Mar 29, 2010 Tami S. Zimmerman Uncategorized
For two consecutive weeks, The Eagle Bulletin has published articles to acknowledge March as National Brain Injury Awareness Month. The first article covered the seriousness of stroke, the second focused on concussions. This week’s article emphasizes the dangers of Traumatic Brain Injury, or TBI.
In a split second, Auburn native Amy Rankin’s life was forever changed.
She was 23 years old, a new teacher in Baltimore, Md. and had just chaperoned her first middle school dance. She and her friend celebrated with dinner and drinks. But after a little too much wine, they decided it best not to drive.
Had 21-year-old Michael Robertson made the same decision, it would be safe to say Rankin’s life would have been unaffected.
But he didn’t.
Robertson ran up a curb, speeding between 50 and 55 mph in a 15-mph zone and hit Rankin, who was standing in a grassy area off the pavement of a nearby shopping mall where the two girls just spent the evening. A first offender of driving while intoxicated, Robertson spent 18 months in jail.
Six years after the accident, however, Rankin continues to adjust to a whole new way of living.
For 33 days, Rankin was in a coma. She was diagnosed with traumatic brain injury; the difficulty was with the swelling of the brain, her father said. The doctors’ prognoses were grim — they gave her family no hope. She wouldn’t be able to walk nor talk. She should be institutionalized, they said.
She spent 101 days in Baltimore — first at the University of Maryland Shock Trauma Center, where she was taken after the accident, then at a rehabilitation center where her parents Bill and Patty said she received very poor care.
After what the family now calls a “ripple effect,” Bill and Patty brought her to St. Camillus Health & Rehabilitation Center.
“A whole bunch of people started popping up talking about St. Camillus,” said Bill, who served 10 years as the Fayetteville-Manlius High School vice principal until 1981.
Amy was admitted to St. Camillus on Feb. 4, 2005. Staff began treatment — physical therapy, speech therapy, occupational therapy — the very next day.
“Walk, talk, eat — those were my goals,” Amy said.
She achieved them in less than a year and literally walked out the doors on June 30.
She spent another two years as an outpatient at St. Camillus, attending exercise classes three times a week.
Consequently, Rankin suffers from memory loss — she doesn’t remember anything about the accident, nor does she recall events that took place up to three years before. She’s just now able to recognize herself in pictures. She’s improving her balance and also takes singing lessons to strengthen her voice.
“Her soft palette in the back of her mouth doesn’t shut down when she wants to talk as opposed to when she wants to breathe,” Bill said. “She has trouble getting air out of her mouth when she talks. It comes through her nose.”
Prior to the accident, Amy played the clarinet, involved herself in clubs and was a natural athlete who ran track and played basketball and field hockey.
“I was busy,” she said.
During alumnae weekend at Dickenson College, she played a game of field hockey with the permission of her physical therapist, Kathy Walsh — so long as she wore a helmet.
“It was awesome,” she said enthusiastically. “I miss it.”
In spite of her physical limitations and continuous therapies, Amy still keeps active. She is a volunteer for Meals on Wheels and takes aerobic classes twice a week.
Since July, she has been writing an autobiography she hopes to have published so she can help other families dealing with similar situations.
“It doesn’t bother me,” she said about sharing her story with others.
In fact, Amy, who, as a sixth grade social studies teacher, taught emotionally disturbed children, now wants to be a counselor to help caregivers and others with TBI.
“I go to this day program here in Auburn, and I see people who have brain injuries and they just kind of give up,” she said. “It’s hard to see.”
“She wanted to get well,” Patty said, attributing a good portion of her recovery to Amy’s own desire and will. “She was a fighter.”
When asked how the family found strength during this trial, Patty said it was through faith and prayers. Bill said you can’t look back, you can only move forward to find peace.
The three even met and forgave the driver, Robertson, whom they said apologized in court.
“It’s a mistake,” Amy said, with all sincerity. “People make those kinds of mistakes.”
Traumatic Brain Injury Waiver is a government-run, statewide program that helps families and individuals with TBI. New York, like many other states, has found that it’s much less expensive to provide services for brain injured people at home, instead of at an institution.
Eligibility depends on the person and their home situations. For instance, a person must qualify for Medicaid, which for Amy was immediate since she suddenly became unemployed.
Medical staff comes to the house to evaluate the person with TBI, and make safety modifications to the home — which are fully funded through the program.
For Amy, an aid and an independent living skills trainer visit at least once a week.
“This is a beautiful program because it allows someone the ability to be home with their family without the financial hardship of these modifications,” Amy wrote in a chapter of her autobiography. “It was a blessing to us.”
Traumatic Brain Injury is defined as a biochemical insult to the brain that was caused by an external force. Injuries can be mild and transient or severe and life-threatening, such as the case with Amy. In severe cases, TBI can be fatal or result in significant and even permanent changes to neurocognitive functioning.
“Depending on what parts of the brain were most affected by the trauma, impairments in speech, memory, attention and other cognitive processes can occur,” said Dr. James Mikesell of St. Camillus Health & Rehabilitation Center.
“At times there can be dramatic changes in mood, personality and alterations to the sleep-wake cycle as well.”
Since severe cases of TBI are caused by accidents, Mikesell said the most effective step in prevention is common safety precautions, such as the use of seatbelts, child safety seats, and wearing helmets when using motorcycles, bicycles, in-line skates, and even skiing. One of the most effective methods of preventing TBI in the elderly is to modify common living areas to prevent falls.
Who are most at risk for TBI?
A number of demographic factors determine the risk for TBI, such as age, gender, ethnicity, substance use, previous TBI and other socioeconomic variables, Mikesell said.
“Individuals age 15 to 24 are at the greatest risk for TBI, and males outnumber females about 2:1,” he added. “The Mayo Clinic reported that individuals who experienced an initial TBI are about three times more at risk for another TBI, and that the risk of a third TBI after the second may be as much as eight times greater.”
St. Camillus Health & Rehabilitation Center provides treatment for patients who typically have had a more severe TBI, many of whom arrive from an acute care hospital to the 20-bed Inpatient Brain Injury Rehabilitation program.
Others receive services in the Day Health or Outpatient Brain Injury program.
Services are provided by a multidisciplinary team, Mikesell said, adding the rate at which a patient will recover or improve after TBI depends on the severity of the injury, as well as other factors such as age or the presence of other medical conditions.
Mikesell said families are an integral part in the treatment of TBI and should be as involved as possible.
“Involvement can take the form of visits, professional case consultation, participation in family meetings and attending various therapies,” he said. “Family members can help the treatment team better understand their loved one, and should also work to become close collaborators with the multidisciplinary treatment team in order to better understand the goals and expectations for treatment and for discharge.”
For more information on TBI, visit the National Institute of Health and the Centers for Disease Control at ninds.nih.gov/disorders/tbi/tbi.htm and cdc.gov/TraumaticBrainInjury/index.html. Also visit the Brain Injury Association of New York at bianys.org.
What are the signs and symptoms of TBI?
Symptoms of mild TBI include:
Low-grade headache that won’t go away
Having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks or making decisions and solving problems
Slowness in thinking, speaking, acting or reading
Getting lost or easily confused
Feeling tired all the time, lack of energy or motivation
Change in sleep pattern — sleeping much longer than before, having trouble sleeping
Loss of balance, feeling light-headed or dizzy
Increased sensitivity to sounds, lights, distractions
Blurred vision or eyes that tire easily
Loss of sense of taste or smell
Ringing in the ears
Change in sexual drive
Mood changes like feeling sad, anxious or listless, or becoming easily irritated or angry for little or no reason
A person with moderate or server TBI may show the symptoms listed above, but may also have:
A headache that gets worse or does not go away
Repeated vomiting or nausea
Convulsions or seizures
Inability to wake up from sleep
Dilation of one or both pupils
Weakness or numbness in the arms or legs
Loss of coordination
Increased confusion, restlessness or agitation
Source: US Department of Health and Human Services, Centers for Disease Control and Prevention