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Celebrating Occupational Therapy Month

April is Occupational Therapy Month and at Special Tree we’re celebrating the many ways our Occupational Therapists (OTs) and Occupational Therapy Assistants (COTA) help our clients to become as independent as possible in their daily life.

Occupational therapy is an integral part of the rehabilitation process because it focuses on the activities and tasks we do on a daily basis for our self-care, work, and leisure.  Special Tree's OTs and COTAs provide the therapeutic interventions to help our clients perform these daily activities in a more functional, successful, and independent way.   The OT team is involved in every phase of recovery from helping clients and/or their caregivers learn basic tasks like dressing, bathing, and eating, all the way through returning to work, home management, and driving.   In addition to helping clients regain meaningful everyday living skills, OTs and COTAs also specialize in vision therapy and sensory integration therapy to address visual perception and sensory issues that are common after a TBI.

We asked Special Tree's Ursula Kotzabassi to share her thoughts on being an Occupational Therapist.

Why did you decide to become an OT?

I was a college student at Eastern Michigan University and I hadn't chosen a major yet, but knew I wanted to do something to help people. I started investigating different types of therapy professions and found that occupational therapy fit best with my personality and the way I wanted to help people. I talked to a friend whose mother had had a stroke when we were in elementary school and learned about her experience receiving occupational therapy. She had to relearn how to care for herself and her family and went on to live an independent and fulfilling life. After that I decided that I wanted to help other people do the same.

What is the most rewarding part of your job?

When people realize they are still capable of doing things for themselves and for others in the face of losing nearly everything. I am excited about my job and the possibilities that exist to help people achieve independence to do the things that they want to and need to do.

What is the most important thing you’ve learned from clients?

Try not to take things for granted, life can change in a matter of seconds. Be open, flexible, stay positive and learn to adapt to situations as they change. Growth can come from adversity, but it takes time and the right mindset.

What do you like to do outside of work?

I love spending time with my family and friends: sharing a meal, watching a movie, playing board games or just talking. My second job is co-parenting a loving and rambunctious 3 year old boy, a geriatric great dane, two ridiculously playful kittens and a handful of well-behaved saltwater fish. I'd love to try some new hobbies so if you have a suggestion come find me in therapy!

Introducing Synchrony: Break Through Technology for Speech and Swallowing


After a brain injury, a person may have to learn to do many things all over again, including eating, drinking, and talking. At Special Tree we’re excited to announce our use of a revolutionary new device called Synchrony, which helps with speech and swallowing.Guided by Special Tree's experienced Speech Language Pathologists specially trained to use Synchrony, the device uses evidence-based protocols, a revolutionary new sEMG Biofeedback system, and ACP’s proven “PENS” e-stim technology to help clients with dysphagia. Common after brain injury, dysphagia is difficulty or discomfort when swalling; when it takes a person more time or effort to move food or liquid from the mouth to the stomach. Swallowing is critical to eating and drinking as well as talking. While we may not be conscious of it, we frequently swallow as a routine part of speaking.

“In rehabilitation, we’re trying to help the brain “remember” how to do things," explains therapist Lauren Garrisi, SLP. "We want to remap the wiring so the body does what it’s supposed to and in the right order." Garrisi goes on to explain that "for the first time with swallowing, we can base therapy on real time data.”  Synchrony helps therapists 'see' what’s happening in the body. In the past, therapists relied on what they could view from the outside, or on what clients were able to communicate to them. With Synchrony, they get real time information about exactly when the client is swallowing, or making certain movements with their mouth which impact speech.

The Syncrhony receives information via electrodes attached to the throught or cheeks which communicate with the device through blue tooth. Each time the patient swallows, it is shown on the screen through therapeutic exercises and games that are fun and engaging. Whether it is a bar graph going up and down or a kangaroo hopping up to capture treats each time the person swallows, Synchrony provides a very effective visual to actually see the swallow. For clients, seeing the swallow helps their brain make the connection and better understand what they need to do. Therapists can then reinforce the correct movements when they are shown on screen, rather than trying to explain verbally what to do.

Being able to swallow properly and speak properly can have a big impact on a person’s recovery and overall quality of life. “The Synchrony is helping us achieve better outcomes more quickly, and could even help some clients avoid more costly treatment," explains Garrisi. "We are excited to see the impact it will have as we begin using Synchrony in treatment with more and more people.”

Special Tree demonstrated the Synchrony on WDIV local 4 Live in the D with Chuck Gaidica and Tati Amare as part of Brain Injury Awareness Month. 


March is National Nutrition Month

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

March is National Nutrition Month and this year’s theme is “Savor the flavor of eating right.”  Consequently, loss of smell is a common symptom after traumatic brain injury (TBI), as well as taste. These two factors make a huge impact on what we eat and how we want our foods flavored.

Therefore many TBI clients want salty and spicy items. The 2015 Dietary Guidelines of Advisory Committee (DGAC) states that the average American should not get more than 2300 mg of salt a day. This can be difficult for most individuals since salt is hidden in many sweets, processed foods, and recipes. Ways we can try to reduce salts is by naturally increasing flavors with spices, herbs, and natural flavor enhancers such as ginger, garlic, lemon, jalapenos, and vinaigrettes.

To learn more about National Nutrition Month visit



ReWalk Opens Whole New World of Mobility for Client

Justin had been in a wheelchair almost five years from a spinal cord injury he sustained in a car accident when he came across an article that would change his life.  The article was about the ReWalk Exoskeleton, a robotic suit with motorized legs that’s helping people who are paralyzed to stand up-right and walk again.   Justin, the father of two young sons, never lost hope that he would walk again, but the discovery of the ReWalk turned hope into a fiery determination to get back on his feet.

Justin’s quest to get a ReWalk would bring him and his mother, Shelly, to Special Tree Rehabilitation System, one of only three rehabilitation providers in Michigan certified for ReWalk training.  Special Tree’s Physical Therapists began screening potential ReWalk candidates last summer and Justin was the first to meet all of the physical and medical requirements, including getting approval from his insurance company to fund the costly device and the required 30-40 therapy training sessions.

Justin’s ReWalk™ Personal System represents the next generation of exoskeleton technology that was first introduced in 2010 by Israeli engineer Dr. Amit Goffer.  Designed for everyday use, the ReWalk enables Justin to sit, stand, and turn, and can be used at home and in the community on different surfaces and terrains with a companion.  Developing the strength and balance to use the 50-pound exoskeleton in a variety of environments is why so many training sessions with Physical Therapists are necessary.

“It’s not so simple to use in the beginning,” said Special Tree Physical Therapist Jennifer Ratermann, who helped Justin take his first steps in the ReWalk back in September.  “Mastering the ReWalk takes hard work before being able to take one home.” 

Justin was up for the challenge.  For the next five months, Justin and his mom drove 80 miles to and from Special Tree three days a week for ReWalk “boot camp,” where he worked on everything from standing and sitting to opening doors and walking up and down ramps. 

“Justin is super motivated.  When he sets his mind to something for sure he’s going to accomplish it,” said Jackie Cunningham, another ReWalk certified Physical Therapist at Special Tree.  “It’s one of his best attributes and why he’s been so successful in using the ReWalk.”

But the ReWalk is giving Justin more than the ability to walk.  “It’s changed his whole outlook on life,” said his mom.  “It’s also been life changing for my grandsons.  They don’t remember when he could walk.  They can’t wait to walk around town with their Dad.  We’re all so proud of him.”

There’s also many physical benefits of using the ReWalk.  Based on data collected by ReWalk, the system helps cardiovascular health, loss of fat tissue, building of lean muscle mass, and improved bowel function.  These improvements can result in better pain management, fewer medications, and potentially reduced hospitalizations.

On March 3rd, Justin graduated from boot camp with flying colors -- demonstrating his mastery of a long checklist of skills before taking the ReWalk home. 

“The ReWalk has changed my life,” said Justin.  “I can regain my independence and walk with my kids again.”



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:

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.