CareMeridian

CareMeridian's skilled nursing services center on subacute care for spinal cord injuries, brain injuries and medically complex cases such as neuromuscular disorders and pulmonary disease or injuries.

News From the Field

Mirror Images May Assist the Brain During Rehab
The Heart and Stroke Foundation reports from this year’s World Stroke Congress that using a mirror during therapy may support the brain’s efforts to recover from stroke.

Japanese research shows that a mirror placed between the legs of patients during rehab exercise helped increase the speed of leg-lifting activity up to 12%.  They suggest that the mirror image may “trick” the mind in some way, helping to support physical recovery.  (Story)

Brain Interface Making Speech Recovery Possible
Erik Ramsey suffered a brain stem stroke nine years ago, leaving him almost totally paralyzed.  But thanks to an implanted electrode, some software and a collaboration, Erik is learning to talk again.  The software interprets signals from Erik’s brain to his vocal tract as he attempts to make sounds, translating his thoughts into sounds.   He can hear his voice in real time, providing him feedback on his pronunciation, helping him to hone his speaking skills.  According to an article in New Scientist, over the course of just a few weeks he improved his speech accuracy from 45% to 80%.

The “brain interface” is collaboration between a Georgia company, Neural Signals and a research team at Boston University.  It currently works best with vowel sounds, and improvements are needed to better articulate consonants as they require more coordination of the body’s vocal system.

Early and Frequent Mobility Keeps Depression at Bay for Stoke Patients
Post stroke depression is a major concern to patient and family, but it also is associated with less participation in therapy and a poorer rate of recovery. 

Dr. Toby B. Cumming at the National Stoke Research Institute in Australia tested the impact of early mobilization on stroke patients.  On average their study group was up and mobilizing within 18 hours after the stroke (the standard care group wasn’t mobile until after 30 hours).  The early results of Dr. Cumming’s study shows that increased physical activity in the days immediately after a stroke has a positive effect on patient’s general mood, leading to more effective rehabilitation and recovery.  (Reuter’s story)

Understanding “Spreading Depression” in Brain Neurology Key to TBI Treatment
Researchers at the University of Cincinnati are leading a $2 million research project, focusing on a brain injury phenomenon called “spreading depression.”  Spreading depressions are electrical failures in the brain’s neural network activity that spread beyond the initial injury site to other parts of the brain.  As many as 60% of brain injury patients experience this phenomenon.

Researchers are trying to determine over how long a period spreading depression continues after injury.    This is key information for early brain injury treatment because as these electrical disruptions spread, they cause increased tissue death or damage due to of the loss of blood and oxygen to those affected areas.  Understanding spreading depression will help in developing early TBI treatment.

The research is being funded by the U.S. Department of Defense as a large number of Iraq and Afghanistan war veterans are being afflicted by brain injury.  (Story)  The DOD has also recently awarded a $60 million grant to the University of California, San Diego to study TBI and its relation to post-traumatic stress disorder.

TBI Sufferers Show Significantly Lower Empathy
The Brain Blogger points to a recent study in the Journal of International Neuropsychological Society that shows that 61% of sufferers of traumatic brain injury exhibit low scores on the Balanced Emotional Empathy Scale (BEES), meaning they had less ability to empathize with others.  The study seems to indicate that the low scores were not influenced by the severity of the brain damage, suggesting that even mild TBI can have lasting effects and that TBI interrupts general social cognition. 

It’s interesting to note that almost simultaneously the University of Michigan has found in a recent study there that nearly one out of five delinquent youths suffer from some level of TBI.  The question comes to mind, could a decreased level of empathy in TBI patients be related to the increased delinquency among youth who have some form of TBI?

Brain and Spinal Injury News Alerts

Employed Caregiver Program Broadcast

A broadcast on “Innovative Employer Caregiving Programs” for employed caregivers is airing on the web and by satellite on September 17, 2008 from 11:00 a.m. – 12:00 noon (Pacific Time).    The Department of Health and Human Services New Freedom Initiative Subcommittee (NFI) is producing the broadcast.

The broadcast is for employers, caregivers and organizations that provide caregiver services.  It will include presentations from employers and organizations that have successfully instituted programs to help their employed caregivers.  Presenters will discuss their programs, experiences, and how their successes can be replicated by others.

Assisting caregivers is an important topic for employers as their full or part-time employees are increasingly being called upon to care for an aging, sick or injured loved one. Helping caregivers through developing intelligent programs keep employees productive and able to balance all the demands on them. There will be a 30 minutes Q&A session by conference call following the broadcast. Employers looking to create services or programs should tune in.   

The broadcast will be available on the web through the National Institutes of Health.  There is also an audio line to listen in via telephone.

To get all the information about accessing the broadcast, and to register click here.  You need to register to get broadcast access details.

Congressional Brain Injury Task Force Newsletter

With 1.4 million Americans experiencing traumatic brain injury and 5.3 million living with long-term and severe brain-related disabilities, the Congressional Brain Injury Task Force is now publishing a quarterly newsletter.  The mission of the Task Force is to educate and promote awareness of brain injury and to support funding for research.

The newsletter recaps legislative activity, studies and reports, media coverage and upcoming events related to brain injury.  While much of the activity in the Task Force is driven by the increased incidence of brain injury in soldiers in Iraq, much of the information and funding impacts anyone with brain injury.

The link to the full newsletter is here.

New Brain and Spinal Injury Web Site and Blog

MIT’s Technology Review brings us a report about a new Brain and Spinal Cord Injury web site and blog.  It is a rich resource, aimed at helping with learning to cope after a life-altering accident.  Spend just a few minutes there and you will see that they are building an extensive knowledge base of information about rehabilitation, recovery, research, coping and treatment. 

You’ll find a growing video library and a daily blog on the latest news and developments.  The blog has a unique “Technology Thursday” posting each week which highlights new technological developments for treatment or assistance. Topic categories on the blog make for easy searching of more specific topics related to brain or spinal injury.  Soon they will have a comprehensive list of treatment centers. 

The website and blog are definitely worth checking out.  You’ll find them here.

America’s Heroes At Work

The U.S. Department of Labor has just unveiled a new web site, America’s Heroes at Work, supporting the employment and success of returning Vets who have TBI and/or post-traumatic stress disorder (PTSD).  It is designed for employers and workforce development organizations or departments and includes fact sheets, presentation & training tools, success stories, on-the-job challenge resources and best practices.

The initiative is jointly managed by the Office of Disability Employment Policy and the Veteran’s Employment and Training Service in collaboration with several federal agencies including the Department of Defense, the Small Business Administration and the Social Security Administration among others.

Reading Your Mind: Brain Books

Since the dog days of summer are upon us we thought it a good time to participate in that time-honored ritual of sharing great books for reading during these hopefully more leisurely days.   

A topic near and dear to our hearts here at CareMeridian is our brains.  Wait!  Keep reading!   Believe it or not there are some really great, fascinating, summer-reading books about that mysterious organ that is responsible for how we experience the world.  These aren’t academic tomes that might belong in neurobiologist’s library – these are fun and fascinating reads that tell us new and exciting things about ourselves, and why we do what we do.  I wonder, don’t you?

Check these out for something different!

Brain Rules
This just hit the bookshelves a couple of months ago and is creating book circle buzz.  Everybody who owns a brain ought to read this book!  Author Dr. John Medina leads us through what a business or learning environment just might look like if we designed them for the way our brains actually work.

He give us 12 simple things (rules) about our brains that will help us work better, help your kids learn better, or even help you give better presentations.

The book is a breezy read, but it also comes with a DVD.  There is a terrific Brain Rules web site (video included) and a fun blog.  Even if you don’t buy the book, the web site gives you a peek at the 12 brain rules and is full of resources.  You can even listen to excerpts from the audio book for free.

On the blog you can view lots of great videos, such as this talk the author gave at Google headquarters on stress and exercise.

There is a lot of good stuff in here to power your brain.

Welcome to Your Brain: Why You Lose Your Car Keys but Never Forget How to Drive and Other Puzzles of Every Day Life

This book will explain why you are a morning person (or not) or why you can’t tickle yourself.

It is a bit of a romp through brain science, biology, and sociology while giving you lots of trivia with which to pepper your next dinner party conversation.  It is as entertaining as it is up-to-date science.

And don’t miss the blog by the same name – it is regularly updated with fun information and really practical examples the authors pull right out of today’s headlines.  It also links to all kinds of interviews and articles about the book and while you are there, browse the sidebar for upcoming events with the authors that might be in your area.

The Body Has a Mind of Its Own

The brain and the body are intertwined and interdependent.  In fact our brains build body maps totally based on what we do with out bodies. For instance, pianists have larger areas in the brain because of all that finger work; violinists have a larger area just for their left hands. What we do with our bodies, has everything to do with what our individual body maps are.

Our body maps can even “extend” feeling beyond our own bodies -  like to tools we use, the horse we might ride, or even lovers may “share” a body map. 

Sometimes our body maps can be dysfunctional too, such as in the anorexic who feels fat, or giving us that creepy “out of body” experience.   

The mother and son authors, Sandra and Matthew Blakeslee, do an excellent job of helping us understand the plasticity of our brains, showing us through examples, how our brains change with and respond to the environments we operate in, constantly adapting to and with our bodies.

The book is slated or release in paperback in September.  Check out the book web site for more information about The Body Has a Mind of Its Own.

Back of the Napkin

Even if you have two left brains, you can express complex information with drawings.  In fact, because our brains love visual information, you might even do it better than ever.

It all starts with a drawing on the back of a napkin.  Dan Roam tells us about his ah-ha moment about the power simple stick-figure drawings can hold.  He was asked to be a last-second fill-in as a presenter to top government officials.  Without the weapons of PowerPoint and computer, he was left with describing what he would talk about on the back of a napkin.  The simplicity and power of the drawing immediately captivated the organizer – and then the audience. 

This book tells us how we can do the same.

Although the message of the book is simplicity, the author sometimes over complicates things with an extended case study, but you won’t miss it if you skip over it.  A great book to help you “re-think” the way we solve problems in business and in life by visualizing them in way more simple ways. 

Our brains like pictures and they don’t have to be fancy!  Check out the web site here.

Read and enjoy your brain!

CaringBridges Helps Recovering Connect with Loved Ones

Recovery is a journey.  It is a journey of heart and spirit as much as it is of body and mind.  It is a journey not only foisted upon the ill or injured, but it becomes a journey for all those connected to them.   And journeys - whether they are joyful or painful - are not complete nor fulfilled unless they are shared.

CaringBridges was created to make that sharing a little easier, and to ease the burden of the sometimes emotionally exhausting task of informing one’s concerned circle about an ill, injured or recovering loved one. 

This is a free web-based service where anyone can quickly and easily create a personal web site that then serves as a hub of communication and support for both the patient and the family.

Each web site has a “journal” for communications from the patient or caregivers, as well as a message board for friends and family to post messages.  Each site has a photo gallery that also serves to help visitors stay connected to the family and loved one.

CaringBridges was founded by Sona Mehring in 1997 when she was faced with task of spreading the word about the premature birth of her dear friends’ baby.  She hit upon the idea of creating a web site as a method to keep their social circle informed during the difficult days ahead.  Sona created her web site the day the baby was born, and it since has blossomed into CaringBridges and has enabled more than100,000 individual web sites, each created by people facing their own short and long-term life journeys.   

While CaringBridges has mostly health-related web pages, a recent story in Delta Airline’s Sky  Magazine cites couples creating a web page at CaringBridges to keep friends informed of their international adoption proceedings, and a displaced nursing home that created pages for all of its residents right after the Hurricane Katrina crisis. 

Not only do these sites serve as a central communication point, they relieve some of the emotional stress for caregivers of delivering news while at the same time being a lifeline of support and encouragement.

CaringBridges is being embraced by healthcare organizations and non-profits serving health-related issues as a way of serving their constituents.  St. Francis Hospital in Minnesota, or example, has gone so far as to put a computer for accessing the site in their Acute Care family waiting room.

CaringBridges has grown to be the largest charitable non-profit website in the world. More than 100 sites are being created there each day, and it averages three people each minute coming to register to visit them.  Visitors from 40 different countries have left over 15 million messages of hope and encouragement.  CaringBridges is supported solely by donations - 90% of them from individuals and families who use the service.

We hope you will stop by the CaringBridges web site and support them by spreading the word.

“The Human Spirit Cannot Be Discounted.”

“I have learned on my journey that the human spirit cannot be discounted. The human spirit is something the doctors can't quantify. It is something they can't give a statistic on. But it is an amazing and incredible thing. You cannot beat someone down who wants to triumph."

That is Lee Woodruff speaking - from experience.  She is the wife of Bob Woodruff, the now famous journalist who suffered a traumatic brain injury in 2006 while in Iraq. She and Bob wrote a book last year about their life, their crisis and their recovery as a family.  The book is titled "In an Instant: A Family's Journey of Love and Healing" and it quickly became a best seller and a “best book of 2007.”

When Lee spoke of the strength of the human spirit, she was speaking to an audience of more than 600 people, and as the recipient of the 2008 Woman of Courage Award bestowed upon her by the Domestic Violence Crisis Center in Stamford, CT.  Her connection to domestic violence with brain injury was highlighted in her talk by way of a little known fact: that roughly 11% of the 1.5 million traumatic brain injuries per year are caused by domestic violence.

Ms. Woodruff’s words and this news story really hit us close to home.  We see the triumph of the human spirit every day here. But it isn’t every day one of CareMerdian’s patients also publishes a book about their own journey through TBI.

In his book, Life After Near-Death, Matt Stepien tells his frightening and compelling story of a rare virus that lead to a brain hemorrhage, three weeks in a coma, and a life completely transformed by this crisis.

Matt describes the book as an autobiography detailing the trials and transformations following severe brain injury.  Toni Bethke at our Santiago Canyon facility where Matt was a patient in 2005 describes it as an amazing and heartwarming story of Matthew's courageous efforts and achievements after a near fatal brain hemorrhage.

Matt’s recovery took more than 2 years, but he is now living independently at home much to the joy of his wife, children and six grandchildren. Matt is employed as a civil engineer.  He lives with permanent neurological damage to his right leg and to the center of the brain affecting his balance.  That is the legacy of his brain injury, but as you will see in his book, he is discovering talents he didn’t – and perhaps wouldn’t otherwise - know he had.

Lee Woodruff likely summed up Matt’s feelings as well when she said at that awards luncheon earlier this week,

"How do you get through any crisis without an amazing network of friends who drop everything and will do whatever is needed? To any one of you who thought about my family in Rye, N.Y., or said a prayer, I want to thank you all. Because I firmly believe that you all brought him back to us. It really does take a village in a situation like this.”

Matt congratulations on your book – and most assuredly on your own triumphs.  You inspire those in your “village.”  You have certainly inspired us.

Matt’s book is published by BIGRED and is available for $14.95 on the web here.

Sesame Workshop Initiative Helps Young Children Cope with Catastrophic Injuries and Military Deployments.

Scan the media landscape and you’ll find literally hundreds of stories published per day about traumatic injury. The immense attention being given to brain injury in particular, is fueled by the large numbers of veterans who are experiencing some form of TBI due to their deployments in Iraq and Afghanistan.

The stories are often filled with the great hope surrounding treatments, research and funding.

But someone very unique leap up out of that landscape today – Elmo.  Yes, that little red Elmo, along with his Spanish-speaking Sesame Street friend, Rosita.

Sesame Workshop, the non profit organization behind the generation-traversing television show Sesame Street, today launched Talk, Listen, Connect: Deployments, Homecomings, Changes, a colorful multimedia, bilingual “kit” aimed at helping young children in military families cope with catastrophic injury and the changes it brings into their young worlds.  The kit includes downloadable posters, videos, music, magazines and adult resource guides. Specific topics separated for children and adults; cover homecomings, deployments and “changes.”

The initiative is actually phase II of Sesame Workshop’s military outreach program, and aims to help young children between the ages of two and five who are experiencing the effects of injury, deployments and the changes in parents returning from the front lines. The success of the first phase of the TLC project, which was called Talk, Listen, Connect: Helping Families During Military Deployment was so successful Sesame Workshop enthusiastically launched its second phase.

The TLC kit is designed specifically for families now living with war-related injuries and for the purpose of helping caregivers build a sense of stability and resiliency during times of separation and change.   According to the Workshop, its goals are:

•    Reduce the level of anxiety children may experience during homecomings after multiple deployments
•    Help parents with ways to cope with multiple deployments
•    Help young children gain an age-appropriate understanding of a parent’s injury by including them and the entire family in the rehabilitation process
•    Reassure children that they are loved and secure and that together with their families, they can learn new ways of being there for one another and having hope for the future

Sesame Workshop will produce and distribute 500,000 DVD kits at no cost to families, schools, caregivers and facilitators.  The TLC web site also contains much of the DVD material.  The DVD kits include videos, print materials and postcards, all featuring the loved Muppet characters.  The initiative serves the estimated 700,000 children between two and five who have a parent in the military. An enhanced TLC web site is also planned for unveiling this coming Fall.

While this initiative was created with some of the unique issues military families face in mind, we believe any family facing the challenges of separation and changes due to catastrophic injury will benefit from this wonderful project.  We salute Sesame Workshop and their partners!

The TLC website is located here.

An Idea Worth Spreading

“…on the morning of December 10 1996 I woke up to discover that I had a brain disorder of my own. A blood vessel exploded in the left half of my brain. And in the course of four hours I watched my brain completely deteriorate in its ability to process all information. On the morning of the hemorrhage I could not walk, talk, read, write or recall any of my life. I essentially became an infant in a woman's body.”

On that morning brain researcher and neuroanatomist Dr. Jill Bolte Taylor suffered a hemorrhage in the left hemisphere of her brain.  Twelve years later she was on the stage of the TED conference providing us with the powerful story of her experience as she - a brain researcher - meticulously observed herself going through it. 

In spite of the fact her brain functions were slipping away one by one due to the massive stroke, she remembered every moment.  From waking up with pain, to floating between right and left brain functions and the brain “chatter”; from her paralysis to her inability to communicate – and to the moment when she felt her spirit surrender.

Watch her talk (or read the transcript). Hear her tell us in a lighthearted, yet deeply moving way about how our brains define us and how they also connect us to the world and to one another. 

This is a story so powerful you will remember it long after you hear it – and you will want to share it.

CareMeridian Joins the Veterans Administration in Caring for Injured Vets

Inside our warm, home-like (yet highly specialized rehabilitation) Fresno CareMeridian facility, we’re proudly caring for some of our country’s veterans.

About one year ago, the Veteran’s Administration contacted us to assist them in caring for some of their most medically complex veteran patients.  We of course welcomed this opportunity to serve with open arms.  Plus, it made such perfect sense.

The VA approached us because CareMeridian has in place the knowledge and high quality medical care programs for the very specialized care that their brain injury, spinal cord injury, tracheotomy, and ventilator-dependant patients require.

The VA is treating more than 200,000 patients from the wars in Afghanistan and Iraq alone. Many of these are brain-injured – a class of injury about which the VA is admittedly struggling to become more knowledgeable.  CareMeridian has a long history of exactly the type of specialized, long-term care such catastrophically injured patients require. 

The VA hospitals are top-notch in acute care.  They also excel at all aspects of limb injuries, rehabilitation and prosthetics. This is because, until very recently, these have been a major source of injury for vets.  The VA over the years has perfected their ability to provide these types of treatments.  But today, with the impressive advances in immediate post-injury and acute care, soldiers are surviving injuries they may not have just a few years ago – and that can mean some soldiers require very specialized long-term care that the VA is now working hard to be able to provide on a broader basis.

In working with the VA on our partnership, it became clear that even though we provide this care in small, highly staffed (4-1 patient to care-giver ratio), 12-bed facilities for personalized care, CareMeridian was able to deliver these services at about ½ the cost that the VA could provide them. 

All in all, this means better care for our vets – and for their families.  Certainly our entire focus on caring for such specialized needs in an intimate environment - that allows for including the family in the care day-to-day - is a primary benefit.  But, because families may also be faced with certain co-insurance payments, our cost-effective care means their co-payments are less as well.  And by placing the appropriate patients within our skilled facilities, the VA in turn has more beds at their facilities to allow for better care for other veteran patients.

We’re proud to be supporting the VA in their efforts by currently providing two types of services for our vets.  We’re caring for those that require round-the-clock skilled nursing, such as IV, tracheotomy, ventilator and other catastrophic injury therapies; as well as those needing neuro-behavioral therapies, community integration, and caregiver training. 

CareMeridian stands ready to support our troops in our own, very unique way.

Spinal Cord Injury: Community Integration

One of the foundations of our patient care for spinal cord injury - and of our philosophy at CareMeridian - is patient community integration.  It differentiates our care from most other rehabilitation facilities and programs.  We emphasize sustaining rehabilitation into the community setting – beyond the hallways of the rehab facility.

Unlike catastrophic illness such as brain injury, functionality and mobility are key to spinal cord injury recovery.  Helping a patient to accomplish everyday tasks in their normal environment means they can achieve greater independence and enjoy daily living.

Traditional recovery often focuses almost completely on physical rehabilitation, which is of course a critical element of healing.  However, community integration also addresses the equally important, if traditionally under emphasized, aspects of independence, friendships, family relationships and participation in activities. 

Technically, community integration is defined as the resumption of appropriate social roles following a disability.  So work, a social network, recreation, along with physical rehabilitation is what truly supports holistic healing and allows the individual to feel part of the larger community.

Knowing the importance of community integration, a part of our spinal cord rehabilitation includes teaching patients to navigate daily activities, such as shopping, going the gym or enjoying an outdoor activity.  But because family becomes a critical source of social and recreational activity for an SCI patient, we also help families to assist patients and encourage them in interacting with their environment in ways appropriate to the individual and his or her injury.

Home is the central touch point of community.  It is why CareMeridian’s facilities look, feel and function like a family home, yet are highly skilled environments for aggressive rehabilitation. Healing the whole person is always at the forefront of our programs, and we believe our commitment to community integration is a factor in the high degree of positive outcomes for our patients and eases the transition from rehab to home.