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Healthy Bites from Special Tree's Registered Dietitian

by Brahmlin Sethi, RD, CBIS, Special Tree Rehabilitation System

Since 1990 National Nutrition Monitoring and Related Research Act stated that every 5 years Dietary Guidelines for general public would be required to be published jointly by U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA). The guidelines focused on encouraging healthy eating patterns, on healthy eating habits over time, a variety of nutrient dense foods in moderation, limiting salt, sugar, and saturated fat calories, and low calorie beverages, and working in community to support healthy eating habits for all.

The top 8 takeaways from the 2015 Dietary Guidelines Advisory Committee (DGAC)

Same ol’ story – Intake of fruits and vegetables remains low while salt is still over consumed.  Dietary sodium recommendations stayed at 2300 mg per day while saturated fats increased to less than 10 percent of total calories per day from the previous recommendation of less than 7 percent.  Encourage fruits, vegetables, whole grains, legumes, seafood, and low fat dairy products.

Don’t hold back- 2015 DGAC used subtle but direct language regarding the state of health for average Americans. The frightening statics painted a picture of one or more preventable chronic diseases that could be changed drastically with individual behaviors regarding nutrition and physical activity.

New bad boy on the play ground – DGAC recommends no more than 10 percent of total calories from added dietary sugars in the form of sweetened beverages, refined grains, sweets and desserts. Low calorie sweeteners should be reduced while sugar sweetened drinks to be substituted by water. Food labels to include “added sugars” label to the Nutrition Facts Panel. The committee wants to place taxes on these items but already getting some resistance to this suggestion. 

The ugly truth – First time a complete chapter dedicated to sustainability. Three diets were recommended; Healthy U.S. style plan, Healthy Mediterranean style plan, and Healthy vegetarian plan since these have the lowest amount of effects on the environment and beneficial health outcomes.  Moderate amount of fish consumption is recommended since health benefits outweigh mercury and pollutants.  Coffee consumption in moderation (3-5 cups per day) is not shown to have long term health risks but the added calories in milk, sugar, and cream could minimize the effects of coffee.  Energy drinks and alcohol should not be consumed together and children should limit or avoid caffeine consumption.

Hello/goodbye- Removed the 300mg/day cholesterol recommendation and instead advising Americans to continue to monitor dietary cholesterol intake but not adding limits to the amounts. This is a controversial topic since other health organizations believe this is still an issue.

Grab the reigns- Placed the responsibility on consumers by encouraging home cooked meals, reduce screen time, reduce frequency of eating out, and educate on healthy lifestyle interventions.

Sip don’t chug- Moderate levels of alcohol (1 serving for women and 2 servings for men a day) are recommended). Disclaimer: some health benefits associated with drinking the recommended amount but if you do not drink then do NOT start drinking.  Higher alcohol consumption has increased associated risk of violence, drowning, injuries from falls and motor vehicle crashes.

Paradigm shifts - Pushing programs and policies for health care - federal nutrition assistance programs, including Food Stamps (the Supplemental Nutrition Assistance Program), should be aligned with the Dietary Guidelines

Chili Cook-Off Highlights Healthy Cooking at Community Residences

Residential and Day Treatment Services staff had a chance to show off their healthy cooking skills at Special Tree’s 7th annual Soup Contest, organized by Registered Dietitians Jill Bruce and Brahmlin Sethi.  This year, the popular contest was a Chili Cook-Off and is an extension of the quarterly food service trainings that Jill and Brahmlin conduct for direct care staff to help them serve up healthy, high quality meals for clients at Special Tree’s 18 Community Residences as well as the Wayne and Troy DTS programs. Representatives from each facility participate in the highly competitive contest held at the NeuroCare Campus and the Troy Neuro Skills Center on March 10th.  To decide the winner, staff sample entries to vote for the best tasting as well as for best presentation.   Each chili is also judged on a nutritional score from Jill and Brahmin, who also factor in client involvement.

This year’s entries were all low on sodium and fat, but big on taste. Trevino’s Hawaiin Chili was a crowd favorite with healthy ingredients like turkey sausage, fresh pineapple, and black beans.  Staff also enjoyed Troy DTS's Delightful Chili.  "We put all our heart and soul in making it so that’s why it’s delightful,” said DTS staff Stephie Hill.  Others cooked up family recipes like mother and daughter Moravian RSTs Sarah and Chelsea Warick’s Bronco Buster Buckaroo Chili.   

Jill and Brahmlin are still in the process of adding up the scores, but to Jill everyone who participated was a winner.  “The chilis were all delicious, healthy and there was a great variety and many wonderful presentations. Thanks to everyone who participated!”  

Special Tree's Team-Based Care Model Takes the Spotlight


Teamwork is key to helping our clients achieve the best outcomes possible after a brain injury, spinal cord injury, or other major trauma.  At Special Tree, case managers, physicians, rehabilitation professionals, and countless others all work closely together to provide person-centered care throughout every phase of recovery.  Our team-based approach to rehabilitation was recently featured in an article by the Michigan Health Council, a local organization that's spreading the word to Michigan care providers on the big impact that a team-based care model can have in the workplace.   In the article, Special Tree's Lela Hickonbottom, Chief Nursing Officer, explains how Special Tree's team-based model works and why it's critical to our whole-person approach to rehabilitation which encompasses the body, mind, spirit, and heart.

Read more at:

http://education2practice.org/2016/02/29/teaming-up-to-overcome-neurological-traumatic-injuries-with-personalized-care-in-se-michigan/

Q & A with Nicole Mauer, Special Tree Social Worker

March is Social Worker Appreciation Month and a great time to say thanks to Special Tree's social workers for all they do to improve the lives and well-being of our clients and their families.  Social workers provide a wide range of important supports and services throughout the entire rehabilitaiton process including case management; individual, family, and group counseling; community support; discharge planning, and more.  We asked Special Tree Social Worker Nicole Mauer to shed some light on why social workers are critical to healing and recovery from a brain injury, spinal cord injury, or other trauma.    Nicole provides social work services at Special Tree's Midland Neuro Skills Center and Saginaw Outpatient Clinic including facilitating a monthly brain injury support group (pictured above at various community outtings).

How do Special Tree social workers support our clients?

We help support the clients and their families adjust to the changes that occur after a brain injury or spinal cord injury. We address the emotional, social, spiritual and physical changes in their lives and help clients to adjust, accept, and find their strengths and supports.   We help clients with goal adjustment or to assist them as needed with creating new life goals. We empower clients to find their voices and the courage they need to become survivors and overcome their obstacles.  We help client’s navigate the system for the resources that they may need for their unique situations. We connect clients to clients to help create peer support and social and leisure opportunities. We provide ongoing education to clients and their families on Brain Injury, Spinal cord Injury as well as multiple other educational components that can be secondary to TBI and Spinal Cord Injury pending on the individuals’ unique situation. We provide coordination of treatment with the other therapies that the clients may be receiving, such as Physical therapy, Occupational therapy, Speech Therapy, Massage Therapy, Recreational Therapy and Vocational therapy. We provide assessment and clinical treatment to address emotional, cognitive and behavioral challenges as well as connect clients with other referrals to help them reach their rehabilitation goals.

How did you get into social work?

The renowned author Shannon L. Alder once said, “Your perspective on life comes from the cage you were held captive in.” In my adolescent years, I was placed in many different environments where I experienced humanity and inhumanity alike. From a young age, I learned that showing compassion and being fully present with someone can change and even save lives.

I was very blessed to have had two selfless Social workers early on who helped me navigate the system, jump through the hoops, who “listened” and who empowered me to find my voice. When I graduated from college, I received a note from one of them, that said, “Finally! it’s about time, now I can retire”- that touches me to this day to know how genuinely they cared.

I can’t say the path to getting into Social work was full of lollipops and rainbows, however it was the path that I needed to be on to discover that being a Social Worker and helping people is my life reward. 

What do you like best about your job?

The passion that I have for Social work always pushes me to continue with my personal and professional growth.  Special Tree has been very supportive in providing me with training and educational opportunities so I am able to continue to improve upon my skills to better serve my clients.

What is the most rewarding aspect about your job?

I feel privileged to be able to work closely with clients, to help them build on their strengths and to be part of a team (Physical Therapy, Occupational Therapy, Recreational Therapy, Vocational Therapy, Psychology, Speech Therapy, and Case Management) that truly makes a contribution to an improvement in their lives.

What is the most important thing that you have learned from clients?

I have learned many things from my clients over the years.  Some that come to mind are:

-I have learned that sometimes you have to just let go and accept what is.

-I have learned that everyone’s story is unique and that we all have the choice to create our own story and edit and change it and live it as our truth, rather than just sitting stolid and waiting for life to happen.

-I have learned that a relationship based on genuine empathy and trust is what helps clients feel empowered to do the work that they need to do.

 

 

 

 

 

 

 

 

 

 

A Place to Grow

Both plants and clients thrive in Special Tree's therapeutic greenhouse.

Just next door to Special Tree's NeuroCare Center in Romulus, Michigan is another healing center where you'll find therapy tools in the form of spades, watering cans, and pots full of dirt.  Special Tree's 1,700 square-foot greenhouse is not only brimming with tropical plants, herbs, and vegetables but with the therapeutic benefits it provides to persons recoverying from brain and spinal cord injuries.  Greenhouse gardening stimulates the senses, strengthens muscles, improves coordination, builds vocational skills, encourages friendship, brightens spirits, and most importantly, inspires hope.  Watch this video to learn more about the unique features and therapeutic programs that make the greenhouse a truly special place for healing. 
 

 

The Importance of Recreational Therapy After Brain Injury

by Grace DeMuch, CTRS, CBIS, Special Tree Recreational Therapist

February is National Therapeutic Recreation Month.   It’s not uncommon to hear the response, “What is a Recreational Therapist?”  This is the perfect time to provide an answer to that question!   ATRA (American Therapeutic Recreation Association) provides the following definition:  Therapeutic Recreation/Recreational Therapy “is a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.”    Potential goals may be to improve motor skills, cognitive functioning, social skills, learn coping skills, improve accessibility of activities, and community re-integration. 

Therapeutic Recreation is an important service for a person who has sustained a Traumatic Brain Injury.   A person may experience various lifestyle changes which may include a decrease in leisure participation, increase in free time, loss of income, decrease in social skills which affects old friendships and establishing new ones, a shift to more sedentary activities, and less social activities.  Experiencing these changes can have a negative impact on life satisfaction.Using meaningful, functional, and satisfying activities/ interventions to address lifestyle changes and deficits sustained from a TBI can affect the recovery process in a positive way as it pertains to improving participation and life satisfaction.  Therapeutic Recreation goes hand in hand with the Special Tree approach to rehabilitation which encompasses the mind, body, heart, and spirit.

Spotlight on Success: Aaron's Story

 

When Special Tree’s Vocational Arts Program began in 2014, client Aaron L. was skeptical about participating. He’d always wanted to try painting, but worried that he couldn’t hold a brush steady due to severe hand tremors that resulted from a brain injury he sustained in 2008. “I wasn’t sure what I could do.”

But all that changed when Aaron finally worked up the courage to give it a try. “I really surprised myself by how much I love to paint,” he said. Program coordinator Ed Meese, who is also a professional artist, showed him techniques for controlling the brush and also tricks of the trade to draw straight lines. “Ed made it easy to figure out how to paint.” Aaron paints twice a week in Special Tree’s art studio, but also spends many hours painting on his own and researching future works. “I enjoy it because it eases my mind and helps me focus.”

Not only is painting having a positive impact on Aaron, it’s also helping him to earn a paycheck.

According to Meese, Special Tree’s Vocational Arts Program is unique because it combines the therapeutic benefits of art -making in a vocational rehabilitation setting. “Through the process of creating art, clients like Aaron experience self-expression and a sense of accomplishment while also developing concrete skills for future employment in the community.” Clients have the opportunity to earn an hourly wage during their time in the studio and to sell their work at local art fairs and online throughout the year. And because the program is therapeutically-based, it can be tailored to meet each participant’s needs, interests, and skills.

Since participating in the program, Meese and others have seen big changes in Aaron. “Aaron’s communication and social skills have greatly improved,” said Meese. “He can dialog about his art and when he makes a mistake or when someone doesn’t like his work, he doesn’t let it upset him.” Brooke Parker who works with Aaron in Special Tree’s Day Treatment Services feels that art enhances his quality of life and improves his outlook. “It’s really opened him up. He’s good at it and it’s something personal that he gets to make.”

Aaron also participates in other paid work experiences at Special Tree’s Industrial Operations Center in Wayne and the greenhouse at the NeuroCare Center in Romulus. He would like to eventually work in the community, but for now he’s working hard on improving skills, building self-confidence, and making art.

 

 

Go Team!

Special Tree is delighted to earn another spot on the Detroit Free Press 2015 Top Workplaces list for the
sixth straight year.

The list, published in a special section of the Freep on November 22, 2015, recognizes the top 100 Michigan
companies and is based entirely on how employees feel about their workplace. Special Tree staff members
were among thousands of employees in Michigan who took an independent survey to rate their company’s
performance on direction, execution, career, conditions, managers, and pay & benefits. High survey scores
and positive written comments from staff members helped Special Tree to rank #20 in the large-employer
category. Our staff’s survey comments praised Special Tree’s leadership, caring work environment, staff
training program, and strong teamwork.

“It’s truly an honor that our staff continues to recognize Special Tree as a Top Workplace year after year,”
said Kate McClain,Director of Workforce Engagement. “It reinforces our efforts to create an environment
where people give their very best and feel their work is important and valuable."

Client is Back on the Airwaves with the Right Mix of Supports

We’re so proud of Kevin, aka DJ Polo, who is back on the air at FM 98 WJLB, Detroit’s top-rated hip-hop and R & B station, after a long recovery from a brain injury he sustained in 2011.

For many Special Tree clients like Kevin, returning to work is an important part of the rehabilitation process.  Whether it’s returning to a former profession, exploring new jobs in the community, or developing job skills in a supported work-environment, Special Tree supports our clients’ employment goals with a wide range of vocational rehabilitation services that are customized to meet their specific needs, interests, and skills.

After two years of intensive rehabilitation at Special Tree, Kevin started working with Special Tree Vocational Specialists to help him return to his job at WJLB, where he was a popular DJ.  “Kevin had made big strides in his recovery, but still had challenges to overcome to make a successful transition back to the station,” said Rene Dell, Associate Director of Vocational Services.

According to Rene, the key to achieving the best employment outcomes for clients is having a very clear picture of each person’s strengths, skills, interests, and capabilities. “We make sure to ask clients all the right questions during our vocational assessments so we can customize a rehabilitation plan that meets their specific needs and goals,” she said.

With Kevin’s input, the team crafted his rehabilitation plan to include one-on-one vocational counseling as well as a job coach at the radio station to provide the right mix of supports to get him back on the air and doing what he does best.

Prior to his injury, Kevin’s job was making DJ mixes for radio play, which he now found difficult.  “Kevin basically had to start from scratch to relearn every step of the mixing process,” said Job Coach Sara Lunsten-Allingham, who accompanied Kevin to the station once a week to practice in the studio.  To support Kevin, Sara learned all she could about mixing and works regularly with both Kevin and Kim James, WJLB DJ Supervisor. “It was frustrating but Special Tree helped me a lot,” said Kevin. “I also learned by listening to my co-worker’s mixes, they’re pretty good.”

It was a long process, but after a year Kevin was recording mixes for the station part-time with minimal support from Sara and Kim.  Kevin’s mixes got better and better and in 2014, he started mixing for a weekly show on WJLB on Saturdays from 10pm – 2am, now ranked as the top radio show in Detroit during the timeslot.  Tune in!

 

George's Story

George G’s song began when he took an interest in music at just five-years-old, and that song has been with him ever since.

From church to school, George played his trumpet everywhere. He was devoted to the instrument, and when it came time to select a place of higher learning, he enrolled at the University of Michigan, managing to enter the competitive Michigan Marching Band. All the while, continuously scoring high grades towards his Aerospace Engineering degree.

One day, in the summer of George’s freshman year in 2011, the music stopped.

“I was on my way to help my dad with a tire change on the highway when the accident happened,” said George. “My car hit the side of a trailer, which flipped a Bobcat earth mover onto my car. By that time my dad already got help. He was retracing my route because I didn’t pick up my phone and actually came across the scene of the accident.”

Critically-injured, George was airlifted to a nearby hospital where medical scans revealed multiple fractures, including a shattered arm and extensive leg injuries.  When George’s cognitive functioning began to rapidly decline a week later, he was diagnosed with a severe brain injury.  After undergoing 10 surgeries, including two brain surgeries, and intensive sub-acute rehabilitation, George was discharged from the hospital to begin the next phase of his recovery at an inpatient facility.

His family’s search for high quality neurorehabilitation and care led them to Special Tree’s NeuroCare Campus in Romulus, where George was transferred in November 2011.

 “We were so fortunate to find Special Tree,” said Connie G., George’s mother.   “I remember another young man who was admitted to the hospital at about the same time as George, and he didn’t have the same options that we did because he was not in Michigan when he was injured. That young man’s recovery was very different because he wasn’t able to go to a place like Special Tree.”

When George arrived at Special Tree, he was still on a ventilator and in a state of waking sleep.  He maintained basic motor skills like standing with assistance, but had little cognitive awareness. To help George achieve the best outcome possible, Special Tree’s highly specialized therapy team developed an integrated rehabilitation plan that addressed his specific needs and care.  Therapists also assured George’s family that everyone would need to work together as a team – family and Special Tree staff – to help George through his recovery.

“That was so comforting to hear, especially after little stumbles or incidents,” said Connie. “I had no idea how much therapists did here. The speech therapists helped him do more than just speech – they helped him learn to swallow and tolerate water and food.”

With the right rehabilitation plan in place and a strong circle of support, George made steady progress in his recovery, and finally regained cognitive awareness during a physical therapy session in the Spring of 2012.   However, he was now painfully sensitive to light, touch, and sounds which interfered with his rehabilitation.   “When you have a brain injury, the way you respond to tactile sensation can be confusing.  Things that are normally not interpreted as painful like pressure, can be interpreted by the brain as painful,” said Gavin Milner, Physical Therapist.

Therapists slowly increased George’s tolerance to stimuli through sensory integration therapy to help reduce constant pain and discomfort.  With his sensory challenges under control, George was able to fully participate in Special Tree’s wide range of rehabilitation services and programs including inpatient, outpatient, residential, day treatment, and vocational rehabilitation.

George was now more determined that ever to get better and impressed everyone at Special Tree with his drive to do whatever was needed to accomplish his therapy goals.  “Whether it was building back his ability to use his hand or improve his memory and attention, George was always ready for anything,“ said Milner.  So when the Michigan Marching Band invited him back to play trumpet as a volunteer, he accepted without hesitation.  George’s song was beginning once again.  With just a few months to prepare for the band’s grueling summer practices, George and his multi-disciplinary team worked closely together to improve the skills he’d need to be successful at band camp including endurance, strength, coordination, concentration, and memory.

“George’s doctor signed off on the camp thinking it would be a few hours a day, but he ended practicing from 8 a.m. to 10 p.m. and did great,”  said Connie.  “He’s very serious about it and that focus helped bring his concentration back. One time a bee managed to fly up his pant leg while he was marching, but he didn’t stop to swat it, even after it stung him. He just kept marching and playing.”

By the fall of 2014, George had made such great strides in his recovery that he was discharged from Special Tree, although he’s the first to say that his recovery is ongoing and long-term.   He now attends Washtenaw Community College with the hopes of one day rejoining his peers at the University of Michigan and is still an active participant in the Michigan Marching Band.

“You have to remain hopeful and never give up on what you want to do,” said George. “At first my mom had to help me when I moved around the house, but now I can walk around like it was nothing. The thing is that you have to stick with it and keep going. It might seem like a long time, and it is, but in the greater sense it’s not. I can’t believe it’s been four years, but you just can’t ever give up.”

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