Podcasts about head trauma rehabilitation

Dr. Therese O'Neil-Pirozzi (t.oneil-pirozzi@northeastern.edu) is an Associate Professor in the Department of Communication Sciences and Disorders at Northeastern University, a research faculty member of the Spaulding Rehabilitation Hospital/Harvard Medical School Traumatic Brain Injury Model System, and a practicing clinician. She is the author/co-author of numerous peer-reviewed publications, spanning a broad range of topics including brain health, cognitive-communicative function, and neuroplasticity. Professor Sohlberg (mckay@uoregon.edu) is known internationally for her pioneering work in the field of cognitive rehabilitation. Her research focuses on the development of treatments that help people with acquired brain injury manage cognitive impairments. Her work includes evaluating treatment protocols for individuals with persistent cognitive effects following concussive injuries, the design and evaluation of assistive technology tools to support adolescents and adults with acquired brain injury function optimally in their communities, and development of processes to facilitate patient centered goal setting. Dr. Sohlberg has contributed to a number of evidence-based practice guidelines supported by the Academy of Neurologic Communication Disorders & Sciences and sits on several national committees working on interdisciplinary practice in cognitive rehabilitation. She has authored two seminal textbooks in the field including her new 2023 text titled Transformation of Cognitive Rehabilitation. Professor Sohlberg has been teaching and conducting research at the University of Oregon since 1994. She teaches graduate courses related to cognitive rehabilitation and evidence-based practice and provides clinical supervision in the Brain Injury and Concussion Clinic (BrICC) in the College of Education HEDCO clinic. Byom, L., O'Neil-Pirozzi, T. M., Lemoncello, R., MacDonald, S., Meulenbroek, P., Ness, B., & Sohlberg, M. M. (2020). Social Communication following adult traumatic brain injury: A scoping review of theoretical models. American Journal of Speech-Language Pathology, 29(3), 1735–1748. https://doi.org/10.1044/2020_ajslp-19-00020 Meulenbroek, P., Ness, B., Lemoncello, R., Byom, L., MacDonald, S., O'Neil-Pirozzi, T. M., & Moore Sohlberg, M. (2019). Social Communication following traumatic brain injury part 2: Identifying effective treatment ingredients. International Journal of Speech-Language Pathology, 21(2), 128–142. https://doi.org/10.1080/17549507.2019.1583281 Meulenbroek, P., O'Neil-Pirozzi, T. M., Sohlberg, M. M., Lemoncello, R., Byom, L., Ness, B., MacDonald, S., & Phillips, B. (2022). Tutorial: The speech-language pathologist's role in return to work for adults with traumatic brain injury. American Journal of Speech-Language Pathology, 31(1), 188–202. https://doi.org/10.1044/2021_ajslp-21-00129 O'Neil-Pirozzi, T. M., Kennedy, M. R. T., & Sohlberg, M. M. (2016). Evidence-based practice for the use of internal strategies as a memory compensation technique after brain injury: A systematic review. Journal of Head Trauma Rehabilitation, 31(4). https://doi.org/10.1097/htr.0000000000000181 Sohlberg, M. M., MacDonald, S., Byom, L., Iwashita, H., Lemoncello, R., Meulenbroek, P., Ness, B., & O'Neil-Pirozzi, T. M. (2019). Social Communication following traumatic brain injury part I: State-of-the-art review of assessment tools. International Journal of Speech-Language Pathology, 21(2), 115–127. https://doi.org/10.1080/17549507.2019.1583280

Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a faculty member at Central Michigan University where I lead the Strong Story Lab. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Mary Ann Eller. We'll be talking about incorporating the Life Participation Approach to Aphasia (better known as LPAA) in Acute Care Settings. Let me first tell you a bit about our guest.   Mary Ann Eller, MA, CCC-SLP is the Assistant Manager for Rehab Services in the Speech and Language Pathology Department at Duke Regional Hospital in Durham, NC. She has worked in the Duke University Health Care System since 1989. She specializes in evaluating and treating adults with neurogenic and swallowing disorders in acute care and inpatient acute rehab. Her current professional passions are finding functional, practical, and patient-center approaches to the care of people with aphasia, dementia and all cognitive/communication problems.   In this episode you will: Receive a permission slip to do secret therapy. Hear about how the Life Participation Approach to Aphasia Core Values can be implemented into acute care. Understand how implementing the Life Participation Approach to Aphasia supports the Joint Commission standards on health literacy. Be empowered to welcome interruptions and struggles and embrace the messiness and the creativity and the joy of using LPAA in acute care.   Katie Strong: Welcome Mary Ann! I'm just so excited to have this conversation with you today! And we were just in Durham, at the Aphasia Access Leadership Summit, where you showcased your beautiful city. Thanks for hosting us.   Mary Ann Eller: I'm really excited to be here and very honored that you asked me to do this podcast.   Katie Strong: Well, I'm excited for people to hear about your thoughts. And as we get started, I wondered if you could share a bit about your own speech language pathology journey, and about the hospital setting you work in.   Mary Ann Eller: I grew up in Pittsburgh. I went to the University of Pittsburgh for my undergraduate and graduate degree and then I went to the Shock Trauma Center in Baltimore for my CFY. And that's where I fell in love with acute care, you can't get more acute than that. Then I moved to Durham, North Carolina and I have worked at Duke since 1989, which is 34 years if you're counting. And I started when I was five! It's been a great experience. I've worked mostly in acute care and acute inpatient rehab. When I was new in my career, I loved the excitement of acute care. And I think as I grew older, I fell in love with rehab because I have more personal experiences with being in the hospital and with myself and with my parents. I just saw how important effective communication was at that time in people's lives. And that's what I really want to talk about today.   Katie Strong: Yeah, I'm excited for this conversation. And as we dig in a little deeper, tell me how you became interested in applying the Life Participation Approach to Aphasia (LPAA) to acute care settings.   Mary Ann Eller: Yeah, this is an interesting story to me. At the University of Pittsburgh, Audrey Holland was there at the time. As people who know her and her work, she is known for being extremely functional. So, I sort of grew up professionally knowing that being functional was the way to go. That was in the late 80s, so the LPAA had not been developed yet, which was around the year 2000, I believe when the impairment-based focus of therapy was recognized as not meeting the mark. It wasn't really helping people where they were at. And so, this LPAA not being a therapy approach, but more of an idea. LPAA is a philosophy of treatment, not a specific treatment approach. So, we could still use the treatment approaches that we knew and were evidence-based, but the philosophy of what we are using them for became more widely known in 2000. So, I didn't know about LPAA until about five years ago, even though I was familiar with being functional. So, in my little isolated world, I wasn't doing CEUs on aphasia because I needed to be a generalist. I had, by that time become a manager in the department and needed to stay up to date on swallowing and dysarthria and cognition. So, I wasn't really in the world of aphasia. So, I continued to do impairment-based therapy for a long time.   But I did secret therapy, which I knew is what Audrey would want me to do. And it was, I would do the things that I knew the patient and the family needed me to do but I'd feel a little bit guilty doing it because I knew it wasn't “evidence- based.” And I wasn't doing the, you know, Response Elaboration Training, or whatever it was that I had learned, but I would meet their needs. So when, about five years ago, I went to an Aphasia Access Conference and Audrey was there, and I got to see her again. And she remembered me, which was really an honor. I was validated that the things that I had been doing in just my nature were correct. They were the best thing for the patient. That was really validating. I was always, and I'm saying this for any clinician who's out there listening, to not be afraid. I was afraid that I was doing it wrong. And I had been doing it for many years, had lots of experience, but I didn't want to get around other professionals that were more recognized in the field, because what if I was doing it wrong? Or what if there was a new approach that I didn't know about? And when I got there, it really wasn't that atmosphere at all at Aphasia Access. It was very welcoming, and it was very validating. And I realized that a lot of my instincts were right.   Katie Strong: I love it. So, it's almost like the LPAA shone a light on that secret therapy, and really validated you.   Mary Ann Eller: It sounds so funny that “secret therapy” but it's really what it felt like. So, I got to bring it out into the open and it was a secret no more.   Katie Strong: Yeah, I love it. Well, I mean, obviously, then you feel like LPAA has value. Do you think LPAA has a role in acute care? And how do the Life Participation Approach Core Values apply to this setting?   Mary Ann Eller: That was a great thing that I had to work out in my brain. Absolutely, it has a role in acute care. What I was learning about LPAA, when I first started learning, was a lot of information for when the clients were further along down the line. So, they were in the community, and they were participating in their goal setting, and they were deciding, “hey, I want to go back to work.” And that's what the speech pathologist was working on. And those things were wonderful, but that's not the setting I was in. So, I started to think about how these Core Values can apply to acute care. The Core Values, I'll read some of them right here, there's five of them. The first Core Value of LPAA is that “the goal is an enhancement of life participation.” So, when you're waking up with a stroke, and aphasia, the life you have to participate in is in a hospital bed. So yes, that applies. Number two, “all those affected by aphasia are entitled to service.” You are entitled to service if you have aphasia, in addition to swallowing and dysphagia services. That's important too, but you are entitled to service if you have aphasia, you don't skip it in acute care. Number three, “both personal and environmental factors are targets of assessment and intervention.” That is a lot of what I do in acute care with LPAA, I am looking into the environment, which includes the nurses and the nursing assistants, and the family, and the call bell, and the bathroom and all of those things that are in the environment. And that is what I am targeting and that's LPAA. Number four, “success is measured by documented life enhancement changes.” It is an enhancement of a person's life, like if they can use a call bell and get to the bathroom. If you've ever been in that situation, that is the most important life-enhancing really, lately. And then number five, “emphasis is placed on availability of services as needed at all stages of life with aphasia.” That includes the beginning, so yes, it absolutely has a place in acute care.   Katie Strong: I love this. I feel like it's preach, you're preaching it girl. You know, it's just, I mean, I think for many, many years, we've thought about, “oh LPAA is just something that you do after you try everything else.” I love hearing you talking about bringing it into acute care just right from the beginning, it's so important.   Mary Ann Eller: If I could say one more thing, I think the weight of responsibility for setting goals is one of the things that's talked about in LPAA. You want to be partners with the person who has aphasia in goal setting. And of course, you want whatever it is that they want to work on to be the center. However, when you wake up with aphasia and you have no experience with it whatsoever, you can't expect someone with aphasia to be able to set their goals of communication at that moment. So, I think that that's the biggest difference with the approach and thinking of LPAA. In acute care, the responsibility is more so on the clinician and the family to get to know the person and what's important to him and set the goals at that stage. Slowly educating and then giving the responsibility over to them as soon as possible to set the goals.   Katie Strong: Beautiful, beautiful. We talked about it earlier, the importance of being able to communicate effectively in your health care setting. And one consideration for LPAA is that JCAHO, or the Joint Commission has placed a real high value on environments that support patients and having conversations about their health care to understand their health status and engage in their own health care decisions. Could you talk about how LPAA supports the Joint Commission standards on health literacy?   Mary Ann Eller: Yes. And let me just say, for people who aren't familiar with hospitals, the Joint Commission is the regulatory board that comes in once every two or three years, and they tell you whether your hospital can continue to operate or not. So, the standards are very, very important. And I'm going to read you one of the standards that they have, and I think every speech pathologist is probably going to be, as they hear the standard, is going to be like “Well, wait, that's not really happening with my people with aphasia”. And I think that's where a real opportunity lies for us. You, I think, are attaching the standards?   Katie Strong: Yes, I'm going to. I'll put them in the show notes so listeners can check them out and we'll have a link to the standards there.   Mary Ann Eller: Okay, so one of the standards says that patients are expected to receive information about their care so they can make an educated decision, be listened to by their providers, and the hospital is required to identify patient communication needs and provide services to meet them. And so, you think about maybe someone who speaks another language, or maybe someone who is deaf, or someone who is illiterate. And those are all most of the things I think that people think about when they read that standard. But this also includes people with dementia, and people with aphasia, because you have that diagnosis, doesn't mean that you're unable to communicate. It means that you need special supports to be able to communicate and a lot of healthcare providers are not aware that speech pathologists can offer that support. And so, I think that's where a lot of our work lies.   There's a quote that I like to use in my talks, it's by George Bernard Shaw, it says, “the single biggest problem in communication is the illusion that it has taken place.” And think that there are so many boxes that are checked in acute care, like “the nurse provided education on stroke, and how to prevent further strokes.” And they check the box, and they do a great job, I'm not getting down in that. But if you have aphasia, you did not receive that communication, she communicated it to you. I communicated something to you but that doesn't mean that you received it. And people when they have a stroke, or a brain tumor, whatever it has that produced aphasia, you and their families are in a state of shock, so you're not able to absorb the information. So, I think that that is one thing we need to really be cognizant of when we are trying to change the culture of a hospital.   Katie Strong: Absolutely. And I was thinking of some of the materials you sent me to take a look at in preparation for our conversation today like that Joint Commission talking about communication requiring that two-way process of expressive and receptive or receiving and understanding, you know. That information is really important, very important.   Mary Ann Eller: Yeah, yeah, absolutely.   Katie Strong: And I think sometimes too, we know that our clients or our patients that we are working with take more time to be able to understand what's going on with them and their health care.   Mary Ann Eller: Yeah, and a lot of times what we use to make that happen isn't really that complicated. It often involves slowing down, turning off the TV, sitting down at eye level, and stopping periodically to say, “did you get that?” and “repeat that back to me.” And that's for everybody, not just people with aphasia. It seems like it should be common sense, but it's really not. People in hospitals, especially in the last three years, have been under a lot of pressure and have to do a lot of things. And so, communication can often get lost.   Katie Strong: Absolutely. All this sounds great Mary Ann, but what do you think might prevent some SLPs from embracing LPAA framework in acute care settings?   Mary Ann Eller: That's such a good question because I went through that for 20-30 years, I guess. I didn't embrace it because I didn't know about it. I think that one of the biggest things is being at the Aphasia Access Conferences. I loved it and I loved having the honor of presenting last time we had it, but I just thought, “gosh, I want this to get to people who don't know about it.” Because there are tons of clinicians who maybe hear about it in grad school and perhaps, they go out to their placements and the supervisors maybe don't know about it. And so, they don't put it into practice, or they don't know exactly how to integrate it into practice. I think that number one, that's the biggest thing that's going to prevent clinicians from using it is because they don't know about it.   I think the other thing is that the “secret therapy” that I talked about is realizing, and if nobody's given you this permission slip, I am giving it to every clinician out there. Here is your verbal permission slip, please treat the communication elephant in the room. Whatever it is with somebody in acute care. If they are struggling to order a meal, if they are struggling to call the nurse, if they're struggling with telling you something or talking to the person beside the bed, that's what you work on. Work on what is right in front of you. You don't have to complete an entire Western Aphasia Battery. You don't have to make sure that you have them name 10 things. Those things all have a place, and I think we can fit evaluation and treatment in, but please deal with the person who's right in front of you, not the agenda that you brought into the room. So, there's your permission slip. I think people don't know how to document it and that's okay. I have a couple suggestions a little bit later when I talk about that. I think they feel it takes too much time and it really doesn't, I think you can do these things instead of the big agenda that you brought into the room. I think these people are going to be dealing with aphasia for a long time. And so, they will get to a speech pathologist who will do the more standard evidence-based treatments when they're appropriate. I'm not saying they're never appropriate, sometimes they are. But in my experience of 34 years, a person in acute care with aphasia needs a ton of education, a ton of successes, and just a lot of validation that here's your recovery process, here's what's going to happen. They are in shock, and they don't know how to deal with things, and I think we are the ones who are speaking to that. Everybody else has their silo that they're speaking about with their blood pressure and their arm and their leg and all of these things. But communication is the soul of a person and I think reassuring those sorts of things and giving them successes at that stage is really vital. So yes, that's your permission slip.   Katie Strong: Yeah, yeah, received. And we're going to make lots of copies of that permission slip and mail them out to everybody. So, you touched on this a little bit, but we'd love to hear some ideas that you have about how to incorporate LPAA principles into acute care.   Mary Ann Eller: Here are some practical things. Honeycomb Speech Therapy is a great service that sent out or made available some free checklists for different settings. I downloaded one of those and so that's a good place to start. So, there's, I'm looking at it now, the Functional Needs Checklists by Setting and looking through using call light, using the menu, asking medical questions, and following safety precautions. I think as a clinician, starting to think through your aphasic patients in acute care by communication need versus impairment.   The other thing I'll say that's a really good way to incorporate this is whatever templates you're using in your electronic medical record. The way that we have done ours in the past has been by impairment because that's how we're trained. “How can you talk?” “How can you comprehend?” “How can you read?” “How can you write?” And in our brains we're pulling it together and we're knowing how this might affect their ability to use the call bell. But I think using a table or a checklist that automatically makes you have to pull it together and give a set of supports that will enable the person to do that or not, depending on how severe they are, is one way to make sure that that you incorporate LPAA.   Katie Strong: I love that. And I love the shout out to Honeycomb and Sarah Baar. We actually had her on the podcast. It's been a couple of years, but I think it's Episode 57 if listeners want to check out a little bit more of hearing her thoughts. But I agree, helping yourself be a little more strategic about how you're going to address all of these areas. Because, as you said earlier time is I mean, time is essential everywhere but in acute care, it's really the big commodity.   Mary Ann Eller: Yup. Another thing is to welcome interruptions because when you're in acute care you will be interrupted. And the nurse will come in to give meds and I think to go into a patient's room open for whatever happens. So that when the nurse comes in and gives meds, you are demonstrating some supported communication techniques. So maybe you always have a pad of paper and a pen or a whiteboard. And so, you write down the medicine, and then you ask the nurse, “what's the medicine for?” and they say, “blood pressure,” and then you write down blood pressure, you show it to the patient, and they nod. And then they have experienced what JCAHO was asking us to do, which is communicating what's happening to them. And not only has that happened, but you also are educating the nurse to see how successful that communication is when you write down a word, for example. Welcome the interruptions to show communication.   I've had doctors come in and explain what's going to happen next for their discharge and I write that down or slow it down or whatever the support needed is. Same with social work. There are so many opportunities to use functional communication and LPAA in acute care. As I was thinking through this question, one of the most effective ways that I remember using it in my recent past is with a patient that had Wernicke's aphasia. And it was at the height of COVID, so everybody had masks on, including her. And she was very, very fluent, and she could not understand spoken language, I mean, lots of it. She could walk, you know, and that made all the more frustrating for her, they'd say, “you can't walk by yourself, you need to sit down.” Well, she didn't understand what they were saying. So, she might say in return, “fine, how are you?” And so, people thought that she was crazy. She was not crazy, she had Wernicke's aphasia. She did not understand spoken language. And so, when we finally got the consult after the woman was put in a Posey Bed, I was able to tease that out. I was able to educate the staff on “hey, if you do X, Y, and Z,” which included writing down what you're saying, a key word, then she can look at it, she can look at the context, and she can follow your directions. And it was the biggest difference. I mean, speech pathologists really do a great service for people with aphasia in acute care. So, those are just a couple of things that I thought of.   Katie Strong: I love it. I love it. Well, you alluded to it earlier, but I'm going to invite it back into the room now. That is the elephant in the room, hello dysphagia. How does an acute care SLP balance the needs of the patient with dysphagia and also support communication issues as well?   Mary Ann Eller: That is a good question, and I don't find it difficult at all to do that. And the reason I don't find it difficult is because I've embraced some messiness in my evaluations.   Katie Strong: Tell me more!   Mary Ann Eller: And sometimes that's hard to do, especially early in your career. Or if you are a very focused kind of Type A organized person, which a lot of speech pathologists are and that's why we're so good at our jobs. But it is a little bit messy. And what I mean by that is, you can easily do both at the same time. You can evaluate dysphagia and you can evaluate their language. You can have them following commands with your clinical swallow even though you're not saying hold up two fingers and point to the window or whatever you were taught. You can say, “hey, would you pick up that glass of water?” without pointing to it and see if they do it. You can ask them open-ended questions and closed-ended questions to see what kind of language they have. While you are writing your recommendations on the whiteboard, you can have them read it back and assess their reading in that way. There's lots of things that you can do to assess both at the same time. So, it really doesn't take that much more time, it just takes a difference in how you think about it.   Katie Strong: Powerful stuff. Yeah. I love that it's not, doesn't have to be mutually exclusive, and couldn't and shouldn't be. I'm sure our listeners would be interested in exploring some of the resources that influenced your thinking about this topic of LPAA. Would you be willing to share a few?   Mary Ann Eller: So, one that I read 8 or 10 years ago was by Lyn Turkstra. And I talked with her about this at a conference once and it was really interesting. It's on Inpatient Cognitive Rehab, Time for a Change. I can't remember the year that she published it.   Katie Strong: I think I've got it here, it's 2013. And listeners we'll have all these resources in the show notes for you, too. But yeah, it's a 2013 publication.   Mary Ann Eller: I talked with her about it at a conference once and she said that she really kind of had a hard time getting it published because it was so against the grain at the time. And basically, what it was is inpatient rehab, for those of you who don't know, is after acute care oftentimes. So, it may be within a week of having a stroke and maybe you stay for two weeks at this point. So, within the first month of having a stroke and having aphasia. So, Lyn Turkstra's thinking was, we're programmed and taught to do things in a world of rehab that used to be months long and now it's only a couple of weeks and now earlier than it used to be. So hey, why don't we focus on some other things like education and laying the foundation and making sure that there's a therapeutic alliance with speech therapy so that the person knows, you know, down the line, this is the person you're going to go to and have a good experience with that. That was the first paper that got me thinking.   And then after I started going to the Aphasia Access a few years ago, I looked up an old paper of Audrey Holland's that was Early Aphasia Management and Acute Care. And that was in 2001 that she wrote that. That talks about a lot of the same things, is that we don't have to do an entire Western Aphasia Battery, but let's take care of their actual needs in acute care.   I loved Roberta Elman's CAPE checklist and I felt kind of dumb when I went to Aphasia Access and I started asking people, “hey, I'm in acute care, and I'm thinking about XYZ.” And they said, “oh, well, that's what CAPE does.” And I was like, “what's CAPE?” I just didn't know. And CAPE stands for, it's a checklist of four interventions, C is connect with the person with aphasia, A is augmentative communication, P is partner training, and E is education and resources. Basically, it's if you do these four things in the very early stages, then you've got your bases covered. And it's like, Oh, that's awesome. I wish I would have thought of that. I'm just glad she did.   Katie Strong: Before you move forward, I just want to say thank you for being so open about feeling uncomfortable that you didn't know things. And I guess from my aspect, I think it's also for maybe listeners who are not practitioners but are researchers putting frameworks out there. We really need to be better at getting our work out to the people who can implement it, you know? So, I mean, I think it takes both sides of things to really get it. You can have beautiful, evidence-based work but if it doesn't get into the hands of the practitioners who are using it, it just doesn't matter. So, thank you for being so open about that and I hope that, I'm thinking that it probably resonates with a lot of the listeners here too. That you know, we don't always know what we don't know.   Mary Ann Eller: Yeah, yeah. Thank you for that. You know, it's funny, because even yesterday, I have a lady who has been in the rehab unit for a really long time, for a variety of reasons. But she has pretty severe aphasia, and I was looking over these notes for this conversation today and I realized as I went through the CAPE that I didn't provide her with any educational resources. It's like, wait a minute, I didn't do this. And it's just, you get caught up in the day-to-day things, even if you're invited to do a podcast about it. And sometimes it's just one of those things. Nobody's perfect. But I think if we can have some standards in front of us and go back to them, that we're going to do a great job, that the frameworks are out there. And I guess the other paper I wanted to mention was also by Roberta Elman it's, “Are we missing the forest for the trees?” and I love that.   Katie Strong: It's a great title.   Mary Ann Eller: Yeah. It was like, okay, we're doing all this stuff for aphasia but the person can't communicate when they get home. And I really, really liked that stark reality and I looked back on a lot of my patients, and I'm like, “ wow, I did a great job while they were in rehab.” But I wonder how they're doing at home because I didn't really work with her husband that much. And that is a failure on my part. And, you know, we do better the next time. But those are the things that really influenced how I thought about this.   Katie Strong: Fantastic. Well, we'll make sure to have links to all of those articles and resources in the show notes. Mary Ann, you've been thinking about applying LPAA in your acute care work for a while now. Do you have any ideas that you could share with us that you have in the works in your own practice?   Mary Ann Eller: Yeah, I have a couple. Well, one of the things that I did and it's a very specific intervention, is I developed a Picture Menu because I was doing a lot of work with dementia care and nutrition because of an initiative in our hospital with geriatric care. And dementia is a place where nutrition is often overlooked because they're usually in acute care because maybe they fell or lots of reasons. And the tray ends up getting put in front of them but because of their dementia, they don't eat it and then they start getting sicker and sicker. So, because of that, I realized, even if they could eat, they might not want the tuna fish sandwich that's in front of them, because that's the standard tray that you get if you don't order your meals. And they don't order their meals because they can't communicate. You know, it's not just dementia, it's people with aphasia. And our menus were extremely word based. They were great but they had a lot of words to them. And if you can't read it for a variety of reasons, maybe you're blind, maybe you speak a different language, maybe you're illiterate, all different reasons. Then the person comes up to your bed and takes a really great bedside order like a waitress on an iPad, but again, all words. I teamed up with some people at my hospital and we went down to the kitchen, and we took pictures of all the items on the menu, and we put it on a big giant, laminated menu that we bring to the bedside and have them point to it. So yeah, and I've trained the patient menu techs, the people who actually take the orders, to use it. So, it's a work in progress because it's an extra step but yeah, it's really useful for the people that can use it. So, that's one thing.   The other thing is the idea that I had, and it is not flushed out at all. I'm just gonna like put it out there and if somebody wants to steal it and do it before I do, feel free. But in my hospital, which is Duke Regional Hospital, it's part of the Duke System, but it's a smaller community hospital made up of about 380 beds. A couple of brilliant speech pathologists teamed up, and developed a trach team. And the trach team consisted of a pulmonologist and a respiratory therapist and a PT and an OT and the main players that revolve around trachs. And through a lot of hard work, they were able to do some culture change and practice change and get these patients with trachs taken care of through weekly rounding and all sorts of focus changes. And I thought, why can't we do that for people with aphasia? Or communication, just have a communication team? And I don't know what it's going to look like yet but why can't we get the players? I mean, maybe it's just the speech pathologist. But identify in my hospital through speech pathology consults, okay, here are the most vulnerable people to not get their needs met in acute care because they have global aphasia or severe dementia and they're on our caseload. Let's put them on a special list and let's give them special attention in some way and have a communication team. And as you round on these patients, you let the rest of the hospital see you doing this. You let them see how to intervene with these people. And it catches on so that they then learn these techniques, whatever they may be. We act as advocates for these people that are particularly vulnerable. Again, I don't know how it's going to work yet, but that's an idea.   Katie Strong: Yeah, I love it. And I would love to hear how it unfolds, so.   Mary Ann Eller: Me too.   Katie Strong: Yeah. Okay. I'd like to take it a little bit further because you're the manager of a department, right? So, talk about maybe a few tips in transitioning to an LPAA focus with a staff that isn't particularly familiar with that philosophy.   Mary Ann Eller: That is a really great question, and there's not one answer. And I'd love to bring in your friend, Natalie Douglas, in implementation science to speak on this. I'll tell you what I did and then I'll tell you what a bigger department might do. I have myself and five full-time speech pathologists, We all have varying levels of familiarity with LPAA and we all have been practicing in some form or fashion. So, I did an anonymous survey, and I asked some questions like, “how comfortable are you seeing people with aphasia?”, “have you ever heard of LPAA?”, “how comfortable are you using supported communication techniques?” And I did it anonymously because everybody is not going to want anybody else to know that they're not comfortable with it. So, even if there's just one person on my team who doesn't know LPAA or who isn't comfortable, I don't know who it is, I have an idea, maybe. But I'm going to put it in front of everybody and say, “hey, there's one person on our team who's not comfortable, let's focus on this.” And so that's what I did. My team is fantastic and they are very open.   And so that's what we did. We had some focus teaching on it we watched some of the Aphasia Access videos on supported communication and LPAA. And then we changed our templates to include some tables that I talked about before that have the checklists on them. I think though, and I had a conversation last night with Kim Irby who is the interim chief over at ‘Big' Duke who has like, I don't know, 40 or 50, speech pathologists. And I asked her, I said, “what have you used with bigger departments?” And she had a really good point, she's like, “you know, education alone is not enough, it's not going to produce a behavior change. People are going to think their behavior is changing and they're going to think, through doing LPAA, and they might be. But really, you have to have people be able to be in the moment with a coach and do it together.” That can be tricky. I mean, you've got people with varying levels of comfort, varying egos, varying all sorts of things. And so, she and I thought, you know, I think probably the most practical way would be to educate and then pair people up together as peers and see a person with aphasia. Try things together then come back and let's all talk about it. It's not, “hey, I'm going to go with you as your boss and make sure you're doing this right.” That would be like totally not cool. So, I don't know, again, I want Natalie to tell me how to implement this.   Katie Strong: We all want Natalie to tell us what to do, for sure. But I love this idea of learning together, right? That you're not imposing “this is what you have to do.” But really, you know, because I do think that the LPAA approach takes your own style...Each person delivers it in a different way, right? And it's different with each patient that you're with because it's personalized.   Mary Ann Eller: Absolutely. And you can't teach that. It's not an agenda, it's an attitude and an openness, armed with the goals that you have, and armed with the core values of LPAA.   Katie Strong: Yeah, I do really love and thinking back to the Turkstra article you were talking about and just that importance of therapeutic alliance with our discipline, right? So that then later on, they think about speech pathology as a positive resource to help. Beautiful. Okay, Mary Ann, as we wrap up, do you have any final thoughts you'd like to share with our listeners?   Mary Ann Eller: I want them to remember the permission slip I gave them. I didn't give it to them, Audrey Holland gave it to them in 1989. Okay. And we're carrying it forward and there is a permission slip to work on the communication elephant in the room. Whatever it is, that is your goal. I think, I guess in my mind, early aphasia intervention should be guided by the person with aphasia's need in the moment first, then the bigger picture. I go in with a really, really loose agenda and I'm open to anything. I welcome interruptions and struggles and I think that that is the messiness and the creativity and the joy of using LPAA in acute care.   I've been a patient in the bed for health reasons and I've sat next to my parents in the bed. I think that once you do that you realize how not only practical but necessary it is that we change our focus on communication at this stage of recovery. Because you don't care what the doctor knows, you care that the doctor cares and can explain it to you in a way that you can make your decisions. And that's the power we have. We've all had health care workers and seen them who have been outstanding and who have been terrible. I think we obviously want to be outstanding. And it doesn't take a lot to be outstanding when you know what your job is, which is to help the person with aphasia to communicate and to be understood in whatever supported techniques that we have and that is our job. And I think that is an amazing privilege. Really, I look at it as a privilege. We are inserting ourselves into a person's worst day and we are the person that walks in there and has the power to help them do two of the most important things, eat and communicate.   Katie Strong: I agree.   Mary Ann Eller: So, I think that those are pretty powerful and I think that it's a real privilege to be able to do that.   Katie Strong: Thank you, thank you. I feel like you've just given us some gold that we need to really admire and take out and show off. Right? That we need to let all of it shine and really take these important pieces about changing our practice in acute care. And really helping people be able to understand and have conversations about their health care so they can participate in really important conversations that impact their life.   Mary Ann Eller: I hope so, I hope so. And I'm not a researcher, I have not done papers and you know, all of those kinds of things. And I used to feel a little bit intimidated by that. It's like, well, do I really have anything to say? And I realized as time goes on, it's like, yes, absolutely. And I want to really reach out to the clinicians that are listening to this. Please use your voice. Please reach out for partners. If you hear somebody at a conference or you reach out to me if you want to, if you're listening to this. Just grow your knowledge and grow your ability to this great job that we have.   Katie Strong: Thanks for a real, practical and inspirational conversation.   Mary Ann Eller: Well, thank you for letting me have it.   Katie Strong: Thanks, Mary Ann.   On behalf of Aphasia Access, we thank you for listening to this episode of Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to check out our growing library of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Guest Contact Information   Email Mary Ann at mary.eller@duke.edu   Resources   Aphasia Access LPAA Training Videos (LPAA 101, LPAA, Core Value, Communication Access- Fundamental Techniques) https://www.aphasiaaccess.org/videos/ Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000). Life Participation Approach to Aphasia: A statement of values for the future. ASHA Leader, 5(3). https://leader.pubs.asha.org/doi/10.1044/leader.FTR.05032000.4 Elman, R. J. (2014). Aphasia intervention: Are we missing the forest through the trees? 44th Clinical Aphasiology Conference, St. Simons Island, GA. http://aphasiology.pitt.edu/2529/ Elman, R. J. (2020). C.A.P.E.: A checklist of four essential and evidence-based categories for aphasia intervention. Chapter 2. In A. L. Holland & R. J. Elman (Eds.) Neurogenic communication disorders and the Life Participation Approach: The social imperative in supporting individuals and families (pp. 21-52) Plural Publishing. Holland, A. & Fridriksson, J. (2001). Aphasia management during the early phases of recovery following stroke. American Journal of Speech-Language Pathology, 10(1), 19-28.https://doi.org/10.1044/1058-0360(2001/004) The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. Turkstra, J. S. (2013). Inpatient cognitive rehabilitation: Is it time for a change? Journal of Head Trauma Rehabilitation, 28(4), 332-336. https://doi.org/10.1097/htr.0b013e31828b4f3f     If you liked this episode – more listening… Additional Aphasia Access Conversations Podcast episodes relating to the topic of acute care and applying LPAA to different settings.   Episode #57 Patient-Centered Home Programs Across the Continuum of Care for Individuals with Aphasia: A Conversation with Sarah Baar.   Episode#99 Communication Partner Training for Health Care Professionals with Dr. Jytte Isaksen   Episode #38 Broadening the Role of the SLP in Acute Care Assessment: A Conversation with Robyn O'Halloran   Acknowledgements – A special thank you to Amanda Zalucki from the Strong Story Lab at Central Michigan University for their assistance in the transcription of this episode.

John D. Corrigan, PhD, is a Professor in the Department of Physical Medicine and Rehabilitation at Ohio State University and Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. For the past 40 years he has treated and studied long-term outcomes of persons with traumatic brain injury. Dr. Corrigan is Editor-in-Chief of the Journal of Head Trauma Rehabilitation. He has been the PI and co-PI of the Ohio Regional Traumatic Brain Injury Model System since 1997 and chaired the Executive Committee of the TBI Model Systems Project Directors from 2007-2017. Since 2013 he has served as the Director of the Ohio Brain Injury Program, which is the designated lead agency in the state of Ohio for policy and planning related to living with brain injury. This position has provided a platform for translation of evidence on long-term outcomes to public policy. Dr. Corrigan is National Research Director for the Brain Injury Association of America and has previously served other national organizations, including CARF, the Injury Control Center at CDC, the Veterans Administration and the U.S. Department of Defense, Defense Health Board. Episode brought to you by Integrated Brain Centers Please consider supporting this podcast for $5 a month through a Patreon membership

In this episode of CUBIST, our hosts discuss the article, “The Persistence of Blast-Versus Impact Induced Concussion Symptomatology Following Deployment,” an article written by Jennifer Belding and colleagues and published in the Journal of Head Trauma Rehabilitation in December of 2021. Article Citation: Belding, J. N., Khokhar, B., Englert, R. M., Fitzmaurice, S., & Thomsen, C. J. (2021). The Persistence of Blast- Versus Impact-Induced Concussion Symptomology Following Deployment. The Journal of head trauma rehabilitation, 36(6), E397–E405. https://doi.org/10.1097/HTR.0000000000000715 Article LINK: https://pubmed.ncbi.nlm.nih.gov/34320556/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to www.health.mil/TBICoE or email us at dha.ncr.j-9.mbx.tbicoe-info@mail.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.

In this episode of CUBIST, our hosts discuss the article, “The Persistence of Blast-Versus Impact Induced Concussion Symptomatology Following Deployment,” an article written by Jennifer Belding and colleagues and published in the Journal of Head Trauma Rehabilitation in December of 2021. Article Citation: Belding, J. N., Khokhar, B., Englert, R. M., Fitzmaurice, S., & Thomsen, C. J. (2021). The Persistence of Blast- Versus Impact-Induced Concussion Symptomology Following Deployment. The Journal of head trauma rehabilitation, 36(6), E397–E405. https://doi.org/10.1097/HTR.0000000000000715 Article LINK: https://pubmed.ncbi.nlm.nih.gov/34320556/ CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to www.health.mil/TBICoE or email us at dha.ncr.j-9.mbx.tbicoe-info@mail.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.

Emotions After Brain Injury: The Recap Noggins And Neurons Facebook Group: CLICK HERE or scan below! OVERVIEW: Pete and Deb chit chat EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk about what we learned about from Drs. Zupan and Neumann. We covered: The new FACES app release information and understanding who should use the app, which is recommended for academic & clinical use. This bothers Pete and Deb sheds a little light on the need for some training. All is not lost! Several quotes from the podcast: Dr. Zupan talking about initial recovery experiences following brain injury, missing the opportunity to notice and address deficits in emotions, subsequent problems that appear and the need for a better discharge plan Cognition, emotions, prioritizing intervention, lack of physician knowledge around TBI symptoms, and the need for a better system in the U. S. at least Inability or difficulty identifying emotions, physiological responses and learning to identify emotions following brain injury Facial recognition training, facial expression software, micro-expressions and watching movies Addressing the higher level cognitive/emotion skills at the onset of brain injury as a means of lower-level skills healing Negative attribution when assessing the emotions of others, family dynamics and stress around meeting the needs of all In two previous episodes Emotion Perception After TBI/Stroke w/ Drs. Zupan & Neumann announced to the world on our show that they'll have a new free app out soon to help folks conquer Alexithymia. Here is some more info on that app: The FACES app is an App version of  the facial affect recognition intervention that we tested and has the highest strongest level of evidence for treating facial affect recognition deficits after TBI. I think we talked about it on your program, but if you think it would help, you  could include some version of the below info.  That said, anyone will be able to download the app, it's just not intended to be self-delivered.  Hope this helps! The FACES App:  What is it?:  It is a therapeutic program consists of exercises intended to help teach individuals who have problems with emotion perception to better recognize others' emotions--- to be able to identify and relate to happy, sad, angry, and fearful facial expressions in others. This is an evidence-based approach (Neumann et al, 2015) and has been deemed a practice standard (Cicerone et al 2019) for treating emotion perception deficits in individuals with neurological disorders. Neumann, D., Babbage, D., Zupan, B. and Willer, B. (2015). A Randomized controlled trial of emotion recognition training after traumatic brain injury. Journal of Head Trauma Rehabilitation. 30 (3): E12-E23 May/ June 2015 doi:10.3109/02699052.2014.901560 Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., Kingsley, K., & Nagele, D. (2019). Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014. Archives of physical medicine and rehabilitation, 100(8), 1515-1533. Who is it for?: Clinicians treating individuals with neurological disorders who have emotion perception deficits Intended Delivery Method: This intervention was created as a clinical tool for therapists and healthcare professionals to use as a resource when treating patients who have emotion perception problems.  It is not intended for patients to use on their own or to be delivered by a care-partner or family member, as that approach has not been tested or validated by research. As always, we want to hear your top takeaways! Please email us at NogginsAndNeurons@gmail.com. Questions and Comments about the podcast? NogginsAndNeurons: The Website Noggins And Neurons Facebook Group Donate to The Noggins And Neurons Podcast with your PayPal app Pete's blog, book, Stronger After Stroke, and talks. Pete's Spasticity Class (CEU, Motivations Inc.) Blog Book: Stronger After Stroke, 3rd edition   Deb's OT Resources: Deb's OT resources The OT's Guide to Mirror Therapy Tri-Fold Mirror (US address only) Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults REQUEST TO BE A GUEST ON NOGGINS & NEURONS. If you're passionate about stroke recovery and have information or a story you believe will help others, we'd love help you share it on the show. Complete the guest request form below and let's see if we're a good fit!   Guest Request Form MUSIC: “Soft Inspiration” by Scott Holmes/Scott Holmes Music/scottholmesmusic.com   Music by scottholmesmusic.com

1. Practice guideline recommendations summary: Disorders of consciousness2. Multiscale Analysis of Independent Alzheimer’s Cohorts Finds Disruption of Molecular, Genetic, and Clinical Networks by Human HerpesvirusIn the first segment, Dr. Jeff Burns talks with Dr. Joseph Giacino about the AAN Guideline update on disorders of consciousness. In the second part of the podcast, we are featuring a discussion with Dr. Jason Crowell and Dr. Joel Dudley discuss the detection of human herpesvirus genes in in a large cohort patients with Alzheimer disease.DISCLOSURES: Dr. Burns has served on the DSMB for NIH-funded trials (non-profit entities); serves on the editorial board for Journal of Alzheimer's Disease; has consulted for Grifols, USA; has served on Eli Lilly Amyvid Speaker's Bureau; and has received research support from Eli Lilly, Avid Radiopharmaceuticals, Toyama Chemical Company, Merck, Biogen, AbbVie, Novartis, vTv Therapeutics, Janssen, and NIH (R01AG058557, R01AG053312, R01AG034614, R01AG03367, R01AG043962, P30AG035982, U10NS077356, UL1TR000001). Dr. Giacino has served on the scientific advisory board for the Traumatic Brain Injury Model Systems National Data and Statistical Center (federal agency); serves on the editorial board for Journal of Head Trauma Rehabilitation; serves as Director of the Spaulding Rehabilitation Network Disorders of Consciousness Program; has received research support from the U.S. Department of Defense, (Co-Investigator, W81XWH-11- 2-0210; Co-Investigator, W81XWH- 08-2-0159; Co-PI, W81XWH-14-2-0176), National Institute on Disability and Rehabilitation Research, (PI, H133A120085; site PI, 90DP0060; PI 4, 90DPTB0011), National Institutes of Health (Co-PI, 1U01NS086090-01; Co-PI, UH3NS095554), James S. McDonnell Foundation, and the The Barbara Epstein Foundation, Inc; and served as expert witness in legal proceedings for DeCorato Cohen Sheehan & Federico. Dr. Crowell and Dr. Dudley report no disclosures.

Today’s episode features one of the nation’s leading physicians and researchers who has spent years studying and treating traumatic brain injuries. Dr. Flora Hammond is a professor and chair of the Department of Physical Medicine and Rehabilitation at Indiana University School of Medicine. She also is the Chief of Medical Affairs and Medical Director at the Rehabilitation Hospital of Indiana. She has been a project director for the Traumatic Brain Injury Model System since 1998. Shortly before we conducted this interview with Dr. Hammond, she and a team of physicians and scientists at Indiana University received a $2.1 million grant to continue research into people who suffer traumatic brain injuries and how these injuries affect the lives of patients as well as their families. Dr. Hammond is a Pensacola, Florida, native who graduated from the Tulane University School of Medicine in 1990 and completed her residency in Physical Medicine and Rehabilitation at the Baylor College of Medicine in Houston. She also completed a brain injury medicine fellowship at Wayne State University School of Medicine in Detroit. Her research in the area of brain injury includes studying the prediction of outcome, aging with brain injury, causes of and treatments for irritability, and quality of relationships. In 2016 she received the Robert L. Moody Prize, which is the nation’s highest honor reserved for individuals who had made exceptional and sustained contributions to the lives of individuals with brain injuries. Prior to the 2016 Robert L. Moody Prize, Dr. Hammond received local and national awards for her teaching, clinical care and research, including the 2001 Association of Academic Physiatrists Young Academician Award, the 2011 Brain Injury Association of America William Caveness Award, and the 2013 Baylor College of Medicine Distinguished Alumnus Award. In 2011, 2012, and 2013, Dr. Hammond led the Galveston Brain Injury Conferences which focused on changing the view of brain injury as an incident with limited short-term treatment to a chronic condition that must be proactively managed over the course of life. She co-chairs the American Congress of Rehabilitation Medicine Chronic Brain Injury Task Force, and serves on Journal of Head Trauma Rehabilitation editorial board. She has authored more than 140 peer-reviewed publications. Links: Flora Hamond faculty profile: https://medicine.iu.edu/faculty/20302/hammond-flora/ "Potential Impact of Amantadine on Aggression" study https://www.ncbi.nlm.nih.gov/pubmed/28891908 Show notes: 4:08: Interview begins. 4:38: Dawn says it’s her understanding that Flora dreamed of becoming a physician ever since middle school. Dawn asks what inspired her at such an early age to become a doctor. 5:02: Flora talks about also wanting to become a teacher, but worried that she would have to give up teaching to become a doctor. 5:40: Continuing with Flora’s history, Dawn mentions that after high school Flora traveled to New Orleans to attend Tulane University. Dawn asks if it’s true that Flora’s grandmother was her landlord while she was in college and med school. 6:20: Ken mentions that Flora’s mother was a dietician and that her father was a pathologist. He asks Flora what specifically inspired her to specialize in brain injury rehabilitation and research. 8:36: Dawn comments on how before Flora accepted a positon at Indiana, she was in the Carolinas, and asks about her work there. 9:30: Dawn asks how Flora ended up at the Indiana University School of Medicine. 10:23: Ken mentions that Flora’s lecture at IHMC attracted a lot of interest and a full-house. He follows up by asking Flora what she thinks is driving the interest in brain injuries. 11:34: Dawn talks about how Flora and a team of physicians and scientists at Indiana have spent years studying and treating TBI (Traumatic Brain Injury) and the effects of TBI on the lives of patients and their fa...

Join host Amy Zellmer as she chats with Mary Lee Etsy. Mary Lee Esty, LCSW-C, PhD, is President of the Brain Wellness and Biofeedback Center of Washington, Bethesda, MD, and a Senior Fellow of the Biofeedback Certification International Alliance in Biofeedback and Neurofeedback. The Center provides biofeedback and neurofeedback treatments for symptoms following concussion, traumatic brain injury (TBI), including headache, insomnia, fatigue, cognitive problems, depression, and post-traumatic stress. Her first research for TBI was done with NIH funding through the Kessler Rehabilitation Hospital, and published in the Journal of Head Trauma Rehabilitation in 2001. Conquering Concussion, by Dr. Esty and C.M. Shifflett, defines numerous effects of concussion: short and long-term physical, social, emotional, and metabolic effects that present therapeutic challenges to health care providers. This book informs professionals and lay people about life-long effects of concussion that are not generally understood. Who knew that Elvis, King Henry VIII, and Howard Hughes were seriously affected by concussion, and about its link to their odd behaviors? Conquering Concussion was awarded a coveted Kirkus starred review and is the educational tool the authors had hoped to create. Purchase her book on Amazon: http://amzn.to/2BEDOTC Episode sponsored by: Minnesota Functional Neurology: Center for Brain Health 

Adam Hoffberg talks with Dr. Suzanne McGarity, a Clinical Research Psychologist here with Rocky Mountain MIRECC, and who recently moved to Denver from the Tampa VA.  In honor of March being Brain Injury Awareness Month we wanted to discuss a recent paper of Suzanne’s that came out in the Journal of Head Trauma Rehabilitation. The article is titled “Community Reintegration Problems Among Veterans and Active Duty Service Members With Traumatic Brain Injury.” The papers findings “highlight the ongoing rehabilitation needs of persons with TBI, specifically evidence-based mental healthcare, in comprehensive rehabilitation programs consistent with a chronic disease management model.”

Mary Lee Esty - Conquering Concussion. What do Henry VIII, Mary Todd Lincoln, Howard Hughes, and Elvis Presley have in common? They suffered traumatic brain injuries that had a significant impact on their lives, and perhaps the course of history. Concussions are a hot topic these days, specifically due to the recent findings of the impact of head injuries on professional football players.  However, many don't realize that concussions and other traumatic brain injuries (TBI's) affect many people and can have a lifelong effect on ones health. In fact, the recent surge in combat veterans incurring TBI's during combat has led to a lot of new research and a much better understanding of exactly what is going on during and after suffering a head injury.  This week on the show we interview Dr. Mary Lee Esty, president of the Brain Wellness and Biofeedback Center of Washington and author of the new book, Conquering Concussion: Healing TBI Symptoms With Neurofeedback and Without Drugs. Dr. Esty is a social worker with a doctorate in health psychology. She is a recognized Senior Fellow in Biofeedback and EEG Biofeedback with the Biofeedback Certification International Alliance. She also has published peer-reviewed research on traumatic brain injury starting with an NIH-funded study published in 2001 in The Journal of Head Trauma Rehabilitation, and a 2012 study with Iraq/Afghanistan veterans with TBI and PTSD in The Journal of Neuropsychiatry & Clinical Neurosciences. Over the past 19 years Dr. Esty has treated more than 2,000 clients with a wide variety of conditions. Current research includes a study with the military medical school evaluating the efficacy of Neurofeedback on TBI and PTSD.  "A concussion depends upon acceleration and sudden deceleration.  When this happens the brain gets tossed around in the skull, because it floats." - Mary Lee Esty Quotes from Mary Lee Esty:  What we learn in this episode: What occupation is the most likely to incur a traumatic brain injury (and it's not sports!) What is neurofeedback and how can it be used to treat concussions? A better understanding of sub-concussions What are common symptoms of concussion? Resources: Conquering Concussion: Healing TBI Symptoms With Neurofeedback and Without Drugs http://www.brainwellnessandbiofeedback.com/