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Newsletter 1998 Spring Issue Serving Acquired (Includes Traumatic) Brain Injured Individuals and Their Families Mailing & Billing
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VISION AND ACQUIRED BRAIN INJURY
Neera Kapoor, O.D., M.S.
Acquired brain injury (ABI) can occur secondary to head trauma (i.e. a blow to the head), cerebral vascular accident (i.e. a stroke), or post-surgical complications (i.e. post-tumor removal). Once a ABI has been sustained, rehabilitation is often necessary. The types of rehabilitation that usually come to mind are vestibular (i.e. balance), physical, occupational, speech, cognitive, and psychological therapy. Although accurate and efficient visual skills are required and involved in many types of rehabilitation, visual evaluations and any subsequent vision therapy are not routinely discussed with ABI patients. Further, insurance companies do not always cover visual rehabilitative services. The importance and the effects of vision on the rehabilitative process have eluded health care professionals, patients, patient advocates and insurance companies alike. It is easy to forget that vision is more than opening our eyes and "seeing".
For example, our eyes move as we move. Therefore, our eyes need to be able to work in synchronicity with each other as well as with us. Signals are sent to the brain specifying that we are moving, the world, the world is moving, our eyes are moving. If inappropriate signals are sent, we may experience motion sickness, dizziness, vertigo, or loss of balance. This illustrates the relationship between the visual and vestibular systems. Such difficulties will also affect physical and occupational therapy in a similar manner. Even of these signals are intact, there are other aspects of vision which may impede the rehabilitative progress.
Other functional aspects of vision are poor eye movements, intermittent eye turns, double vision, intermittent blurry vision, and dye eye. Such visual function deficits can decrease the accuracy and efficiency of visual processing by causing intermittent blur or double vision (at far or near), loss of place while reading, a decrease in speed of reading, or even an avoidance of reading. These manifestations impede progress in cognitive therapy as well as physical, occupational and vestibular therapy.
Visual deficits may also affect a person psychologically with respect to self-esteem and level of independence, both of which may seem decreased relative to before the ABI. The person may feel that (s)he can no longer things visually as quickly, effortlessly, and efficiently as before the injury. Another sentiment that is common to patients who commence any kind of therapy is the fear of regression. Patients are often concerned that their new and improved level of performance is not lasting and will decrease again at any time. Reinforcement that there are "hills and valleys" along the way to recovery is extremely important. After all, the goal of any therapy is to teach a person the necessary skills to cope with his/her situation. Therefore, successful therapy effectively involves a decrease in the difference in performance during the "hill" and the "valleys".
Vision is more than just opening one's eyes and "seeing". Vision involves several skills such as eye-tracking, eye-teaming, focusing, and visual-processing. A deficit in any visual skill may impede the way a person functions physically, cognitively and/or psychologically. Any effect on physical, cognitive, and/or psychological performance obviously affects rehabilitation in those areas.
Neera Kapoor, O.D., M.S., Dir.- Unit Operations, Head Trauma Vision Rehab. Unit, SUNY-Univ. Optometric Center
We Love that IRS
For purposes of paragraph (3), an organization described in paragraph (2) shall be deemed to include an organization described in section 501 (c)(4), (5) or (6) which would be described in paragraph (2) if it were an organization described in section 501 (c)(3). (section of the Internal Revenue Code)
On Goal Setting
Patient failed to fulfill his wellness potential. ( doctor's note on the chart of a patient who died)
RESTORING INITIATIVE AND MOTIVATION AFTER A BRAIN INJURY
Jacqueline Y. Barnett, Ph.D.
Apathy is distinctive from depression, occurs in over 10 percent of patients in the post-acute phase following stroke, and is prevalent in-patients diagnosed with Parkinsonism. Lack of motivation, deficient drive, and faltering initiative (Abulia) may simulate or intensify the intellectual and emotional impairments comprising the pseudodepressed frontal lobe syndrome variant and right hemisphere affective dysregulation, and is related to greater cognitive and activities of daily living (ADL) difficulties. The importance of assessing and treating traumatic brain injury (TBI) survivors for functional and emotional deficits that are actually amotivation and apathy concomitants is underscored by the fact that reportedly as many as 3/4 of a group of brain-injured patients involved in rehabilitation were deterred from achieving therapeutic goals because of apathy, irrespective of whether they were clinically depressed. Comorbid apathy and depression may amplify the constellation of frontal lobe deficits incurred after stroke. However, pathophysiologic mechanisms hypothesized to be linked with apathy differ from the neurobiological correlates of depression after vascular or traumatic brain injury.
Younger age and severe head injury are associated with volitional disturbance, exclusive of a depressive disorder, that is sufficient to interfere with progress in rehabilitation. Loss of interest and diminished pleasure in all activities (Anhedonia) was assessed as a significant factor, which prolonged goal attainment in 11-45 percent of patients recovering from a head injury, both at entry into a rehabilitation program as well as after 1 year. Behavioral and personality changes commonly including lack of spontaneous thought, lowered initiative, and diminished or absent self-awareness (Anosagnosia) hinder recovery from right hemisphere stroke and, moreover, may worsen or even impress as a specific disorder of cognition, for example, affecting receptive language, praxis (nonverbal symbolization), or sensorimotor coordination. Apathy and depression are not interdependent.
The head injury survivor's experience of a lack of self-insight corroborates the degree to which there are problems with activating or generating appropriate goal-directed behavior and, thus, represents an index of frontal lobe dysfunction. Thorough neuropsychological evaluation of post-concussion symptoms should emphasize motivational level. Observations by family and/or spouse of a patient with TBI can determine whether a discrepancy between the perception of capabilities and their performance in intellectual, interpersonal, routine/non-routine ADL, and community domains contributes to passivity and, perhaps, conflict escalation.
When a motivational deficit is defined as either a failure or inability to recognize reward incentives, then what might seem to be a complex interplay of drive and goal-oriented responsiveness can be simplified to the level of perceptual and cue-processing functions. Amotivation and apathy in the patient recovering from moderate-to-severe TBI are treatable disorders. An approach to intervening in the "frontal lobe" overlay on focal cognitive deficits that poses a major ramification to reciprocal participation by the patient in rehabilitation is based on increasing awareness of and ability to apply skills in the areas of: motor initiation, generating concepts in accordance with category cues, psychomotor rate, effortful learning, and concept formation. Coupling intermittent social praise with rehearsing a sequence of actions wherein an optimal or desired outcome is tangible and accessible at the outset (backward chaining) are suggested techniques for maximizing learning efficiency as the TBI patient progresses in rehabilitation.
Jacqueline Y. Barnett, Ph.D., Clinical Neuropsychologist, Clinical Instructor in Psychiatry, NYU Medical Center
And the Program was Titled:
The Southeastern Georgia Alzheimer's Chapter presents a dinner cabaret, "A Night to Remember." (From an association program)
The New York Academy of Traumatic Brain Injury
Academia Schedule
Hospital for Joint Diseases
2nd Avenue and 17th Street, Loeb Auditorium
New York, New York
- April 2nd, 1998, Thursday, 6PM - 8PM
Focus: Clinical Problems of Neurotoxic Exposure in the Workplace: Assessment and Referrals for Further Study
- What Have We Learned from the Research Laboratory?
Hugh Evans, Ph.D., Prof. Of Environmental Medicine, NYU Medical Center
- Problems in the Assessment of Cultural Minorities.
Cheng Wang, Ph.D. Research Scientist, Environment Medicine, NYU Medical Center
- May 7th, 1998, Thursday, 6PM - 8PM.
Focus: Integrating Significant Others into the Holistic Neuropsychological Rehabilitation of Adult Brain Injured Patients.
- Ellen Daniels-Zide, Ed.D. Clinical Assistant Professor, Rehabilitation Medicine, NYU School of Medicine,
Asst. Director, Traumatic Brain Injury Day Treatment Program
- Leo Shea, III, Ph.D. Clinical Assistant Professor, Rehabilitation Medicine, NYU School of Medicine,
Asst. Director, Traumatic Brain Injury Day Treatment Program
- Laura DeFilippo, Ph.D., Staff Psychologist, Traumatic Brain Injury Day Treatment Program
- June 4th, 1998, Thursday, 6PM - 8PM
Focus: Related issues on TBI, Speakers TBA
No admission charge to any of the above scheduled events. Information regarding this schedule, please write to: Rolland Parker, Ph.D., President, 50 West 96th Street, (9C), New York, NY 10025.
LOGO DESIGNER FOUND After much interviewing, a designer from the Parson School of Design has offered to work with Brain Injury Society on its logo. Mr. Richard Levy, who had sustained a major brain injury in 1996 in a motor vehicle accident by which the car that he was a passenger in was turned over and crushed. After awakening from a coma and recovering from surgery, he continued his education and pursuits in Florida and at the Olympic Games in Atlanta. The top 100 firms and Ivy League Universities to create logos and designs for various projects have hired him. This included a prestige projects at the United States Olympic Games. He is a most talented designer and Brain Injury Society is most appreciative of his generous offer
WORDS OF WISDOM Banking Policy
Texas Federal has established a policy to consider a robbery of an ATM to be an authorized transaction. (Texas Federal Savings bank in a letter to a customer who has been robbed at an ATM)
Communication is Always Best
Gentlemen, I have nothing to say. Any questions? (hockey player Phil Watson to reporters)
Relaxation Methodology
I've got to run now and relax. The doctor told me to relax. The doctor told me. He was the one. He said, "Relax." (President George Bush, at the end of a press conference at Andrews Air Force Base.)
Overheard At Dinner
Said to Menucha Fogel, the founder of Brain Injury Society. "... anyone who starts a brain injury organization has to be brain injured." Menucha simply said ... "Yes."
TRAUMATIC BRAIN INJURY K. Menucha Fogel
Traumatic Brain Injury also known as TBI, is a silent and growing concern in this borough, the state and throughout the country. Traumatic Brain Injury is a nondiscriminatory and finds itself can be found in all cultures and nationalities.
A rapid motion of the head in many directions, sometimes-called "whiplash" causes traumatic brain injury. It is also an acceleration and deceleration of the head during which the brain is thrust back and forth at crushing speeds thus bouncing the brain off the walls of the skull. An example of this is when you shake an uncooked egg. The sloshing sound you hear is the yoke hitting the shell. Shake the egg hard enough, the yoke cracks and breaks. This is what happens to your brain during rapid acceleration and deceleration. Your brain becomes injured. This is Traumatic Brain Injury - TBI.
Traumatic Brain Injury is known as "The Silent Epidemic" because it is often unseen. Physical symptoms often do not accompany a brain injury, therefore; the brain injury is not visible.
Traumatic Brain Injury - TBI may cause intellectual, emotional, social, behavioral, vocational, cognitive, visual, vestibular, speech, hearing, and physical difficulties. As with any head injury, smell and taste are also often affected.
The intellectual, behavioral, vocational difficulties may often affect present and care, future life styles and personality behavior of the brain injured recovering and recovered individual. In most instances, the person you knew, no longer exists. A new person reemerged, a person who is unknown to you and even to them. This person is different and will more than likely never be the person you knew and loved. The are a different person. They are discoverers of a new individual with a new potentials to be fulfilled.
The symtomology of Traumatic Brain Injury often shows itself immediately. Denial is the first line of defense. The symptoms vary greatly and it depends upon the extent of the location of the brain injury. Memory problems, learning difficulties, personality changes and physical disabilities are common and often seen by the recovering individual family members and friends. They can either be subtle or major in nature.
1. Cognitive impairments: May be very mild to exceedingly severe. They include memory deficits (short or long term), difficulties with concentration, slowness, thinking, attention, perception, communication, reading, writing skills, planning, sequencing, and judgement.
2. Physical impairments: Speech, hearing, vision, and sensory impairments, headaches, dizziness, vertigo, lack of coordination, spastically of muscles, paralyses to one or both sides, and seizure disorders are often seen.
3. Psycho-Social-Behavioral-Emotional Impairments: Fatigue, mood swings, denial, self centeredness, anxiety, depression, lowered self-esteem, sexual dysfunction, restlessness, lack of motivation, inability to self-monitor, difficulty with emotional control, inability to cope, agitation, excessive laughing or crying and difficulty relating to others.
There is no cure for Traumatic Brain Injury, only correct rehabilitation and development of compensatory skills, sharpened strategies and heightened techniques for the TBI recovering individual.
Traumatic Brain Injury - TBI is not a mental disorder. It is a dysfunction of the brain hemispheres due to an injury. It is covered separately by the American Disabilities Act, United States Federal Law and New York State Law. Traumatic Brain Injury - TBI, is an acquired brain injury and an acknowledged disability.
K. Menucha Fogel, B.A., Founder Brain Injury Society, also known as Metropolitan Brain Injury Association NY
SOCIAL SECURITY FACT
DID YOU KNOW?
President Clinton has committed to introducing a "Pass" program for SSD recipients.
BRAIN INJURY SOCIETY (BIS) BUZZING ALONG
"BIS is the Buzz." As the saying goes. "BIS" is often paralleled to the bumblebee. This incorrect and atomically impossible creature that G-d created shouldn't do what it does so well.. The bumblebee has a huge body, its wings are short and it should not fly, let alone be able to do any formable work, but it does. The bumblebee does the impossible. To many, the bumblebees are the favorite species of bees. The founder of Brain Injury Society, K. Menucha Fogel, confronted with many obstacles, established a successful organization. The saying is "She as a brain injury, she didn't understand it couldn't be done. She did it anyway! She has an aphasic problem with words such as; can't and no. Her vestibular dysfunction which keeps her "balanced" and to add to all this she has a vision dysfunction, she sees she can do the impossible, then gets it done." She has a new lease on life, she calls it a sense of humor and positive attitudes. "Could you imagine, if I didn't have to deal with this on daily basis, life would be so dull."
VOLUNTEERS NEEDED People like you have been spreading the existence of Brain Injury Society around. The need is tremendous, which is why BIS need volunteers like you. We have much to do and to accomplish. You can work from your home or come to our in-kind office, which is not Menucha's living room. It is an actual office. If you have the time... Do give us a call at 718 645-4401. We really do need you!
AUTUMN 1998 FORUMS SCHEDULED
SET THE DATES ASIDE
November 16 and November 23, 1998 at Bellevue Hospital for our Autumn forums.
Focal topics will be
- Speech and it relationship to Dentistry
- Communication and Executive Functioning
- Educating the educators - working with the students and parents
- Legal responsibility of both the parent and the school system
- Resources - who are they and where are they.
New Websites for Children with Acquired Brain Injury
Programs for our special children are for children under 17 years of age that have been diagnosed with brain tumors. Here children can chat with one another in the comforts of their home. This website provides an outlet for children with cancer to tell their stories to the world. The site will give the child their own WebPages to explain what they are going through in their own way. Additionally, they can put a picture of themselves on the page. This is fantastic therapy for these special children. For additional information contact [email protected]. 'Cancer Kids' Website address: http://home.att.net/~TillisonC/programs.htm
OUR MASTERFUL WEBSITE DISIGNER
Our deepest thanks to Dr. Al Musella, President of the Musella Foundation for Brain Tumor Research And Information, for donating his services to create and for continuously upgrading our new website, http://www.virtualtrials.com/bis. He not only has kept BIS in hyperspace but also has built the most important brain tumor site http://www.virtualtrials.com, and set up a company, A1webs, which creates websites. He can be reached at 516 295-4740.
NEWSLETTER NAME FINALISTS SELECTED
IT'S UP TO YOU TO HELP US SELECT THE NEW NAME!
Vote Early and Vote Often!
READ THIS: To Vote: Rank these choices from 4 to 1. We add up the totals, so a "4" is for your favorite..
Place a 4 next to your favorite choice
Place a 1 next to your LEAST favorite choice
The winning name will be announced in the Summer 1998 issue.
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Ads & Rates | Feedback | Specialty Pages | About TBI | About Us | Links | Government | GoalsDisclaimer: Medical information is presented on this site to promote better understanding of brain injury. This site does not diagnose or treat patients. All patients should consult appropriate professionals for diagnosis or treatment.They are encouraged to use this site as an educational resource. Accuracy of the information linked from this site are not guaranteed. The use or reproduction of any part of these electronic pages is prohibited, without the express written permission of the Brain Injury Society.
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