Dietary Restrictions with Traumatic Brain Injury

               

Written by Bret K.

              Do you or somebody you know have difficulty swallowing, chewing your food, or both? If you have experienced a stroke, head or neck injury, cancer, cerebral palsy, or dementia this could be a side effect of your condition. Difficulty with chewing and swallowing can also be due to the average aging of a person.

                Difficulty swallowing and chewing of the food is clinically named dysphagia. Dysphagia should be evaluated and treated by a multidisciplinary team consisting of a radiologist, a speech pathologist or occupational therapist, a dietitian, and a nurse. When swallowing difficulties arise there may be a number of problems occurring. There are four types of swallowing difficulties; esophageal phase dysphagia, oral preparatory dysphagia, oral dysphagia, and pharyngeal phase dysphagia. Oral dysphagia is defined as presenting a difficulty controlling the food bolus while in the mouth. Oral preparatory dysphagia is defined as difficulty taking food, chewing, mixing with saliva, and creating a food bolus. Esophageal phase dysphagia is a difficulty with the food bolus when it reaches the esophagus. There may be a delay in action due to the person’s condition. Pharyngeal phase dysphagia defined is difficulty swallowing food due to it becoming trapped at the top of the pharynx of the throat. Aspiration, or the inhaling of food particles into the lungs, is a result of inadequate chewing and/or swallowing. It is said to be a major contributor to respiratory infections and pneumonia in adults that are institutionalized. This poses a large problem to the brain injury community as a whole.

                 If the person has a large difficulty swallowing, they may be on a non oral feeding method for the majority of their nutrients. There are three ways the person may experience a tube feeding. Mostly used for a short time to deliver nutrients to a person is the Nasogastric Tube, or NG. This is a long tube that passes through the nasal cavity and down to the stomach. Liquid nutrients are then given either several times daily or throughout the night while sleeping. As you can imagine, this is not very comfortable, which is why it is used only for short term. The second method is a Percutaneous Endoscopic Gastrostomy or PEG tube. This is used for long term delivery of nutrients directly into the stomach. Nutrients are given in the same manner as a NG tube would be. The only difference is that a PEG tube is surgically placed through the abdominal wall, directly into the stomach. The last way to receive nutrients into the body for a non oral feeding person would be through an IV. An intravenous catheter is placed directly into a vein and nutrients are pushed through the blood.

                After a person has experienced a life altering event that leaves them with a brain injury, they often find themselves with some sort of non oral feeding method in place. They must then work their way back to a regular diet of eating normally. But first they must go through many scans to see if the body is working properly to transport the food bolus from the mouth to the stomach. If difficulty arises in chewing of the food and transporting it to the back of the throat a puree diet may be put in place.  A puree diet is designed for patients presenting a difficulty chewing and swallowing food. All foods should be blended until smooth, and may need to be thickened with a gelatin based food thickener. Thickeners may be useful for adapting pureed foods to meet individual needs. When food is pureed a spoon should be able to stand up in the center without falling to the side of the bowl or cup it is served in. The person is allowed some foods and should avoid the following. Breads and crackers are typically not permitted while a person is on this diet. Nuts, dried fruit, seeds, and desserts that crumble should be avoided. Raw, tough, or vegetables with skins will not easily blend and should be avoided. Tough meats, cheese, and peanut butter pose a difficulty while blending and should be avoided as well while on a puree diet.  Some foods that are allowed while on this diet consist of pudding, yogurt without fruit pieces, applesauce, and blended canned fruit. You may need to thicken the applesauce and canned fruit after blending.  Well cooked vegetables without skin or seeds are allowed but may need to be blended and thickened to pureed consistency. All meats must be blended until smooth. Fish, poultry, and ground meat may be tender enough to puree well. Gravy can be used to maintain a smooth consistency while blending meat. These were examples of foods that may or may not be consumed while on a pureed diet.

                The next step up in dietary restrictions would be a mechanical soft diet. This diet is designed for individuals who have difficulty chewing food but are able to tolerate a wide variety of foods. It includes foods that are soft in texture, semi-solid, moist, and can stick together. Foods must be presented to the person in bite size amounts. A mechanical soft diet gives the person some chewing ability while eating. While on this diet bread is avoided along with dry, hard, crumbly, crispy, or sticky foods. Some foods that are allowed are sugar and sugar substitutes, bite sized, chopped canned fruit, bananas and juices. Watermelon should be avoided if the person on this diet also restricted by thickened liquids. Foods that should be avoided are jams, preserves, all candies, and any items with seeds, nuts, dried fruits, hard/dry toast, and French toast. You may change the consistency and texture of foods to fit this diet by cooking, chopping, mincing, or mashing them.

                There’s another step on the dietary restriction list. It is the edentulous soft diet. This diet is very particular as to what may be consumed by the individual. There is some debate surrounding this diet due to it being so similar to a mechanical soft diet. The only difference in the two would be the foods allowed and avoided. If you have been placed on this diet please ask your team of specialists for a list of foods you are allowed to have.

                After you have made the progress necessary you may be able to eat a regular diet without any restrictions. These foods would be prepared normally without any mechanical alterations necessary. But you may not be able to consume regular thin liquids.

                Often times when a person is diagnosed with Dysphagia they have problems with consuming thin liquids. These drinks must then be altered by a thickening agent to be consumed by the individual. Thin liquids may be thickened to nectar, honey, or pudding consistencies depending on the needs of the person. Nectar thick liquids are a bit thicker than thin liquids, much like a glass of eggnog, tomato juice, or peach nectar would look.  Honey consistency liquids are easily offered on a spoon to the individual. They may be controlled in the mouth easier than thin or nectar thick liquids. There are no natural liquids this consistency without a thickening agent. Pudding thick liquids are used when a person has little to no control over their tongue and mouth movements. These liquids should be given by a spoon to the individual; each bite should be no more than a half of teaspoon of the liquid. It should be kept in mind that there are many things that have “hidden” liquids. These items would be jello, ice cream, watermelon, and any other substances that possibly melt from a solid to a liquid. There are many ways to thicken thin liquids, utilizing bread crumbs, instant apple or potato flakes, instant baby cereal, instant flour, and instant pudding mix. Commercial agents such as Thixx, ThickenUp, and Thick It, may also be used to thicken up foods and liquids.

                If you or somebody you know is having difficulty swallowing or chewing food, I hope this article gave you some insight as to what could be happening.  If you have any questions please see your doctor or speech pathologist to confirm or deny any type of dysphagia. I wish you the best of luck in the future with any difficulties swallowing or chewing food or drinking liquids.

           

Things To Do

            Looking for something to get you out of the house this weekend? I can tell you a bunch of ideas for things to do despite the cold. The following shows, concerts, and events are sure to get your blood pumping and keep you warm.  

            Let’s start with local events and festivals happening in Detroit and the surrounding area.  The North American Auto Show will continue to be on display at Cobo Hall through the end of this weekend, January 27, 2013.  Not interested in cars? No problem, in Frankenmuth there will be the 22nd Annual Zehnder’s Snowfest. This festival features ice carvings, multiple snow sculpture championships, a firework display, and many activities for children.  The cost to attend is free. The Ferndale Blues Festival will also be going on January 25 through February 2. There will be various venues throughout Ferndale participating in this event, hosting dozens of live bands daily throughout the festival. The Rochester Fire and Ice Festival will be January 25th through the 27th. Located on Third and Water in Rochester this festival is free to all attendees. They will also be featuring ice and snow sculptures, a firework show, dog sledding, tube sledding, and cross country skiing exhibits. The two firework shows will be Friday and Saturday evenings at 8pm.  Lastly the Ann Arbor Folk Festival will be held at Hill Auditorium in Ann Arbor on January 25 through the 26th. Admission for one night will cost $35 per person.  All proceeds will benefit The Ark, Ann Arbor’s non-profit home for folk,roots, and ethnic music.

            Want to do something else besides attend a festival? Try a concert! Detroit and the surrounding area have plenty to offer you this weekend! Nelly Furtado will be performing on January 26 at 9pm at Caesar’s Windsor. Cost to attend this concert will moderately cost you $40 per person.  The Filmore in Detroit has plenty going on this weekend. Concerts include FUN, Flogging Molly Green, and Soundgarden. FUN and Soundgarden are currently sold out, but Flogging Molly Green has some seats still available. The show will start at 7pm on the 25 and tickets range from $27 to $36 per person.  Harpos will be presenting the 10th Annual Metalfest on January 26. Doors are scheduled to open at 5pm with tickets costing $10 per person. If rock and roll is up your alley, the Magic Stick will have Emancipator/ Eliot Lipp performing on January 24 at 8pm. Tickets will cost $15 in advance and $18 at the door. They will also have The Darkness playing on January 25 at 8pm. Tickets for this show will cost $25 per person.

            If live shows and plays spark you interest, you’re in luck because there are plenty to see this weekend. Downtown at the City Theatre there will be a show called “Conned”. This show will be playing from January 17 through January 27. Tickets are available at ticketmaster.com and will cost between $32.50 and $37.50 per person. Also downtown this weekend at the Detroit Opera House will be the stage show Shen Yun. From Thursday January 24 through January 27 the show will start at 7:30 with additional matinees on Saturday and Sunday at 2pm. Ticket prices range from $80 to $180 per person depending on where you want to sit. The Purple Rose Theatre Company of Chelsea will be having a show called “The Meaning of Almost Everything” by Jeff Daniels January 10 through March 9. Tickets for this show will vary in cost with student prices being $21, seniors and teachers $39, and a regular adult ticket will cost $42. If you are in the mood to laugh Eddie Griffin will be performing at the MotorCity Casino on Thursday January 24 at 8pm. His stand up performance will cost between $27 and $30. A play named White’s Lies will be performed January 9 through February 3 at Meadowbrook Theatre in Rochester Hills.  At the Macomb Center for the Performing Arts you can see Luna Negra Dance Theatre at 8pm on January 25. You may also choose to view Midtown Men on January 26 at 8pm or January 27 at 3pm.  If you are trying to entertain little ones, Sesame Street Live will be performing at the Fox Theatre January 24 through February 18. Tickets will cost between $12 and $65.

            If nothing you have read above strikes you as something entertaining to attend, think about an expo, convention, or trade show. You can browse multiple vendors at these shows. The Novi Suburban Collection Showplace will be hosting the Home Improvement Show January 25 through the 27.  There will be a $5 parking fee for all vehicles as well as an admission of $8 for adults and children 13 and above, $7 for seniors. Children 12 and under are admitted for free into the showplace.   The Gibraltar Trade Center will have two events within their two locations this weekend. The Mount Clemens location will be hosting the WPC Winter Swap Meet on Sunday January 27. Admission will be $3 per person plus $2 per vehicle to park. To enter the event early it will cost you $10. The Taylor location will be hosting a Sports Cards, Antiques, and Collectables trade show over the course of the weekend. Admission will vary for this location with a $2 fee for parking.

            Last of all, we have sporting events. Although there will not be a nationally recognized sports teams playing in Detroit this weekend, you can still visit the Palace of Auburn Hills for a Cheer and Dance Competition. The festivities will begin at 10am on January 27. It will cost $12 for general admission in advance. Tickets may also be purchased at the door for $15. Keep in mind that children two and under will be admitted for free.

            I hope I sparked some interest in you with all this stuff you could do if you live in southeast Michigan. Whether you plan to head to the auto show or are going to the     Metalfest I hope you will have a blast. Please comment below if you attend any of these activities or have any other events to recommend.  

Power Vs. Manual Wheelchairs

     There are many advantages and disadvantages to both power and manual wheelchairs. For instance, power chairs can be used for longer distances than manual chairs but are often heavy and not as storage friendly. Whether you decide to get a manual chair or a power chair you should know what you are getting yourself into.
     There are many good things that come with a power chair. Power chairs have the ability to climb uphill with the least amount of effort put forth by the driver. They can travel over a variety of terrain with minimal difficulty. Power chairs are often designed for easier use by patients with limited range of motion. They may be built to suit their driver with customizable seat and back cushions. This can be a huge advantage if the user requires assistance with trunk control. Power chairs can also come with a tilt or recline option. This is a good way to relieve pressure for patients with inability to reposition themselves in the chair. When deciding to get a power chair, wheel placement is very important. Power wheels can be placed either in the front, middle, or back of the chair’s base. Keep in mind that the middle placement of power wheels offers the highest maneuverability. Power chairs can give their owners a sense of freedom from the manual chair if they have a difficult time moving about.
     Manual chairs also have a lot of advantages to bring to the table. They are generally more cost efficient than their power wheelchair cousin. They are lightweight and are getting lighter everyday with new designs and new metals being used in their construction. Manual chairs offer a coast option while traveling downhill, this offers a break in using upper or lower body strength. The manual chair user may be assisted by another person with built in handles for pushing. Manual chair users have the opportunity to build muscle strength while self propelling the chair, users also don’t need a designated hand to steer. They are more discreet by being smaller and quieter than most power chairs. Manual chairs are easier to be transported in a vehicle due to most of them being able to fold up and fit into an average trunk. They offer various seat positioning for the user to be able to self propel with either their arms or legs.
     While using a power wheelchair can conserve personal energy, there is always a chance the battery could die. They are larger and heavier than manual chairs which has been noted to decrease the user’s personal image. Power wheelchairs often cost much more than manual and require a special mechanic to repair any problems, costing even more money. These chairs also do not offer any type of exercise for their users. Power chairs pose a problem in some inclement weather, often getting stuck in mud or snow and spinning out on ice. These chairs are large and sometimes awkward to fit through average sized doorways and into bathrooms. Power chairs pose problems with transportation in a vehicle, often requiring a mechanical lift and they must be tied down with special tie-downs.
     Manual wheelchairs have a lot less disadvantages than power chairs. The largest disadvantage would be that they require a high endurance level from their users. The user may have a difficult time getting up inclines or ramps. This depends on the upper or lower body strength of the user and the level of incline present. A lot of people can exhaust themselves just by getting to where they need to go, with no energy left for the activity. There can be some negative long term health conditions such as shoulder injuries or back problems from poor posture that comes with the use of a manual chair over a long period of time. Despite these disadvantages, manual chairs are prevalent because of their cost effectiveness.
     Wheelchairs are a good thing whether you choose a power or manual chair. If you don’t see much benefit in getting a power chair then I would recommend a manual chair because of the cost. All in all, if you need a wheelchair, either choice would be beneficial to you.

Hockey in 2013

^{Hockey fans are overjoyed with an agreement that has been made that will end the 2012 Hockey Strike. The first games of the season are finally scheduled to be played on January 19, 2013. Teams all over the United States and Canada are preparing for the short season and have high hopes in preventing head injuries within the hockey community.
     The first games of the season are scheduled to be played at 3pm and 8pm on Saturday January 19, 2013. It seems that almost every team will be playing, with a total of thirteen games to be completed by the end of the night. The team I declare my favorite, The Detroit Red Wings, will be playing at St. Louis against the Blues. The game is set to begin at 8pm eastern time. The Red Wings will be sporting a white jersey with red sleeves and a red "Red Wings" logo on the chest. With fifteen forwards, eight defensemen, and two goalies the Red Wings are ready for an amazing season.
     According to BrainandSpinalcord.org in 2007, 5,483 persons presented at the hospital with head injuries due to hockey, this number has only been rising. This is quite alarming for anybody that plays such an aggressive sport. The leading cause of traumatic brain injury in hockey is recurring concussion. A concussion, despite the severity, is still a closed head injury. A head injury can occur anytime an outside force causes the brain to violently shift within the skull. This can lead to the bruising, bleeding, and/or tearing of the brain. This can cause a player to feel dazed, confused, or even to lose consciousness. Although symptoms of head injury may take hours or several days to develop they still need to be taken extremely seriously. Symptoms of head injury include headache, lightheadedness, confusion, dizziness, nausea, convulsions, the inability to move part of the body, blurred vision or speech, and possibly loss of balance. All symptoms may not appear to all, but if any present, you should head to the hospital for observation and testing.
     As you may or may not know, Vladimir Konstantinov was a Red Wing defenseman over a decade ago. He was in a serious vehicle accident, after winning the Stanley Cup in 1997, which left him with a severe traumatic brain injury. He has made great progress in his recovery to this point. He is able to utilize painting and art to aid in his rehab. He even had an art show of over 40 of his own personal pieces on display in 2011. He is still attending therapy and progressing daily throughout his rehabilitation. Although Vladimir did not receive his injury while playing hockey, it is a reminder that Traumatic Brain Injury can occur to anybody at any time.
     So what is the NHL doing to prevent future head injuries while playing hockey? They are researching and discussing rule changes to protect the players. One rule is to penalize a player for a blindside hit with a trip to the penalty box or possibly a high fine; it has yet to be decided. They are also discussing various rink sizes, and possibly regulating the rink size for NHL level games. One more stride to prevent head injury in the hockey community is to create a stronger helmet to absorb more shock and further protect the player’s heads.
     Head and brain injuries are always bad, even if they are not from hockey. All the physical contact in hockey makes it a lot higher risk of a head or brain injury. This is why I’m so happy that the NHL is going to try and put a stop to some unneeded contact.}

Our Trip to Chicago

               
              Written by Bret K.

              The weekend of December 7^th was an exciting one for select Oakland and Wayne DTS clients.  Four clients from each facility accompanied by two staff were able to drive to Chicago for the weekend. This trip was for pleasure, although a small amount of business did occur.

                It took staff over four hours to make the drive from Detroit to Chicago.  They listened to music, played various road trip games, and socialized to make the time pass faster.  When they finally arrived, everyone was happy to get out of the vans and stretch their legs.

                The group was able to stay at the Fairfield Inn located in the heart of Chicago.  Once checked in and settled from the drive, the group set out to see the town.  They were able to eat lunch and stop at the Shedd Aquarium for the afternoon. Seeing the different animals of the sea was a great experience for the group.  A short stop at the gift store was all that was left to do before going to a nice dinner.

                The group stayed together throughout the weekend, participating in the same activities, with the exception of the two bosses who visited the Rehab Institute of Chicago.  The group was able to see the Field Museum for an afternoon along with doing some shopping, because what is a vacation without shopping? While in Chicago, the group visited the Sears Tower as well as the Navy Pier. They loved all of the sites that they were able to stop and see.

DTS Invades The Palace

           

Written by Bret K.
          
           The Wayne County Day Treatment Services Program of Special Tree attended a Detroit Pistons game in mid-November against the Orlando Magic.  Upon arrival they were greeted with a pleasant surprise.  Clients and staff alike were also able to enjoy a half-time show by a famous artist.

            The program director, Joe, along with Neal and seven staff were able to orchestrate a flawless event.  Several Special Tree Residential facilities were able to participate in the event totaling nearly 40 clients in attendance.   Everyone gathered at the Wabash facility for pizza prior to leaving for the game.  Staff then loaded the vans and headed to Auburn Hill in a lengthy caravan. 

            Upon arrival to the Palace, everyone received a gift from a Palace worker.  He brought over an abundance of Pistons duffle bags for all DTS attendees to take home.  The group was extremely thankful for the gift.  Then everyone settled into their seats just in time for the game to begin at 7:30pm.

            The first half of the game seemed to fly by, with the Detroit Pistons working hard for a big win.  Soon enough, the lights dimmed as the players headed to the locker room.  The half time show was under way and everyone was anxious to see who would be performing.  As the smoke cleared, it became apparent to the group that Bobby Brown would be the one putting on the show.  He sang a couple songs and had numerous dancers perform center stage with him.  Although some of the DTS attendees did not particularly enjoy Bobby Brown’s performance, they still had a blast at the game.

            The Pistons emerged from the locker room reenergized and ready to attempt to win this game.  They put on a good show despite their loss to the Orlando Magic.  All DTS attendees were glad that they came.  As everyone was preparing to head home they were met with another great surprise.  A group of the Piston’s cheerleaders had come up to their section to say hello.  They took pictures and chit chatted with the clients about the game.  If they weren’t already having the time of their life, they sure were now.  After some time, staff politely said their goodbyes and loaded up the vans to head home.

            It was about 11pm when the caravan returned to the Wabash facility.  Everyone was in good spirits even though the Pistons lost the game.  They were delighted with the new bags and photos they had acquired from the game.  All in all, DTS had a good time at the game and plans to attend more events like this in the near future.

           

            If you have any ideas of events or activities please feel free to comment below. We appreciate your thoughts and ideas!

Ceramics in Traverse City

                                                                      Written by Bret K.

          The Ceramics Studio at Special Tree’s Day Treatment Services program was on the move in early November.  They received an invitation to attend a ceramics show in Traverse City to attempt to sell their goods.  The staff was extremely delighted to attend the show, and began prepping immediately.

          Every person involved in the Ceramic Studio worked hard every day to create the best pieces they could for the show.  They spent time pouring molds, cleaning the pieces, firing them, painting the pieces, firing them again, and packaging them up for the trip. And let’s not forget the pricing part of the job.  Sure it was a little stressful, but they all pulled together as a team and had the van loaded and ready to go on November 5, a day ahead of schedule.

Four clients along with two staff were able to travel to Traverse City for the weekend business trip. They drove the four hours and were able to bunk up for the night after setting up their tables and ceramic pieces.  The next morning would be the beginning their chance to show off their work to the public, and boy were they excited!

The morning of the first day of the ceramic show, the group was slightly nervous to see if the public would like and purchase their goods.  Needless to say, they had nothing to fear.  They were able to sell over $500 worth of goods throughout the two day event. 

The trip wasn’t all work and no play for the group of attendees.  They were able to spend an evening out on the town.  Starting with dinner at a restaurant and continuing through the night. They were full of fun and laughter, delighted that their hard work was paying off.

Upon returning home from the show, all attendees were anxious to share their good news with everyone at DTS.  People liked their goods and purchased over half of the supplies they took with them.  Everyone was able to enjoy themselves as well as get the job done while selling some ceramics!

All in all, this was a good trip for the group.  They were able to sell some of their ceramics, as well as having a little bit of bonding time within the group.  On top of it all, everyone enjoyed themselves!