THE NOGGIN
January 2016
Vol. 1 Issue 8
The Brain Injury Alliance of Arizona
Bowl for Brain Injury 2016:
Familiar faces return to
signature fundraiser
You can see almost anything at a Bowl for Brain Injury
event. Previous years featured bowling brides and young
pageant winners throwing a ball down the lane. Some bowlers even bring an extra brain…encased in their bowling
ball. And some teams get a little zany.
But what every bowler who participates in the annual fundraiser for the Brain
Injury Alliance of Arizona has in common is raising money that directly supports brain injury survivors and caregivers. It’s what keeps many teams coming
back year after year.
In this Issue

Profile: BIAAZ
members Chris &
Amy Hotaling

Funds also support BIAAZ’s resource facilitation, a core service that helps caregivers and survivors connect to the services they need and get support. Not to
mention the myriad of other services provided by BIAAZ, like staff training for
facilities with brain injury survivor clients, community outreach efforts and fun,
like the Tucson socialization group.
Meet BIAAZ:
Staff members
Dee Farrand and
Meg Bakke

This March some of the most prominent bowlers from past Bowl for Brain
Injury events are ready to do it all
again.
Advanced
Neurologic Rehabilitation brings
brain injury services to Gilbert

Kim Covington, the Honorary Chairwoman of Bowl for Brain Injury in
2014, was that year’s top fundraiser,
raising $2,810.
Rehab Ready:
Physiatrist Dr.
Christopher
Barnes

ADA Matters:
Paint your own
paradigm

The Gavel: The
challenges of
presenting an
MITBI case
The most notable use of Bowl for Brain Injury funds is Camp Can Do scholarships that make the week-long, adult session at a fully-accessible camp in Payson, Arizona affordable for BIAAZ members.
Kim Covington, the Honorary Chairwoman of Bowl for Brain Injury 2014,
will be back at the lanes this year.
The former 12 news anchor survived a
car accident in October 2013 that left
her a traumatic brain injury survivor,
so her passion and dedication aren’t
surprising.
Continued on page 3...
The Brain Injury Alliance of Arizona (BIAAZ) is a nonprofit organization dedicated to preventing brain injuries and to improving the lives of individuals with brain injuries through prevention, education, information, and community support.
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From Executive
Director Carrie
Collins-Fadell
This time last year I lived in upstate New
York and had my photo taken with this twostory snowman. My move to Arizona in the
spring of 2015 to take the helm of the Brain
Injury Alliance of Arizona means things
have changed quite a bit for me since that
photo was taken.
Just as things change for people, organizations go through life-cycles and changes as
well. Last year some new faces joined the
Brain Injury Alliance of Arizona and in this
month’s issue of The Noggin you’ll meet
two of them.
Meg Bakke, our new Operations Manager, comes to us with a decade of experience with a national
nonprofit. She jumped right in securing the day-to-day operations so the resource facilitation program can run smoothly and many members have already had positive interactions with her. Being a
part of BIAAZ’s staff is personal for Meg. In addition to being a talented professional, she has a familial experience with brain injury.
You’ll also learn more about Dee Farrand, who we profiled as a survivor in an earlier edition of The
Noggin. Dee is a brain injury survivor herself who brings passion and commitment to her post as BIAAZ’s full-time Events & Special Projects manager. She’s already hard at work making this year’s
Bowl for Brain Injury a success.
I’m also excited to begin the new year with the support of Jefferson Holm, physical therapist and
founder of Advanced Neurologic Rehabilitation in Gilbert. Jefferson has brought much-needed services for brain injury survivors who live in the southeast valley and plans to be an ardent supporter of
BIAAZ in 2016. In these pages you’ll read about his state-of-the-art facility and why he chose to specialize in treating brain injury. But this won’t be the last you’ll hear of Jefferson. Look for him in
March as he laces up his bowling shoes for Bowl for Brain Injury.
Finally, an important reminder: Members, survivors, donors, and volunteers will want to mark their
calendars and join us on Thursday, January 28, 2016 from 5:30 to 7:30 p.m. for the BIAAZ Annual
Meeting. We will honor our Camp Can Do volunteer s, top Bowl for Br ain Injur y par ticipants
and teams, corporate sponsors, professional members and more. Last year was a great year. Help us
send it out in style! You can register at biaazannualmeeting.eventbrite.com or contact our BIAAZ
Operations Manager Meg in the office at 602-50-8024 or e-mail [email protected].
There’s already a lot to look forward to in 2016, and it’s thanks to our wonderful staff, volunteers
and members like you.
Happy New Year,
Carrie Collins-Fadell
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Continued from page 1...
Kim attributes part of her fundraising success to the 2014 bowling event’s proximity to her accident.
"My news vehicle accident and the traumatic brain injury it
caused were top of mind for many people,” Kim said. “That made
the Bowling for Brain Injury fundraising relevant for donors.”
Kim knows the time that has passed since her accident has not
made supporting brain injury survivors any less important. Since
her accident she has become a board member and one of BIAAZ’s most vocal advocates.
But it’s her personal experience that underscores for Kim how
every penny counts.
“Before the accident I had never heard of BIAAZ and all of the
services it provides, including the premier camp for survivors,
Camp Can Do,” she said. “It's incredible what BIAAZ can do on
such a limited budget.”
Today, Kim is focused on ensuring BIAAZ can continue its
work.
“BIAAZ needs help filling in the gap, and now I know how critical our Bowl for Brain Injury event is and I will do everything I
can to meet the needs of the brain injured community," Kim
said.
BIAAZ member and brain injury survivor Marc
Nielsen bowls every year .
Marc Nielsen, also a brain injury survivor, has been a regular participant at the event for years.
“A brain injury can occur in an instant, changing lives forever,” Marc said. “My TBI changed my life forever and
the BIAAZ helps caregivers, survivors and their families, plus professionals working with brain injuries, to engage in programs of support and education.”
For Marc, it’s not just about raising money for a great cause; it’s also about having some fun.
“So let's all Bowl for Brains on March 12, and raise money for the good work of the BIAAZ,” he said. “You may
even meet a new friend."
Marc and Kim don’t bowl by themselves, however. In order to bowl, participants need to create or join a team,
which adds to the fun spirit behind the fundraising.
Many teams are made up of brain injury professionals, not surprising given that BIAAZ is a valuable professional
resource that facilitates professional network meetings and the annual conference for professionals. Bowl for
Brain Injury offers a great way for coworkers to spend time together outside their work environment.
In 2014, the Everlasting Services team, made up of residents and staff of the long-term care facility company,
was one of the top donors. The team held a pre-event bowling session that raised $700 which they donated to BIAAZ.
And bowling isn’t the only way one can participate. BIAAZ’s Director of Development Josh Belkin said there are
plenty of options for those who don’t want to don bowling shoes themselves.
"There are a lot of different ways for you to get involved. You can form a team, support a bowler, donate a prize
or buy some raffle tickets,” Josh said. “The main thing is for you to get involved!"
You can register now for Bowl for Brain Injury 2016, so get a group of friends together, think of an awesome
team name and let the fun – and fundraising – begin!
To learn more about the event, contact Josh at the BIAAZ office by calling (602) 508-8024.
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Healthy Living to meet quarterly
with longer classes in 2016
Juli Bryan demonstrates how to make a healthy dip perfect for holiday
parties during the December Healthy Living Group .
The holidays are synonymous with tempting treats and even the Healthy Living Group, the monthly Project Independence and Empowerment class facilitated by BIAAZ, took some time to indulge during its December class.
Using just a food processor and a handful of ingredients – goat cheese, cream cheese, pesto and sun-dried tomatoes
in olive oil – Juli Bryan, the licensed nutritionist that leads the snack portion of the class, taught everyone to make
a decadent dip.
Bryan conceded that the olive oil, pesto and cheeses did pack a caloric punch, but she also pointed out the dip was
full of good fats, had no sugar was and gluten free.
“If you’re going to indulge, it’s the best way to do it,” Juli said.
Besides, she added, the versatile recipe could be easily tweaked to be healthier. Neufchatel could be used in place
of cream cheese and the olive oil can be drained from the sun-dried tomatoes, both of which would cut down fat
significantly. Paired with rice or whole-wheat crackers, the and with festive green and red layers, the dip is a perfect take-along dish for a holiday party.
Since it began two years ago, the Healthy Living class had followed a popular format. Juli spends about half an
hour during the beginning of the class teaching attendees to make a healthy snack. Afterwards, there’s usually a
mini-class or presentation. In December, for example, Chris and Amy Hotaling gave a presentation on mindfulness
(see our page 6 profile on the Hotalings in this issue).
Starting in 2016, however, the class will change its format. Instead of being held monthly, classes will be once every four months or so. And, rather than being only an hour, they will now be two-hour long sessions.
The new format will allow topics to be explored more in-depth, possibly taking the form of a full introductory
class.
For more information on Healthy Living, or any of the activities facilitated by BIAAZ call the office at (602) 5088024.
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Guiding others with
the map they made
Chris and Amy Hotaling use their experience
with brain injury to help others move past it
Chris and Amy Hotaling, key members
of BIAAZ, use their own experience
navigating brain injury to help others in
one of BIAAZ’s first support groups.
The brain injury community is a tight-knit group. Nowhere is this
more apparent that at brain injury support group meetings. Every
month in Arizona rooms fill with strangers whose lives are forever
altered, all of whom share an experience that, though common among
all participants, is perversely unique for each member, too. As the saying goes, “If you’ve seen one brain injury, you’ve seen one brain injury.”
It’s not unusual for support groups to become second families for survivors and caregivers, especially as many members watch their own
pre-injury support networks fade away in the months following the
catastrophic injury. Meetings become one of the few, if not the only,
social outlet afforded to caregivers and survivors, especially during initial phases of recovery. Even after the dust
has settled, many support group members continue to attend meetings for years, finding solace in people who can
empathize with the often baffling, and frequently invisible, long-term impacts of brain injury.
The Brain Injury Alliance of Arizona facilitates seven support groups throughout the state, but it owes the success
of one of its most successful groups to a very special couple, Chris and Amy Hotaling.
When Chris and Amy came to Arizona in May of 2006 from New Jersey, Chris was a brain injury survivor who
had already gone through years of extensive therapy, much of it led by Amy herself. They had been involved in
one of Brain Injury Association of New Jersey’s support groups and wanted to see what the Arizona branch could
offer.
As it happened, a support group was needed in the northwest valley at HealthSouth Valley of the Sun Rehabilitation Hospital. Chris, prior to his accident during the late-1990s, was a trained counselor who had worked for the
New York City School District. Chris hadn’t worked since his accident and had some trepidation about facilitating a meeting, but felt more confident with Amy by his side.
Twenty-three people showed up to the first meeting. Chris, still recovering from his own brain injury, used several
coping mechanisms to help him be successful. He read hand-written notes aloud and asked that participants speak
one at a time because overlapping sounds made it difficult for him to focus.
The meeting must have gone well because, as Chris put it, “it just grew exponentially from there.”
Soon, so many people attended meetings that Chris and Amy had to split everyone into two groups (one for family members and another for survivors) just to keep meetings manageable. Before long, the group grew in its scope
6
as well. A social committee was formed and fundraisers were held to finance outings and activities. A holiday
party became a much-anticipated holiday tradition.
“We did all kinds of things,” Chris said. “It was just so touching, to see such a need, and people come each
month.”
By the time Chris and Amy stepped away from the group five years later in 2011, over a 150 families attended
the holiday party.
The group’s members weren’t the only beneficiaries of the supportive environment. Amy marveled at Chris’s
own improvement. He no longer needed a strict format to keep from getting overwhelmed. Today, Chris walks
around a room while giving presentations, ad libbing when necessary with ease.
“But it’s not only Chris,” Amy said. “We noticed the survivors in our group, month after month after month, seeing their growth.”
In one of those small acts that within the context of brain injury are huge breakthroughs, one day a brain injury
survivor who never spoke aloud announced he had something to say. The group quieted and, for the first time,
the man spoke to the room full of members. It wasn’t uncommon for caregivers to tell Chris and Amy that,
thanks to the group, they finally felt like they weren’t alone.
In June 2007 Chris was asked to be part of a lunch panel at one of BIAAZ’s first Rays of Hope conferences.
“One thing led to another as the story goes and soon both of us
were being asked to give presentations,” Chris said.
Chris credits Robert Horton, a contractor for the Governor’s
Council on Spinal and Head Injuries, for their early involvement
in brain injury education and presentations.
“Robert’s encouragement, along with the support of others at the
council and BIAAZ, provided the opportunity for me to reclaim a
piece of my life before my injury that I thought was lost forever,”
Chris said.
In the meantime Amy, who lost a banking job when the Great Recession hit in 2008, found fulfilling work as one of BIAAZ’s resource facilitators.
“That gave me a feeling of wholeness and that I was here for a
purpose because there were so many callers that I helped with the
true knowledge of living through this,” Amy said.
And live through it Chris and Amy had, without much of the
knowledge and support available to today’s survivors and caregivers.
Chris Hotaling giving a presentation on mindfulness during DeContinued on next page... cember’s Healthy Living Group.
7
Continued from previous page…
Brain injury “back then”
What we know about brain injury and how to treat it has come a long way during the past two decades, a fact few
people can appreciate like Chris and Amy. When Chris was injured 17 years ago, even advanced technology for
the time couldn’t detect certain kinds of injury.
At the time, Chris and Amy were young professionals living in New Jersey who commuted to New York City.
Amy worked for a high-level financial institution managing the documentation department in midtown Manhattan. Chris was a guidance counselor under the New York City Department of Education. Chris was being recruited for an assistant principal position he was slated to begin the following semester.
One day, a fire broke out in Chris’s building. During the evacuation a steel fire door hit Chris on the right side of
his head.
“From what they tell me, I hit a couple of concrete walls and eventually the floor,” Chris said. “When I regained
consciousness I, of course, had no clue what happened.”
When Chris awoke, a colleague stood over him.
She helped him get up and evacuate the building. The fire was eventually extinguished and
Chris went back inside to return to work. But the
colleague who had revived Chris urged him to
report the incident.
“I think she really saw some things happening
that I wasn’t aware of,” Chris said. “I didn’t
think it was really a big problem, I had a headache, but from what she said had happened I
expected that.”
“My colleagues would say, ‘Just write
this down,’ and that’s when I realized
something wasn’t right because my
hands seemed disconnected from my
brain.”
~ Chris Hotaling, after a steel fire door
struck him in the head
They went to the assistant principal’s office where Chris was asked to fill out a report. To Chris’s surprise, he
couldn’t fill out the form in front of him.
“I wasn’t able to do it,” he said. “My colleagues would say, ‘Just write this down,’ and that’s when I realized
something wasn’t right because my hands seemed disconnected from my brain.”
Chris was transported by ambulance to an emergency room. There, while examining Chris’s head for physical
injury, he asked Chris two questions: who the president was and how many fingers he held up in front of Chris’s
face. Chris answered both questions correctly and was discharged with instructions to take two aspirin and have
his wife keep an eye on him.
But when Chris walked down the hall to meet Amy in the hospital lobby, he had to use the wall to keep his balance. That was on a Friday. Over the next two days, Chris’s issues worsened. His left foot began to drag behind
him and he couldn’t navigate where he was going.
Continued on next page...
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Continued from previous page…
“If I wanted to walk towards Amy I’d end up on the other side of the room even though I was looking at her,”
he said.
His speech devolved from a slur to a stutter. On Sunday, Chris woke up to the discovery his face was numb.
The couple assumed Chris was having, or had experienced, a stroke. They went back to another emergency
room
where a CT scan was performed on Chris. At the time, doctors speculated there may have been a micro bleed
that went undetected. In any case, enough time had passed from the initial impact that some of the organic damage may have already healed.
Chris’s rapidly deteriorating condition, however, was undeniable, so doctors used his symptoms to patch together a diagnosis.
“That’s the first time we heard the term brain injury,” Amy said.
By the time Chris was admitted into a rehabilitation facility, about four to six weeks later, he couldn’t speak at
all, walk on his own or feed himself.
Chris himself was only partially aware of his condition. He thought he walked into the rehab facility helped by
Amy and two of his brothers. But five years later Chris learned his family had essentially carried him through
the doors as his feet hung uselessly.
When he got through the doors of the facility, attendants immediately strapped him into a wheelchair. He could
barely feed himself or hold his head up. That was when Chris said he realized he was in for a long road of recovery.
After several weeks of inpatient therapy, Chris began 18 months of outpatient therapy that consisted of everything from participating in a study for emotional regulation – he was having emotional outbursts – to traditional
physical, speech and language, occupational, cognitive therapies, as well as counseling.
Chris left the facility better than when he entered – he could now walk with a cane – but he still wasn’t recovered and he and Amy both knew it.
“Even when I finished outpatient, I felt kind of patched together,” Chris said.
Wife, caregiver, partner
That’s when Amy stepped in and became Chris’s de facto at-home therapist. One of Chris’s physical therapists
had offered to guide Amy with more exercises once Chris reached a certain point.
Cognitively, however, Amy was on her own, so she followed her gut instincts. She went to a bookstore and
bought first-grade reading and Math workbooks, having Chris work on them daily. Amy supplemented that
work by playing games like Scattergories with Chris. Throughout this period, Amy made a conscious effort to
Continued on next page...
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Continued from previous page…
merge Chris’s mental and physical recovery.
“Even when we would go for a walk, I would ask him those questions from Scattergories, so he would have to
walk and think at the same time,” Amy said. “I was always trying to work his brain.”
Amy was ever-vigilant, watching for both signs of fatigue and mobility issues. When she saw Chris was having
a hard time reaching for things, she would ask him to reach for soup cans from the top shelf of the pantry, standing behind him in case he lost his balance. She learned to watch for the signs that he’d had enough and needed
rest.
“What was amazing was Amy’s background was not in therapy, it was
in finance,” Chris said. “But she had this really incredible ability to just
observe me, see what my challenges were, and use her gut instinct on
how she could use these practical, functional tasks to help me improve
the challenges I had.”
To help Chris’s balance and coordination, Amy took him to the pool.
They were both swimmers, but Amy worried at first she’d made a mistake. The water’s ripples caused a vestibular reaction in Chris that was
so severe at first Chris could only stand in the pool.
But they went back, day after day, and soon Chris could lift a leg while
holding on to Amy. By the end of the summer, Chris swam the length
of the pool using a modified crawl stroke.
Amy saw it as a watershed moment.
“I call it a huge brain growth,” Amy said.
Chris and Amy Hotaling at the 2015
Brain Injury Alliance of Arizona Professional Conference, where they
were featured speakers.
Both Chris and Amy attribute much of Chris’s success to his willingness to participate in activities.
“I was always a willing participant, I was always eager to improve,”
Chris said.
Step by step, Chris and Amy rebuilt their lives. Chris began to drive again and Amy returned to work. But the
non-physical, permanent impacts of Chris’s injury made New Jersey and New York unbearable for Chris. The
noise often overwhelmed Chris, who had trouble going grocery shopping by himself.
And though Chris could drive again, he still struggled with navigation. Amy sometimes received calls at work
from Chris asking where he was because he had gotten lost. Driving in ice and snow was utterly exhausting for
him.
They realized that to improve their quality of life, they would have to move. Chris had family in Arizona, where
Continued on next page...
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Continued from previous page…
the couple had planned to retire anyway, so Amy left her job in New York and in May of 2006 the couple found
themselves in Arizona.
An ending, and a beginning
In a way, stepping down from the support group in 2011 was an epilogue to what had been a long, often times
grueling, recovery journey for Chris and Amy.
But it was the beginning of a new volume of their lives, too. Amy has since returned to banking. Chris has continued to counsel, in a manner of speaking, through Aspire Place, a life coaching company he and Amy formed
that focuses on moving forward after brain injury and other significant, life-changing events.
Chris describes it as a “non-therapeutic approach” to learning to live with brain injury, with a focus on getting
through the practical aspects of a person’s day.
“What it allows us to do is coach others, caregivers and survivors, on moving forward, living with their brain
injury, learning that it doesn’t define who you are,” Amy said.
The couple also continues to give presentations and reach out to the brain injury community.
Resource Facilitation Team Manager Jeanne Anderson knows first-hand the value of Chris and Amy’s unique perspective.
“I have seen professionals, survivors, and family members all connect with them and learn something from Chris and Amy’s
talk,” Jean said.
They have also written a book together with Mark Leads, Learning to Live Again…a day at a time.
Coping with both the ever-present impacts of brain injury but not allowing it to subsume everything in one’s life
is a difficult balancing act. But that’s exactly what Chris and Amy have learned to do.
Chris and Amy will once again be presenting at the BIAAZ May 2016 Rays of Hope conference for brain injury
survivors and care partners. To register visit raysofhope2016.eventbrite.com or call Meg in the BIAAZ office
at 602-508-8024
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Rehab Ready
Brain injury introduces survivors and caregivers to an array of health care providers who specialize in brain injury. This list of
specialties and sub-specialties can be overwhelming or confusing to caregivers navigating the system. We’ve all heard of an
optometrist, for example, but how is a neuro-ophthalmologist different? The Brain Injury Alliance of Arizona offers referral services to help people navigate these sometimes overwhelming options. Here in The Noggin, each month we feature a brain
injury specialist and explain what they do and the role they play in the recovery process.
Dr. Christopher Barnes,
physiatrist
Dr. Christopher Barnes’s formal title is a mouthful. He’s a physical
medicine and rehabilitation specialist, or PM & R, at HealthSouth
Valley of the Sun. But most would call him a physiatrist for short.
Dr. Christopher Barnes, PM & R
HealthSouth Valley of the Sun
Rehabilitation
A brain injury survivor typically sees a physiatrist after their release
from the hospital once they’re transferred to a rehabilitation facility.
The physiatrist is trained to work with the team of professionals who
help people with catastrophic injuries or issues navigate recovery.
“We’re trained to work with the physical therapist, the occupational
therapist and the speech therapist,” Dr. Barnes said.
As the patient recovers, the physiatrist follows the person’s medical progress, determines if any equipment is
necessary for their continued recovery and treats any specific medical issues.
Within the context of brain injury, that can include treating physical symptoms like TBI fatigue, headaches,
neurogenic bladder and bowel dysfunction and agitated behavior stemming from brain injury.
Because brain injury is a sub-specialty of physiatrists, a survivor may benefit from seeing one even several
years after their recovery is complete.
“Seeing a physician even years later is not a bad idea,” Dr. Barnes said. “Even just for the satisfaction of
knowing what you’re dealing with and finding out if there’s more therapy or more counseling or a different
medication that can be helpful.”
For Dr. Barnes, being a physiatrist is a lifelong calling.
“I just love being a doctor, just always wanted to be a doctor,” Dr. Barnes said. “So I gain satisfaction from
doing every day what I always wanted to do.”
Part of what drew Dr. Barnes to his specialty is helping people “who are at a point in their life when the chips
are down.”
“Something catastrophic has happened and you help them pick up the pieces,” he said.
Physiatrists complete a one- to two-year fellowship following their three-year medical residency. They may
then earn certifications or do focused fellowships in sub-specialty fields, such as brain injury, spinal cord injury or neuromuscular medicine.
13
Where brain tech meets heart
Advanced Neurologic
Rehabilitation brings
state-of-the-art facility
to the East valley
For physical therapist Jefferson
Holm, the November opening of
Advanced Neurologic Rehabilitation was a life-long dream come
true.
The facility, located in Gilbert, is
one of the only privately-owned
rehabilitation centers in the east
valley that specializes in treating
brain injury survivors.
Much of the physical therapy equipment at Advanced Neurologic Rehabilitation, in Gilbert, is weight supported so patients with limited mobility can use it.
“The great thing about our facility is
we’re a one-stop shop,” Jefferson
said. “We’re really outfitted well to
work with this population from a
technology standpoint and from an experience standpoint.”
The facility offers occupational, speech and physical therapy. It is connected with an extensive network
of brain injury specialists like neuro-optometrists. That allows the Advanced Neurologic Rehabilitation
staff to form comprehensive teams that work on all facets of a client’s rehabilitation.
Cutting-edge, proven technology also sets the facility apart. Survivors with balance issues can wear frenzel lenses that pinpoint where balancing challenges stem from.
“We can put on the lenses and look to see if the dizziness is from a central origin, like from the brain
injury itself, or whether it’s coming from a peripheral origin like the inner ear,” Jefferson said.
Much of the physical therapy equipment, like the treadmill and elliptical, is weight-supported allowing
patients with mobility issues to exercise. Functional electronic stimulation is used to help patients who
have difficulty with certain movements like reaching.
“We try to utilize the latest technology, but also evidence-based research, and marry the two to really
maximize outcomes for our patients,” Jefferson said.
Jefferson first became interested in working with brain injury survivors at Arizona State University
where he earned his undergraduate degree in kinesiology. Part of his undergraduate work included shadowing Arnie Fonseca, the owner a Tempe rehabilitation facility called the Neuro Institute.
Arnie, himself the step-father of a traumatic brain injury survivor, “really inspired me to work with this
population,” Jefferson said. “When I did that shadowing I really fell in love with, not only working with
this population, but also the idea of creating something like [the Neuro Institute] myself someday.”
So Jefferson moved across the country to earn his doctorate in physical therapy from the University of
Pittsburgh. To gain more experience with brain injury clients, he spent several years working for the
Center for Neuro Skills, a California facility that exclusively serves brain injury survivors. While there,
Jefferson became a certified brain injury specialist.
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Jefferson, however, knew there was still a need to serve
brain injury survivors in the east Phoenix valley. So he
moved again, this time back home to Arizona. Now, his vision of opening his own facility, one that follows in the
footsteps of the Neuro Institute that inspired his career path
years before, is a reality.
Like many brain injury professionals, Jefferson enjoys that
with the help of a diverse team of professionals he is able to
help people he sees as part of an oft-overlooked demographic.
“I really enjoy working with the brain injury population because it’s kind of this population that is a lot of time forgotten,” Jefferson said.
Jefferson Holm, founder of Advanced Neurologic Rehabilitation, knew early in his career
he wanted to work with brain injury survivors.
Part of that, Jefferson said, is because not all of a brain injury survivor’s challenges are physical or immediately obvious, but still make reintegration back into the work force
challenging or put a strain on the survivor’s family relationships.
“All these things that are unseen, and it’s really difficult for
outsiders to see the deficits that life beneath,” Jefferson said. “It’s a struggle for this population to feel
like their needs are being met and that people understand where they’re coming from.”
Which is why Advanced Neurologic Rehabilitation offers services like speech therapy for highfunctioning clients.
“Using a team approach, we really can make a difference in these people’s lives that is not always observable,” Jefferson said.
Jefferson isn’t limiting his support to his facility’s clients, however. He’s also the newest member of the
BIAAZ Advisory Council. And he’s going to participate in Bowl for Brain Injury 2016.
“I’d love to be a volunteer and
contribute whatever I can to this
population,” Jefferson said. “I
love that (BIAAZ) provides a
centralized location for patients
with brain injury to go to get
the help and the resources they
need,” Jefferson said.
Advanced Neurologic Rehabilitation is in the process of being
added to the Brain Injury Alliance of Arizona’s resource database. All BIAAZ resources
meet very specific criteria. BIAAZ staff does train facility
staff members to work with
brain injury survivors. For
more information, call (602)
508-8024.
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A M E R I C A N S WI TH D I S AB IL I TI E S A C T
ADA Matters
By Michele 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 facilitate 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.
Paint your picture, create your paradigm!
I ran across a quote attributed to artist Pablo Picasso: “There is only one way to look at things
until someone shows us how to look at them with different eyes.” He was a genius, but not for
the reason you might think. Not because of his art, nor his abilities, though substantial. He was a
genius who had dyslexia and intellectual disabilities.
He made them work for him. He celebrated his humanness!
He was a genius because he created his own paradigm, one that rigorously defied the current norms that
simply did not work for him. He looked with different
eyes the thing he loved, art, and then went about
changing the world with it. And yet, his efforts in creating this new paradigm and his efforts toward artistic
innovation were not about looking forward to new technologies or the skills and techniques of the future. They
were instead focused on looking back and unpacking
the baggage of cultural expectations and tired creative
standards and traditions to become an artist that was
more fully himself, more fully human. Our humanness
matters as it is our picture – our paradigm - to paint.
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That got me to thinking about whether we can paint our
future –our paradigm – using his techniques, seeing
through his very human eyes, by looking back. If we
“unpack the baggage” of cultural expectations, standards and traditions which were conveyed by ADA and
inclusion, and make it more acceptable to be more fully
human, more fully ourselves, we truly can paint our
humanness and impact our communities. Ah, but for
us to do this will take courage, for our pictures reflect
truly who we are!
Unpacking the legislation, the current view through the
lens of ADA and inclusion, we can see it is limited. The United States Access Board says: “Among other things, the Americans with Disabilities Act (ADA) ensures access to the built environment for people
with disabilities.” ADA is more about prohibiting discrimination concerning the built environment than it
is about enabling humanness; we need to see that differently. ADA is but a small brush to use in painting the picture. It cannot make us more fully ourselves, but merely give us nondiscriminatory access to
the canvas. We have to look further...
The current view of “inclusion”--in and of itself--does not represent a defined legal requirement, although it serves as an underpinning of, “legal notions of equality in the Individuals with Disabilities Education Act (IDEA) and Section 504 regulations.” Inclusion is defined as: “The practice of engaging the
full participation of exceptional individuals or marginalized groups in educational, social, or civic activities.”
So, inclusion is little bit bigger brush to paint with,
addressing equality and the practice of engaging
participation. But is it big enough to paint our picture with? No, we have to look further…
Universal Design is the concept of designing all
products and the built environment to be aesthetic
and usable to the greatest extent possible by everyone. This seems to be a bigger brush to use to
paint our picture of humanness. While we need access and equality, usability to the greatest extent
possible looks like the best brush with which to
paint our canvas of humanness.
If we “unpack the baggage” of cultural
expectations, standards and traditions
which were conveyed by ADA and
inclusion, and make it more
acceptable to be more fully human,
more fully ourselves, we truly can
paint our humanness and impact our
communities.
The canvas of humanness shows patterns blended
into our lives through policies, procedures and processes. These may be given clearer definition
through legal challenges, public opinion of people affected, and public input as new legislation. These
are all things we can influence, shape and blend to reflect our humanness. Rather than reflecting some
idealized version of what we should look like.
So here is where we may be able to help others see our pictures differently!
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In asking how I can encourage myself and
others to see with different eyes, the following came to light; current views, mindsets and events are changing rapidly due
technology and communications and they
color our world, but they are not our humanness. Only we can paint that picture.
We must step up to the canvas. So in this
attempt to paint our picture, we can take
action.
We paint our picture, our paradigm, as
we work, live, and play. I encourage
you to paint a big picture of
humanness. Our humanness, seen,
results in a 3-D printing of prosthetic
devices for children. Our humanness
experienced makes it business as usual
for a theater showing captioning and
audio description. Our humanness, felt,
is jobs with livable wages,
accommodations and acceptance in the
workplace.
to
Action 1: Prioritize awareness of policy
making efforts which affect your universal design, access, inclusion and you.
Submit YOUR picture of reality; your
picture of solutions and needed resources. Tell your story of accessible
housing that is needed and resources that
are required, in your picture! This is where
we need to show others how to look differently at our true colors, our asymmetrical shapes of beauty,
our minds that think differently, our communications using visual languages, using bright colors of advocacy. They need to see us through different eyes. See us for who we are; then we can make an impact. Pick up the brush.
Action 2: Educate ourselves on processes to comment and speak out where proposed policies
reduce or negatively affect universal design, access or inclusion. Policy makers may not know
the full impact of actions on us, on our picture. It is our responsibility to let them know. We cannot hide
in complacency and presume, someday, someone else will paint our picture… If you see it,
know it, experience it and can impact it: paint your own picture, tell your story, your view, advocate and say something! Don’t hide your paradigm!
We paint our picture, our paradigm, as we work, live, and play. I encourage you to paint a big picture of
humanness. Our humanness, seen, results in a 3-D printing of prosthetic devices for children. Our humanness experienced makes it business as usual for a theater showing captioning and audio description. Our humanness, felt, is jobs with livable wages, accommodations and acceptance in the workplace. Paint your picture – your paradigm - where you are, advocate, submit public comments, talk
about how lovely your picture of humanness is, paint it clear, strong and bold and never ever put down
the brush. ADA, Inclusion, Universal Access are but brushes to paint with. Use them.
Need support? BIAAZ facilitates several survivor
and caregiver support groups that meet monthly
throughout the Valley. Check out our Facebook
page at www.facebook.com/
BrainInjuryAllianceAZ for more information. Or,
ask to subscribe to our e-Blasts by emailing
[email protected].
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Meet BIAAZ:
Events and Special Projects Manager
Dee Farrand
Dee Farrand, the Brain Injury Alliance of Arizona’s Events
and Special Projects Manager, sees her role at BIAAZ as
more than just a job. For her, it’s a way to advocate for her
community.
“I’m a survivor myself and giving back to my community
is important to me,” Dee said. “And I really like the BIAAZ’s commitment to survivors and families.”
Dee has been living with a brain injury since 2000, when
she was struck by a falling swamp cooler. She had just
Dee Farrand, Brain Injury Alliance of Arizograduated with a bachelor’s degree in social work the prena’s ne w Events and Special Projects Manvious May and was a young single mother to her 9-year-old
ager, with her son, John-Gabriel T. Causbie
son, but refused to allow her injury to determine the course
of her life. (Read more about Dee’s inspiring recovery here on page 13.)
Dee had to relearn how to read, cope with an identity crisis brought on by significant personality changes
that stemmed from her injury and a host of other physical challenges and issues, including migraines she
still gets today.
None of those hurdles stopped her from living the life she wanted, however. In spite of everything, Dee
went on to earn a Master’s Degree in Nonprofit Management. Although she’s only been with BIAAZ a few
months, she’s already played a major role in the success of last year’s professional conference and is now
turning her attention to this year’s Bowl for Brain Injury event.
Meanwhile, Dee’s 9-year-old boy has grown into a young man in the military, making “proud Army mom”
her favorite title.
Her personal experience with head injury makes Dee especially passionate about her work with BIAAZ and
she has some ideas about what she’d like to help the organization achieve.
For one thing, Dee wants more people to know about BIAAZ and its resources.
“I would like to see us well known in the community,” Dee said. “Right now it’s kind of a well-kept secret
and considering how many of our kids through sports, professional athletes, veterans and people just in every day accidents end up with some kind of a brain injury, more people need to know we’re here.”
Dee lived in Tucson for 30 years before moving to Phoenix in 2011.
Her work at BIAAZ and private practice don’t leave Dee much in the way of free time, but when she does
have spare time, she enjoys visiting Tucson to see her family and spending time with her two pups, an
American bulldog mix and a Chihuahua Jack Russell.
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Meet BIAAZ:
Operations manager Meg Bakke
For Meg Bakke, the Brain Injury Alliance of Arizona’s new operations
manager, the opportunity to work for a nonprofit serving brain injury
survivors, professionals and caregivers came at a particularly prescient
time.
Just prior to Meg joining BIAAZ, her nephew was in a car accident on
Halloween and became a brain injury survivor. Though in a coma for
several days, Meg said he amazingly he awoke with his cognition intact.
“We just couldn’t believe it,” Meg said.
Meg Bakke, the Brain Injury Alliance
of Arizona’s new operations manager.
Meg had already spent the previous year looking for nonprofit work but
her nephew’s accident spurred her to look up local brain injury organizations and see if she could work for them.
“It was one of those things where I knew this was the kind of work I needed to be doing,” Meg said.
Meg and her family moved to Arizona in 2011 from outside the Washington, D.C. metro area. There Meg began
her career as a development stewardship specialist for the Inova Fairfax Hospital for Children in Falls Church, Virginia. She managed all donor interaction, special events, and finances related to giving.
From there Meg went on to become an operations manager for the Food Allergy and Anaphylaxis Network, a national, nonprofit education and advocacy organization that does everything from give input on food labels to train
school staff on food handling and serving.
“It was very rewarding,” Meg said. “It’s life-saving work.”
After a vacation to Arizona in 2011, however, Meg and her husband decided it was time to pack up and head west
for what she called “semi-retirement.”
It’s going to be a busy retirement. As BIAAZ’s operations manager, Meg maintains and tracks both the membership and brain injury professional databases, explores new ways to connect with the community, works on large
projects and events with other staff and manages the day-to-day office operations.
“Meg joined our team in November and really hit the ground running,” said Carrie Collins-Fadell, BIAAZ’s executive director. “She brings a great skill set that our members have already benefited from.”
Meg enjoys the supportive nature of her role.
“For me, it’s always been about how I can make the job easier for other people so they can do their job,” Meg said.
And, Meg is grateful for the opportunity to do meaningful work for an important cause and community.
“Working for a nonprofit always gives you the ability to know you’ve actually made a difference, you’ve done
something important,” Meg said.
She is especially looking forward to meeting the brain injury survivors and caregivers BIAAZ serves and “letting
them know that there’s people here that care about them and are here to help them.”
In her free time, Meg enjoys hiking and being outdoors. She admits she misses the woods and snow from back
East, but looks forward to exploring Arizona’s version when she heads to the northern parts of her new home state.
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THE GAVEL
BRAIN INJURY SURVIVOR LEGAL ISSUES
Mild Traumatic Brain Injuries:
The challenges of presenting a legal
claim
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 piqued when she had an immediate 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 consequences of a mild TBI.
A significant issue with “mild” TBI legal claims is the difficulty in presenting the severity of the injury. Literally
every symptom the survivor has can backfire and be used against them. Defense experts, attorneys and hired doctors are professionals at painting a picture to show there is no real, significant, lasting injury or impact, even
when that is patently false.
When there is a moderate or severe TBI, the severity can clearly be shown from numerous sources:
 The MRIs or scans.
 Obvious symptoms, i.e., inability to speak, walk, etc.
 In-patient care records.
Contrast that to a Mild TBI (“MTBI”). Mild TBIs occur with much more frequency than severe injuries, and
bring a whole separate set of issues in the legal arena. Many MTBI Survivors look outwardly “normal” in that
they can walk and talk with no outward appearance of the severity of their injuries. The impact of their injury on
their daily lives isn’t immediately apparent. There is no MRI or scan showing the presence of a brain bleed or
shift or sheering injury. Their complaints are often diverse and difficult to quantify, describe or reproduce. Legitimate symptoms often mimic those reported by someone who is malingering. (Malingering is fabricating or exaggerating the symptoms of a mental or physical disorder for “secondary gain,” such as financial compensation
for an injury claim.)
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When dealing with a MTBI, after treatment is completed, the survivor may appear in a routine, non-adversarial or non-threatening and
comfortable scenario as completely normal. But when stress is introduced, the survivor’s TBI symptoms may revert to the severity or
level of impairment experienced shortly after the injury.
A survivor under stress in the legal context may have to testify on the
stand in front of a judge or jury or in an administrative legal process,
give a deposition, or have a Medical/Psychological Evaluation conducted. But those are exactly the kind of stressful situations in which
a survivor may perform very poorly. Some examples of performance
failures in stressful settings, and how those can be misinterpreted,
include:
Poor historian or inadequate self-assessment; comes across as an
intentional liar. A Survivor may mix up the sequence of events and
appear to be lying when confronted with actual records, or simply get
facts wrong. Sequencing is a key component of brain function that is
often impaired after a MTBI. The survivor may have an unrealistic or
unclear understanding of his past concussion history or the impact of
earlier life sports or injuries or events on his current status, or be unaware of the ordinary results of his behavior on his life.
For example:
Typical survivor
challenges due to stress
of litigation:

Poor Historian/
Inadequate Self Evaluation: Interpreted as intentional lying.

Anger at Questioner:
Comes across as attempt to
hide information or being
caught lying.

Trying to Outsmart
Questioner: Appears condescending or gives inaccurate answers.

Over-Analyzing Symptoms and Impact: Looks
like trying to exaggerate
symptoms.

Testifying a particular treatment started two weeks after
the injury, but the records reflect it was not until three
months later. Even if the start date has no impact as to validity of the injury; the lie creates a major issue.

Claiming no prior concussion, when the neuropsychologist report shows prior concussions
during high impact sports participation. When accused of prior concussions causing the
current symptoms, the Survivor can become agitated and deny any prior concussions,
which is contrary to his own doctor’s report concerning prior sports activities, and is actually only an error in understanding of what constitutes a concussion.

Reporting no problems with anger or aggression, while employment records reflect the Survivor was terminated due to anger issues post-injury. This can be used by defense teams to
show the survivor lost his job for reasons not related to the injury, but he wants to blame
the injury for financial gain.

Blaming spouse or loved one for separation post-injury, and failing to comprehend or understand their significant post-injury personality and functionality changes. This may appear to be an effort to hide or misconstrue their
failures.
Anger at the questioner comes across as an attempt to
hide information or as a reaction to being caught lying.
When a lawyer or doctor is asking questions or pointing out
errors in testimony or statements, the MTBI victim often
becomes frustrated, and in typical survivor manner, expresses that frustration as uncontrolled anger.
The MTBI victim verbally berates the questioner, who is
doing nothing more than asking him to look at accurate information and explain why it does not match with what he
said. The end result is that the jury sees an angry per-
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son, giving inaccurate information, which appears to be an intentional
lie or attempt to hide information, and being angry at being caught.
Trying to outsmart the questioner. This is particularly difficult for
highly intelligent MTBI survivor. Some of the coping skills a survivor
learns following an MTBI is to carefully analyzing questions to make
sure they understand what is being asked, and answer the correct question. A simple question like, “What is your name?” can be difficult for
the survivor if one has been married previously, divorced since the injury, or for any other reason had a name change. If there is a question
with multiple parts, the MTBI victim may come across as condescending or answer incorrectly.
Solutions in Opening Statement or Pretrial Statement:
 Discuss expected failures by survivor.
 Understand lies are evidence of
injury/not intentional.
 If victim is not Likeable, it is
result of the injury.
Over-analyzing of symptoms and impact. After being misunder  Create consideration of injuries
stood for months or years about the symptoms of his MTBI, the survias cause of negative impression
vor often feels compelled to over-explain in detail and provide analysis
they will have of victim.
of his understanding of his own behavior, in a misguided attempt to
help the defense team understand what he has experienced. Unfortunately, this often comes across as an effort to make up symptoms, results, or impacts from seemingly minor issues, in a failed attempt to paint the big picture, instead of letting his
attorney do that work.
With all this negative potential in presenting a MTBI claim, what’s to be done? It is critical to have a legal team
who understands MTBIs, and who will protect the survivor from the machinations of the defense team.
The survivor’s attorney can request a written instead of verbal deposition, or pre-review of deposition questions
to overcome the stress (a hard-fought battle not always won and dependent upon doctors’ orders or restrictions).
The lawyer can request a second person attend all medical/psychological evaluations with the survivor, to assist
in communications and clarity (and also as a witness). The attorney ought to demand that all evaluations be recorded, at least audio if not video. The lawyer might in the opening statement to the jury, or pretrial statement
judge:

Discuss the nature of the MTBI injury and expectations of failures that are
likely to be seen during testimony of the victim, or as already documented
by defense doctors.

Help the jury understand before they occur that any apparent “lies” are really
further evidence of the injury.

Create pre-understanding that if the survivor does not seem likeable based
upon loss of temper and other mishaps during the trial, those issues are the
result of the injury.

Develop consideration of the fact that the very injuries have created the negative aspects that the judge or jury, during the limited window of time involved in the trial, is going to observe in the survivor.
In summary, only through a realistic understanding of the overall issues relating to MTBI can an attorney effectively provide representation to a fair result, and overcome the unfair prejudices that develop from what is relatively common for a MTBI Survivor’s behavior.
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 [email protected]. Brenda is a paralegal for Wrnock,
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Board of Directors
President
Directors
Dr. Robert Djergaian
Banner Good Samaritan
Rehabilitation Institute
Kim Covington
Arizona Community Foundation
Past President
Dr. Christina Kwasnica
Valley Physical Medicine & Rehabilitation
Rebecca Armendariz
Banner Health
Vice President
Ray Norris, Esq.
Gallagher & Kennedy
Tom Nielsen
Retired Executive
Sharon Phillips
Freedom Manor
Edgar Martinez
Tucson Metro Chamber of
Commerce
Kay Wing
SWAN Rehab
Carrie Collins-Fadell
Executive Director
Secretary
Dr. Alex Hishaw
University of Arizona Medical
Center
Matt Riegel
The Northern Trust
Company
Treasurer
Amanda Wigal-Schlosser
Brandables
Sean Badding
Everlasting Services
Julie Rake
Physician Assistant
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THE BRAIN INJURY ALLIANCE OF ARIZONA
THANKS ITS SPONSORS FOR THEIR SUPPORT.
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