OUTPATIENT ADULT BRAIN INJURY SERVICES A GUIDE FOR PATIENTS AND FAMILIES HOW THE BRAIN HEALS People used to believe that any healing that was going to take place in the brain after an injury or stroke would happen within the first six months. After that period, providers simply focused on helping patients learn how to “cope” rather than how to actually improve their functioning. That’s changing. We are finding out just how resilient the brain really is and how, under the right conditions, it can actually “rewire” itself and start performing tasks that previously were thought impossible. Effective techniques include intensive movement therapies that help “re-train” the brain; medications that “feed” neuro-transmitters and help neurons “re-learn” tasks; drugs such as Botox™ and Baclofen™ that can stop muscle spasticity; and alternative modalities such as acupuncture that help reduce pain and allow freer movement. Obviously, this is a complex field that is changing all the time. In addition, the symptoms a patient has depend largely on where and how the brain was injured. This diagram shows just a few of the symptoms related to specific parts of the brain. The following should not be considered a complete list of symptoms related to injuries in different parts of the brain. But it may help you – as you discuss possible treatments with your doctor – to have a better understanding of the challenges facing you or a loved one. 1. Frontal Lobe Partial paralysis; difficulty with sequences of movements; inability to focus; personality and mood changes. Difficulty with awareness and judgement. 2. Parietal Lobe Inability to name an object or find the right word; difficulty with drawing objects, doing math, or distinguishing left from right. 3. Occipital Lobes Vision problems, including hallucinations, word blindness, and problems identifying objects, colors, or movements. 4. Temporal Lobes Short-term memory loss; difficulty recognizing faces, understanding words, identifying or describing objects; increase or decrease in sexual interest; increased aggressive behavior. 5. Brain Stem Difficulties with breathing and swallowing; sleep difficulties; dizziness and nausea; problems with balance. 6. Cerebellum Loss of ability to walk or coordinate; tremors, dizziness, and slurred speech. THE REGION’S LEADING REHABILITATION CENTER Crotched Mountain opened in 1953 as a rehabilitation center and school for children with disabilities. Since then, it has grown into one ofthe most respected rehabilitation facilities in the nation. A licensed specialty hospital, Crotched Mountain offers inpatient and outpatient services to children and adults with inherited and acquired disabilities and brain injuries. The peaceful mountaintop setting provides a natural, supportive facility for recovery and rehabilitation. In addition to physicians, psychologists and a neuropsychologist, there are physical, occupational, speech, therapeutic recreation and cognitive rehabilitation therapists on staff. Our facilities include multiple physical therapy centers, a gymnasium, and both a swimming pool and a heated therapy pool. Thanks to recent advances in physical medicine and other therapies, the typical length of inpatient stays for brain injury patients is now measured in weeks instead of months. Our new outpatient programs provide a valuable resource for patients who function effectively in their daily lives when provided with appropriate support. THE REGION’S LEADING SPECIALIST IN BRAIN INJURY REHABILITATION Rocco Chiappini, MD, Director of Rehabilitation and Physical Medicine at Crotched Mountain has been recognized as New Hampshire’s “Top Doctor” in rehabilitation physical medicine by Business New Hampshire. A graduate of the Medical College of Virginia, Dr. Chiappini completed his residency at Johns Hopkins and Sinai Hospitals and has been actively involved in the field of physical medicine (physiatry) for his entire career. He is certified by the National Board of Medical Examiners, the American Board of Physical Medicine and Rehabilitation, and is also certified in acupuncture. He is a member of the American Academy of Physical Medicine Rehabilitation, the Association of Academic Physiatrists, and is on the board of the Brain Injury Association of New Hampshire. Dr. Chiappini is the lead physician for all of the outpatient adult brain injury clinics that are offered at Crotched Mountain. Mild Traumatic Brain Injury (TBI) Clinic Mild traumatic brain injury (TBI) is extremely common—but frequently not recognized. It can be caused by a car or bike accident, workplace or sports injury, or even a simple everyday fall. Often, the patient may not even lose consciousness. Later, however, he or she may develop persistent symptoms such as headache, double vision, dizziness, fatigue, nausea, memory/concentration problems, irritability, depression and/or problems with relationships and work performance. At our TBI clinic we perform a complete assessment to determine if TBI occurred and, if so, develop a treatment plan that may include medications, acupuncture, vision therapy, and other modalities. Spasticity/Tone Management Clinic Spasticity affects people with many different types of disorders: from stroke and injuries to the brain or spinal cord to multiple sclerosis and cerebral palsy. Spasticity causes severe stiffness of the arms and/or legs. It can interfere not only with patients’ movements and ability to care for themselves, but also with the ability of others to care for them. Our Spasticity/Tone Management Clinic includes a comprehensive assessment by a Board Certified Physiatrist, followed by an individualized treatment plan, which may include oral medications, physical and/or occupational therapy, acupuncture, Botox™ injection, Baclofen™ pump, and/or aquatic therapy. Neurorehabilitation Clinic People with neurological conditions caused by injury or disease often must deal with a complex range of physical, psychological, and social challenges. We’ve found a team approach achieves the best outcomes. At this clinic, we formulate a plan of care that maximizes the resources of the primary care physician, community support services, and the wide range of outpatient therapies provided here at Crotched Mountain. Comprehensive On-Site Rehabiltation Services On-staff specialists provide brain-injury patients with the latest rehabilitative treatments: Aquatic Therapy Assistive Technology Audiology Driver Evaluation & Training Dysphagia Occupational Therapy Physical Therapy Psychological Assessments Speech-Language Pathology Wheelchair Seating & Mobility THERE ARE OPTIONS. THERE IS HOPE. In 1985, Crotched Mountain opened a licensed specialty hospital to provide advanced inpatient brain injury services to patients throughout New England. New treatments have made it possible for many patients to realize significant improvement by receiving treatments on an outpatient basis, after hospitalization. Our new Outpatient Adult Brain Injury Services is led by director Dr. Rocco Chiappini, one of the country’s leading brain injury specialists, and many of our staff members have successfully completed the Certified Brain Injury Specialist program of the American Academy of Brain Injury Specialists. In fact, Crotched Mountain is one of the few training centers in New England that offer this advanced training program. In other words, at the Outpatient Adult Brain Injury Center, you (or your family member) will receive the very latest treatment from leading professionals in one of the country’s most advanced specialty centers for the treatment of brain injury. We can help with: Headaches that just won’t go away Memory that just won’t come back Pain that comes and goes Problems with speech or movement Stiffness of the limbs Caused by: Traumatic Brain Injury Stroke Chemotherapy Post-Operative Complications Cerebral Palsy Multiple Sclerosis It’s worth the trip! Crotched Mountain is located in the Monadnock Region of central New England, about 1.5 hours from Boston, MA and 45 minutes from Manchester, NH. Medicare is accepted as a form of payment for approved services. One Verney Drive Greenfield, NH 03047 603.547.3311, ext. 360 and toll-free in NH 800.258.1466 email: outpatient@crotchedmountain.org www.crotchedmountain.org