Look at Rainbow's Semi-Independent Adult Levels Program ... (Available in Ann Arbor, Mich.)

Level 3 — Once there is no longer a need to access staff in

the same building, clients are able to move to an outlying

apartment in the complex. At this level, individuals begin

budgeting their money for groceries and taking public

transportation to school, work and medical appointments. In

some cases, interaction with staff is limited to signing in and

out when accessing the community and/or going on a leave of

absence.

Level 4 — At this level, people take on a portion of their rent

and utilities to further budgeting and bill-paying skills. The

ultimate goal is full independence. When participants graduate

from the program, they are able to live independently without

supports and are discharged from Rainbow.

Rainbow's Adult Levels Program offers a continuum of semi-independent living options

providing care and support as individuals rehabilitate and become self-sufficient.

Rainb owVisions 1 5

Occupational TherapyContinued from page 14

Verbal Cueing — Some people benefit

from reminders when performing tasks.

They may not need hands-on assistance,

only a reminder to get started. For

example, OTs can put a programs in place

where staff visit or call a client to remind

that person to do laundry.

Group Therapies — Group sessions can

address time management, community

re-entry, awareness of deficits, fitness,

nutrition and provide education on brain

injury. They also provide opportunities for

leisure exploration and socialization.

Through assisting clients with self-care,

education, employment, community

integration and social interaction, OTs

increase clients self-sufficiency and help

them to carry on with satisfying and

productive lives. Occupational therapists

allow brain injury survivors to get on

with the “job of living.” Whether in the

Semi-Independent Apartment Program,

outpatient therapy, town house or group

home, OTs provide training for the skills

clients need for satisfying, independent

lives.

For outpatient clients, occupational

therapy treatments are available at all

of our southeastern Michigan treatment

centers: the Ypsilanti Treatment Center,

Rainbow Oakland Center, NeuroRehab

Campus and through our home health care

program. Whatever your needs, Rainbow

will customize a plan of care designed

around you and implement programs

necessary to ensure your success. For more

information on our programs, log on to

www.rainbowrehab.com.

About the Author ...

Anne Ulrich, OTR, CBIS

Anne received her Bachelor of Science in

occupational therapy from Eastern Michigan

University in Ypsilanti, Mich. in 1995.

Anne currently works at the Ann Arbor Semi-

Independent Apartment Program with adults

who have traumatic brain injuries. She has

worked at Rainbow Rehabilitation Centers since

2000. She is a Certified Brain Injury Specialist.

Apart me n t Pro gram

ClubhouseThe Ann Arbor Apartment Clubhouse at Rainbow offers

another environment where OTs help clients. The clubhouse provides an area for people to play pool, card games, prepare

and eat meals, use the Internet, and socialize with others.

The clubhouse is governed by clients who take an active

role in choosing and participating in the activities offered.

1 6 Rainb owVisions

w w w. R a i n b o w V i s i o n s M a g a z i n e . c o m M a R C H 2 0 0 9

The Academy for the Certification of Brain Injury Specialists (ACBIS)

offers a national certification program for entry-level staff and experienced professionals

working in the field of brain injury.

As a service to the brain injury community, Rainbow Rehabilitation Centers will be offering a free training course this summer (2009) in Canton, Michigan to

prepare for the ACBIS Certified Brain Injury Specialist test.

For details <CLICK HERE>

A C B I S A N N O U N C E M E N T S

New Family and Caregiver’s Brain Injury Resource and Training Program Under Development

he Academy of Certified Brain Injury

Specialists (ACBIS) Advisory board is

developing an online reference and training

tool geared toward families and support

staff working with brain injury survivors.

There has been a growing need for

people who do not need or qualify for

certification as a Certified Brain Injury

Specialist, but still need information

to understand relevant aspects of care

for those with brain injuries. This non-

certification program plans to meet that

need.

The planned program design includes:

•An online training program. Self-paced

and interactive, it provides modules on

a wide variety of topics, including brain

injury anatomy, myths and facts of brain

injury, behavior management, advocacy,

community reintegration, cognitive issues,

aging, vocational retraining and more.

These modules will include knowledge

checks with immediate feedback, enabling

provider organizations to ascertain that

learners have achieved a certain level of

understanding through the training.

•Personal account and login information.

•PowerPointformatwith graphics and

illustrations.

•Printed certificates indicating when

a module is successfully passed and

completed.

•A glossary of difficult or medical terms.

•An online resource of additional brain

injury sites.

Organizations using the program will

also receive a complete administrative

package to track usage and related

demographics. The BIAA office has

estimated that the project will be released

mid-2009. Cost per user is still to be

determined. Look for more information

on this tool in upcoming issues of

RainbowVisions magazie.

www.aacbis.net

The Essential Brain Injury

GuideEdition 4.0

Brain Injury Association of America

T

Rainb owVisions 1 7

For more information call toll free ... 1.800.968.6644 E-mail: Rainbowvisions@rainbowrehab.com

www.rainbowrehab.com

Ypsilanti Treatment Center 5570 Whittaker - PO Box 970230 Ypsilanti, MI 48197 734.482.1200

Oakland Treatment Center 32715 Grand River Avenue Farmington, MI 48336 248.427.1310

NeuroRehab Campus 25911 Middlebelt Road Farmington Hills, MI 48336 248.471.9580

Rainbow Treatment CenterLocations:

RainbowVisionsMagazine

SUBSCRIBE NOW!

1 8 R a i n b owVisions