The Brain Injury Association of America's (BIAA) Business Practice College is under way this week in Las Vegas. Rehabilitation industry leaders from across the country participate in this program, which offers sessions for CEOs, COOs, Human Resources and Marketing professionals. The group's focus is to share exemplary strategies ensuring access to, and development of quality healthcare. Lakeview Vice-Presidents Sue Bartlett, LCSW, CRC and Dianne Schwarz, MEd, OT will be presenting a general session to the group on Medicaid mechanisms and trends as they relate to brain injury and rehabilitation. Sue Bartlett has over two decades of experience in BI case management, contracting and development, while Dianne Schwarz recently joined Lakeview after many years in New York state government, involved with the care of over 7,000 individuals with BI and related conditions.
The Business Practice College opens with the annual meeting of the BIAA Business and Professional Council, Chaired by Lakeview's President/COO Dr. Tina Trudel. As noted at www.biausa.org, the Council's primary goal is to increase access to care. Membership in the Council offers opportunities to stay up-to-date on health care policies, participate in coordinated legislative action, share in brain injury health outcomes and business intelligence, and communicate and network with colleagues.

The romantic drama, 'The Vow', depicting a couple dealing with the aftermath of traumatic brain injury (TBI), was released just in time for Valentine's Day box-office success. Many have asked, could something like this really happen? Yes, in fact the story is loosely based on the true story wherein Krickitt Carpenter sustained a TBI and lost memories of falling in love with her husband (Kim Carpenter). Their compelling story about TBI and the power of love can be found all over the internet. However, there are a few caveats to remember: First is that individuals with TBI typically typically have minimal retrograde amnesia (memories learned before the TBI) and far more difficulty with anterograde amnesia (memories learned after the TBI); second, most individuals injured severely enough to suffer major retrograde amnesia also have other challenges such as personality, cognitive and/or physical changes; and lastly, divorce is unfortunately common after TBI - a challenge for all of us to reach out and support those couples we encounter who are finding their way through the often difficult post-TBI journey.

Unlike non-contact sports, football, hockey and other frequent high-impact sports are associated with risk for concussion, brain injury and chronic traumatic encephalopathy (CTE). For many, CTE is a new term and new idea, that repeated insults to the brain can lead to lifelong progressive, degenerative problems long after an athlete's sports career is over. CTE can cause personality change, memory loss, cognitive impairment and even dementia. While more widely accepted as a consequence of boxing, until recently, CTE and the risk of both symptomatic and asymptomatic concussion from hits to the head through other sports, was not fully appreciated. Implications for youth avoiding hits to the head, practicing without full contact and minimizing hits to the head in the game are critical, and should be a top priority for parents and coaches at all levels. For more information on CTE, visit the BU Center for the Study of Traumatic Encephalopathy http://www.bu.edu/cste/.

Across New England and the Midwest, Lakeview offers state of the art brain injury rehabilitation services for Veterans and Active Duty Service Members through our various contracts with the VA and Tricare. Services are available across the continuum of care, including acute care hospitalization and ventilator weaning, acute neurorehabilitation, neurobehavioral services (such as treatment of PTSD, substance abuse, aggression and depression as co-occurring conditions), post-acute rehabilitation, community integrated programs, supported living and specialized home healthcare. Programs nationally are under the direction of Dr. Tina Trudel, Research Coordinator and former Site Director (2005-2010) of the Defense and Veterans Brain Injury Center - Charlottesville Rehabilitation Programs. Dr. Trudel was recently appointed by Governor John Lynch to serve on the NH PTSD and Brain Injury Commission, was a founding member of the North American Brain Injury Society Blast Injury Institute, and has spoken internationally, authored numerous chapters and peer reviewed articles on issues related to caring for our service members with brain injury and PTSD, from rehabilitation to community re-entry. Lakeview's New England programs are headed by clinical neuropsychologist Dr. Jim Taylor, a Vietnam Combat Veteran with decades of experience in rehabilitation and behavioral health. Lakeview is proud to serve our men and women in uniform!

Those of us working in neurotoxicity have long realized that it does not take much lead exposure to adversely impact the developing nervous system. Last week, the US Advisory Committee on Childhood Lead Poisoning recommended that the lead blood level iindicating dangerous exposure for children age 5 and under, be cut in half, from 10 micrograms per deciliter (current) to 5 micrograms per deciliter (proposed). This change would increase the number of children officially diagnosed with lead poisoning from 250,000 to 500,000.
When children are exposed to lead, this heavy metal toxicity damages the brain and other organs, often resulting in attention deficit disorders, reduced intellect and learning capacity, slowed motor responses, diminished coordination, behavior problems, cardiovascular changes and immune system issues. Many children go undiagnosed and untreated. While these brain-behavior effects are lasting, children can benefit from neurobehavioral treatment and specialized rehabilitation models. Although not a cure, significant progress can be achieved if diagnosis and referral for treatment occur in a timely manner.
The ultimate solution to childhood lead poisoning and other neurotoxin exposures is prevention, as the effects to neurobiology are irreversible. Unfortunately, children's blood tests are often the means through which substandard housing is identified after a child has been poisoned. The CDC estimates 24 million American homes are contaminated with lead, 4 million of those with children in residence. Lead is not only in house paint, but also has been detected in imported pottery, jewelry, candy and children's toys. While lead exposure is only one of the many potential neurotoxins that can damage children's brains and development, it is among the most widespread and preventable. Both the CDC's Healthy Homes website www.cdc.gov/healthyhomes and the Consumer Product Safety Commission www.cpsc.gov have information on removal and protection from lead and other harmful substances.

The North American Brain Injury Society (NABIS) publication 'Brain Injury Professional' is launching a new feature on technology in the field of brain injury. This regular column will be authored by Lakeview's COO, Dr. Tina Trudel, and focus on upcoming technological aids and interventions in brain injury. The emphasis will be on technology as part of person-centered care. Initial topics slated include approaches to selecting technology, specific devices and apps, smart environments and home modification, as well as technological advances in treatment such as current research efforts using magnetic fields and electrode stimulation. A special issue devoted to technology, and a preconference workshop at the annual NABIS meeting September 11-15 in Miami, are also planned. Dr. Trudel served on the 2010 International Advisory Committee for the World Congress on Neurotechnology in Rome, Italy. She has published and/or presented case studies and pilot projects regarding use of GPS, PDA, driving simulation and computerized instructional models in post-acute rehabilitation. Dr. Trudel coordinates research at Lakeview and is presently the Research Coordinator for the Defense and Veterans Brain Injury Center (DVBIC) - Charlottesville Rehabilitation Programs where she served as Site Director from 2005-2010.

Lakeview provides supports and services to individuals with Huntington's Disease (HD) in both community integrated and residential treatment settings. HD is a neurodegenerative genetic disorder that typically affects people in the prime of their lives, between ages 35-44. The disease causes muscle incoordination and involuntary movements, as well as cognitive decline and often mood and behavioral changes. Because HD is an autosomal dominant mutation, the child of an affected parent has a 50% risk of inheriting the disease, thus HD running in families.
Individuals with HD require supports and services at some point in the progression of the disease process, which typically has a course of 15-20 years. Quality of life and maximizing physical/mental health maintenance are critical aspects of HD care. While many individuals receive care in nursing home settings, other models should also be considered. Both residential treatment and community integrated supported settings can provide the needed supports and service and a high quality of life and participation. Lakeview's program models include on-site nursing coverage, direct care for personal needs and activities of daily living, community integration specialists for adapted activities and psychological supports for behavioral health, development of coping skills and family counseling. Additionally, these residential treatment and community integrated settings have access to medical specialists and the full rehabilitation team - occupational, physical, speech and respiratory therapy, ensuring maximal support for maintaining functional status through active treatment, use of extenders, implementing adaptive equipment and utilizing assistive technology. To learn more about HD options at Lakeview, contact us at 1-800-4-REHAB-1 [800-473-4221].

Lakeview's Rehab at Home is a a group of licensed therapeutic home health agencies operating in New England since 2011, and now in Wisconsin, serving Green Lake, Portage, Marquette, Columbia, and Waushara counties. The Lakeview Wisconsin team specializes in nursing, physical and occupational therapy, respiratory therapy, behavioral therapeutic treatment, and home living assistance. Lakeview's WI team members, led by Dr. Mustansir Majeed, include 17 licensed practitioners dedicated to providing complete therapeutic interventions for medical, psychological and orthopedic needs for pediatric, adolescent, adult and geriatric patients. Lakeview's goal is to assist every person we serve in reaching their best functional capacity while providing exceptional care in their personal home environment.
Lakeview Rehab at Home in New Hampshire is soon expanding to Massachusetts and Maine. Under the Direction of Susan Bartlett, LCSW, CRC and Caroline Pierce, RN, Lakeview Rehab at Home in NH offers all home health nursing and therapy services, with specialties in rehabilitation and behavioral health. Additional related services include neuropsychological assessment and applied behavior analysis consulation, including comprehensive assessment and treatment services provided by experienced professional staff for individuals with stroke, brain injury, developmental disabilities, neurodegenerative conditions (MS, Huntington's Disease, etc.) and autism spectrum disorders. At Lakeview Rehab at Home, dedication to quality care is an ongoing standard, with active participation in Lakeview's Center of Excellence programs.

Lakeview's Chief Information officer, Russell Merka, will be joined by Janet Courtney as Vice-President of Information Technology, to enhance growth, development and IT project planning and implementation, as Lakeview launches an array of new products and services nationwide. Ms. Courtney is a management and information technology leader with over 20 years of health related experience, working across health plans, pharmacy platforms, regional healthcare systems and other settings. She has implemented innovative, practical and cost-effective solutions and worked through innumerable regulatory and accreditation processes. Ms. Courtney served as Sr. Project Manager Strategic Product Development for APS Healthcare, Inc.; Sr. Vice President for Intermed Solutions, Inc.; Manager of Information Systems for Helix (Medstar) Healthcare and in various other consulting capacities. She received her Bachelor of Science in Medical Technology from Loyola College of Maryland and is certified as a PMP Project Management Professional, ASCP Associate Member, CAP Inspector, certified in TQM, COI, and Facilitation, and as a Project Management Scrum Master as well as in ITIL V3 Foundations. Ms. Courtney will support Lakeview programs and services nationally and be based out of Lakeview Specialty Hospital and Rehab in Waterford, WI.

Lakeview's Chief Operating Officer, Dr. Tina Trudel delivered two addresses at this week's TBI Summit Conference in Beaver Creek, CO, hosted by Craig Hospital. Dr. Trudel's first presentation provided an overview of gender issues in brain injury rehabilitation, including a comprehensive review of the literature on women's recovery and the influences of economic, domestic violence, behavioral health, hormonal and other issues. She will be a co-presenter with other leaders in the field at a pre-conference workshop on women's issues during the International Brain Injury Association meeting in Edinburg, Scotland March 21-25, 2012. Dr. Trudel's second presentation reviewed her years of work with colleagues on aging with brain injury as Chair of the Brain Injury Long Term Issues Task Force of the American Congress of Rehabilitation Medicine. Additionally Dr. Trudel presented the findings from the systematic review of the current research literature on dementia after brain injury, which she initiated with colleagues as the Senior Scientist - Section Leader (Dementia-Aging) in 2008-2009 as part of the Moody Foundation Galveston Brain Injury Conference/Study Group. These presentations will be featured as part of Lakeview's 2012 Third Thursday at Three continuing education speaker series.