THE NOGGIN

The mind-body connection Project Independence and Empowerment grant allows

BIAAZ members to take Brain Gym® classes for free

By Christina Sampson, Editor

At the Viginia G. Piper Sports and Fitness Center for Persons with Disabilities, usually called SpoFit, Kathy Brown and Mary Ann Beebe, licensed Brain

Gym® instructor/consultants, faced six people of varying physical ability. The Thursday evening class had already completed the “pace” warm-up from the Brain Gym® program, a set of four movements that support the mind-body system in becoming more Pos-itive, Active, Clear, and Energetic. Mary Ann helped the class participants select from a bin filled with mini bas-ketballs, large foam paddles, rubber balls and other sports equipment, encour-aging everyone to use whatever they chose in a way comfortable for them. As everyone spread out in the group fitness room, bouncing, catching, tossing or paddling, she invited everyone to imagine that the equipment they were using represented an area of their life they wanted to improve, something they wished was easier. One woman, Stephanie, tossed a palm-sized bean bag back and forth with Kathy. Drew Bolender, an engaging 36-year-old who is a Brain Gym regular, used a flexible, mesh hand paddle to toss a small ball back-and-forth with his brother, John. Chris, who is blind, stood and bounces a mini basketball back and forth with Mary Ann. After about a minute, Kathy challenged everyone to make their activity a bit more difficult. I had chosen to dribble a mini basketball with one hand, so I switch from my right, dominant hand to my left.

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The Brain Injury Alliance of Arizona (BIAAZ) is a nonprofit organization dedicated to preventing brain injuries and to im-

proving the lives of individuals with brain injuries through prevention, education, information, and community support.

Brain Injury Alliance of Arizona Newsletter

October 2015 Vol. 1 Issue 5

In this Issue Inside a Brain

Gym class

Courtney Carver, BIAAZ’s neuro social worker, brings BIAAZ to northern Arizona

ADA Matters: A call for walkable communities

Rehab Ready: Physical Thera-pist Monica Idstein

The Gavel: Get-ting care after the hospital

The Mobility Fitness Institute Fills a fitness gap for Tucson’s disabled

Brain Gym® participants Chris and his

caregiver, Mary Ann, work on “Noticing”

during a recent session at SpoFit.

From Executive Director Carrie Collins-Fadell This is my first fall in Arizona and I am still awed by how beautiful this state is and the friendliness of the people who live here. I have enjoyed get-ting to know so many of you over my first six months as the new executive director of the Brian injury Alliance of Arizona. If I haven’t had the chance to meet you yet, I hope you will reach out to me or join us at one of the Brain Injury Alli-ance of Arizona’s signature events.

I am so grateful to our members, survivors, spon-sors and community partners who continue to al-low the organization to grow and thrive. The larger we grow, the more people we can serve through connections to community resources, education on brain injury prevention, and em-power through activities and events.

Speaking of growth, check out the profile on Courtney Carver, our new neuro social worker, who is bringing BIAAZ to northern Arizona. Down south in Tucson, our new community part-ner, The Mobility Fitness Institute, is in the process of becoming part of our ever-growing re-source database. The Mobility Fitness Institute is an incredible facility that takes people with disabilities a step farther than traditional physical therapy with equipment specifically designed for people in wheelchairs or with mobility issues. The story of how the innovative gym came to be is an inspiring one you’ll find in this month’s issue as well. And, you’ll read about one of our regular classes offered free to members through a Project Independence and Empowerment Grant, Brain Gym. Finally, you’ll meet Monical Idstein, a physical therapist at SWAN Reha-bilitation in our Rehab Ready section.

If you are a professional interested in providing quality care to those impacted by brain injury, please join us for our third annual professionals conference on November 13th in Phoe-nix. There will be a keynote by Dr. Alex Hishaw, the Medical Director of Polytrauma at the Southern Arizona Veterans Administration and an Assistant Professor of Neurology and Psy-chiatry through the University of Arizona Health Sciences Center. The conference also features a luncheon with traumatic brain injury survivor, Ali Wallace, Miss Oregon 2015 and a survi-vor’s panel with Allie and Evan Marshall.

If you are a longtime participant of our survivor and family conference, the Rays of Hope: Sur-vivor & Family Conference will take place in Phoenix on May 13, 2016.

As always, it’ll be busy at BIAAZ, but that’s just how we like it. I can’t wait to see you at one of our great events.

Carrie Collins-Fadell

Continued from page 1…

Unsurprisingly, my dribbling becomes harder to control and I often have to lunge or reach for the ball. Kathy paused everyone to ask, “How are you doing? What do you notice is working well? What do you wish was easier about it?” Then Kathy and Mary Ann invited everyone to put down their equipment and return to their seats. They showed everyone a large poster of four Brain Gym activities, that day’s “Learning Menu.” They asked if anyone could tell “which one we should do first,” and taught it to the group, modifying where neces-sary to accommodate people’s specific challenges. Eventually, we completed all four of the movements on the poster. One, the Double Doodle, calls for “drawing” mirror-image shapes in the air using both hands. The ac-tivity calls on both brain hemispheres simultaneously, encouraging them to coordinate and “team.” In another movement called Earth Buttons, we stood with fingers of one hand resting under the lower lip while the other palm covers the navel. Then the hands are switched. This activity supports our ability to feel grounded. After the four movements, everyone resumed their earlier activity with the sports equipment. Several people, myself included, found the activity easier to do. Dribbling with my left hand was no longer any more difficult than my right. “I kept the ball more when bouncing it,” Chris said. He added that after the movements, it was easier for him to track where the ball was. “It’s because you taught your brain a new pattern,” Kathy said. “You’ve created a balanced pattern in the brain where there was confusion before.”

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Mary Ann Beebe, left, and Kathy Brown, right, lead a Brain Gym session at SpoFit. The movements

help improve thought patterns in the brain and have helped people with everything from reading to

overcoming their fears. BIAAZ members may attend Brain Gym free thanks to a Project Independ-

ence Empowerment grant.

Continued from previous page… The mind-body connection Brain Gym is the entry-level program of a much larger disci-pline called Educational Kinesiology, or Edu-K, the study of how specific physical movements, done with focused intention, can improve physical coordination, emotional balance, cognitive function, and more. Edu-K and Brain Gym were developed in the 1970s by Paul E. Dennison, Ph.D., and his wife Gail Dennison. The Dennisons began by developing movement protocols to help both children and adults who had learning challenges, eventually realizing it could benefit just about everyone. Today, Brain Gym is taught all over the world.

It helps people of all ages in an incredibly wide array of areas, from overcoming a fear of public speaking to learning how to read to complementing physical therapy regimens.

One of Kathy’s private clients used Brain Gym when she was learning to fly a helicopter to help her with hovering, the only skill that gave her difficulty. After one session, Kathy’s client told her that her ability to hover the helicopter improved. In the client’s next lesson, she hov-ered perfectly. Mary Ann Beebe described Brain Gym as “intentional movement” that leads to “a higher level of daily function.” You don’t need to convince Drew of Brain Gym’s efficacy. He’s been attending classes for about a year and a half. “I give it 10 out of 10 stars,” he said, smiling. “It helps me focus here and at school,” he said. John said it has helped Drew deal better with frustrations during phys-ical and occupational therapy sessions. “It keeps me calm,” Drew said. Drew uses a rolling gait chair to get around, but since the Brain Gym movements are adaptable, he still participates in every activity and movement.

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Drew Bolender said Brain Gym

has improved his focus. over a

year. The Brain Gym session like the one described in this article typically includes a sequence of activities called a “Learning Adventure.” It consists of three simple steps: Inviting everyone to do an activity that calls on physical coordination, and Noticing what’s easy about it and what’s challenging about it Choosing from a “Learning Menu” of Brain Gym movements. Then returning to the initial activity, and Noticing how it’s working now, paying attention to any changes in body awareness, coordination, or attitude.

Continued from previous page... He’s been trying to convince his girlfriend to attend classes with him. The path to Brain Gym

® Both Mary Ann and Kathy became Brain Gym in-structors after experiencing it for themselves. Mary Ann was first introduced to it in 2008 when her grandson was diagnosed with Attention-deficit/ Hy-peractivity Disorder, or ADHD. They both tried Brain Gym and Mary Ann said she “just fell in love with it right away.” It helped her grandson improve his focus and it helped her with stress management. Kathy was first introduced to Brain Gym 18 years ago after finishing a 23-year-long career as an elementary school teacher. A friend showed her one of the movements, which Kathy said helped her immediately “download” stress. Afterwards, “I wondered where it’s been my whole life,” Kathy said. But it was when she took her first class that Kathy said “the bells really started to go off.” “I was astonished at how simple it is,” Kathy said. “It doesn’t take much to see a big difference.” Although she had decades of teaching elementary school children, Brain Gym gave Kathy a new under-standing of children’s learning difficulties, where they stem from and how to actually overcome them.

For example, difficulties in reading or other activities may be due to lack of specific kinds of movement experiences, like crawling, or other activities that acti-vate both sides of the brain. Brain Gym helps people with basic movement pat-terns which in turn helps improve key cognitive and coordination skills. That being said, Brain Gym is not a “cure” or miracle solution for learning disabilities or physical limitations.

“Brain Gym is not a means of fixing peo-ple,” Kathy said.

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The Brain Injury Alliance of Arizona offers two Brain Gym classes a month for free to its members thanks to a Project Independence Empowerment grant. Classes are held in the Viginia G. Piper Sports and Fitness Center for Persons with Disabilitiess, located at 5031 E. Washing St., on the first Wednesday of the month at 1pm, and the third Tuesday at 5:30pm. Reminders are also posted regularly on BIAAZ’s social media, so be sure to check Facebook, Twitter, Google+ and LinkedIn as well for information about upcoming classes.

BRAIN GYM:

WHERE & WHEN

Mary Ann Beebe learned about Brain Gym when it was

used to help her grandson with ADHD.

Continued from previous page... “It’s a means of inviting people to change…and supporting any change they would like to make.” Still, for nearly 20 years now Kathy has held workshops in schools, personally consulted with individuals and witnessed countless peo-ple overcome fears and begin positive changes in their life. She has also written a book, Educate Y our Brain, that explains many of the movement protocols and what they do.

“If you start using it and really dedicate yourself to it, you will see changes,” Kathy said. Teaching Brain Gym is rewarding work. “I love the looks on people’s faces when they realize that they can now do something they have always wanted to do,” Kathy said. “I love watching the shifts and changes people make,” Mary Ann said. “Some have made some dramatic changes and it’s amazing to watch.” Kathy Brown, licensed Brain Gym instructor/consultant, contributed to this article. She also created the modified Brain Gym warm-up on the following page.

Kathy Brown, a retired elementary

school teacher, first discovered

Brain Gym when she did it herself.

Last month, we ran this powerful photo-graph of disability activists protesting for the Americans with Disability Act. The photograph was taken by Tari Hartman Squire, though it is often misattributed to Tom Olin.

Tari is not a profes-sional photographer, but happened to be there at this incredible moment in history and snap the photo. She has generously granted us permission to use the photo and we are planning a future interview with her to learn more about what it was like to be part of such a landmark moment.

Meet Courtney Carver BIAAZ’s new neuro social worker is blazing a trail to northern Arizona

Courtney Carver, a licensed neuro social worker and the newest ad-dition to the Brain Injury Alliance of Arizona staff, is an Arizona girl. With the exception of two living in Canada, Courtney has lived in Ari-zona her whole life.

Which makes her the perfect person to bring BIAAZ’s services to the northern part of the state.

“I absolutely love northern Arizona, but something that I see is there’s a lot of disconnect,” Courtney said. “There might be services, but people don’t know about them.”

Beginning in September, Courtney began traveling to Flagstaff, Pres-cott and surrounding areas to assess what services were already available to brain injury survivors and caregivers, educate profession-al and community leaders about what BIAAZ does and start filling any gaps.

“I would really love for us to expand,” Courtney said. “I would really love for us to be as well known in northern Arizona as we are here (in

Phoenix).”

Ultimately, Courtney’s goal is for “hospitals to be referring people to us like they do in the Valley (and) sur-vivors to just have support in that area and know that we’re there.”

It’s an ambitious scope of work, but Courtney’s hit the ground running. Already, she’s earned the nick-name “Courtney the Connector” from a vocational rehab specialist in the area.

To that end, one of Courtney’s current projects is forming a second support group in Prescott and a new one in Show Low.

When she’s not up north, Courtney is at the Brain Injury and Concussion Center at the Barrow Neurologi-cal Institute in Phoenix helping families and caregivers who have a loved one that recently sustained a brain injury. In addition to connecting them to the right resources, Courtney often councils family members and survivors.

“I find that often times survivors, their families and even their friends don’t understand what’s going on and I want them to know that there is somebody who wants to hear them, understand them, be there,” Courtney said.

Courtney originally planned to work with families and children, but while earning her graduate degree at Arizona State University did a year-long internship with BIAAZ and found it to be exceptionally fulfilling work.

“I realized I loved helping people in this situation,” Courtney said. “I love connecting them with the right services and knowing that I did something. And I just fell in love with the medical community, getting to work in the hospital setting sometimes, and understanding the brain more, it’s just very interesting. You’re always learning new things.”

As a social worker, Courtney is used to working one-on-one with people, but her position at BIAAZ allows her to do that as well as build programs and create services.

“I love it,” Courtney said. “It’s a really cool, different kind of job.”

Courtney earned her master’s degree from Arizona State University and her undergraduate degree in so-cial work from Northern Arizona University. In her free time she has, Courtney enjoys going out to eat, hiking and going to movies with her husband.

Courtney Carver, BIAAZ’s

new neuro-social worker.

Monica Idstein, the author of this article, is a physical therapist at Southwest Advanced Neurological (SWAN) Rehabilitation, an outpatient neurological clinic located in Phoenix. The mission statement of SWAN is to “create an environment of hope which enriches the quality of life of our clients’ and their families. We do this through our passion for clinical expertise, innovation, and considerate and compassionate care for survivors of stroke, brain injury and other neurological conditions.” SWAN rehab offers speech, physical, and occupational therapies to assist the rehabilitation process.

Monica Idstein, Phystical Therapist Physical therapy is a unique profession which helps individuals return

to their highest level of independence and function. Physical therapists

specialize in working with individuals of all ages and with a variety of

abilities and diagnoses.

Physical therapists are seen throughout the rehabilitation process in a

variety of settings. These include the hospital with acute/subacute rehab, skilled nursing/

extended care facilities, the home, a clinic for outpatient services, the school system, while in

hospice care, fitness centers with an emphasis on wellness, occupational environments, and

in federal agencies. A brain injury survivor will likely be evaluated by a physical therapist in the

hospital and can be recommended to further services within the hospital (acute/subacute re-

hab), at home (home health) or at an outpatient clinic depending on their needs.

After a brain injury, a physical therapist helps a person reach their optimal physical potential

by increasing their ability to perform daily tasks with assistance. This can include training on

bed mobility or the ability to rolling in bed and move from laying down to sitting up. Physical

therapists also teach transfers, or the ability to move from one surface to another. For exam-

ple, they may teach a client to sit from standing or move from the bed to the wheelchair. Bal-

ance and coordination are also important aspects of physical therapy whether the client is in

sitting, standing or walking. For those able, physical therapists work on gait training, with or

without assistive devices, to increase the person’s independence. For those who use a

wheelchair, physical therapists train the person on mobility, propulsion, and wheelchair skills.

All of these treatments are customized for the individual by the licensed physical therapist and

may include stretches and strengthening exercises.

If a person requires additional support to increase their independence, physical therapists

work with other specialists to order orthotics, braces and durable medical equipment including

canes, walkers, manual and power wheelchairs. After brain injury, it is important to find a

physical therapist and rehab team that is experienced in treating those with neurological con-

ditions. The Brain Injury Alliance of Arizona offers resources on finding therapy teams to fit

your individual needs.

Monica Idstein, PT, DPT

Physical Therapist,

SWAN Rehabilitation

Rehab Ready

Taking it to the next level in Tucson

The Mobility Fitness Institute gives people with disabilities a chance to do athletic performance training

Willie Caldwell, a former na-tional track and star champion, never expected to be the owner of the Mobility Fitness Institute, a gym specialized for people with disabilities, but now that he is, he loves it.

“I’ve been personal training for 20 years and no one ever really said thank you, but the first time I worked with someone in a wheelchair they thanked me for putting them through one of the hardest workouts they’d ever been through,” Willie said.

Willie said he “bumped into” disability fitness when he first began as a personal trainer, long before he ever had his own fa-cility.

“We would get people in that [had] spinal cord injuries that we couldn’t work with, so I started develop-ing my own equipment to work with that type of population of people,” Willie said.

Before long, Willie had designed and patented custom machines and workouts to help people with disa-bilities reach new levels of fitness. Some machines allow a person in a wheelchair to lift heavy weights. Other equipment is designed so that a trainer can put the person into the machine and then leave the cli-ent to complete their workout independently. For example, a stationary bicycle may have braces to sta-bilize a client’s legs so they can pedal.

It wasn’t long before Willie realized he had stumbled upon an unfulfilled need in the disability community. Many people, already receiving physi-cal therapy or perhaps even after finishing a physical therapy program, wanted to go a step further.

“I noticed that people were looking for more than what was available to them, so we offered them this type of athletic performance training,” Willie said.

Although every client has their specific needs, there’s no mistaking a training session at Willie’s facility for a run-of-the-mill rehabilitation ses-sion.

“What we try to do is take people to that next level,” Willie said. “When you talk about just traditional physical therapy, they’re supposed to just get you back to functioning. Well, some people want

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Specially designed equipment at the Mobility Fitness Institute, de-

signed by owner Willie Caldwell himself, allows someone in a

wheelchair to lift heavy weights.

Continued from previous page...

more and so when they come to us that’s what we give them.”

If there is an ability to increase mo-tion, strength, mobility or fitness, Wil-lie said “we will train you to become that person.”

He said he’s seen people in wheel-chairs walk again, but no less of a vic-tory is when someone can walk with a walker or other assistance. Sometimes a victory is simply mobility or strength where there wasn’t any before.

And, like fitness regimens of all kinds, the results follow.

“What we’re seeing is a dramatic change in people’s lives,” Willie said. “Over a six-month period of time, I’ve seen a lot of people come out of that depression, reduce their meds, and things like that,” Willie said.

Much of Willie and his staff’s success, however, lies in how they not only focus on the physicality of a client but their mental state as well.

“What we do is we put the client in a position to be successful,” Willie said. “I call them wins and loss-es. I tell my staff, ‘If you know that person’s not ready to stand, then don’t stand them. Let’s get them strong first, then stand them because that’s a win.’”

If there isn’t progress, Willie says he and his staff “just work a little harder,” figure out what needs to change and get back to it for another six weeks.

For Willie, working with people with disabilities presents its own professional challenges. Many of his clients are recovering from catastrophic injuries.

“You have to be a bit persistent because you’re not always getting a person that’s highly motivated to train,” Willie said. “There’s that depression, they’ve been through a tough time.”

Fortunately, most clients see some progress even after just one session. Once that happens Willie said “then it gets a little easier.”

For the most part, however, clients at the Mobility Fitness Institute find themselves surprised.

“What surprises them is when they see the many things that they can do that they were maybe told that they couldn’t do,” Willie said.

It’s even hard for Willie to think of a few standout examples because all his clients have achieved some level of success.

“All of our clients are pretty special and all of them have done something special that they weren’t do-ing before the program,” Willie said.

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The Mobility Fitness Institute staff, from right to left:

David Cooper, Willie Caldwell, Jeremy Walrath and

Kristin Donovan

Continued from previous page...

Unsurprisingly, Willie’s business has grown from clients with spinal cord injuries to encompass both

mental and physical disabilities, including traumatic brain injury. “We cover the board when it comes to disabilities now instead of staying focused on just one type of disability,” Willie said. The facility’s client base has also expanded to include people born with disabilities, as opposed to just

those recovering from catastrophic injuries, like many veterans returning from Middle Eastern conflicts. “It’s different when you’re a veteran, versus a person that was born with that disability,” Willie said.

“Now I’m seeing that, hey, we’re making a difference in that person’s life, someone who’s struggled all

their life, plus that person who just recently became disabled.” Unsurprisingly, the Mobility Fitness Institute’s clients are very loyal. “Our turnover and clientele is very small,” Willie said. When people do leave, it’s usually because of financial reasons or, rarely, a person simply feels they’ve

achieved what they desired. But many, Willie said, could transition to a more traditional facility but

choose not to. Willie is grateful to be able to combine his love for athleticism with an ability to help others. “I just kind of lucked out and fell into one of the greatest jobs ever,” Willie said. “I’m making a differ-

ence in the community and I’m working with a population that really needed it.”

Questions about a loved one who suffered brain injury? Do you believe you may be

experiencing symptoms of brain injury? It’s never too late to call the Brain Injury

Alliance of Arizona. (602) 508-8024

After the hospital: Obtaining continued care By Brenda Hamilton Brenda Hamilton is a personal injury and wrongful death paralegal with more

than 35 years experience who works for Warnock, MacKinlay & Carman in

their Scottsdale office. Her interest in TBIs was peaked when she had an im-

mediate family member who sustained a “mild TBI” and had to battle with

worker’s compensation and automobile insurers to establish the seriousness

of injuries that caused 100% disability. She works closely with the catastrophic

injury team at WMC to assist families with TBI issues and is well-versed in

helping attorneys and insurers understand the seriousness and long-term con-

sequences of a mild TBI.

This is the first part of a two-part series. Look for the second part in November’s issue.

When a moderate or severe traumatic brain injury (“TBI”) occurs, once the initial emergency-level care is finished, long-term issues begin. During initial phases, there is little discussion as to how the care can be obtained or paid for, as it is usually provided at the initial hospital. Under the Emergency Medical Treatment and Active Labor Act (“EMTALA”), a hospital with an emergency department must provide any patient with an emergency medical condition with treatment until he is stable, or transfer him to another hospital. The transfer option is available after stabilization, or if the receiving facility does not have the necessary resources for the type of injury or care necessary. (This is a broad overview of EMTALA to assist in under-standing why a hospital treats until stabilization regardless of insurance or ability to pay.) Since enactment of EMTALA in 1986, initial emergency care for a TBI patient is assured, with or without health insurance, at least until the condition is stable.

Post-Emergent Care. When the TBI survivor is ready to move to the next phase of recovery, determining the best steps is difficult. For the moderate to severe TBI patient, care likely includes a rehabilitation facili-ty. Merely determining the type of care needed can be daunting, with differing recommendations from the neurologist, a neuropsychologist, and other care providers for injuries other than the brain that may have occurred in the same event. There are two very specific categories for this discussion:

Legal Claimants: Those who were injured in an accident or other event that gives r ise to a Legal Claim against a negligent person or company. These will be addressed in Part Two in next month’s newslet-ter.

Health Insurance Only or Private Pay (no insurance) Claimants: Those who sustained a TBI, either through an accident or event such as a stroke, but have no claim against another person. We will call these “Health Insurance” patients, even though some may be uninsured.

THE GAVEL BRAIN INJURY SURVIVOR LEGAL ISSUES

Ongoing Care Decisions/Placement. A person with normal brain function would have a difficult time de-termining necessary care, where best to obtain that care, and who will pay for it. Other than the hospitals required by EMTALA to provide initial emergency care, medical providers won’t typically treat without some plan for payment. A TBI survivor has an impossible task to sort out who should pay and how to arrange for the ongoing care necessary for the best recovery—especially while his brain is not functioning at full capacity. There are several services available to assist with initial or ongo-ing decisions and placement:

A first level option for assistance is the staff of BIAAZ, and the resource facilitation staff in particular. See the Au-gust 2015 Newsletter for more details, but they generally are well-versed in connecting brain injury survivors and their families to the resources available within the commu-nity.

Rehabilitation Specialist who has expertise in TBI care. BIAAZ can refer you to one, and you can read about one such specialist in the August 2015 newsletter.

Nurse or care specialist appointed by your health insurer. Use this person to the full extent he or she is available, but also understand that the insurer is controlling care costs, and do not allow this coordinator to overrule your doctors’ recommendations.

Use and Understand Health Insurance. In general, health insurance should be used if available to obtain the care, regardless of whether it is a Legal Claimant or a Health Insurance only TBI survivor. The first step is un-derstanding what care is necessary and recommended by the primary care TBI doctor, ordinarily a neurologist. (See the sidebar for appropr iate questions to ask to gain clar ity as to the type and duration of care.) If the TBI patient’s family is well-versed in duration and types of care available under existing health insurance, the doctor can endeavor to tailor a plan for treatment that falls within those parameters. If the patient or fam-ily has no understanding of coverages, the doctor will make recommendations, but that care may not be fi-nancially feasible nor available.

Care Facility Assistance. For moderate and severe TBI patients, the care facilities that specialize in longer-term rehabilitation programs are often the best resources to obtain funding. With health insurance, providers are experts at getting the care approved that they provide. If the patient does not have health insurance, they can connect the patient or family with appropriate services to seek approval of publicly-funded health care, such as AHCCCS (Arizona’s version of Medicaid). Most health insurance plans limit the number of days of active rehabilitative care per year, or number of inpatient days at a nursing facility. The patient/family must carefully plan around those limitations to obtain the services at the best time to maximize recovery. Assis-tance of a Rehabilitation Specialist with TBI expertise is often crucial during this time. If long-term care is required, work with the medical providers to determine the best plan so there is no lapse in that care. If long-term inpatient care is expected, apply for long-term benefits such as Arizona Long Term Care System (ALTCS) as soon as the status is known, and for Social Security disability and Medicare benefits if appro-priate.

If you have other legal areas relating to traumatic brain injury you would like to see addressed in future issues, please contact Brenda Hamilton at (602) 399-0659 or email info@biaaz.org. Brenda is a paralegal for Wrnock, MacKinlay & Carman.

How long will rehabilitation

care be needed?

Inpatient or outpatient?

Is home health care be

necessary/can patient be left

home alone?

Can the patient drive?

What is the prognosis, short-

term and long-term?

PLANNING QUESTIONS TO ASK

YOUR DOCTOR

ADA Matters AMERICANS WITH DISABILITIES ACT

By Milchele Stokes, ADA compliance

specialist for the City of Tempe

Michele Stokes, deaf/oral/lip reader, is currently the ADA Compliance Specialist for the

City of Tempe. She has been in the accessibility field for over 25 years. She also serves as

the CEO for Behold Charities International, a new non-profit, whose mission is to facili-

tate universal design in accessible affordable housing. She also a brother who has had a

traumatic brain injury since age five. Michele is married to Bill Stokes; has four adult

children, 11 grandchildren, one great grandson, three dogs, five cats, and a dozen fish.

She reports there might be a gecko or two in the house, as well.

Ask your city council member what they are doing to Step It Up! The 19th U. S. Surgeon General, Vice Admiral Vivek H. Murthy,

M.D., M.B.A., sent out a “Call to Action,” that I would like to

share with you. He talks about the value of walking and walkable

communities. He gives information on the high value of getting

out and moving about and discusses solutions to some of the barri-

ers we face in doing so; and most importantly, he includes sever-

al actions we can take to address those barriers. He has a booklet

with more information which you can find on line here: Step It

Up! He says:

Physical activity is one of the most important things Americans can do to improve their health, and walking is an easy way to get moving. Walking helps people stay both phys-ically and mentally healthy… However, there are barriers to choosing even this simple form of physical activity. Many of us live in neighborhoods that can present barriers to walking. Important places, such as shops, schools, parks, or senior centers, may not be near enough to reach by walk-ing; there may be no sidewalks; or there may be concerns about safety… Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities calls on us to increase walking by working together to increase access to safe and convenient places to walk and wheelchair roll and to create a culture that sup-ports walking for Americans of all ages and abilities.

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Continued from previous page... What really got my attention is the role that you and I can play in this effort, along with actually getting out and moving about. I admit readily, that I am one who needs to get out and move about more, and have recently begun doing so. He mentions some personal barriers we all are aware of including lack of time and health issues. Yet there are some things we can do to be a part of a broader community solution. It does take becoming aware of the issue; and also making a phone call or sending an email to your city council person. Never underestimate the value of your involve-ment! The Surgeon General is correct in saying that we ALL can be a part of the solution; I agree with that! Designing communities to encourage pedestrian activity makes it safer and easier for all users, including those with mobility lim-itations. “For example, streets can be designed to include side-walks and improve traffic safety, and communities can locate res-idences, schools, worksites, businesses, parks, recreational facili-ties, and other places that people regularly use within walkable distance of each other.” So what can you do to help design communities? Look on your city’s, town’s or county’s website and register to be informed of public comment periods when they have projects affecting right-of-ways (sidewalks, parking spaces on the street, curb ramps, compliant driveway crossing on sidewalks, on-street accessible parking, street improvements, etc.). During the “public comment period” submit comments, ask questions, and review their plans which may be on-line or at public meetings to express your preferences to ensure compliance with 2010 ADA Standards and request compliance with guidelines that the U.S. Access Board is currently developing: Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way. These guidelines apply to all areas where people walk or use a mobility device and include specific details to ensure that they are accessible, safe and easy to use by everyone:

Sidewalks, pedestrian overpasses and underpasses, and other circulation paths, in-cluding requirements for access routes, alternate access routes when pedestrian cir-culation paths are temporarily closed, and eliminating protruding or overhanging objects on pedestrian paths

Pedestrian street crossings, medians, and refuge islands, including requirements for

curb ramps or blended transitions, and detectable warning surfaces Street crossings at roundabouts, including requirements for detectable edge treat-

ments where crossing is not intended, and activated signals at multi-lane pedestrian street crossings

Street crossings at multi-lane channelized turn lanes at roundabouts and at other sig-

nalized intersections, including requirements for pedestrian activated signals Pedestrian signals, including requirements for accessible pedestrian signals and

pushbuttons

Vice Admiral Vivek H. Murthy,

USPHS by United States Depart-

ment of Health and Human Ser-

vices Licensed under Public Do-

main via Commons

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Transit stops and bus shelters at bus and light rail stops, including requirements for

boarding and alighting areas at sidewalk or street level, boarding platforms, and

route signs

Pedestrian at-grade rail crossings, including requirements for flangeway gaps On-street parking that is marked or metered, and passenger loading zones Pedestrian signs, including requirements for visible characters on signs and alterna-

tive requirements for audible sign systems and other technologies Street furniture for pedestrian use, including drinking fountains, public toilet facili-

ties, tables, counters, and benches Ramps, stairways, escalators, handrails, doors, doorways, and gates.

For more detailed information and resources on how to promote walking and make our communities more walkable, visit www.surgeongeneral.gov. You don’t need to know details of disability access in order to encourage cities to follow the ADA and Access Board’s guidelines. All you need is to let those that design city rights of ways know that this is important to YOU, your health, your family, and your community. Step it up!

President

Dr. Robert Djergaian

Banner Good Samaritan

Rehabilitation Institute

Past President

Rebecca Armendariz

Banner Health

Vice President

Tom Nielsen

Retired Executive

Secretary

Dr. Alex Hishaw

University of Arizona Medical Center

Treasurer

Sean Badding

Everlasting Services

Carrie Collins-Fadell

Executive Director

Directors

Kim Covington

The Covington Companies, LLC

Dr. Christina Kwasnica

Valley Physical Medicine &

Rehabilitation

Ray Norris, Esq.

Gallagher & Kennedy

Sharon Phillips

Matt Riegel

The Northern Trust Company

Amanda Wigal-Schlosser

Brandables

Kay Wing

SWAN Rehab

Board of Directors

WITH HEARTS FULL OF GRATITUDE, THE BRAIN INJURY ALLIANCE OF ARIZONA THANKS ITS

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