Right Place, Right Time

The traumatic brain injury workshop was, in a word, amazing! There were two speakers, both of whom were terrific. The neuropsychologist went first. I could go on and on and on about what she said, but I'll confine myself to 5 things:

1. The brain is full of white matter tracts that create a sort of neuron superhighway. As a matter of fact, if you put all the white matter end to end, it would span the globe three and a half times!
2. Traumatic brain injury often tears the axons that connect neurons, throwing up roadblocks on the white matter superhighway and forcing dead-ends and detours (diffuse axonal injury). This results in disrupted communication within the brain. She compared it to heavy snow bringing down phone lines.
3. She highly recommended a book on traumatic brain injury called "Where Is the Mango Princess?" It's written by the wife of a successful attorney who suffered a TBI and was never quite the same afterwards.
4. Memory symptoms are extremely common after a TBI. TBI tends to mess up memory by making it more difficult for information to "make the leap" from working or short-term memory into long-term memory. However, things that were well known before the TBI will not be forgotten because those memories are stored all over the brain.
5. Changes in social competence and executive planning skills are some of the longest-lasting and highest hurdles that make it difficult on family members and hard for patients to successfully re-integrate into their home, work, and school environments.

The second speaker was a PT who talked about the continuum of care for brain injuries. Basically, the continuum of care goes like this:

1. Shock Trauma/Neuro Intensive Care Unit: All about survival, prevention of secondary complications such as ICP, decubitus, aspiration pneumonia, etc., and stabilization so the patient can move on to #2.
2. Neuro Floor: More stabilization and work on increasing endurance to three hours, which is the minimum required for acute rehab. Patients will get out of bed and work on walking and sitting endurance.
   
3. Long Term Acute Care (LTAC, pronounced EL-tack): Increase endurance, allow for continued cognitive clearing, wound and infection management, and vent weaning if necessary.
4. Skilled Nursing Facility (SNF, pronounced "sniff"): Step up prior to acute rehab or down following acute rehab when the intensity of acute rehab is not tolerated/no longer required. More wound and infection management if necessary.
5. Acute Rehabilitation: Gain independence in mobility and ADLs (activities of daily living). Address behavior issues. Train family to provide safe care at home.
   

These steps are followed by home health (if housebound), outpatient treatment, and a residential community re-entry program that will enable patients to re-integrate into their community.

The speaker also showed some amazing before-and-after videos of people who had made tremendous progress with their mobility and movement. Of course, the time between before and after was years in some cases, but there was significant improvement. She also talked about using a baclofen pump for spasticity and tone management.

So, after all that meaty goodness, the VP of the company from which the speakers came spoke at the mic and said his company is opening a new TBI community re-entry residential facility this fall...ten minutes from my house!! I beat feet up to speak to him and ask about shadowing, and he went one better, saying I might even be able to get some paid hours as an assistant who helps patients get to the therapy room and back. In my case, I'd take patients to and from OT and watch the whole session as it was happening. Nifty, eh?

But the faboo networking didn't end there. I also talked to a woman who does home health, home assessments for aging in place, and senior driver assessments, which I also find very interesting. She gave me her brochure and asked me to get in touch with her about shadowing.

Needless to say, both of these lovely people got e-mails from me today.

That clunk you just heard is my life falling into place.