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Website: www.BISociety.org Brain Injury Society Bikur Cholim--Click Here Manhattan 19 West 34th Street Suite Penthouse Between 5th and 6th Avenue Manhattan, NY

Newsletter 1998 Summer Issue Serving Acquired (Includes Traumatic) Brain Injured Individuals and Their Families Mailing & Billing Address Only: 1901 Avenue N - Suite 5E Brooklyn, NY 11230 Clinicial and Administrative Office: 1517 Voorhies Avenue - Suite 1G Btwn Sheepshead Bay & Q Train Station Brooklyn, NY 11235 Telephone & Helpline: 718-645-4401

MEDICATION AND BRAIN INJURY

Survivors of brain injury may be given a variety of medications. In acute situations, lives may be saved by use of certain drugs. Steroids, for example, may reduce swelling after trauma. Anticonvulsants are used to prevent seizures. These drugs all have potential side effects, requiring assessment of the risks and the benefits. Unfortunately, patients and their families do not always get a clear picture of what is being done. They might incorrectly assume that the steroids used in this situation are the same drugs that are abused by some athletes to build muscle mass, when in fact they are quite different. They may also focus on the side effects that occur in patients who take steroids for many years. Those are important for people with chronic inflammatory conditions, but usually are not relevant in acute traumatic brain injury.

Several types of drug are used to facilitate the recovery process. Agitation can be quite severe after some brain injuries, and can be reduced with several types of mood-stabilizing medications. Depression can bring a rehabilitation program to a complete halt, but many effective drugs are currently available. Deficits in concentration and attention may respond to some stimulants. Decreased appetite can sometimes be treated medically. Bowel and bladder control can be facilitated. Spastic muscles can be relaxed with oral medications and injections.

Communication becomes critically important when some of these medicines are prescribed. Physicians need as much information as possible about current symptoms, even if patients or family members are embarrassed. When outpatients are seeing multiple doctors, then clear reporting of all current medications is essential. Breakdowns in communication can lead to treatment with dangerous combinations of drugs. A complaint of pain, for example, may lead to prescriptions for multiple pain relievers. Patients may not realize that they are taking brand name and generic versions of the same drug, leading to overdoses. Bringing a written list of current medicines, as well as any that were discontinued previously, for each visit to a doctor can prevent this problem.

Some medicines require monitoring of blood levels, or other laboratory testing. In the hospital, this is easily arranged. For outpatients it is essential that the tests are performed, and the results must be available to the appropriate doctor.

Medications that are primarily used for one purpose may have other alternative uses. This can allow creative solutions to some problems, but can lead to confusion. A patient may be surprised to hear from a pharmacist that his prescription is for seizure treatment, depression, or abnormal heart rhythms if he was not previously advised that the drug could also treat pain. Other professionals may later make incorrect assumptions about medical history if the patient does not explain why he takes certain drugs.

Many people are interested in "alternative" medicines. Many of these are sold without prescriptions. Although some of these may eventually prove effective with further research, one should remember that they might also prove to have major side effects.

Medicines sold over the counter at pharmacies and supermarkets may also interact with prescription drugs. Pain relievers, for example, may interact with anticoagulants ("blood-thinners").

There is no medical "cure" for brain injury. Appropriate use of available medicines can save lives or improve quality of life, but effective communication is needed to optimize the benefit to risk ratio.

Edwin F. Richter III, M.D
Attending Physician Rusk Institute of Rehabilitation Medicine
Associate Professor NYU Medical Center
New York, NY

Dual Diagnosis: Acquired Brain Injury and Substance Abuse

The term dual diagnosis gained popularity in the 1980's when many substance abusers were found to have a coexisting mental disorder. Other references to dual diagnosis have included mental retardation/mental illness and a combination of mental disorders including multiple forms of depression. With the growing professional and public awareness of Acquired Brain Injury (ABI) the term dual diagnosis now also includes individuals with ABI who have a history of substance abuse or are actively abusing either licit or illicit drugs. In fact, a recent study found that between 40% and 50% of adolescents and adults admitted to trauma centers after ABI have a history of alcohol abuse. Posttraumatic amnesia has been shown to last much longer for those mild head injury patients who were intoxicated upon admission. Other studies have shown that 20% of those who abstained or were light drinkers before injury showed high volume use after. Another 36% of pre-injury low users had increases to medium volume use. Thus, the use of illicit and legal drugs among ABI clients is more frequent that originally thought.

The effects of drugs, which include alcohol, are different for people after ABI. Drinking and using drugs can cause seizures, affect balance, cause depression, alter the effects of prescription medications, have a more powerful effect than before, and interfere with concentration, thinking and judgement which may already be compromised as a result of the ABI. The use of alcohol may also slow down cognitive recovery. Finally, the chances of another head injury are three times greater for people who have had one already. In providing advice to persons who have an ABI, the only amount of use that a professional can safely recommend is none.

After an ABI, one can experience a multitude of changes to one's personality, basic attentional processes, memory capacity, language abilities, level of awareness, cognition, and executive functions. After ABI, when the individual may have more difficulty in processing information, remembering and monitoring behavior, treatment for substance abuse requires a modified approach to allow the individual the opportunity to process and apply treatment information. Dual diagnosis patients are in need of education, family support and community resources (AA) as part of their treatment. Treatment programs at all levels of care need to provide substance abuse treatment as an integrated part of their program. By increasing awareness of the dangers, improving access to services and promoting continuity of care, ABI clients can improve their chances of controlling their substance abuse.

Specific information on substance abuse treatment for ABI can be found at the Ohio Valley Center for Brain Injury Prevention and Rehabilitation (http://www.ohiovalley.org/).
Harold Lifshutz, Ph.D.
Associate Director, Traumatic Brain Injury Program Bellevue Hospital Center
NY, NY

BRAIN INJURY SOCIETY INVITED TO SPEAK AT ASSOCIATION OF ORTHODOX JEWISH SCIENTISTS

BIS have graciously accepted the invitation of the Association of Orthodox Jewish Scientist on the subject of Stress and Brain Injury at the Nevele Grand Hotel in the Catskill Mountains the weekend of August 7-9, 1998. Rolland Parker, Ph.D. of the BIS Advisory Board will be the noted speaker and Menucha Fogel, B.S. will be the facilitator for the hour session. It is the second year that BIS has been invited to speak on Traumatic Brain Injury.

LEADING CAUSES OF TRAUMATIC BRAIN INJURY

1. Motor vehicle crashes (1/2 of all injuries)
2. Violent related incidents including domestic, child and elderly abuse.
3. Falls.
4. Sports related accidents. This cause of brain injury is on the rise. The youngest children and oldest adults sustain injuries due to falls more often than young-to-middle age adults, who are more often injured in motor vehicle crashes.

Leading causes of traumatic brain injury in children

Falls, abuse, recreation accidents, and motor vehicle accidents. The youngest children are more often injured due to falls and abuse. "Shaken Baby Syndrome" due to shaking the infant severely, can cause brain injury in infants. Other examples; falls from shopping carts, accidents involving children in "walkers," and falls from windows, bicycle falls and all sports related accidents. Children ages 5 to 13 years old often are brain injured in recreational accidents, such as all-terrain vehicle, bicycle accidents, street hockey, rollerblading and general outdoor sports (those who do not use helmets have a significant higher severity of brain injury than those who do). Teenagers and young adults are in risk high range and who are mostly brain injured in motor vehicle crashes. Alcohol use has always been seen as a significant factor in major brain injury.

UNCONSCIOUS AND UNABLE TO COMMUNICATE?

It is not often that BIS endorses a product or organization, but Medic Alert is a different story. The bracelet or necklace has saved millions of lives. A person with a brain injury should consider a Medic Alert bracelet or necklace. This internationally recognized symbol speaks for you. The symbol alerts medical professionals to your condition. Medic Alert maintains a detailed database of member's medical information with international translators available. A call to the phone number listed on the bracelet sets this lifesaving system into action. For more information on Medic Alert, call 1-800-432-5378.

BRAIN WAVE BIOFEEDBACK FOR STROKE AND HEAD ACCIDENT PATIENTS

Due to either stroke or accident, particularly to the occipital area of the brain (the back of the head), people will unfortunately experience a condition known as "hemianopsia" or half-vision, where half of the visual field disappears. For example, my father had a stroke to the right side of his brain and lost his vision to the left of his mid-line. Presently the standard treatment is to prescribe a type of lens, prism, to shift the lost field in the opposite direction. For example, if the left field is lost, a prism would be used to shift everything to the right to be seen in the unaffected right visual field. In many cases, however, the patient and his family are told that there is nothing than can be done leaving them with a sense of hopelessness. In addition, a perceptual phenomena occurs known as "side of neglect". For the body, side that is on the same side as the lost visual field, there is a reduced awareness of that body side, and that direction in space. Needless to say, side of neglect causes perceptual and psychological confusion, and is a hindrance in the rehabilitation of paralyzed arms and legs.

The development of this technique, which I assisted in is where we amplify the brain waves and display them on a computer screen as user friendly video games. The computer programs allow a selection of input from either the right or left brain. The favorite computer program, and the most effective, consists of an image on the computer screen that represents the patient's visualized concept of the damaged or blocked area. As the patient increases his brain wave pattern , small, white smiley faces appear as the image of the damaged or blacked area disappears.

Patients with a variety of brain injury problems ranging from stroke, accident, and surgical intervention have been trained using this technique. We find improvement in several areas:

1. The "lost" visual field starts to expand usually in the vertical direction first. We typically measure a small improvement after each session. Depending on the specific nature of the problem, the number of training sessions and the amount of improvement are determined. We can usually make a good prediction after the first few training sessions.
2. A change in the EEG is also noted. Typically, we train the patient to be alert and relaxed. We have found that this state of mind optimizes other bodily functions.
3. The balance of the EEG between the right and left brains is mediated by a structure in the brain known as the hypothalamus. Many other functions are controlled by the hypothalamus including: the immune system, the emotions, the pituitary gland, and the pineal gland. As the patient's visual field improves with an increased EEG, we notice a change in some or all of the other functions regulated by the hypothalamus.

   
   Joseph N. Trachtman, O.D., Ph.D., F.A.A.O.,
   Brooklyn, NY
   
   
   

   Support Groups

   Summer 98

   Please call to confirm your attendance and support group.

MANHATTAN Bellevue Hospital Center East 27th and First Avenue Room 6E35 New York, New York 10016 6:00 – 700PM, 3rd Wednesday of each month Facilitator: Jacqueline Barrnett, Ph.D.

QUEENS St. Mary’s Hospital for Children 29-01 216th Street Bayside, New York 11360 7:00 – 8:00PM, 3rd Wednesday each month Facilitator: Paul Berger-Gross, Ph.D. @ 718 281-8824 or Michelle 718 645-4401

Please call in August for Autumn ‘98 to Spring ‘99 Support Group Schedule
*Additional support groups to be announced for day and evening to accommodate schedules individual and family schedules.
INFORMATION ON SUPPORT GROUPS, MEDICAL and FACILITY REFERRALS, CONFERENCES, FORUMS, and WORKSHOPS. CALL 718 645-4401:
We Are Here When You Need Us!



 

QUESTIONS THAT SHOULD BE ASKED AFTER AN ACCDENT THAT OFTEN ARE NOT ABOUT TRAUMATIC BRAIN INJURY

DEFINITION: Traumatic brain injury (TBI) is an insult to the brain, not of degenerative or congenital nature but caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning.

INJURIES: Males aged 14 to 24 years are at highest risk, followed by infants and the elderly. Males are twice as likely as females to sustain TBI due to differences in risk exposure and lifestyle. According to the National Pediatric Trauma Registry, more than 30,000 children sustain permanent disabilities as a result of brain injuries.

OCCURS: Mid-afternoons to early evenings, weekends and the summer months are critical times during which TBI is most likely to occur. Children are especially at risk in the afternoon hours after they are dismissed from school. 42.6% of children's injuries occur on roads, 34.3% at home and 6.6% in recreation areas.

CONSEQUENCES: Cognitive: may include short and long term memory loss; difficulties with concentration, judgment, communication and planning; spatial disorientation. Physical: may include seizures; muscle spasticity; vision, hearing, smell and taste loss; speech impairment; headaches; reduced endurance. Psychosocial/Behavioral/Emotional: may include anxiety and depression; mood swings; denial; sexual difficulties; emotional lability; egocentricity; impulsively and disinhibition; agitation; isolation.

Review Of Medical History: Description of blow to the head, Was there shaking or acceleration and deceleration of the head, Was there a loss of consciousness, Was a neurologist consulted, Was there clear fluid in the ear, Were there any abnormal reflexes, Was there a skull fracture, Was there diagnosis tests, scans, EEG and ENG done and when.

Review of Physical History: Is there a dizziness problem and when does it occur, Is a nightlight used during sleeping hours, Is there a tendency to fall in low light, Is dizziness brought on by movement (e.g.: dressing, lying down, standing, riding in a car, heights). Complaints of nausea (e.g.: during eating, movement, dressing, riding in a car). Complaints of fatigue. Complaints of ringing in the ears (e.g.: all the time, by movement, with loud music complaints of recurrent headaches (e.g.: cover the entire head, behind the eyes, at the base of the skull, in the morning, afternoon, evening, after going to bed, discomfort with being touched, changes in vision, has it been blurred, corrective lenses now required, double-vision is occurring, three or four images are seen, images overlap, difficulty with reading, difficulty with losing place while reading, sensitivity to indoor lighting and natural sunlight, changes in smell and/or taste, more sensitive to noises, more sensitive to crowds and/or busy environments.

Review of Psycho-Social History: Have there been problems with attention, difficulty concentrating, difficulty keeping up with conversation, difficulty reading, difficulty watching television, difficulty working. Is there "rambling" more when speaking. Is there now depression or anxiety problems, Is there a change in sleep patterns (e.g.: going to bed later, going to bed earlier, waking up earlier or later or during the night). Is there been a change in eating habits increase or decrease and/or (e.g.: eating different foods, drinking coffee or caffeine drinks, drinking alcoholic beverages, eating has increased or decreased. Changes in sexual drive (e.g.: increased or decreased). Have you or others noticed a change in concentration, memory, use of alcohol and drugs, an increase in fears, decrease n productivity, in safety awareness, in judgement, in temperament, in social isolation, difference in post-injury work patterns or quality. Has there been a drastic change in medication.





MAY ’98 FORUM PROGRAM AT BELLEUVE DRAWS OVER 100 PARTICPANTS

Learning Abilities, Techniques and Methodologies in Adults and Children after Brain Injury

• What are the outcomes of Brain Injury? E. Richter, M.D., Rusk Rehabilitation.
• Late Developing Consequences of Concussive Brain Injury Children - Cognitive Loss: Endocrine Dysfunction, R. Parker, Ph.D., NY Acad.
• Traumatic Brain Injury, Educational Treatment Implications of Traumatic Brain Injury E. Kagan, Ph.D. Herbert Birch Services
• What special considerations, educational and psychotherapeutic facilities are needed to assist the brain injured to learn and succeed, P. Berger-Gross Ph.D., St. Mary’s Hospital For Children
• Vision and Vestibular Therapy their linkages with learning abilities after brain injury, N. Kapoor, O.D, M.S., SUNY School of Optomelogy
• Coping Skills in Speech Recovery in Traumatic Brain Injury, E. T. Silverman, M.A., CCC, SPL
• Building Bridges to Recovery:, Common Progress Of TBI. From Injury to Feeling "Normal" Again., J. Ryder, Ph.D., Private Practice

Want to assist with future planning of forums, workshops and conferences, call 718 645-4401. All help graciously accepted and welcomed.




LOGO ESTABLISHED

After much redoing, faxing, copying, telephone and e-mail conversing, a logo has been designed. Along with Richard Levy and then by Joy Benzequen, wife of Isaac Benzequen, Ph.D. (member of the advisory Board) A logo was perfected. The logo incorporates all parts of the brain and Brain Injury Society initials.

In one of our test sites, we were called upon to assist the medical staff in their duties with the patients. The patients knew that they had an ally they could lean upon to assist in the demagogue of hospital bureaucracy. Are volunteers gladly assisted where ever they were needed.





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."





Discussion on Challenges for the Brain Injured.

Recovering from Brain Injury is like the getting to the top of the Mazada Mountain. You can use the flight car or the snake trail. Both are challenging for the brain injured. Some prefer to use the car and view the beauty of the area and enjoy the climb to the mountain and have more time to enjoy the excavations without being exhausted. Others may enjoy the challenge of being their balance as did the Jews during that time and while enjoying the view as they climb. Both are good. It is just a matter of viewpoints. The end result is that those who reach the top and have enjoyed the trip to it.




NEW WEBSITE 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 & Information, for donating his services to create and continual upgrades our new website, http://www.virtualtrails.com/bis. He not only has kept BIS in hyperspace but also has built the most important brain tumor site http://virtualtrials.com, and set up a company, A1webs, which creates websites. He can be reached at 516 295-4740.




A CALL FOR VOLUNTEERS

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, come to our Manhattan or Brooklyn office, neither which is Menucha’s apartment (actual office). Make the time. Call today 718 645-4401. We really do need you!




AUTUMN 1998 FORUMS SCHEDULED

SET THE DATES ASIDE

Wednesday,October 21, at Maimonides Medical Center,
November 16 and November 23, 1998 at Bellevue Hospital
Focal topics will be:

• Law
• Social Security Disability Benefits
• 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.


Distinguished speakers are:

• Kayla Menucha Fogel, B.S., Executive Vice President, Brain Injury Society
• Elliot Kagan, Ph.D., Clinical Psychologist, Herbert Birch School for Exceptional Children
• Gershon Ney, M.D., Neurologist, Director of Epilepsy, Long Island Jewish Hospital, Assistant of Neurology, Albert Einstein College of Medicine
• Andrew Segal, Ph.D., Neuropsychologist, Private Practice, Albany, NY
• Eleanor Tobis Silverman, M.A., SPL, CCC, Associate Professor – NYU Medical Center Department of Neurology
• Sidney Silverman, DD.S., NYU Medical Center
• Mark Ylvisaker, Ph.D., Neuropsychologist, Rose College, Troy, NY
• Joseph Romano, Esq,
• plus others.






WORD FROM THE EXECUTIVE VICE PRESIDENT

CONFERENCE IN ISRAEL

It was a great opportunity to visit Israel and see how another country deals with various methods of rehabilitation after a person acquires brain injury. Israel since 1948 has had the most brain injuries and due to being completely surrounded by four aggressive enemy nations as been in this area the longest.

Relationships are important and vital in all personal and professional areas. Brain injury is not alone in this. Needed is more physical communication with resources with brain injury rehabilitation clinics and services to explore methods of improving techniques for the brain injured.

In the development process is such a conference for February ’99 in Israel. Needed are speakers in the field of brain injury, sponsors and funders and volunteers. If you fall in one of these areas, please call 718 645-4401. Let us not forget the victims of brain injury who are valiantly attempting to recover.




Newsletter Name Finalists Selected.

IT’S UP TO YOU!
Please make your final vote for a newsletter name.
Enter a 1,2,3 and 4 in the appropriate boxes
4 for best selection and 1 for least favorite.
The winning name will be announced in the Autumn 1998 issue.


	Explorer
	Forerunner
	Pathfinder
	Trailblazer
	Your Email Address






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." Is her response.




DOUBLE CONGRADUATIONS

It takes great pleasure to announce that Menucha Fogel founder of Brain Injury Society received her Bachelors of Science in the field of Speech and Disability Studies (Education and Psychology) in January 1998 from City University of New York - Brooklyn College Campus. Graduation ceremonies were at the Manhattan Community College where members of the Executive and Advisory Board were at the ceremonies to applaud her accomplishments. …and the Speech Department at Brooklyn College said it couldn’t be done and then put barriers in her path. Let it be said "Never underestimate the motivation of a person after brain injury!"

On June 3rd Menucha Fogel’s son, Yehoshua (Josh) married Simi Semel of Brooklyn, NY. She is an aspiring Speech Pathologist and works for the New York City Board of Education elementary level. Rumor has it they were in the same Speech classes. Advise to the daughter-in-law, always say wonderful things about your mother-in-law. You may work together one day.




BIS LIBRARY IS ESTABLISHED

"Share your knowledge and information to all that seek it."
Contributions helped to start our library, including from our advisory members, Rolland Parker, Ph.D., Jonathan Silver, M.D., Mark Ylvisaker, Ph.D. The next step is up to you. Any and all written, audio, software, visual matter pertaining to head injury and trauma, we are interested in. Books, journal materials, booklets, any and all information on all levels. Material packets on community integration, activities in daily living, etc. Call us at 718 645-4401 and we will arrange to bring your generosity to us, with our thanks.


BRAIN INJURY SOCIETY BOOKSTORE

CATEGORIES & SUBJECT MATTERS

• Anatomy of the Brain
• Brain Injury – ABI and all components
• Neurology
• Psychology
• Speech
• Vocational
• Law
• Resources
• Rehabilitation
• Special Education
• Medical Dictionaries
• Illustrations/Charts
• Articles relating to issues of brain injury.


(Reprints sold with written permission of the author-s)
Book reviews and synopsis will be available.
All sales will be final.
Expected titles to be available

AUTHOR	TITLE	AREA
MacKay	Maximizing Brain Injury Recovery	Critical Care
Stoler	Coping with Mild Head Injury	Health
Winslade	Confronting TBI	Health/Social
Bennett	Applied Neuropsychology-V4-4	Neuropsych
Parker	TBI and Neuropsychology	Neuropsych
Ponsford	TBI: Rehabilitation	Neuropsych
Uzzell	Recovery after TBI	Neuropsych
Guilmette	Pocketguide to Brain Injury	Neuroscience
Stevenson	Fetal & Neonatal Brain Injury	OBGYN
Bontke	Rehabilitation of TBI	Physical Med
Davies	Starting Again: Early Rehabilitation	Physical Med
Horn&	Medical Rehabilitation of TBI	Physical Med
Rosenthal	Rehabilitation of the Adult	Physical Med
Ylvisake	TBI Rehabilitation	Physical Med
Quinn	Coming Out of the Dark: One Woman’s Psych	PBT
Killburn	Chemical Brain Injury	Public Med
Glang	Students with Acquired Brain Injury	Spec. Edu
Kreutzer	Community Integration Following BI	Spec. Edu
Singer	Children with Acquired Brain Injury	Spec. Edu
Gillis	TBI Rehabilitation	Speech

Articles by Rolland Parker, Ph.D. and Mark Ylvisaker, Ph.D. available for sale.
Listing to follow.
If you know of titles and/or journals that would be appropriate for us to sell, please contact us.
We are working to be standard bookstore and mail-order.




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