HEADLINER. The Newsletter of the Brain Injury Alliance of Oregon hats Inside. Fall 2014 Vol. XX Issue 4. Presidents Corner Page 2

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1 HEADLINER The Newsletter of the Brain Injury Alliance of Oregon hats Inside Presidents Corner Page 2 Fall 2014 Vol. XX Issue 4 Board of Directors Page 2 Professional F Members Page 3-4 BIAO Calendar Page 4 The Layers Desk Page 6 hat is a Concussion Page 7 emembering ayne Eklund Page 8 Alcohol and the Brain Page 9 Art Therapy - by arl Moritz Page My Story - illiam Hunter Breedlove r Page Coming to grips Page 14 Living ith a BI Page 15 Sneak Peak Page 16 Making the most of memory Page esources Page Support roups Page The Headliner Fall 2014 page 1

2 Brain Injury Alliance of Oregon Board of Directors Craig Nichols, JD/President...Portland Chuck McGilvary, Vice Pres.....Central Point Carol Altman, Treasurer Hillsboro Jeri Cohen, JD. Secretary....Creswell Gretchen Blyss,DC.....Portland Aaron DeShaw, JD DC.... Portland Nancy Irey Holmes, PsyD, CBIS...Redmond Eric Hubbs, DC....Beaverton Kendra Ward COTA/L....Astoria Ex-Officio Rep Vic Gilliam, Ex-Officio......Silverton Advisory Board Kristin Custer, QLI....Omaha, NE Danielle Erb, MD Portland Andrea Karl, MD......Clackamas Dave Kracke, JD..... Portland Ronda Sneva RN......Sisters Bruce Wojciechowski, OD...Clackamas Kayt Zundel, MA...Portland Staff Sherry Stock, MS CBIST Executive Director Pat Murray, Peer Mentor, Director-Brain Injury Help Center Becki Sparre, SG Facilitator, Admin, Trainer Brain Injury Alliance of Oregon PO Box 549 Molalla, Oregon Fax: (c)(3) Fed. ID Headliner DEADLINES Issue Deadline Publication Spring April 15 May 1 Summer July 15 August 1 Fall October 15 November 1 Winter January 15 February 1 Editor: Sherry Stock, John Botterman, Dave Kracke, Jeri Cohen Advertising in Headliner Rate Schedule Issue Annual/4 Issues (Color Rate) A: Business Card $100(125) $ 350(450) B: 1/4 Page $ 200(250) $ 700(900) C: 1/2 Page $ 300(375) $ 1000(1300) D: Full Page $ 600(700) $ 2000(2400) E. Sponsor Headliner $ 2500 $ 10,000 Advertising on BIAOR Website: $10,000 for Banner on every page $5000/year for Home Page $250 for active link Pro-Members page Policy The material in this newsletter is provided for education and information purposes only. The Brain Injury Alliance of Oregon does not support, endorse or recommend any method, treatment, facility, product or firm mentioned in this newsletter. Always seek medical, legal or other professional advice as appropriate. We invite contributions and comments regarding brain injury matters and articles included in The Headliner. The President s Corner Craig Nichols, JD October 19th found supporters of the Brain Injury Alliance of Oregon on the decks of the Spirit of Portland enjoying a beautiful fall evening dinner cruise and auction to support BIAOR. Local recording artist Steven Hale provided wonderful entertainment, and the evening concluded with a successful silent and oral auction. Our thanks go out to all of you who participated and donated to BIAOR, and our Executive Director Sherry Stock performed an amazing job of organizing the evening festivities. Please don't miss next week's joint Brain Injury Alliance of Oregon/Oregon Trial Lawyers Association seminar "Handling the Traumatic Brain Injury Case in Oregon." The seminar is scheduled for this Thursday, December 4, 2014 beginning at 9:00 a.m. at the Doubletree Hotel at Lloyd Center. A flyer is available online at This seminar will be a full day CLE for attorneys focusing on the finer points of representing an individual with a traumatic brain injury. The cast of speakers represents some of the best medical and legal experts on traumatic brain injury in the Northwest. DO NOT MISS THIS OUTSTANDING PROGRAM. I am pleased to announce that the Brain Injury Alliance of Oregon has been selected by the Metro Portland New Car Dealers Association ("MPNCDA") to be one of six charities to participate in the 2015 Portland International Auto Show Charity Preview Party on Wednesday evening, February 4, 2015, from 6:00 p.m. to 10:00 p.m. This charity event sponsored by Portland's new car dealers provides an excellent opportunity for supporters of BIAOR to attend this gala function, enjoy the food, spirits, music, all provided by the new car dealers, and most of all, the dramatic showing of next years lineup of new vehicles, all in the name of charity. The cost is $100 per ticket, which receives a 100% charitable donation tax deduction courtesy of MPNCDA. We are extremely grateful to be included in an event that last year resulted in local charities receiving a generous donation from the Metro Portland New Car Dealers Association of $250, PLEASE MARK THE DATE FEBRUARY 4, 2015, on your calendar - more from us on this soon. Finally, this is a time of year to reflect and count one's blessings as we head into the holiday season and New Year. Please have a happy and safe Holiday Season from the Brain Injury Alliance of Oregon! Craig Nichols BIAOR Board President Craig Nichols is the senior partner at Nichols & Associates in Portland. Nichols & Associates has been representing brain injured individuals for over thirty years. Mr. Nichols is available for consultation at (503) Fred Meyer Community Rewards - Donate to BIAOR Fred Meyer's new program. Here's how it works: Link your Rewards Card to the Brain Injury Association of Oregon at Whenever you use your Rewards card when shopping at Freddy's, you ll be helping BIAOR to earn a donation from Fred Meyer. page 2 Fall 2014 The Headliner

3 When looking for a professional, look for someone who knows and understands brain injuries. The following are supporting professional members of BIAOR. Names in Bold are BIAOR Board members Attorneys Oregon Astoria Joe DiBartlolmeo, DiBartolomeo Law Office, PC, Astoria, Bend Dwyer Williams Potter Attorney s LLC, Bend, Warren John West, JD, Bend, or Eugene. Derek Johnson, Johnson, Clifton, Larson & Schaller, P.C., Eugene Don Corson, Corson & Johnson Law Firm, Eugene, Charles Duncan, Eugene, Tina Stupasky, Jensen, Elmore & Stupasky, PC, Eugene, , Portland Paulson Coletti, John Coletti, Jane Paulson Portland, Craig Allen Nichols, Nichols & Associates, Portland William Berkshire, Portland PI Jeffrey Bowersox, Lake Oswego, PI Tom D'Amore, D'Amore & Associates, Portland Aaron DeShaw, Portland Lori Deveny, Portland Jerry Doblie, Doblie & Associates, Portland, Wm. Keith Dozier, Portland Sean DuBois, DuBois, Law Group, Portland, Brendan Dummigan, Pickett Dummigan, Portland Peggy Foraker, Portland Sam Friedenberg, Nay & Friedenberg, Portland Guardianship/Conservatorship Bill Gaylord, Gaylord Eyerman Bradley,PC, Portland Timothy Grabe, Portland, Julia Greenfield, Disability Rights Oregon, Portland Sharon Maynard, Bennett, Hartman, Morris & Kaplan, Portland , SSI/SSD Richard Rizk, Rizk Law, Inc., Portland Trucking Injuries, WC, Empymt & LT Disability Charles Robinowitz, Portland, J. William Savage, Portland Richard A. Sly, Portland , SSI/SSD/ PI Steve Smucker, Portland ± Scott Supperstein, The Law Offices of Scott M Supperstein, PC, Portland Tichenor& Dziuba Law Offices, Portland Ralph Wiser III, Wiser & Associates, Inc., Lake Oswego , PI & SSI/SSDI Salem Adams, Hill & Hess, Salem, Richard Walsh, Walsh & Associates, PC Keizer, Roseburg Samuel Hornreich, Roseburg, Washington Bremerton Seattle Bremerton Kenneth Friedman, Friedman Rubin, Bremerton, Seattle Kevin Coluccio, Coluccio Law, Seattle, WA Richard Adler, Adler Giersch, Seattle, WA Care Facilities/TBI Housing (subacute, community based, inpatient, outpatient, nursing care, supervisedliving, behavior, coma management, driver evaluation, hearing impairment, visual impairment, counseling, pediatric) Sherry Acea, Fourth Dimension Corp, Bend Carol Altman, Homeward Bound, Hillsboro Linda Beasley, LPN CBIS, Autumn House, Beaverton, Hazel Barnhart, Psalm 91 Care Home, Beaverton, or TBI 35+ Karen Campbell, Highland Height Home Care, Inc, Gresham & Portland, or Medically Fragile Casa Colina Centers for Rehabilitation, Pomona, CA, Damaris Daboub, Clackamas Assisted Living, Clackamas Wally & Donna Walsh, Delta Foundation/Snohomish Chalet, Snohomish, WA Care N Love AFH LLC, Corrie Lalangan, Vancouver WA Danville Services of Oregon, LLC,, Michael Oliver, Portland (800) Maria Emy Dulva, Portland Herminia D Hunter, Trinity Blessed Homecare, Milwaukie, , Dem/Alz 70+ Kampfe Management Services, Pam Griffith, Portland, Apt Karin Keita, Afripath Care Home LLC, Adult Care Home Portland Terri Korbe, LPN, High Rocks Specialty Care, Clackamas Learning Services, Northern CA & CO, Mentor Network, Yvette Doan, Portland Joana Olaru, Alpine House, Beaverton, Oregon Rehabilitation Center, Sacred Heart Medical Center, Director: Katie Vendrsco, Quality Living Inc (QLI), Kristin Custer, Nebraska, Ridgeview Assisted Living Facility, Dan Gregory, Medford, WestWind Enhanced Care, Leah Lichens, Medford, Melissa Taber, Oregon DHS, Polly Smith, Polly's County AFH, Vancouver, Day Program and home Uhlhorn Program, Eugene, Supported Apt Windsor Place, Inc., Susan Hunter, Salem, Supported Apt Chiropractic Gretchen Blyss, DC, Portland, Stefan Herold, DC, DACNB, Tiferet Chiropractic Neurology, Portland Eric Hubbs, DC, Total Mind & Body Health, Beaverton Michael T. Logiudice, DC, Linn City Chiropractic, West Linn Garreth MacDonald, DC, Eugene, D.Stephen Maglente, DMX Vancouver, Vancouver WA Bradley Pfeiffer, Bend Cognitive Rehabilitation Centers/ Rehab Therapists/Specialists Rehab Without Walls, Mountlake Terrace, WA Julie Allen Progressive Rehabilitation Associates BIRC, Portland, Quality Living Inc (QLI), Kristin Custer, Nebraska, (BI & SCI) Marie Eckert, RN/CRRN, Legacy HealthCare, RIO Admissions, Portland, Marydee Sklar, Executive Functioning Success, Portland, Counseling Heidi Dirkse-Graw, Dirkse Counseling & Consulting, Inc. Beaverton, OR Sharon Evers, Face in the Mirror Counseling, Art Therapy, Lake Oswego Donald W. Ford, MA, LMFT, LPC, Portland, Jerry Ryan, MS, CRC, Oregon City, Elizabeth VanWormer, LCSW, Portland, Dentists Dr. Nicklis C. Simpson, Adult Dental Care LLC, Gleneden Beach Educators/Therapy Programs Gianna Ark, Linn Benton Lincoln Education Service District, Albany, Andrea Batchelor, Linn Benton Lincoln Education Service District, Albany, Heidi Island, Psychology, Pacific University, Forest Grove, To become a supporting professional member of BIAOR see page 23 or contact BIAOR, The Headliner Fall 2014 page 3

4 ± McKay Moore-Sohlberg, University of Oregon, Eugene Jon Pede, Hillsboro School District, Hillsboro, Expert Testimony Janet Mott, PhD, CRC, CCM, CLCP, Life Care Planner, Loss of Earning Capacity Evaluator, Life Care Planners/Case Manager/Social Workers Rebecca Bellerive, Rebecca Bellerive, RN, Inc, Gig Harbor WA Michele Lorenz, BSN, MPH, CCM, CHPN, CLCP, Lorenz & Associates, Medford, Vince Morrison, MSW, PC, Astoria, Michelle Nielson, Medical Vocational Planning, LLC, West Linn, Dana Penilton, Dana Penilton Consulting Inc, Portland Thomas Weiford, Weiford Case Management & Consultation, Voc Rehab Planning, Portland Legal Assistance/Advocacy/Non-Profit Deborah Crawley, ED, Brain Injury Association of Washington, or Disability Rights Oregon, Portland, Eastern Oregon Center for Independent Living (EOCIL), Ontario ; Pendleton ; The Dalles Independent Living Resources (ILR), Portland, Jackson County Mental Health, Heather Thompson, Medford, (541) Oregon Chiropractic Association, Jan Ferrante, Executive Director, Kayt Zundel, MA, ThinkFirst Oregon, (503) Legislators Vic Gilliam, Representative, Long Term TBI Rehab/Day Program s/support Programs Carol Altman, Bridges to Independence Day Program, Portland/Hillsboro, Anat Baniel, Anat Baniel Method, CA Benjamin Luskin, Luskin Empowerment Mentoring, Eugene, Marydee Sklar, Executive Functioning Success, Portland, Medical Professionals Marsha Johnson, AnD, Oregon Tinnitus & Hyperacusis Treatment Center, Portland Kristin Lougee, CBIS, cell Carol Marusich, OD, Neuro-optometrist, Lifetime Eye Care, Eugene, Kayle Sandberg-Lewis, LMT,MA, Neurofeedback, Portland, Bruce Wojciechowski, OD, Clackamas, Neurooptometrist, Northwest EyeCare Professionals, Looking for an Expert? See our Professional Members here Physicians Sharon Anderson, MD, West Linn Bryan Andresen, Rehabilitation Medicine Associates of Eugene-Springfield, Diana Barron, MD. Barron-Giboney Family Medicine, Brownsville, OR (541) Jerald Block, MD, Psychiatrist, James Chesnutt, MD, OHSU, Portland Paul Conti, MD, Psychiatrist, Beaverton, Danielle L. Erb, M.D., Brain Rehabilitation Medicine, LLC, Portland M. Sean Green, MD, Neurology, OHSU, (503) Steve Janselewitz, MD, Pediatric Physiatrist, Pediatric Development & Rehabilitation-Emanuel Children s Hospital, Portland Nurse: Dept: Michael Koester, MD, Slocum Center, Eugene, Andrew Mendenhall, MD, Family Medicine, Addiction & Pain, Beaverton ± Oregon Rehabilitation Medicine, P.C., Portland, Kevin Smith, MD, Psychiatrist, OHSU, Francisco Soldevilla, MD, Neurosurgeon, Northwest Neurosurgical Associates, Tualatin, Gil Winkelman, ND, MA, Insights to Health LLC, Alternative Medicine, Neurobiofeedback, Counseling, Portland, David Witkin, MD, Internal Medicine, Sacred Heart Hospital, Eugene, Psychologists/ Neuropsychologists Tom Boyd, PhD, Sacred Heart Medical Center, Eugene James E. Bryan, PhD, Portland Caleb Burns, Portland Psychology Clinic, Portland, Amee Gerrard-Morris, PhD, Pediatrics, Portland, Elaine Greif, PhD, Portland Nancy Holmes, PsyD, CBIS, Portland Sharon M Labs PhD, Portland Ruth Leibowitz, PhD, Salem Rehab, Michael Leland, Psy.D, CRC, Director, NW Occupational Medicine Center, Inc., Portland, Susan Rosenzweig, PsyD, Center for Psychology & Health, Dec 4 Dec BIAOR Calendar of Events For updated information, please go to Call the office with any questions or requests Legal Conference on Brain Injury - Co-Hosted with OTLA see page Holiday Party at John s Incredible Pizza - Hosted by BIAOR see page 8-9 Feb 4 Sneak Preview see page 16 March Speech and Language/Occupational Therapist Channa Beckman, Harbor Speech Pathology, WA John E. Holing, Glide ± Jan Johnson, Community Rehab Services of Oregon, Inc., Eugene, Sandra Knapp, SLP, David Douglas School District, Sandy Carol Mathews-Ayres, First Call Home Health, Salem Anne Parrott, Legacy Emanuel Hospital Warren Kendra Ward, COTA, Astoria, State of Oregon Dave Cooley, Oregon Department of Veterans Affairs, Salem, Stephanie Parrish Taylor, State of Oregon, OVRS, Salem, (503) Technology/Assistive Devices RJ Mobility Services, Independence, 503) Second Step, David Dubats, Eugene, STEP Veterans Support Mary Kelly, Transition Assistance Advisor/Idaho National Guard, Belle Landau, Returning Veterans Project, Portland, Vocational Rehabilitation/Rehabilitation/ Employment / Workers Comp D Autremont, Bostwick & Krier, Portland, Roger Burt, OVRS, Portland Arturo De La Cruz, OVRS, Beaverton, Marty Johnson, Community Rehab Services of Oregon, Inc., Eugene, SAIF, Salem, Stephanie Parrish Taylor, State of Oregon, OVRS, Salem, (503) Kadie Ross, OVRS, Salem, Professionals Ronda Sneva, R&G Food Services, Inc. Sisters/ Tucson, Names in bold are BIAOR Board members Corporate Member Gold Member Non-Profit Silver Member ± Bronze Member Sustaining Member Platinum 13th Pacific Northwest Brain Injury Conference - Living with Brain Injury & Neurological Disorders page 4 Fall 2014 The Headliner

5 Imagine What Your Gift Can Do. The most important achievements often start where they are least expected. That s why BIAOR is the perfect place to give. It allows your money to go where it s needed most, when it s needed most. BIAOR provides information about brain injury, resources and services, awareness and prevention education, advocacy, support groups, trainings and conferences and meetings throughout the state for professionals, survivors and family members. Your gift makes a difference at BIAOR. Please mail to: BIAO PO Box 549 Molalla O Fax: Name Address CityStateip Phone Type of Payment Check payable to BIAOR for $ Charge my VISA/MC/AMX/Discover Card $ Card number: Exp. date: Print Name on Card: Signature Approval: Zip Code that CC Bill goes to: Join us to learn and grow as care providers while earning FREE Continuing Education Units (CEU). This seminar is designed for long-term care workers in community-based settings. This interactive course reviews common challenging behaviors seen in adult populations and guides students through methods to appropriately intervene, identify support strategies and tools, and review Behavior Support Plans. SEIU is partnering with Oregon Care Partners to provide statewide no cost caregiver trainings on challenging behaviors. RSVP today! DATE ADDRESS PHONE Learn more and RSVP: Don t have internet access? You can still register! Call our Training Administrator, Rachel, at (971) Fall Sudoku The object is to insert the numbers in the boxes to satisfy only one condition: each row, column and 3 x 3 box must contain the digits 1 through 9 exactly once. (Answer on page 17) RALPH E. WISER Attorney Representing Brain Injured Individuals Auto and other accidents Wrongful Death Sexual Abuse Elder Abuse Insurance issues and disputes Disability: ERISA and Non-ERISA, SSD, PERS One Centerpointe Drive, Suite 570 Lake Oswego, Oregon Phone: (503) Fax: (503) FREE INITIAL CONSULTATION Free Parking/Convenient Location The Headliner Fall 2014 page 5

6 The Lawyer s Desk: A Look at TBI Legal Representation By David Kracke, Attorney at Law Nichols & Associates, Portland, Oregon I just found out that my friend and longtime BIAOR board member Wayne Eklund passed away and I would be remiss if I didn t begin this column with a tribute to Wayne and all that he did for tbi survivors in Oregon and throughout the world. Wayne embodied all that is good in people who have dedicated themselves to helping those survivors create a better life and his passing will leave a void for those who he helped and those who loved and admired him, myself included. He often told me of his work with survivors in Oregon, Hawaii and elsewhere and I consulted with him many times to get his perspective on difficult cases. His intelligence and compassion were always out front in every conversation I had with him and I could always count on Wayne to analyze a situation with care and concern. I met Wayne years ago when I first started working with the BIAOR and I looked upon him as a mentor and a friend. He was quick to laugh and quick to understand problems and roadblocks that were impeding a survivor s progress. His practice focused on how best to help survivors cope with uncertain futures and his expertise and dedication to his calling made real positive differences in the lives of many survivors. Wayne was a person who lived to help others and his loss will be felt far and wide. Thank you Wayne for the help you gave me and for the work you did to enhance the lives of tbi survivors everywhere. So where to go from these opening paragraphs? What do we take from the passing of a life dedicated to helping tbi survivors? Perhaps we redouble our efforts, whatever those efforts are, with the awareness that there is one less person helping and therefore a void to fill? Perhaps we take time away from everything to be thankful, to be grateful, and to count our blessings, wherever and whatever they are. In a time of Thanksgiving this latter course seems most appropriate and I will take my advice this weekend and throughout this holiday season to slow down a bit, be thankful for those blessings that exist around me, to be humble and to live in the moment as much as possible with the awareness that life is short and we should do what we can to recognize the beauty wherever it blooms. But rest can only happen for so long before the work needs to continue and so I know that I will soon be back at it working to help tbi survivors through the legislative process and through my individual representation of tbi survivors. We will be addressing a need to develop funding sources for BIAOR programs and we hope to convince the Oregon legislature to provide funding through a proven mechanism with more details on that effort as it develops. Inherent in that effort is all of the persuasion and drafting that we know is necessary to get such a bill passed. It s another cog in the wheel of tbi survivor representation and one ARE YOU A MEMBER? that I, and others, do willingly and without concern toward personal sacrifice. We do it because we can and because it s the right thing to do. This is what Wayne did through the BIAOR and this is what we need to do in his honor and with the recognition that if not us, who? And if not now, when? Originally this column was going to be exclusively about the new legislative push underway, but in light of Wayne s passing and the hole it leaves in the tbi survivor community, I have gone off in another direction and I ask you to understand my motivation. There is an expiration date for us all and in that recognition is an understanding that our productive days are limited. We don t have the luxury of waiting to get things done. Instead we have an obligation to work hard to help the people and causes we hold dear. Paraphrasing the old adage, to those who are given much, much is expected. The much we are given takes many forms, and as you reflect this holiday season on where you are in life, also reflect on what the much is in your life because it is there. And when you recognize it be thankful, be humble and commit to helping someone in return. This is how Wayne lived his life and we all need to follow his lead. You will be missed, my friend, rest in Peace. David Kracke is an attorney with the law firm of Nichols & Associates in Portland. Nichols & Associates has been representing brain injured individuals for over twenty two years. Mr. Kracke is available for consultation at (503) The Brain Injury Alliance of Oregon relies on your membership dues and donations to operate our special projects and to assist families and survivors. Many of you who receive this newsletter are not yet members of BIAOR. If you have not yet joined, we urge you to do so. It is important that people with brain injuries, their families and the professionals in the field all work together to develop and keep updated on appropriate services. Professionals: become a member of our Neuro-Resource Referral Service. Dues notices have been sent. Please remember that we cannot do this without your help. Your membership is vitally important when we are talking to our legislators. For further information, please call or See page 23 to sign up. Brain injuries have a way of making hearts flip-flop between hope and the reality of loss. Larissa Murphy In EIGHT TWENTY EIGHT page 6 Fall 2014 The Headliner

7 What Is A Concussion? The Definitive Guide For Understanding Traumatic Brain Injury Your brain is fragile. Treat it like you would your iphone but better because it's your brain. You don t need to be on the receiving end of a Joe Frazier left hook or feel the explosive collision of one football helmet against another to suffer a concussion. They can happen just about anywhere, which means understanding how they work and what they need can predict either longterm recovery or future injury. What s A Concussion, Exactly? Your brain basically sits inside a watery pile of Jell-O. In science-talk it s called cerebrospinal fluid. This fluid acts as a cushion so that when your head gets jostled around, your brain is still able to move comfortably inside without bashing into the inner wall of the skull each time you re headbanging to Metallica or speeding up to a red light. Still, the anatomy isn t fool-proof. No matter what you put around your head, if the forces are strong enough you re not going to prevent that brain from moving inside the skull, Dr. Micky Collins, program director for the University of Pittsburgh Medical Concussion Program, told Medical Daily. On the left, a brain injury from concussive force. On the right, an injury of subconcussive force. Greater intensity indicates intracranial pressure (Cited from The Journal of Neuropsychiatry). On its own, the brain sloshing around doesn t pose much of a problem. But it s the really hard forces that matter, because they cause damage at the cellular level. These forces cause the individual brain cells, called neurons, to stop communicating. They also cause the membranes surrounding the neurons to stretch, leaking important supplies of potassium from the cell. When potassium goes out of the cell, Collins explained, there is an increased demand for glucose or energy, what we call hyperglycolysis and so the neuron is actually saying Whoops, something s wrong. I need more energy. At the same time, the calcium that is supposed to stay outside the cell floods the now vulnerable membrane, causing the brain to siphon off blood flow. These two conflicting forces make normal processes, such as thinking, moving, and talking, much harder. We call this resulting energy crisis a concussion. Patient Recovery Left alone, the energy crisis typically resolves itself within a few weeks. The stretched out membranes shrink back to their normal states, and cognitive processes go back to humming along like they usually do. But complications arise when patients go into their head injuries already suffering some sort of deficiency upstairs, even if it s minor. Concussion fights dirty, Collins said, referring to the (Concussions Continued on page 10) At Windsor Place, we believe in promoting the self-confidence and self-reliance of all of our residents Susan Hunter Executive Director Phone: Fax: Windsor Place, Inc Windsor Ave. NE Salem Oregon The Headliner Fall 2014 page 7

8 Remembering Wayne Eklund It is with great sadness that we say goodbye to board member and our former President, Wayne Eklund, RN RNLCP. He will live on forever in our fondest memories. In his term as president, Wayne took BIAOR from a volunteer organization to what it is today. Speaking for this organization and the hundreds of survivors you have helped, we will miss you and never forget you. Wayne Eklund with his two sons, Eric (left) and Lee Rabbit's clever," said Pooh thoughtfully. "Yes," said Piglet, "Rabbit's clever." And he has Brain." "Yes," said Piglet, "Rabbit has Brain." There was a long silence. "I suppose," said Pooh, "that that's why he never understands anything. A.A. Milne, Winnie-the-Pooh The Brain Injury Alliance of Oregon can deliver a range of trainings for your organization. These include: CBIS Training (Certified Brain Injury Specialist) Brain Injury 101 Anger Management and TBI Vocational Rehabilitation-working with clients Methamphetamine and Brain Injury ADA Awareness Cross Disability Training including cognitive interactive simulation for Employers Judicial and Police: Working with People with Brain Injury Traumatic Brain Injury: A Guide for Educators Native People and Brain Injury Aging and TBI How Brain Injury Affects Families Brain Injury for Medical and Legal Professionals-What you need to know Caregiver Training Domestic Violence and TBI Dealing with Behavioral Issues Returning to Work After Brain Injury Returning Military & Veterans with TBI/PTSD And more! For more information contact Sherry Stock, Executive Director, Brain Injury Alliance of Oregon at page 8 Fall 2014 The Headliner

9 ALCOHOL S DAMAGING EFFECTS ON THE BRAIN Difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory: Clearly, alcohol affects the brain. Some of these impairments are detectable after only one or two drinks and quickly resolve when drinking stops. On the other hand, a person who drinks heavily over a long period of time may have brain deficits that persist well after he or she achieves sobriety. Exactly how alcohol affects the brain and the likelihood of reversing the impact of heavy drinking on the brain remain hot topics in alcohol research today. We do know that heavy drinking may have extensive and far reaching effects on the brain, ranging from simple slips in memory to permanent and debilitating conditions that require lifetime custodial care. And even moderate drinking leads to short term impairment, as shown by extensive research on the impact of drinking on driving. A number of factors influence how and to what extent alcohol affects the brain, including how much and how often a person drinks; the age at which he or she first began drinking, and how long he or she has been drinking; the person s age, level of education, gender, genetic background, and family history of alcoholism; whether he or she is at risk as a result of prenatal alcohol exposure; and his or her general health status. Some common disorders associated with alcohol related brain damage and the people at greatest risk for impairment. It looks at traditional as well as emerging therapies for the treatment and prevention of alcohol related disorders and includes a brief look at the high tech tools that are helping scientists to better understand the effects of alcohol on the brain. BLACKOUTS AND MEMORY LAPSES Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events. Blackouts are much more common among social drinkers than previously assumed and should be viewed as a potential consequence of acute intoxication regardless of age or whether the drinker is clinically dependent on alcohol. White and colleagues surveyed 772 college undergraduates about their experiences with blackouts and asked, Have you ever awoken after a night of drinking not able to remember things that you did or places that you went? Of the students who had ever consumed alcohol, 51 percent reported blacking out at some point in their lives, and 40 percent reported experiencing a blackout in the year before the survey. Of those who reported drinking in the 2 weeks before the survey, 9.4 percent said they blacked out during that time. The students reported learning later that they had participated in a wide range of potentially dangerous events they could not remember, including vandalism, unprotected sex, and driving. Equal numbers of men and women reported experiencing blackouts, despite the fact that the men drank significantly more often and more heavily than the women. This outcome suggests that regardless of the amount of alcohol consumption, females a group infrequently studied in the literature on blackouts are at greater risk than males for experiencing blackouts. A woman s tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcohol induced memory impairments, even when men and women consume comparable amounts of alcohol. ARE WOMEN MORE VULNERABLE TO ALCOHOL S EFFECTS ON THE BRAIN? Women are more vulnerable than men to many of the medical consequences of alcohol use. For example, alcoholic women develop cirrhosis, alcohol induced damage of the heart muscle (i.e., cardiomyopathy), and nerve damage (i.e., peripheral neuropathy) after fewer years of heavy drinking than do alcoholic men. Studies comparing men and women s sensitivity to alcohol induced brain damage, however, have not been as conclusive. Using imaging with computerized tomography, two studies compared brain shrinkage, a common indicator of brain damage, in alcoholic men and women and reported that male and female alcoholics both showed significantly greater brain shrinkage than control subjects. Studies also showed that both men and women have similar learning and memory problems as a result of heavy drinking. The difference is that alcoholic women reported that they had been drinking excessively for only about half as long as the alcoholic men in these studies. This indicates that women s brains, like their other organs, are more vulnerable to alcohol induced damage than men s. Yet other studies have not shown such definitive findings. In fact, two reports appearing side by side in the American Journal of Psychiatry contradicted each other on the question of gender related vulnerability to brain shrinkage in alcoholism. Clearly, more research is needed on this topic, especially because alcoholic women have received less research attention than alcoholic men despite good evidence that women may be particularly vulnerable to alcohol s effects on many key organ systems. BRAIN DAMAGE FROM OTHER CAUSES People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease. For example, thiamine deficiency is a common occurrence in people with alcoholism and results from poor overall nutrition. Thiamine, also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. Thiamine is found in foods such as meat and poultry; whole grain cereals; nuts; and dried beans, peas, and soybeans. Many foods in the United States commonly are fortified with thiamine, including breads and cereals. As a result, most people consume sufficient amounts of thiamine in their diets. The typical intake for most Americans is 2 mg/day; the Recommended Daily Allowance is 1.2 mg/day for men and 1.1 mg/day for women. Wernicke Korsakoff Syndrome Up to 80 percent of alcoholics, however, have a deficiency in thiamine, and some of these people will go on to develop serious brain disorders such as Wernicke Korsakoff syndrome (WKS). WKS is (Alcohol Continued on page 18) The Headliner Fall 2014 page 9

10 (Concussions Continued from page 7) injury s knack for exploiting preexisting conditions. Whatever system doesn t work real well to begin with is usually what s outed. The research backs this up. People who suffer from migraines tend to get more migraines post-concussion; people who have eye problems keep experiencing eye problems. Difficulties also crop up when the concussion isn t the patient s first. Recovery times lengthen from three weeks to as long as seven, although the good news is that full recoveries are still possible, provided patients follow-through with their physical therapy. If they don t, that s when the risk of long-term damage enters the picture. The worst offense for concussion recovery is returning to play in the same sport that delivered the injury before getting the green-light from a physician. It s not like adding one plus one in that situation, Collins said. Injuries build. They compound on one another, and not always in the most noticeable of ways. Looking Long-Term Earlier this July, more than 4,500 retired players from the National Football League learned their lawsuit against the league was making headway. Their claim that the NFL misled its athletes about the risks of concussion was sound. An $870 million settlement wasn t going to cut it. Instead, U.S. District Judge Anita Brody ruled the NFL must stick to a formula when former players come forward seeking compensation. The formula takes into account the retiree s condition and age. For example, a young retiree with Lou Gehrig s disease (amyotrophic lateral sclerosis) would receive $5 million, while a retiree in his 80s would get approximately $25,000. Brains with chronic traumatic encephalopathy reduce in size and inhibit normal cognitive function related to speech and motor skills (Cited from the Boston University Center for the Study of Traumatic Encephalopathy). This formula, however, belies the fact that one injury stands above the rest: chronic traumatic encephalopathy, better known as CTE. First described in 2002, CTE can only be observed after death making it a blameless non-issue for the leaders of the league but a haunting What if? for its current players. Since CTE results from hundreds, if not thousands, of sub-concussive hits, scientists can t point to one incident alone. Of the 79 deceased athletes scientists recently opened up, 76 brains contained traces of CTE, and there isn t a single person or thing that s responsible. It s a combination of factors. Years of headfirst tackling mixed with poor medical oversight on the part of the NFL leave the hulking athletes with nothing left between their ears. They forget their names and how to perform basic functions like driving a car or getting dressed. Sometimes they suffer from other disorders simultaneously, including schizophrenia, and turn to substance abuse to numb the pain until it ends for good. What Comes Next The future of concussion research comes with both good news and bad news. The good news is that scientists have the broad strokes under control. People like Collins and his colleagues can observe an injury in the brain otherwise a locked box of information and see a great deal of trauma without much uncertainty. This lets them design guidelines like the Heads Up program, the Centers for Disease Control and Prevention s effort to increase awareness. The bad news is that these programs don t stick with people. A recent survey found the majority of parents incorrectly believed that MRI and CT scans can be used to diagnose concussion. (In actuality, the only way to diagnose concussion is with direct examination, through tests of vision, hearing, balance, and reflex.) Worse, 26 percent of parents confessed they didn t have a firm grasp of the Return to Play guidelines, which detail how long children should wait before resuming their sport or return to school. If there s a silver lining in that challenge it s that the hard problem is mostly nailed down. Generating awareness is far easier than doing the science of concussion experiments, so the better scientists can communicate with parents, coaches, and even the players themselves, the fewer concussions we ll see. Death rates are already falling, thanks to better equipment and safety guidelines. But incidence has jumped more than 300 cases per 100,000 since Reversing the trend means keeping a watchful eye on how we live our lives, even if Joe Frazier left hooks and colliding helmets aren t much of a threat. Source: By Chris Weller Medical Daily Reading reduces stress by 68 %, more than listening to music or taking a walk. Exercising makes you both more productive and happier for the day that you exercise. It affects your brain function and memory, and the positive effect lasts for the entire day fax: page 10 Fall 2014 The Headliner

11 Art Therapy - My First Complete Custom Bike Build I have been cycling commenting and participating in local area Bicycle Century event for the past fifteen years. My daily commute to work and back would be an average of forty miles. My initial plan was to customize a Trek Y- Foil into a Time Trial bike because I really love the frame design and the fact that it was banded by the UCI (Union Cycliste Internationale) for its aerodynamics and Carbon frame design. The frame was only produced for two years. The T/T idea was just because I like the look of a bike that looks like it is moving while standing still and I don t participate in Time Trials. I was shopping to purchase this bike to customize in my own personal way. But due to my nearly fatal life change when I was involved in an accident with a car while riding my bicycle home from work, in which the car ran over me and dragged arl Moritz underneath for some thirty feet on 6/29/10. Ending up with fractured spine, skull and broken pelvis that I had to receive thirteen Titanium screws to hold it back together. All ending up with a Saver TBI which all meant that my plans changed as well. Oh, and did they ever! I really wanted to have this unique bike build completed for my fourth year TBI Rebirth as a present to myself, but with all the prepping, details, components searching and planning, time got away from me to finish on that date. So it will now a late Birthday present. I am calling this Art Therapy, because as an Apparel Tech. Designer I wanted to apply my years in design and with an artistic approach with high orientated details. Note: I say Rebirth because as a TBI survivor; it really is a Rebirth because one has to learn almost everything all over again. Back in the day prior, the original T/T build idea was just to customize the same type of bike with just paint and graphics and this Single Speed idea would be a total frame up custom build. After doing some research on S/S and the benefits of riding this type of bike (balance, cadence & strength). I decided to change from a T/T Multi speed build to a single speed build because I can now benefit from these attributes. I also researched if anyone has ever converted a Y-Foil into a Fixie / Track set up. I could only find a few post that said; Put down your tools and don t destroy a beautiful design. I had to save all my Birthday and other holiday money for the past few years to get this going because now I am on Disability. The Frame is a 98, 58cm pictured as the way that I got it from my immediate family on a major birthday. One of the first things that I did after getting the frame was to download the Manufactures specification of the frame. That way I would know the exact components size and thread type that I would need to replaced. Depending on the make and year of a frame, the components specification would change. I am now on a fixed income so I did not want to spend time and money on a component that would not fit correctly and have to return and order the correct one. Getting started, -I removed the front derailleur mounts, bottle cage mounts and all the cable housing mounts (4) from the carbon frame filling in all the rivet holes with a two part epoxy resin. I did this because I wanted the frame to be silky smooth with no visual or aero distractions. So it will now be a single speed frame forever, unless it is taken to have the mounts professionally reinstalled. I researched for components with the best user preferences and of course for the price. In removing any components that I would reuse later, I put them in a zip lock baggy and marked the name of the component on the bag for later use because I did not want to get anything mixed up or lost. I believe that maybe now that I am over diligent on keeps files and other stuff in my life a lot more organized. I went out and asked for advice from my Goggle+ Communities on if I could create a single cog with a double chainring. As ---I wanted more gear options due to my daily commute ride that has a 13% grade incline and I wanted to use it for local event rides. The answer was -no, because of chain tension even with a chain tensioner. They suggested to use a step back two speed rear hub. I never knew this even existed. I wanted to assemble as much as I could on this build myself including building a custom wheel-set. So, I bought a set of 70mm Deep V rims and a new rear hub with 100% ratio on 1 st and 138% ration on 2 nd gear along with a The Headliner Fall 2014 page 11

12 front Disc 32H hub. I didn t want to set this bike to skid for braking, because I am older than most Hipsters and wanted this bike to safely stop and go. From my parts bin I used my 170mm carbon crank arm set, carbon seat post and carbon T/T bars. It was kind of difficult to find a Disc mounted front fork for a one inch head tube, but I finally found one on line made for Cycle Cross. I went with a 160mm Disc Rotor at the front and no rear brake. I went several times plus volunteered at a Non-Profit bicycle repair shop in Portland, Oregon. called Bikefarm (http://bikefarm.org). The benefits (my) of going to an N/P is; No Sales Pitch and to learn on how to make bike repairs yourself. Before starting to lace the rims, I applied a red vinyl carbon laminate film (Wrapped as it s called in the Auto field) over the rims. I then had to have the spoke length calculate once I got the hubs that I would use on the new rims. The unique lacing pattern is one that I created myself by using 4 White Double Butted Spoke and 4 Black Bladed spokes X4. The reason I used the 4 white Double Butted Spoke is to make the black bladed spokes to visually be set back. I have never seen this done before. So I m calling the wheel set lacing pattern Laced Mag Style. Lacing the wheel set took a very long time especially for a first timer. And the fact that I was working with two different spokes shapes to coordinate in a pattern series all doing this on my living room floor before I would go and true the wheel-set. Time wise, I spent three weeks on Friday & Saturdays trueing the wheel-set at four hours set at each increment. But it s all done and I m very happy with the results! Bikefarm also guided my in the process of pressing in new fork headset s caps, rethreading the Bottom Bracket threads on the frame and using the wheel balance stand to adjust spoke tension and balancing the wheel-set. I balanced the wheel-set to a one millimeter tolerance. Because I rather spend the time now and do the best that I can than to spend more time later going back and fixing a problem. I bought a new chain-ring on line that is an asymmetrical 46 teeth and a 22 teeth rear cog that is a propelled by a black and gold chain. Bikefarm also guide me through the process of converting from a threaded fork to thread-less set up for a disc mount front fork set up, including installing the Bottom Bracket and correct chain line. I was not sure whether the step back hub would work well with the asymmetrical chain-ring, but so far no issues and I absolutely love it! I really wanted the have the frame professionally painted like I had done on my other bike projects, so I sent out pictures of the frame to several local bicycle paint shops and auto paint shops to get an estimate on the price. Wow, I was blown away at the proposed cost, I didn t want to spend more money on the paint than on the cost of the frame itself! So I wet sanded the frame, seat post, crank arms and T/T bars removing all Brand/model names with 320 & 400 grit sandpaper getting it ready to paint it myself. After having the frame all prepped for paint, my former neighbor Taji helped me and took the sanded and all prepped frame to a painter contact that would apply paint and graphics. The bike Graphic of a Flaming Flying Eagle I designed myself using Adobe Illustrator and took the file to a local Vinyl Sign Shop to have it cut out at in a gold color laminate. I used a clear gloss shaker paint on the crank arms, seat post, and T/T bars because I wanted the carbon texture to be exposed on these components. For the longest time I have been a fan of the 50 s hot rod, so that s where the color scheme comes from red, gold, black, and white plus I wanted the finished project to look Neo-Vintage. All in all, this bike was 100% hand built by myself with only the frame paint being out sourced. After having the bike all completed, I went for a spin one day and rode past by a UPS shop and thought, Let s see how much this puppy weighs? Hmm a total weight of 15.7 Lbs. Not so shabby for my first build but I was a little surprised on the weight and thought it would be a little bit less! It is was it is. My final comments: BIAOR.Org thank you for posting my Bike build story. Readers; thank you for taking time to read this Post. Bicycling is in the top three of physical exercises that help improves cognition because you are asking your beautiful Noggin to multi-task on many levels and also exercise that helps gets blood flow through your whole body. With that said, it leads me to the lyrical quote from the band Queen, Bicycle bicycle bicycle, I want to ride my bicycle, I want to ride my bike, I want to ride my bicycle I want to ride it where I like. So get on your bikes and ride! Since my Rebirth I have completed fifteen Bike Century rides, oh what joys! As a TBI survivor, accept your new life and don t fight your new life and try to pursue your goals. I tell my TBI acquaintances that you got to first take Baby steps first before you can run or even sprint (Metaphorically). My three boys (Cubs) are doing fantastic and now they want a custom bike built, more fun to create more bike projects. page 12 Fall 2014 The Headliner

13 Thats my story and Im sticking to it - illiam Hunter Breedlove r. From a Traumatic Brain Injury (TBI) survivor stand point: The world is slowly becoming aware of the struggles and obstacles' that have had to be overcome, to reintegrate back into society. This is a short version, in the hope that it will be posted on your web site. See below: Relating this experience in the first person has always been difficult. Not only from my recollection; But from other peoples reference point of view Relating what is 'normal' to me, is foreign to others: A difficult challenge, to say the least. I will try to relate these experiences in as 'simple' a format, as I can. My Traumatic Brain Injury (TBI) incident began December 18, 1986 as a young man (6'4" tall 150 pounds) at 19 years of age. A roller coaster ride, with many failures and successes that followed in the days and years since that tragic instant; changes my life forever are constantly evolving. I learned a lot about me from the recovery process (1 month in ICU/ 3 months in inpatient therapy and over a year in outpatient therapy). These events started with a blow to the head, from a splitting maul an hour away from civilization in the Skamania Forest, in Washington State. At that time; given the weather conditions, life flight wasn't available and the folks I was with had to drive me for over an hour to a local store in La Center, Washington to an awaiting ambulance. I was admitting to SW Washington Medical Center, in Vancouver. I was diagnosed with a Linear Depressed Skull Fracture that literally split my skull into an inverse 'Y' pattern from the rear of my skull to the extent of both my eye sockets. Radial stress fractures spiraled across my left side of the left side of my skull. All the medical doctors could do was burr a hole at the top of my skull, to release the pressure; stitch my scalp back together and place me in a 'coma' (10 days) and restrained; due to violent, involuntary movements my body was making. Somewhere during that time: I saw what I consider 'the afterlife' and walked/ talked with 'Jesus'. I still have vivid memories to this today; they allow me solace and comfort to the fact of my beliefs and moral view of the world around me are compassionate and helpful to others. I was transferred to another hospital two days later. My brain was also damaged from the impact affecting the left side affecting speech, cognitive reasoning and balance (damage to my inner ear). My right (dominate) side of my body was paralyzed. The recovery process started; AND, I had to regain physical and psychological functions; as they were identified and treatment started when I was transferred to Good Samaritan Hospital in Portland, Oregon. I spent a month in the Neurological Intensive Care Unit (NICU); Three months as an inpatient with Rehabilitation Institute of Oregon (RIO) AND a over a year as an outpatient. There it was identified that structurally and psychologically speaking: I was a mess; But recoverable, none the less. When I awoke, the first words out of my mouth was 'Pi'. Mathematical inclinations aside; It was the first words that I could see out the window of the hospital bed - A 'Pie & Coffee' shop in NW Portland. The relearning processes intuitively were the most difficult part. Building basic associations to my surroundings and relearning bodily functions took some time to resolve. What led me to write this story to be published on the Brain Injury of Oregon's web site is as follows. People should know that society doesn't have the best resources in place to solve all the problems of a TBI survivor. I was denied Social Security Disability Insurance (SSDI); because the extent of my relearning process was not yet complete ( ). I was approved to receive <$100 per month from Washington Department of Labor (WDOL) for a few months, while I was completing RIO Out-Patient training. If it wasn't for my parents medical insurance; I don't know what level of recovery, I would have been able to achieve. My motor skills came back relatively quickly; as I regained control of my right side. I was able to get my driver's license back after a year. The process then shifted to employment. I went through SW Washington's Private Industrial Council (SWWA-PIC) for about three months where I assigned a job as a janitor, working the night shift. The physical labor and hazardous chemical fumes were too much for me to bear. I learned quickly that there is an additional process for being employed (Do NOT mention your physical/ psychological limitations); so through their resources: I found and secured multiple position(s) as an order puller/ warehouse worker, in various warehouses in the Portland Metro area. The physical demands were again, also difficult and the social obstacles' were still 'work in progress'. All social interaction with anyone aided in my development, returning back into society. I found it difficult, sometimes impossible to relate to others. How do you express yourself to others that take their knowledge and skills for granted; or have no reference to what you have witnessed? It is disappointing, to say the least; walking in my shoes, you might get a glimpse I am unique. I was able to get my own apartment in At 24 I had 'friends' and I met my future wife a year later. I fell in love and married 11 years after the traumatic event in I am a husband and father to two children, today and live in Oregon City, Oregon. I continued working in warehouses and monitor alarms control activities, which evolving into inventory control responsibilities for a company on Canby, Oregon until 9/11 (September 11, 2001) happened. I was let go from the company I was working for as part of a cost cutting, from reduced sales. Out of money and time: I reached out to Department of Human Services Vocational Rehabilitation Department (VRD), from a back injury, I suffered around the fore mentioned time frame, that I recently had surgery for. The back injury alone granted me VRD assistance. When I mentioned the fact of my TBI, the case worker advised me that they had no real support for that and I would have to apply for SSDI, again. This was unacceptable to me, so I suggested to the case worker that the focus be on the physical, instead of the psychological. The case worker agreed and I went back to school to learn computers. I focused my education to build/ design and administer database driven website. I reasoned that few people could do this and the jobs were available; also, it was continuation from previous high school programming classes, I took before the TBI incident and a refinement from the web sites I was developing for my family's graphic arts and design business in Portland, Oregon. This allowed me to take college courses for job retraining as a Computer Application (My Story Continued on page 14) The Headliner Fall 2014 page 13

14 page 14 Fall 2014 The Headliner (My Story Continued from page 13) Specialist at Clackamas Community College (CCC). While at CCC, I excelled and was awarded the President's Scholarship (2004) from my grades and activity as the President of the college's Computer Club (C5). This scholarship allowed me to complete my training, graduating with an Associate's Degree. I graduated at the top of my class with National Honor Society - Phi Theta Kappa honors and accolades'. Due to my adaptabilities in the computer field: I have had many 'jobs' both as an employee and as a contractor servicing IT Support of networked equipment, end-user training, programming and web mastering skills to various companies and individuals in Oregon/ Washington. Because of my TBI experience and the retraining I received: I am exceptionally adept to troubleshoot and resolve most, if not all computer related issue that I have come in contact with (hardware and programming of software). Still, there is learning that is involved. Change and flexibility have become arenas' of environment in the business world, which I welcome; however they have come at a financial cost to obtain stable employment. To review my skill set(s): I invite the reader to review an adaptive version of my resume - And can be downloaded at With a TBI, it not only affects the individual; But, everyone that you come in contact with. I still seeking stable employment opportunities and growing my knowledge base/ skill set(s); not only in computers But in social interactions, as well. Making associations and learning to incorporate solutions to the problems in my world today, 28 years later. What having a TBI means to me is that the world isn't prepared for dealing with survivors? I refused to be type cast as being less of a person and forced to work labor intensive jobs, for financial needs at minimum wages. It is a monumental achievement that I have gone as far as I have. I would normally not speak of it to an outsider whom is unprepared; I fear being misunderstood and ostracized as a crack-pot or failure. Knowing what I know about myself, now; having a TBI changed my life Possibly for the better; because it happened and allowed me to become more aware of my surroundings. Since college graduation and struggles to obtain stable employment: I am again working with VRD from the psychological perspective of a TBI. This has presented me with even more challenges'. I am undaunted; however. I have obtained marginal contractor employment for IT Support projects. I have completed National Career Readiness Certification (NCRC) Qualified Level: Silver from Oregon's Work Source (OWS) and am ready to work! During this time: I have been accepted for On The Job (OJT) training for employers, with stipulations; but, when I even mention the TBI I am passed by the job, I am qualified for. Social stigmatisms and suspicions will always follow me; as I gear up to continue my education. The past is the past and can never be repeated in exactly the same way again. We are all connected to this Möbius strip we call life; to learn and grow. What we learn and how we apply what we have learned, defines us to the ones we are connected to. I can do the work. Give me a chance: I won't let you down! That's my story and I'm sticking to it! William Hunter Breedlove Jr. Coming to grips with anger After a brain injury, some find themselves becoming incredibly angry at surprisingly small things. They may also find themselves resenting others, or holding on to grievances against others. Family members and partners often find themselves becoming emotional punching bags as anger is directed at them, often when they have done nothing to deserve the hostility. Recognize what makes you angry Knowing the triggers to your anger is a great start. You can avoid these situations or develop strategies to cope. After a brain injury, you may not realize you are actually angry until you ve developed a full-blown rage. See if you can learn to detect the early signs while you can still think rationally and act appropriately. Seek reconciliation Angry outbursts tend to alienate others and eventually cause resentment. Asking forgiveness is humbling, but it can free you from emotional slavery. It can save family relationships too. Read up on anger If you know you struggle with anger, take the time to read one of the many good books out there on the subject or check with BIAOR for Fact Sheets on anger, work on strategies to manage your anger. Anger management BIAOR or your Brain Injury Association should be able to provide counselling or direct you to other agencies who run anger management courses. Let go of bitterness It is human nature to become angry when we feel our rights are being violated. But hanging on to bitterness can lead to lack of sleep, ill health, depression and a negative outlook on life. A person may survive a brain injury but may hamper their recovery and happiness with bitterness toward someone who caused the injury. See conquering your anger as character-building. You can t choose what happens to you but you can choose how you respond. Choose to control your anger, instead of letting it control you. Remember your anger will often hurt you more than the person it is directed against.

15 I got very tired of hearing how lucky I was, says author Kara Swanson. This was not some vacation-gone-wrong that I would return from with horrific tales of adventure. From the moment I left that hospital, I heard slap-on-the -back choruses of It could have been worse! and God, you were lucky! Intellectually, I understood that. But emotionally, I did not feel very lucky. There s no denying that life is different after a traumatic brain injury (TBI). In addition to all the physical changes a brain injury may bring, a TBI can also mean the loss of a career or the disruption of an education. It can change your plans for the future, alter the way you meet and make friends, and affect the way you think about yourself. Life after a brain injury usually involves challenges, but that doesn t mean life is less valuable or fulfilling. By writing a book about her struggle with brain injury, Kara was able to embark on a journey of self-discovery, one that required a tremendous amount of honesty and courage in order to face the reality of her new life. While everyone with a brain injury embarks on their own unique journey toward recovery, there are some common experiences that many people share experiences that can offer tremendous inspiration and support at various points in life. Dealing with the injury Soon after the injury, most people tend to focus on the abilities that have been lost. Emotionally, the experience can be overwhelming, confusing, and frustrating. But as time goes on, everyone begins to grapple with their injury in both productive and non-productive ways. One common response is to deny the significance of the injury; unfortunately, a brain injury can t simply be walked off. Brains are notoriously slow to heal, which only compounds the frustrating aspects of a brain injury. Brain injury also has a tendency to bring a lot of psychological challenges and may affect mental health. Depression, anger, and anxiety are common repercussions of brain injury, so people with TBI should be vigilant to seek out qualified care and support if they experience mental health problems. As people begin to regain lost abilities or acquire new coping skills, they also begin to accept the realities of their injury. At this stage, a person might express that they are no longer fighting the injury but rather seeking ways to integrate their TBI into their lives. Moving forward after a brain injury A brain injury is supposed to set off a clear chain of events, all of them around a person s medical care: the emergency room, the ICU, hospital care and then rehabilitation. But there isn t a road map for all the aspects of life that fall outside of medical care just ask someone like Kara, who seemed surprised that life marched on despite her injury. One of the realities about living with a brain injury is that you may need additional check-ups, routine doctor visits, or ongoing rehabilitation. Even people who feel like they re back to normal may visit a neuropsychologist for periodic testing or may incorporate various cognitive exercises into their daily routine. The Headliner Fall 2014 page 15

16 Receive a parking pass for every two tickets purchased page 16 Fall 2014 The Headliner

17 Specialists in Brain Inury Care Collaboration, Cooperation, Compassion. At Learning Services, these words mean something. For over twenty years, we have been providing specialized services for adults with acquired brain injuries. We have built our reputation by working closely with residents and families to support them with the challenges from brain injury. Our nationwide network of residential rehabilitation, supported living and neurobehavioral rehabilitation programs provide the services that help our residents enjoy a quality of life now and in the future. Gilroy Campus, California To learn more about our Northern California program or our new Neurobehavioral Program in Colorado, call or visit learningservices.com. Learning Services Neurobehavioral Institute - West "Count your age by friends, not years. Count your life by smiles, not tears." - John Lennon Fox Tower 805 SW Broadway, Suite 2540 Portland, OR Fall Sudoku (Answer from page 5) The Headliner Fall 2014 page 17

18 (Alcohol Continued from page 9) a disease that consists of two separate syndromes, a short lived and severe condition called Wernicke s encephalopathy and a long lasting and debilitating condition known as Korsakoff s psychosis. The symptoms of Wernicke s encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. For example, patients with Wernicke s encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernicke s encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that this disorder may be present even if the patient shows only one or two of them. In fact, studies performed after death indicate that many cases of thiamine deficiency related encephalopathy may not be diagnosed in life because not all the classic signs and symptoms were present or recognized. Approximately 80 to 90 percent of alcoholics with Wernicke s encephalopathy also develop Korsakoff s psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff s psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination. Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in laying down new information (i.e., anterograde amnesia) that is the most striking. For example, these patients can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation. Treatment The cerebellum, an area of the brain responsible for coordinating movement and perhaps even some forms of learning, appears to be particularly sensitive to the effects of thiamine deficiency and is the region most frequently damaged in association with chronic alcohol consumption. Administering thiamine helps to improve brain function, especially in patients in the early stages of WKS. When damage to the brain is more severe, the course of care shifts from treatment to providing support to the patient and his or her family. Custodial care may be necessary for the 25 percent of patients who have permanent brain damage and significant loss of cognitive skills. Scientists believe that a genetic variation could be one explanation for why only some alcoholics with thiamine deficiency go on to develop severe conditions such as WKS, but additional studies are necessary to clarify how genetic variants might cause some people to be more vulnerable to WKS than others. LIVER DISEASE Most people realize that heavy, long term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy (20). Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal. New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic Human Brain Schematic drawing of the human brain, showing regions vulnerable to alcoholism-related abnormalities. encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and manganese, have a role in the development of hepatic encephalopathy. Alcohol damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells. Binge Drinking and Blackouts Drinkers who experience blackouts typically drink too much and too quickly, which causes their blood alcohol levels to rise very rapidly. College students may be at particular risk for experiencing a blackout, as an alarming number of college students engage in binge drinking. Binge drinking, for a typical adult, is defined as consuming five or more drinks in about 2 hours for men, or four or more drinks for women. Treatment Physicians typically use the following strategies to prevent or treat the development of hepatic encephalopathy. Treatment that lowers blood ammonia concentrations, such as administering L ornithine L aspartate. Techniques such as liver assist devices, or artificial livers, that clear the patients blood of harmful toxins. In initial studies, patients using these devices showed lower amounts of ammonia circulating in their blood, and their encephalopathy became less severe. Liver transplantation, an approach that is widely used in alcoholic cirrhotic patients with severe (i.e., end stage) chronic liver failure. In general, implantation of a new liver results in significant improvements in cognitive function in these patients and lowers their levels of ammonia and manganese. ALCOHOL AND THE DEVELOPING BRAIN Drinking during pregnancy can lead to a range of physical, learning, and behavioral effects in the developing brain, the most serious of which is a collection of symptoms known as fetal alcohol syndrome (FAS). Children with FAS may have distinct facial features (see illustration). FAS infants also are markedly smaller than average. Their brains may have less volume (i.e., microencephaly). And they may have fewer numbers of brain cells (i.e., neurons) or fewer neurons that are able to function correctly, leading to long term problems in learning and behavior. Treatment Scientists are investigating the use of complex motor training and medications to prevent or (Alcohol Continued on page 19) page 18 Fall 2014 The Headliner

19 (Alcohol Continued from page 18) reverse the alcohol related brain damage found in people prenatally exposed to alcohol (24). In a study using rats, Klintsova and colleagues (25) used an obstacle course to teach complex motor skills, and this skills training led to a re organization in the adult rats brains (i.e., cerebellum), enabling them to overcome the effects of the prenatal alcohol exposure. These findings have important therapeutic implications, suggesting that complex rehabilitative motor training can improve motor performance of children, or even adults, with FAS. Scientists also are looking at the possibility of developing medications that can help alleviate or prevent brain damage, such as that associated with FAS. Studies using animals have yielded encouraging results for treatments using antioxidant therapy and vitamin E. Other preventive therapies showing promise in animal studies include 1 octanol, which ironically is an alcohol itself. Treatment with l octanol significantly reduced the severity of alcohol s effects on developing mouse embryos. Two molecules associated with normal development (i.e., NAP and SAL) have been found to protect nerve cells against a variety of toxins in much the same way that octanol does. And a compound (MK 801) that blocks a key brain chemical associated with alcohol withdrawal (i.e., glutamate) also is being studied. MK 801 reversed a specific learning impairment that resulted from early postnatal alcohol exposure. Though these compounds were effective in animals, the positive results cited here may or may not translate to humans. Not drinking during pregnancy is the best form of prevention; FAS remains the leading preventable birth defect in the United States today. GROWING NEW BRAIN CELLS For decades scientists believed that the number of nerve cells in the adult brain was fixed early in life. If brain damage occurred, then, the best way to treat it was by strengthening the existing neurons, as new ones could not be added. In the 1960s, however, researchers found that new neurons are indeed generated in adulthood a process called neurogenesis. These new cells originate from stem cells, which are cells that can divide indefinitely, renew themselves, and give rise to a variety of cell types. The discovery of brain stem cells and adult neurogenesis provides a new way of approaching the problem of alcohol related changes in the brain and may lead to a clearer understanding of how best to treat and cure alcoholism. For example, studies with animals show that high doses of alcohol lead to a disruption in the growth of new brain cells; scientists believe it may be this lack of new growth that results in the long term Fetal Alcohol Syndrome Children with fetal alcohol syndrome (FAS) may have distinct facial features. deficits found in key areas of the brain (such as hippocampal structure and function). Understanding how alcohol interacts with brain stem cells and what happens to these cells in alcoholics is the first step in establishing whether the use of stem cell therapies is an option for treatment. SUMMARY Alcoholics are not all alike. They experience different degrees of impairment, and the disease has different origins for different people. Consequently, researchers have not found conclusive evidence that any one variable is solely responsible for the brain deficits found in alcoholics. Characterizing what makes some alcoholics vulnerable to brain damage whereas others are not remains the subject of active research. The good news is that most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence, though some people take much longer. Clinicians must consider a variety of treatment methods to help people stop drinking and to recover from alcohol related brain impairments, and tailor these treatments to the individual patient. Advanced technology will have an important role in developing these therapies. Clinicians can use brain imaging techniques to monitor the course and success of treatment, because imaging can reveal structural, functional, and biochemical changes in living patients over time. Promising new medications also are in the early stages of development, as researchers strive to design therapies that can help prevent alcohol s harmful effects and promote the growth of new brain cells to take the place of those that have been damaged by alcohol. Source: The Headliner Fall 2014 page 19

20 There are some techniques that can help the following aspects of memory getting information into memory more efficiently, storing information more efficiently, and recalling information more efficiently. Getting information into memory more efficiently In order to remember something we must get the information into memory first before it can be stored away. This can be very difficult after a brain injury, especially for someone who has difficulties with attention and concentration. Some simple rules to follow when giving information to someone with memory impairment are: Concentrate on relevant material that the person wants or needs to remember Simplify information and written instructions Reduce the amount of information that has to be remembered and just concentrate on the essentials Divide the information into small chunks Give the chunks one at a time Encourage the person to take their time and pay close attention Ensure that the information has been understood by having the person repeat it back in his or her own words Encourage the person to make associations by linking the new information to something that is already familiar Use the little and often rule it is better to work for a few minutes several times a day than for a longer period once a day Encourage the person to organize the information for example, grouping items on a shopping list into distinct categories Use two or three different methods to improve learning of one piece of information for example, if you want to teach someone with memory impairment the way to the local shops, you could either draw a map; describe the way verbally, or accompany the person along the route Choose a good time to practice information will be taken in more efficiently when the person is fresh and alert. There are three further main systems used in order to get information into memory efficiently. These are: errorless learning, mnemonics and PQRST. Errorless learning While many people learn from their mistakes, this is not the case with people with memory impairment they tend to repeat the same mistakes as they cannot remember making them. This can be very frustrating, and a more efficient approach is to prevent them from making mistakes when learning new information. This approach is known as errorless learning. One way to do this is to guide the person with page 20 Fall 2014 The Headliner

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