Jim Para-Cremer, MS, BCBA, Lakeview Administrator of Residential Programs in Wisconsin, and Daniel Parker presented a CEU course entitled ‘A Practical Approach to Positive Behavior Interventions and Support (PBIS) within Applied Settings’ at the August 13, 2012 Wisconsin statewide ABA conference.  Utilizing data and functional analysis, this workshop outlined methods that enable educators to determine the types of supports and interventions needed for students. The focus of the workshop addressed how to develop systems that assist with determining the accommodations and skills needed to promote positive adaptive and functional skills for learners.  Lakeview’s leadership team, including Jim Para-Cremer, are available to present evidence-based and best practices and approaches in the areas of education, treatment, and rehabilitation of youth and adults with neurobehavioral and developmental needs, including those with diagnoses of brain injury and autism spectrum disorders.

 The recent Bloomberg article on abuse at the FINR brain injury rehabilitation program has spurred strong emotions and much discussion.  It is both tragic for those affected, and inexcusable to have occurred.  Lakeview hopes that the brain injury community and the general public recognize that this one example does not reflect the field of dedicated providers who respect human rights, follow rules and regulations and value the moral responsibility that is inherent in operating healthcare facilities and serving persons with BI and related conditions.  The Lakeview affiliated companies are privately owned by the very people whose bios and long term commitment to support and advocacy, are evident on this website.  This small, accountable and committed group includes our Chairman, Tony Merka, North American Brain Injury Society (NABIS) Lifetime Achievement Awardee and early supporter for the foundation of the Brain Injury Association of America (BIAA); our President, and Tony’s long term business partner Carolyn McDermott, a committed BI advocate; CEO Chris Slover, former Chairman of Brain Injury Association’s Business & Professional Council, member of the BIAA Board of Directors; and COO Dr. Tina Trudel, BIAA Founders Award Honoree (2008) for advocacy and service, as well as a board member of BIAA, NABIS and the Sarah Jane Brain Foundation, among other roles.  Lakeview programs are CARF and/or Joint Commission accredited, as we welcome external review of what we do.  We further maintain stringent corporate compliance, quality assurance and internal audit programs, including an anonymous 800 number so that any of our program participants, families, staff, funders or members of the public can directly contact our leadership with a mandatory 24 hour response time.  Lakeview always seeks to improve and lead in the field – both in our quality of care and in the respect and dignity afforded to all who receive that care. 

While details of the death of Junior Seau are still undetermined, his death bears a striking resemblance to other suicides and deaths from violent means that have been associated with Chronic Traumatic Encephalopathy (CTE) in professional athletes. CTE results from repetitive closed head injury wherein degeneration of brain tissue and the build-up of tau protein occur. This results in a progressive condition where dementia-like changes occur, along with mood swings, cognitive decline, memory problems and physical impairments. Previous to this self-inflicted gunshot wound, Seau had been arrested for domestic violence and had driven his car off of a cliff (reportedly due to fatigue) in 2010, potential behavioral warning signs for CTE. While not known for being concussion prone, Seau, a 12 time Pro-Bowler, amassed over 1,500 tackles in his NFL career and was an aggressive player even from his younger days in football. His brain is likely to have sustained thousands of small to large concussive forces throughout such a lengthy career.

Seau's death via a self-inflicted gunshot wound to the chest closely parallels last year's death of Dave Duerson, NFL safety, who shot himself in the chest and died. Only later was it disclosed that Duerson shot himself in the chest so that his brain could be donated for study to discern the effects of repeated concussion. Duerson's brain was studied by the Sports Legacy Institute (SLI), a Boston University based foundation started by neurologist Robert Cantu and former Harvard football player Chris Nowinski to study the long-term effects of concussions. Their examination of Duerson's brain showed he had CTE, with similar findings in the brains of 20 other dead players. Perhaps in this desparate, tragic act, Junior Seau also was sparing his brain, which had already been through so much. May the Seau family find comfort and Junior Seau rest in peace.

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].