Local program helps people cope with brain injuries

August 8, 2005

Bulletin Staff Writer

Writing down the time for an appointment and making sure it is kept may be routine for most people. But for adults recovering from brain trauma, even simple tasks such as that may have to be relearned.

Helping them master those daily skills and return to work, is what Carlton Redd does at the Brain Injury Services Initiative of the Making Another Right Choice Workshop Inc. (MARC) on Jordan Street in Martinsville.

"We work with individuals who have sustained brain injury," said Redd, the initiative's coordinator. "We concentrate on helping with work adjustments and life skills."

Those adjustments and skills may be basic tasks, such as learning how to remind themselves to eat or how to count change from a purchase at a store, he said. Once taken for granted, such skills can be lost after an injury to the head.

David Draper, MARC executive director, said the program began last year, shortly after a grant was received from The Harvest Foundation in February. The three-year grant was for more than $111,500.

"We had an initial grant from the United Way," he said, "but The Harvest Foundation grant was the one that got us going."

The idea to start the services was Draper's, who said the Brain Injury Association of Virginia encouraged him to get the ball rolling.

"I saw a need for it," he said.

Since MARC, which has been in existence since 1969, already provides employment and educational services for anyone with a disability, Draper said basing the program there made sense.

The focus is on providing clients the training to help them get back to work and living their daily lives with the needed skills.

However, the training must be highly individualized, he said.

"No two head injuries are alike," Redd said. "They may have the same type of trauma (to the brain), but it (the effects) will be different. It's just like there are no personalities exactly alike."

Accidents are the cause of most such injuries, he said, with car wrecks the most common.

Other causes include falls, sports mishaps, assaults, brain tumors and strokes.

Even a hard bump on the head or an athlete getting his or her "bell rung" can cause a concussion and subsequent trauma, Redd said.

Such incidents are more common than people may think, said Draper, who added that nationally, about 5 million people incur brain injuries each year, with 28,000 in Virginia. Of those statewide, about 2,000 result in permanent brain damage.

The average age of someone with a brain injury is 32, Redd said, and 55 percent of clients are men.

Since training has to be individualized, the number of clients that can be handled is limited, he said. The initiative now serves eight local residents. That number is projected to rise to 22, the most that can currently be handled.

The success of each client, he said, depends on many factors, including the severity of the trauma and the effort put forth by the client.

"They pretty much have to relearn" the skills they have lost, Redd said.

For example, training a person to return to the work force may involve tasks such as following instructions and getting to work on time. Also, skills as focusing, concentration and hand-eye coordination may need to be taught.

Sometimes, it's a matter of "cognitive replacement," Draper said, explaining that the client must learn new cues to trigger an action to replace the old cues, like looking at the time in order to be reminded to eat.

Both Draper and Redd have been certified in job development and job placement through the University of Maryland, Draper said.

"We match clients to jobs," Draper said, since getting them back to work is one of the initiative's main objectives, even if it is a job that is different from the one the client previously held.

The particular course and length of treatment depends on the goals set by the client, said Redd, with the input of family members and medical professionals.

"Services are coordinated," he said. Referrals usually involve the state Department of Rehabilitative Services and Piedmont Community Services, and that is after the client has been through a thorough medical evaluation and possibly other types of therapy.

Computers are a big part of teaching, he said, as well as basic methods a classroom teacher may use, from flash cards to memorization.

But teaching the information and skills may not be as simple as in a typical classroom situation.

"With brain injury, the unusual is the usual," Draper said, giving an example of a man he knew that, because of a brain injury, had lost his ability to feel pain.

"If he hurts himself, he has to tell you," Draper said. "But most of the time, if he's not bleeding, he doesn't know (that he's been hurt)."

Redd said another aspect that must sometimes be handled is depression, because victims cannot do the things they used to be able to do.

"Somewhere along the line ... they may become depressed and have to confront their limitations," he said.

A related problem can be short-term memory loss, Draper said, similar to the symptoms of Alzheimer's disease. "Research on brain injuries and Alzheimer's is beginning to overlap," he said.

Veterans often must deal with the effects of brain injury, Draper said, and one of the goals is to eventually serve them, especially those who have served in Iraq.

Although Traumatic Brain Injury (TBI) is not uncommon in wars, Redd said, "the war in Iraq is being defined by TBI," with many more cases being reported than in any war since World War II.

The reason, he said, is that while the sophistication in protective equipment as well as advances in medical technology are saving more lives, soldiers who survive often experience TBI, mainly because of the impact of the percussion caused by explosives.

With an expected growth in the numbers being served, the unit is starting a new program this fall -- a brain injury support group.

That's because clients and family members can benefit from sharing experiences, Redd said.

The three-year grant from The Harvest Foundation should be enough to get the program off the ground and self-sufficient, Draper said.

"We should be self-sustaining by then (when the grant expires)," he said, adding that legislation is being pushed in Richmond by the Brain Injury Association of Virginia that would help fund the program here.

"Funding is possible," he said, "but it's on hold until the state has a surplus."

Most insurance policies don't cover the expense of providing the services offered at the MARC initiative, Draper said.

"They (insurance companies) just haven't caught up (with the need)," Redd said.

However, some reimbursements are obtained through Medicaid, he said, adding, "We don't turn anyone away."

Both men are confident the program will be a success because the need is there for a problem that can affect anyone at virtually any time.

"If you get hit in the head, you had better take it seriously," Draper said.


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