In this week’s Jump Start January, Takara Harley, Daniel Schaeffer, Deborah Vega, and Dave Wethington share tips for setting and meeting goals — and connecting with people or activities that give you hope.

Takara Harley, EP

Shepherd Center Exercise Physiologist, Eula C. and Andrew C. Carlos Multiple Sclerosis Rehabilitation and Wellness Program

• Start small and build momentum. Big resolutions can feel overwhelming. Begin with one small, realistic change (5–10 minutes of movement, one extra glass of water, one intentional pause each day) and build from there.
• Focus on consistency, not perfection. Progress isn’t about doing something every day perfectly — it’s about returning to it even after a missed day. Missing a day doesn’t mean you’ve failed; it means you’re human.
• Choose goals that fit your life, not someone else’s. Sustainable habits are the ones that align with your current energy level, schedule, and abilities — not what social media or others say you “should” be doing.
• Redefine what counts as success. Movement doesn’t have to be intense to be effective. Stretching, seated exercises, short walks, or simply changing positions more often all count and support overall wellness.
• Listen to your body and respect your energy. Some days call for activity, and other days call for rest. Both are productive. Learning when to push gently and when to pause is key to long-term health.
• Pair habits with something you already do. Attaching a new habit to an existing routine (stretching while watching TV, practicing mindful breathing before bed, or taking movement breaks during work hours) makes it easier to stick with.
• Use compassion as a motivator. Self-talk matters. Encouraging, kind inner dialogue will help you stay engaged longer than guilt or pressure ever will.
• Celebrate small wins often. Acknowledging effort — no matter how small — reinforces motivation and builds confidence. Small victories add up over time.
• Plan for flexibility, not rigidity. Life happens. Having backup options (shorter workouts, gentler alternatives, rest days) will help you stay engaged instead of giving up altogether.
• Remember that wellness is more than physical health. Mental, emotional, and social well-being all play a role. Connecting with others, managing stress, and prioritizing rest are just as important as exercise.

Daniel Schaeffer, PT, DPT 

Shepherd Center Therapy Education Coordinator, Spinal Cord Injury Rehabilitation Program 

When you have a lot that you want to achieve, setting goals can feel overwhelming — and not having a realistic plan may lead to failure. The keys to success are accountability and consistency. 

Start by focusing on just one or two small, achievable goals over a few weeks. Once you’ve met those, move on to the next progression or add a new goal. Progress on these smaller goals for shorter periods of time builds momentum and will lead to accomplishing the bigger goals you truly care about. 

Setting clear, realistic goals keeps you consistent and accountable, which is the foundation for success! 

Deborah A. Vega M.S. CCC-SLP, HC, MSLP-C 

Shepherd Center Speech-Language Pathologist and Board-Certified Holistic Health Coach

• Build a Healthy Community 
  Surround yourself with people who uplift and encourage you. Positive social connections reduce stress, improve mental health, and even support cognitive resilience.
• Use Your Voice for Good 
  Speak words that encourage and inspire — positive communication strengthens relationships, uplifts your mood, and supports cognitive health.
• Cognitive and Voice Fitness 
  Just like your body, your brain and voice need exercise! Engage in activities like reading aloud, singing, word games, or learning something new to keep your mind sharp and your voice strong.
• Take Care of YOU — Holistically. Wellness isn’t just physical — it’s mental, emotional, spiritual, and social. Prioritize rest, hydration, movement, and positive engagement with others. Practice gratitude and nurture relationships that bring joy, because “a merry heart does good like medicine.”  Small, consistent habits create lasting health. 

Dave Wethington, MA, BCC

Shepherd Center Chaplain

At the start of a new year, or after a life-changing event like many of our patients face, people find themselves thinking, “Now what?” It can help to reflect on what brings you joy, really plugging into something that gives you hope. It might be in your church or community of faith where you discover hope that was there all along, or it could be in trying a new sport or rediscovering a hobby that you enjoy. When you find yourself wondering, "Now what?," take time to reconnect with the people and activities that bring you joy. 

Advice from staff has been edited for length and clarity. 

 Even for those who don’t make New Year’s resolutions, the start of a new year is a good time to check in with your health and well-being. And Shepherd Center’s expert staff members have you covered.

In this week’s Jump Start January, Shepherd’s Research and Innovation Best Health Wellness Team shares advice for making movement a habit, and Jasmin Brumby Smith, an occupational therapist in the Eula C. and Andrew C. Carlos Multiple Sclerosis Rehabilitation and Wellness Program, offers tips she often shares with patients on ways to conserve energy to reach goals and prevent burnout. 

 Alexandra (Allie) Juarez, EP, RYT 200 HR; Nathan Kimmel, EP; and Marina Moldavskiy, EP, ACRP-CP, RYT 200 HR

Shepherd’s Research and Innovation Best Health Wellness Team

• Identify purposeful movements and physical activities that you enjoy and make an exercise plan out of them.  For resources to create your plan, check out the Best Health Suite webpage.
• Schedule time in your planner to move your body like you would schedule a haircut or oil change — you wouldn’t want to skip those, right?
• Lean on your peers and find an accountability buddy with whom you check in (even if you missed a movement session).
• Anything is better than nothing at all. Even if you only have five minutes to move your body, that is still more than zero.
• If you don’t feel like exercising, try to at least commit to the warmup. Most of the time, once your mind becomes focused, you will find it easier to stay and finish the workout. If you complete the warmup and still have no interest in the workout, it may be time to give yourself a break.
• Keeping your goals in mind, ask yourself what you can do today to get closer to them. Small things like filling your water bottle and making sure you’re drinking water throughout your day, taking time to move for a few minutes at the end of each hour, or packing your lunch and making healthier food choices during meals, can add up.

 Jasmin Brumby Smith, MOT, OTR/L

Shepherd Center Occupational Therapist

• Plan ahead to reduce effort.
  Organize tasks, gather supplies first, and think through steps to avoid unnecessary movement or repeated trips. Make a schedule of your tasks for the day or week to make sure that you don’t pack too many heavy tasks into one day. Spread heavy tasks and errands throughout the week. Alternate heavy tasks with lighter tasks to allow time for rest periods during your day.
• Prioritize what matters most.
  Focus your energy on essential or meaningful activities and let go of non-urgent or non-essential tasks. Decide what activities have to be done and which can wait. Also, decide which tasks can be done by someone else: Delegate.
• Pace yourself.
  Break tasks into smaller steps, take rest breaks, and avoid rushing to prevent fatigue and burnout. Do the hardest activities when you are feeling your best. Alternate between high-energy and low-energy tasks and listen to your body’s signals to prevent overexertion.
• Use proper body mechanics. 
  Sit instead of standing when possible and position items within easy reach to reduce physical strain. Use good posture when standing and sitting.
• Use powered devices and labor-saving tools.
  Use adaptive equipment and power-assisted devices to help you complete a task. These devices can provide extra leverage and reach, keep your joints in the most functional position, prevent strain on your muscles and joints, and save your energy. Some examples include a tub bench, a reacher/grabber, a power wheelchair, electric appliances, and a wheeled cart. Also, don’t hesitate to ask others for help.

Advice from staff has been edited for length and clarity. 

For the 79% of Americans who make New Year’s Resolutions, at least one of their goals for the new year 

In the first iteration of Jump Start January, Macy Moore and Deborah Vega share their advice for using food and nutrition to improve your overall health. 

Macy Moore, RDN, LD 

Shepherd Center Dietitian

• Boost your fiber intake! Fiber has been shown to improve your overall health by lowering cholesterol, lowering blood sugars, and improving GI health. Reach for whole foods — fruits, vegetables, and whole grains — over processed ones whenever possible.
• Try adding healthier foods to your diet, rather than restricting foods. Look at what you are eating in a positive light. Add vibrantly colored fruit and vegetables to your diet, the more color the better!
• Plan ahead! Meal prep or decide what you plan to eat that week, and make a grocery list to have those healthy, easy-to-prepare meals on hand.
• When planning your meals, make sure half of your plate is filled with fruits and vegetables. These are the most nutritious with the lowest number of calories. And ideally fill the other half of your plate with lean proteins and whole grains. 

Deborah A. Vega M.S. CCC-SLP, HC, MSLP-C 

Shepherd Center Speech-Language Pathologist and Board-Certified Holistic Health Coach

• Hippocrates said, “Let food be thy medicine and medicine be thy food.” Nutrition matters! Foods rich in omega-3s, antioxidants, and vitamins (like berries, leafy greens, and nuts) support cognitive function, reduce the risk of stroke, and promote overall brain health.
• A balanced diet benefits vocal health. Staying hydrated and eating and nutrient-rich foods keeps vocal folds flexible and reduces strain — especially important for those who use their voice professionally or frequently.
• Dysphagia (difficulty swallowing) can affect people of all ages. Practice slow, mindful eating, and choose textures that are safe and enjoyable. This supports both nutrition and safety. 

For additional nutrition guidance on everything from tube feeding to maintaining a healthy weight, visit myshepherdconnection.org. 

Advice from staff has been edited for length and clarity. 

The holidays can often mean a change in routine, making it a challenge to stay healthy. Here are some tips to help you stay on track and feel your best this holiday season and beyond.

1. If you’re traveling during the holidays, resistance bands are a great lightweight option for quick strength sessions. Try using cans of beans or water bottles as weights instead of dumbbells. You don’t need a gym to get a great workout!
2. Practice new family traditions that include activity! Try planning a family walk after holiday meals to help food settle and create more activity as a group. Goals are easier to establish and attain when you can do them together.
3. If the holidays mean a busy schedule, try planning shorter workouts to stay on track. Even 10–15 minutes of movement counts. Try bodyweight exercises like squats, lunges, or chair dips during downtime between holiday activities. Circuits with resistance bands can be beneficial as well.
4. If the winter weather makes outdoor activity difficult, try using indoor facilities like malls or department stores. These places can offer a more comfortable environment for getting moving.
5. Practice gratitude when feeling overwhelmed with the holiday season. Write down three things you’re thankful for each day to boost mental well-being. Try writing in a daily journal. Reflecting gratitude can sometimes help reset your perspective and mental clarity.
6. Stay mindful of your hydration during the winter. Cold temperatures can suppress your thirst — set reminders or use a marked water bottle to help you maintain your water intake.
7. Create a plan and minimize the obstacles between you and the time set aside for exercise. If you plan to work out in the morning, set out your clothes and fill your water bottle the night before. In the morning, that will make things easier, require fewer decisions, and make taking time to exercise feel less difficult.
8. Practice balance during the indulgent holiday season by prioritizing what you place on your plate and also the order in which you eat different foods. Try making space for fruits and vegetables first, so they’re not relegated to the smallest space on the plate. Promote what your body needs first, then what it wants!
9. Holidays are often full of cozy time at home or social events that include food and drinks. Overindulged? Resume healthy habits right away, but move away from restriction. A few festive events won’t derail your health goals.

Top Tips to Prevent Falls

1. Stay healthy and active. Keep up with annual eye exams, hearing exams, and physicals, which can alert you and your doctor to problems that might make you more prone to falls. Maintain muscle tone and core body strength by staying active. Talk with your doctor if you’ve had a fall or think you are at risk of falling. The fear of falling can be an indicator of future falls — be honest with your doctor to proactively maintain independence.  They can provide resources.
2. Think twice before climbing that ladder. If you must get on a ladder, please have someone else present to spot you and ensure the ladder is adequately secured. If using a step ladder in your home, make sure it has sturdy grips and is locked in place before climbing. Never use a chair as a step ladder.
3. Hire a professional. It’s best to leave outside jobs like cleaning the gutters or painting the house to the experts. Spending the money to have the gutters cleaned is a lot less costly than a catastrophic injury.
4. Stay alert. Always be extra careful when drinking alcohol, and avoid looking at your phone while walking, especially going down stairs!
5. Make modifications to your home. Remove any loose rugs or cords, keep pathways clear, ditch clutter, use motion-activated night lights, and keep flashlights handy to help guide you in the dark. Non-slip mats and grab bars, if needed, can help make bathrooms safer.
6. Wear suitable shoes. Make sure they fit well. Ideally, shoes should have non-skid soles.
7. Always wear a helmet. If you ride bikes, motorcycles, scooters, or horses, protect your head.
8. Review your medications. Talk with your healthcare team about the medications — prescription and over-the-counter — you take. Sometimes, certain medications or combinations of medications can leave you feeling off-balance.
9. Accept assistance when you need it. If you feel unsteady or unsure, ask for help.

People with spinal cord injuries (SCI), brain injuries, and multiple sclerosis (MS), as well as those who’ve experienced stroke or traumatic amputation, can have a higher risk for cardiovascular problems. Since February is Heart Health Month, it’s a great time to work on preventing heart disease and stroke by reducing risk factors like obesity, diabetes, high cholesterol, and high blood pressure. 

It's important to eat a healthy diet and try to get at least 150 minutes of exercise per week. If you use tobacco products, talk to your healthcare provider about ways to quit. Making lifestyle changes may seem daunting, but remember that even small changes can make a difference. Here are some tips to get you started. 

Eat an overall healthy dietary pattern that emphasizes: 
• A wide variety of fruits and vegetables 
• Whole grains and products made up mostly of whole grains 
• Healthy sources of protein (Mostly plants such as legumes, and nuts; fish and seafood; low-fat or fat-free dairy; and, if you eat meat and poultry, ensure it is lean and unprocessed.) 
• Liquid non-tropical vegetable oils such as olive oil and avocado oil 
• Minimally processed foods 
• Minimized intake of added sugars 
• Foods prepared with little or no salt 
• Limited or preferably no alcohol intake 
 

If you are looking for a healthy “diet” to follow, the Mediterranean diet is a great place to look for guidance and recipes. 

A Mediterranean-style diet typically includes: 
• plenty of fruits, vegetables, bread and other grains, potatoes, beans, nuts, and seeds 
• olive oil as a primary fat source 
• dairy products, eggs, fish, and poultry in low to moderate amounts. 

Fish and poultry are more common than red meat in this diet. It also centers on minimally processed, plant-based foods (like beans and lentils, not processed meats or plant-based meat substitutes like Impossible meats). Fruit is a common dessert instead of sweets. 
 

Here are tips to make your next grocery store run a healthier one: 

1. Plan ahead, make a list, and don’t shop hungry.
2. Start by shopping the perimeter of the store first. 
   • Most grocery stores stock fresh vegetables, fruit, dairy, fish, seafood, poultry, and lean meats on the outer aisles. Choose foods that are in their whole form instead of processed foods.
3. Read Nutrition Facts labels and ingredient lists. 
   • Look for foods with little to no added sugar and salt (especially when selecting canned foods), less saturated fats, and more fiber. Look for “whole” in front of the grain name and make sure it is the first ingredient.
4. Go for lean cuts of meat. 
   • Some of these may include sirloin, flank steak, tenderloin, and skinless chicken breasts. Choose ground meat with 12% or less fat ratio. When choosing canned fish or chicken, look for those packaged in water rather than oil and labeled “no salt added” or “lower sodium.”
5. Portion out what you bring home. 
   • To prevent overeating, portion out your snack foods such as unsalted nuts and whole-grain crackers, fresh fruit such as grapes or cherries, and fresh vegetables such as celery sticks and baby carrots into small containers or snack-size baggies. This can help with portion control and make grabbing healthy foods an easy choice.
      

Exercise can be just as important as nutrition when it comes to heart health, and Shepherd Center offers several resources to help you stay active. Tune in to exercise classes through burnalong®, which offers live and on-demand classes created by Shepherd Center specialists for people with spinal cord injuries, brain injuries, stroke, chronic pain, and multiple sclerosis. Recreation therapy health and wellness clinics are also held year-round, with virtual and in-person events around the country. Additionally, Atlanta community members can also visit Shepherd to use the ProMotion Fitness Center — a fully accessible gym — or participate in one of many health and wellness clinics throughout the year. 

For more heart healthy nutrition tips, you can visit the American Heart Association’s Diet and Lifestyle Recommendations. 

By Macy Moore, RDN, LD 

Macy Moore, RDN, LD, has been a Clinical Dietitian at Shepherd Center for 18 years and a Registered Dietitian for almost 23 years. Her previous work experience was at Roosevelt Warm Spring Institute for Rehab for 5 years. She received her Bachelor of Science in Nutrition at Miami University of Ohio and completed her Dietetic Internship at University of Tennessee at Martin. She also has completed a Certificate of Training in Weight Loss in Obesity. Macy's special dietetic interests include outpatient counseling, weight management, SCI nutrition, especially pertaining to adolescents, and health/wellness. 
 

While I was at Camp Twin Lakes, I heard about Adventure Skills Workshop (ASW) for the first time. All the rec therapists told me that if I had fun at this camp, ASW would blow my mind. Alesha, a friend I made at Twin Lakes, seconded their point, gushing about how much fun she had when she attended. Despite this encouragement parade, I sashayed my way out of making any formal commitment to participate because of my apprehensions about getting in the water again. Eventually, my worries subsided. Alesha reminded me that applications opened for ASW in March. Unfortunately, I procrastinated, and the slots filled much faster than I expected.

I missed my chance in 2023, but in 2024, I applied as soon as the application window opened, which happens every year on March 17, St. Patrick’s Day. That ended up being lucky for me because slots filled in just three hours. Within a few days of applying, I knew I had gotten a spot. I received an email from Kelly Edens, CTRS, recreation therapy manager at Shepherd, who was Yoda for the weekend, guiding me and all the participants. She shared a list of everything we needed to pack, explained how the weekend would go with activities, asked what I wanted to do, etc.

Two months later, the first day of ASW finally arrived. My partner and I packed our 2017 Chrysler Pacifica and embarked on our journey to Alabama. It teetered between drizzle and steady rain the entire way there. From 20 West to 85 North to the back roads of Alabama, the trip took about 2 1/2 hours. With crinkles and crackles, the gravel road announced our arrival at Camp ASCCA, an accessible facility on Lake Martin near Jackson's Gap. We parked by the dining hall, unsure of where to go. Donning my camo poncho with my partner sporting a big umbrella, we got out of the car to explore and see precisely where we needed to go. Luckily, a group of volunteers from Brasfield & Gorrie happened to be passing by and pointed us to the pavilion. One person was even kind enough to walk us there.

Inside the pavilion/gym, Shepherd staff ushered us to tables where we registered and got a bag full of goodies: t-shirts, according to our size, a microfiber towel, a canteen, a baseball cap, snacks, sunscreen, and mosquito repellent. At the next table we received the schedule of activities. The weekend was scheduled to a T, including everything from when the swim test was open to when lunch and dinner were served to when you could try each activity you signed up for. The volunteers helped unload our vehicle, and we settled into the room.

The weekend was meticulously planned, and even the rain didn't stop anything. It only delayed some activities for safety reasons. Still, even while it was raining, the therapists set up basketball, cornhole, Giant Connect Four, and other games to keep everyone engaged and having fun.

Once the weather cleared up, water activities began. People immediately got into the pool for their swim tests. The test consisted of holding your breath for 20 seconds while face down in the water, rolling over from your stomach to your back, and if you wanted to swim unattended in the pool, you had to float on your back with a lifejacket on for one minute unassisted. Passing the swim test was your golden ticket to water skiing, kayaking, tubing, jet skiing, tubing, scuba, water polo, and swimming without assistance. For safety reasons, if you didn’t pass the swim test, those activities would be off-limits for you, but the therapists were encouraging enough to allow you to try again.

Taking the test was my first time in a pool since my accident, which is a huge feat. Even if you didn’t pass the test, like me, you could still partake in enough activities — fishing, shooting, board games, etc. — to keep yourself more than occupied. For me, that included connecting with several people from the disability community, including professional swimmers and dancers. Not once did I feel out of place, which sometimes can occur when abled-bodied people surround me. A woman I met at a few different Shepherd Center functions described my feelings precisely but more poetically, “It’s nice to be able look at people eye to eye rather than be butt-level all the time.” These moments of camaraderie with people who have intimate knowledge of my daily experience is a truly one-of-a-kind adventure that I might not have had without the help of Shepherd Center. Thanks to the donor-funded Recreation Therapy Program, I’ve made lifelong friends and connected with people throughout the disability community.

ASW was the most fun I have had in a long time. After an injury or illness, it can be challenging to figure out how to get back in the swing of things and do activities that you enjoy. Without Shepherd's guidance, I would have struggled to learn to fish or kayak. The therapists were always encouraging. They dedicate their weekend to you, showing you what is possible and how you can still live your life. Anyone will have a great time, no matter their disability, at ASW.

During my childhood, wearing a helmet to ski was decidedly uncool. Perhaps more telling of that era was the idea that skiing in jeans was very cool.

Out of the 10 million or so people who ski and snowboard in the United States, 600,000 injuries occur annually. Of those, head trauma accounts for 20 percent and is the most common cause of morbidity and mortality in these winter sports. (Haider 2012)

Thankfully, in the past few years, helmet use in winter sports has become the norm with an almost 70 percent compliance rate – almost triple the number in 2003. (McMillan 2013) The rate of helmet compliance is encouraging, but it has brought to light some troubling statistics. Despite the number of people wearing helmets, the number of skiers and snowboarders sustaining brain injuries or fatalities has seen no reduction. Worse, studies have claimed that head injuries have actually increased.

According to a Western Michigan University School of Medicine’s 2012 study, head injuries have increased by 60 percent in seven years. The University of Washington furthered those results in its 2013 study, showing a 250 percent increase in snow-sports-related head injuries among youths and adolescents.

Experts have debated several theories that may explain the simultaneous rise in helmet use and head injuries. Perhaps the most convincing argument relates to risk-taking behavior. It is telling to examine who is getting hurt: 70 percent of snow-sport fatalities involve males in their late teens to early 30s. (McMillan 2013) As snow sport technology has yielded better, faster skis and snowboards, a push for more extreme sporting has followed. Resorts have opened more dangerous trails and are accused of propagating the risk-taking skier/boarder mentality with sponsorships and promotions of ever-more dangerous flips and tricks.

Often, people are surprised to learn that brain injuries can occur even when wearing a helmet. That leads researchers to believe there is a false sense of security that is leading to an increase in risk-taking behaviors.

Snow sports are a fun and great way to spend a winter afternoon, but like any sport, these activities come with some risk involved. Arm yourself with these tips (and helmets) to prevent a brain or spinal cord injury. Knowledge that leads to better decision-making is the key to prevention.

There are several, other smaller safety precautions that everyone should consider before hitting the slopes.

1. Stay at your level. Trails are always marked with a green circle, blue square, or black diamond. Staying in control of your skis or snowboard is key to preventing injury.
2. Constantly scan. Watch out for those who are going too fast, and/or have lost control and get out of their way fast.
3. When going down a mountain, if you have to stop for any reason, move to the side of the trail. This prevents collisions with other skiers or boarders.
4. Take a break when tired, and skip the last run of the day. Injuries happen when you are tired and not paying full attention to your surroundings.
5. Skiing off-piste exposes you to hidden rocks, ledges, and avalanches, and is not worth the risk. Trees are not your friend when skiing, sledding, or boarding.
6. When sledding or tubing, always go down feet first. Breaking a leg is far better than hitting your head.
7. Wear your helmet. Even when sledding. Keep your head warm and avoid concussions and more serious brain injuries.

For more information on Shepherd Center's Injury Prevention Program, click here.

Sources
Haider, Adil H. "Helmets Save Lives of Skiiers and Snowboarders." Journal of Trauma and Acute Care Surgery, 2012.
Mayo Clinic. 2015. www.mayoclinic.org/diseases-conditions/spinal-cord-injury/basics/causes/con-20023837
McMillan, Kelley. "Ski Helmet Use Isn't Reducing Brain Injuries." The New York Times, Dec. 31, 2013.

EMMA HARRINGTON is the director of injury prevention and education services at Shepherd Center. Previously, Emma started the injury prevention program at Grady Memorial Hospital in the Trauma Department. She holds a master of education degree in international education policy from Harvard University. Originally from Boston, Emma is a licensed social studies teacher.

Start planning as early as possible. 

Accommodations are essential for students’ success when returning to school, but it can take some time to determine what is appropriate. It can also take time to work through the school system to get accommodations approved and implemented, so try to get started as soon as you know what accommodations are recommended and feasible.

Know the options. 

Familiarizing yourself with how accommodations can be provided to help you advocate for your student. An Individualized Education Plan (IEP) and a 504 plan are formal plans to help students that are developed by families and schools together. An IEP is a plan created for a child’s special education experience at school. This can include modifications to instruction and the learning environment. A 504 Plan helps plan for a child’s access to learning at school and how the school will provide support and remove barriers for a student with a disability. This can include accommodations to account for modifications to absence and makeup work policies or concerning the student's personal care, like bowel and bladder programs. These examples are not an exhaustive list, and you can find more information in this helpful overview from Children’s Healthcare of Atlanta. 

Helpful hint: These plans are NOT set in stone! If you find you need something different than what is in your plan, you can change it.

When you’re returning to school after injury or illness:

When in doubt…ask!

This one is big! Advocating for yourself is important in returning to school and for life. First, ask for a school tour so you can find accessible ways for you to get to class before school starts. Give your school counselor access to one of your therapists so they can understand more about your disability. If you have a 504 or IEP that isn’t working the way you need it to, talk to your counselor at school, and elevate it beyond that if you need to. IEPs and 504s can be changed, but you have to speak up to make that happen.

Don’t let personal care needs impact social time at school.

Being with friends is a big part of returning to school, and it’s essential for social development and fun! Make sure your personal care time for things like catheters does not take up time in recess or lunch. If you need extra time for these things, remember to address them during planning for your accommodations.

A Note for Teachers and Staff:

Asking what the student needs or wants to facilitate better learning can help you understand their needs. Some students may be fine with talking about their needs in front of others, and some will want to be addressed privately. Students may need preferential seating in the front for ease of access or the back to not disturb others during weight shifts. You can also ask for a contact for your students’ therapy team for more information. The key thing to remember here is to advocate and ask!

I just want to say what an honor and a privilege it is to be a registered nurse (RN), and especially a staff RN at Shepherd Center. I have been a nurse for eleven years. I work on the comprehensive rehabilitation unit (CRU). I love CRU because we get to treat the widest variety of patients. What I can tell you is that while nursing can be tough, it is a fulfilling career that is worth it. Here are some tips I think are helpful to think about if you are considering becoming a nurse.

Five tips for considering a career in nursing

1. Know your why. Why nursing? What are your expectations? The admission process is competitive, and achieving the degree is tough. However, nothing compares to your first year in nursing. It can be overwhelming. So, there are plenty of what I call “gut checks” along the way. I have seen many new nurses stop their careers short because nursing wasn’t what they thought it would be. So, please do some soul searching and get as clear as you can about your answer to “why nursing?” Try to get past the “I want to make an impact” answer. Remember that there is a difference between the role of nursing and doing the job of a nurse.
2. Work in the field. Trust me. Get a certification as a certified nursing assistant (CNA) or medical assistant. You will learn a lot and see the full spectrum of care. Also, many nursing programs now require you to work as a CNA. This will help you truly understand the role and the job as a nurse. You may find out that you would rather pursue a career in respiratory therapy, physical therapy or another discipline.
3. Find at least one nursing mentor. Ask them a lot of questions. Try to find nurses in different roles and places in their careers. It will help you get an idea of how to navigate the career options in your area. I relied heavily on my nursing mentors, and they really helped me through some of the crossroads I faced as a student and as a new nurse.
4. Assess your strengths and weaknesses. Be honest. Are you resilient? Good with computers? Good with people? How do you handle pressure? How do you handle change? Ask for honest feedback from your current employer or peers. Are you disciplined enough for a grueling school schedule? Nursing is more than strong academics. Taking care of people requires some self-awareness. Do you have some mental health issues you need addressed? Anxiety? Depression? Make sure you are mentally, emotionally and physically ready for this challenging but rewarding career. You cannot give from an empty cup. So, start filling it now.
5. Just do it. Get as much experience as you can. Volunteer for new experiences. Nursing school will only give you the basics. You must work hard to get good internships and clinical experiences. Go for it again and again. The strongest nurses are always willing to learn a new skill. You will never know when those skills could come in handy.

By Gloria Fagan, RN, BSN, CCM workers compensation outreach manager at Shepherd Center

Every year, July serves as Disability Pride Month, spreading awareness and recognizing progress for disability inclusion and advocacy. In my role as a workers' compensation outreach manager at Shepherd Center, this cause is particularly close to my heart because it educates about disability employment issues and celebrates the many and varied contributions of American workers with disabilities. As someone who advocates for people who have been injured on the job to receive rehabilitative care at our hospital, I see a need for more discussion around this important issue.

The Americans with Disabilities Act (ADA) was the first comprehensive civil rights act for people with disabilities. While it set the foundation when it passed 32 years ago, there is still more work to be done. Disability Awareness Month still highlights how important it is for employers to continue practicing, discussing and expanding inclusivity in their policies and procedures.

At Shepherd, I’m proud of how we emphasize the importance of inclusion for our employees. In fact, we were recognized this year as a "Best Place to Work for Disability Inclusion" by Disability:IN and the American Association of People with Disabilities. This is because of policies and procedures we’ve put in place, like increasing office accessibility for employees who use wheelchairs by providing roll-under work desks, accessible ramps, wider hallways and push pads to open doors throughout the hospital. For employees with visual impairments, we provide laptops that come with magnification and screen reading, as well as things like office light adjustments. Things like this ensure a more equitable opportunity for people with disabilities to thrive in the workplace, leading to a more diverse workforce.

While there is always more work to be done in this space, we will make progress if we work together and actively participate in these conversations. The Department of Labor’s Office on Disability Employment Policy (ODEP) offers a range of resources to help employers and other organizations encourage inclusivity in the workplace. Throughout the rest of this month and year-round, I encourage employees and employers to take steps to continue progress. 

It’s no secret – getting a good night’s sleep is essential for your physical and mental well-being. But, so many of us still struggle to get the proper amount of quality sleep on a regular basis, which can affect our mood, productivity, and overall health. Fortunately, by adopting healthy sleep hygiene practices, you can pave the way for a restful and rejuvenating slumber. 

 1.     Stick to a consistent sleep schedule.

One of the best ways to manage your sleep patterns is by keeping a consistent sleep schedule. Aim to wake up at the same time every day, even on weekends or during vacations. Minimize daytime naps unless medically recommended. If you benefit from naps, limit them to 20-30 minutes. This all helps set your body's internal clock, making it easier to fall asleep and wake up naturally.

2.     Set a sensible bedtime.

It's crucial to ensure you get enough sleep each night. The recommended sleep time for a healthy adult is typically seven to eight hours; however, everyone is unique. Plan your bedtime accordingly to allow your body enough time to rest and rejuvenate.

3.     Listen to your body.

Only go to bed when you’re sleepy. If you find yourself lying awake for more than 20 minutes, don't force it. Instead, get out of bed and engage in a quiet activity with minimal light exposure until you feel drowsy.

4.     Create a bedtime oasis.

Quality of sleep is just as important as the amount of sleep you get. Keeping your bedroom cool, dark, and quiet can create a more restful environment and might promote better sleep. 

5.     Stay active and eat well.

Regular exercise and a balanced diet contribute to better sleep quality. Engaging in physical activity during the day can help you fall asleep faster and enjoy deeper sleep at night. Avoid intense workouts close to bedtime as they can temporarily increase alertness.

6.     Create a bedtime routine.

Establishing a soothing bedtime routine can signal your body that it's time to wind down. Reading a book, taking a warm bath, or practicing gentle stretches are all examples of calming bedtime activities. Start winding down at least 30-45 minutes before your normal bedtime.

7.     Keep the bed for only sleep and intimacy.

Avoid using your bed as a workspace or a place to watch movies, as this can disrupt your sleep patterns.

8.     Avoid caffeine or alcohol.

Both alcohol and caffeine can disrupt your sleep patterns. Avoid drinking caffeine in the afternoon or evening, and avoid consuming alcohol before bedtime.

9.     Keep snacks to a minimum.

Heavy meals before sleep can cause discomfort and disrupt your sleep. If you're hungry at night, opt for a light and healthy snack to satisfy your hunger without overloading your digestive system.

10.  Turn off electronics 30 minutes before bed.

Studies have shown that using your phone, computer, or television before bed can interfere with the body’s production of melatonin, a natural hormone that is released to help you feel tired and ready for sleep. The bright lights on your devices can stimulate feelings of alertness when you should be dozing off.

By Emma Harrington, director of injury prevention and education at Shepherd Center

Recent heat waves have prompted many important conversations around hot weather safety, including what we should consider to prevent child fatalities in hot cars. While we have experienced a decrease in hot car deaths since the pandemic began in 2020, those numbers are starting to rise again at an alarming rate. As we veer back into the fast lane of our busy lives, it is important to take a culture of safety with us. Here are some tactics I recommend.

Top Tips to Prevent Hot Car Injuries and Fatalities for Children

1. Leave your phone, purse, or briefcase in the backseat. Accidents happen to even the most attentive, loving caregivers. For example, factors like sleep deprivation can wreak havoc on cognitive abilities. Create a system like leaving items in the backseat to ensure you always check for your child before locking up the vehicle.
2. Even if it is relatively cool outside, do not leave a child in the car. Cars heat up very quickly. It only takes 10 minutes for a car’s temperature to rise 20 degrees. Children cannot regulate their body temperature like adults, so even if it’s cool outside or you park in the shade, bring them with you.
3. Keep your car locked when at home or parked. Kids can and do use the car as a hiding spot and a jungle gym. Ensure they cannot get into the car by locking it when you are not present.
4. Teach your child to unlock your car door from the inside and practice. Just like you teach your child to memorize their phone number and recognize helpers, this should be in every family’s safety training. Begin practicing as soon as your child is cognitively ready.
5. Get your car seat checked by a certified car seat technician. A culture of safety begins now. 75% of us install our car seats incorrectly. Learn how to do it right, every time. Find a certified technician near you here.
6. Low-tech to high-tech solutions. From simple lanyards that clip into the car seat to high-tech sensors and alarms that alert you when the baby is left in a car there are many options out there to suit every budget.
7. Bonus tip: Remember your pets. Temperatures as low as 57 degrees can become deadly in minutes. Avoid leaving your furry friends in the car, as well.

Sources:
National Highway Traffic Safety Administration
Prevent Child Injury

By AJ Veal
Outreach Coordinator and Veteran
Shepherd Center’s SHARE Military Initiative

This PTSD Awareness Month, I want to shed some light on how post-traumatic stress disorder (PTSD) can affect an important segment of our population — veterans, service members, and first responders. The following statements are based on accounts from the hundreds of heroes I have listened to over the past three years as outreach coordinator with Shepherd Center’s SHARE Military Initiative. I hope it paints a picture of what they go through and how they end up reaching out to organizations like SHARE that can give them the help they need.

In my role, I come into contact with some of America’s greatest patriots who gave everything for their country — and then some. Some clients are still serving, some just separated from service and some have been out for a long time. We see special operators, engineers, pilots, infantry, medics, clerks, supply, cooks, and every other job function that falls under the Department of Defense. They all present a similar story — facing adversity, overcoming that adversity to complete the mission, and coming home feeling different, lost and alone.

They have experienced and witnessed things most Americans will never have to and, in doing so, are left marked by those experiences. They experience vivid flashbacks, taking them back to a traumatic event, seeing the faces, reliving the smells, feeling the adrenaline rush, etc. They wake up in cold sweats, angry or sad. They feel nauseous, anxious or super alert. They have little patience and have a hard time focusing or enjoying the things they once did. Building or maintaining a connection or relationship with friends and loved ones becomes harder. The shadow of feeling abandoned and lonely creeps in. They often feel bewildered, frustrated, ignored, confused, or stuck by the time they speak to me.

The list of symptoms above that many of our clients at SHARE are seeing, feeling and acting upon can be attributed to PTSD, and a variety of other mental health concerns, which, in most cases, have never been addressed. First, you don’t usually talk about mental health while in the service. That’s where it starts. It can affect your job duties, security clearance, leadership/gaining rank opportunities, etc., so most just hold it in and don’t talk about it. Then, when they come home, many veterans have to get a job, be a mom or dad, and go on living as “normal.” They wake up, put on some slacks, go in to work by 0900, and thank a customer with a smiling face, then wash, rinse, repeat.

The unravel begins. Small events begin to snowball, and the symptoms start up. Work becomes harder, communicating with loved ones becomes frustrating and the retreat into seclusion/avoidance begins. It may be followed by copious amounts of alcohol or other substances to numb or pause the pain, feelings or emotions, when in reality it only exacerbates those symptoms and can land some folks in some hot water. Legal trouble, addiction/dependency, and the continued spiral of feeling lost and hopeless continues.

So, they seek help, frequently by direction or ultimatum of a loved one. This is when a client reaches out to us or other high-quality Veteran Service Organizations (VSOs) for help. VSOs exist to break the stigma, offer a warm, helping hand and pay it forward to the heroes and their families. These organizations operate for the sole purpose of helping a true hero, a warrior of a dying breed, get better and back to living. Veterans, service members, and first responders  just have to ask for help because the door is always open. Clinical programs like Shepherd Center’s SHARE Military Initiative exist to help that veteran get better and back to as normal as normal can be.

About SHARE Military Initiative

Shepherd Center’s SHARE Military Initiative is a comprehensive rehabilitation program that offers veterans, service members, and first responders help and healing for their daily struggle with traumatic brain injuries and any co-occurring psychological or behavioral health concerns, including post-traumatic stress. Learn more at shepherd.org/share.

By Alex Alverson, Ph.D., ABPP, clinical neuropsychologist in Shepherd Center’s Brain Injury Rehabilitation Program

Almost 800,000 people in the U.S. experience a stroke every year. While the most obvious symptoms are often physical or cognitive (e. g., problems with moving or speaking), many people who have had a stroke will also experience changes in mood and behavior. Injury to specific brain regions can lead to these changes, or they may come from changes in lifestyle, roles, and abilities.

Treatment for mood changes isn’t always necessary because feelings like grief, sadness, and worry are normal responses to a significant life event like a stroke. However, when these symptoms are chronic and severe enough to impact daily functioning, a person may have a mood disorder. At least one in three people affected by stroke is diagnosed with depression within five years after a stroke, and one in five is diagnosed with an anxiety disorder. Because mood disorders can interfere with rehabilitation and increase disability, recognizing and treating these symptoms is important for recovery. Many people affected by stroke can benefit from psychological and/or psychiatric treatments.

Symptoms of depression and anxiety may be different for different people and often overlap. Some of the most common symptoms are listed below.

Treatment

Interventions for mood disorders may include psychological treatments (e.g., psychotherapy), behavioral and environmental modifications, and medications. Psychotherapy involves working with a licensed mental health provider (e.g., psychologist, licensed professional counselor) and may focus on setting goals, solving problems, improving relationships, acceptance, relaxation, and meditation, or changing unhelpful patterns of thinking. Some individuals who have had a stroke may not be able to participate fully in psychotherapy due to problems with memory, language, or reasoning. Fortunately, creating a supportive and positive environment and engaging in pleasant activities positively affects mood.

Your medical doctors (e.g., psychiatrist, neurologist) may also prescribe medications to treat mood disorders. These medications work by targeting chemical changes in the brain after stroke. For example, antidepressants increase the activity of chemicals related to motivation and drive. All of these interventions can be effective in reducing symptoms of depression and anxiety, but they work best in combination.

What can you do in the hospital or at home?

Medical providers and members of the treatment team can work with patients and caregivers to generate strategies for managing or responding to changes in mood. Some recommendations might include:

• Encourage and allow for rest and quiet time.
• Orient the person to the situation (such as day, time, place, and activity).
• Maintain structure and routine in daily schedules.
• When someone is outside their usual environment, keep familiar items nearby, such as photographs, mementos, and special clothing.
• Validate emotions. There is no ‘right’ or ‘wrong’ way to feel when recovering from a stroke.
• Spend time on enjoyable activities and socialization. Feeling engaged and connected to others can improve mood.
• Focus on concrete, short-term, achievable goals.

If you or a loved one is concerned about changes in mood, be sure to talk to your medical providers. You are not alone!

Sources:

https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke

Post-Stroke Depression: A Review, Robert G. Robinson and Ricardo E. Jorge, American Journal of Psychiatry 2016 173:3, 221-231

My name is Burnise Charpentier, and I’ve been a social worker for 22 years. I’m not so sure I should even admit that! 

I graduated with my undergraduate degree from Florida International University, and my graduate degree is from Florida State University. To explain why I chose to be a social worker, I have to explain my cultural background. 

I am a second-generation American. My parents are from Hispaniola. My mother is Haitian, and my father is Dominican. My parents migrated to the United States and landed in New York.  I can only imagine the hardships they encountered navigating a new city, learning a new language, and gaining successful employment. Those hard times were always smoothed out by the kindness and assistance of strangers, friends, and family.  This kindness has intrinsically evolved to my family's core mission of “being a blessing”! 

I chose to be a social worker so I can serve my community, to provide compassion at my patient’s time of need, to instill hope, to advocate for my patients when they feel powerless, and of course, to “be a blessing”.  

While working as a case manager at the Shepherd Center, I’m currently in a position to assist patients and their families with hardships they have encountered due to illness or catastrophic spinal cord injury. Life always comes full circle. I would love to say I chose Shepherd, but really Shepherd chose me. Shepherd’s mission and vision align with my core ethics as a social worker.  Shepherd is a very special hospital that advocates for its patients, as well as families.  They look for unique ways to rebuild lives with hope, and independence, with the continuance of advocating for full inclusion in all aspects of community life while also promoting safety.   Shepherd’s mission aligns with my perspective as a social worker – and of course, it allows me to “be a blessing!’

By Emma Harrington, director of injury prevention and education at Shepherd Center

Ask any new parent who is routinely pouring their cereal into their coffee if fatigue impacts their ability to function. Not getting enough shut-eye has serious cognitive consequences, like inhibiting decision-making, attention, and memory — all significant skill sets needed to drive safely. Substantial time and attention have been paid to the distracted driving epidemic in our nation. Still, perhaps more education needs to be done on drowsy driving because it is easy for even the most vigilant among us to slip into it. The CDC reports that 1 in 25 has fallen asleep at the wheel in the last month. Most likely underrepresented in the data, at least 6,000 fatal crashes may have involved a drowsy driver in 2020. Certainly, more research on drowsy driving needs to be done, but for now, here are a few tips on how to keep yourself and your loved ones safe.

1. Talk to your kids about the importance of getting enough sleep — and lead by example. Set regular bedtimes and limit screen time before bed.
2. Familiarize yourself with your state’s Graduated Drivers Licensing laws: most states restrict new drivers to daytime driving, as nighttime hours are far riskier. This is especially true for drowsy driving, where most injuries and fatalities occur between midnight and 6 a.m.
3. Recognize and talk about the warning signs of drowsy driving, including weaving, hitting the rumble strips, missing your exit or turn, blinking and yawning, and not remembering the last few miles driven.
4. When appropriate, pull over and call for help or switch drivers. Using your parents’ trick of turning up the radio is not enough to keep you safe on the road.
5. Be aware that your brain may operate differently late at night. According to neurologists at Mass General, your brain’s chemicals change at night, resulting in negative changes in attitudes and behavior.

Sources:

https://www.frontiersin.org/articles/10.3389/fnsys.2014.00046/full

https://www.cdc.gov/sleep/features/drowsy-driving.html

https://www.wishtv.com/news/medical/scientists-say-when-it-comes-to-the-brain-nothing-good-happens-after-midnight/

By Wendy Magnoli, Ph.D., Licensed Psychologist, Dean Stroud Spine and Pain Institute at Shepherd Center

We've seen tremendous progress in pain and its management over the past several years. However, there are still a lot of myths and misconceptions out there. Here are the top 10 myths I hear most frequently.  

1. If you cannot find the exact cause of your pain, then it must be in your head.

Many pain syndromes are not correlated with findings on any medical tests or scans. Just because the cause of your pain does not show up on tests, this does not mean that your pain is not “real.” Many patients with chronic back pain have no significant findings on MRI scans. The opposite is also true – many individuals who have significant findings on MRI imaging report no problems with back pain.

2. Chronic pain isn’t that bad because you get used to it after a while.

Chronic pain always hurts. Yes, you may get used to it, modify your life around the pain, and learn to function with it, but it still hurts.

3. If you take opiates, you must be or will be an addict.

Most people who take opiates for an extended period develop a chemical dependence on the medication and can go into withdrawals if the medication is suddenly stopped. This, however, is NOT addiction. Addiction is a condition characterized by cravings and misuse of the medication to get a “high” or attempt to relieve negative emotions such as depression or anxiety.

4. Chronic pain is forever.

Chronic pain is not necessarily an incurable disease. If a chronic pain condition has been present for years, it is unlikely that a doctor will be able to fix it in just a few visits. Still, it may be possible to diminish or even eliminate chronic pain with persistence and teamwork.

5. Living with chronic pain eliminates the possibility of a fulfilling life.

While chronic pain can significantly impact daily life, it does not mean life must be spent in isolation or without joy. Although some modifications may be necessary, an individual with chronic pain can continue to live a fulfilling life consistent with their values.

6. Chronic pain is an inevitable part of growing older.

Although a few aches and pains are to be expected as we get older, a generally healthy person should not expect to wake up every day with chronic pain. Chronic pain is not inevitable, and thinking that it is may become a self-fulfilling prophecy.

7. The best treatment for chronic pain is bed rest.

Prolonged inactivity can actually make chronic pain worse through deconditioning. It is important to stay physically active without overdoing it. Talk to your doctor and/or physical therapist to determine the right balance for you.

8. Weather has no impact on “real” pain.

Changes in weather can affect pain levels related to joint pain, and barometric pressure changes can affect headache pain. Depending on the type of pain, extreme heat or cold can also impact pain levels.

9. Alternative treatments are ineffective.

Many alternative treatment modalities (such as acupuncture, essential oils, massage, herbal supplements, etc.) can be excellent additions to a more traditional treatment plan. Check with your treating physician to ensure that any alternative treatment you are considering is safe and will not interfere with your current treatment plan.

10. If a person has “real” physical pain, then psychological treatment is not needed.

People with chronic pain face many challenges and stressors related to their medical struggles and life changes and may experience symptoms of depression and anxiety. Since chronic pain can impact every aspect of life, supportive therapy for dealing with these issues can be very helpful. Pain psychology can also help people with chronic pain learn new skills (such as relaxation techniques) that can be helpful in the self-management of pain.

About Dr. Magnoli
Wendy Magnoli, Ph.D., is a psychologist for the Dean Stroud Spine and Pain Institute outpatient clinic. She received her Ph.D. in clinical psychology from Auburn University and completed her internship at the University of Alabama at Birmingham School of Medicine. Dr. Magnoli has specialized training and experience in pain psychology as well as other areas of health psychology. She is a certified clinical trauma professional with years of experience treating individuals with both acute and chronic trauma histories. She is especially interested in the association between trauma and chronic pain.

By Kristina Carbone, PharmD, and Julie Parker, PharmD, MSHI

As a leading neurorehabilitation hospital, Shepherd Center takes pride in educating the next generation of clinicians through fellowship programs. Shepherd Center’s pharmacy residency program aims to prepare graduate pharmacists for medication-related care for various conditions. As this year’s residency ends, our two program residents reflect on what they’ve learned.

We started this residency year ready to learn and grow into the best pharmacists that Shepherd Center could prepare us to be! While this year has been one of the most challenging – if not the most challenging – years we have ever experienced, it has also been the most rewarding. There were long nights, a lot of coffee, and some tears along the way. Now that we have made it through, we can’t believe how much we have developed, and we are endlessly thankful for our incredible experience!

Here are our top 5 takeaways from our residency year:

1. Organization – You can’t be prepared enough when starting residency.
   • We both started residency thinking organization was a strength with our calendars ready to go and fill out. We quickly realized that residency requires a new level of organization, and Outlook became our best friend. Triaging was an essential process we learned as we had long to-do lists and not enough time in the day to accomplish it all.
2. Guidelines – They never end, and you never know it all.
   • New research is constantly being done in the medical world, and we have become well equipped to always search for the most up-to-date guidelines, even presenting on a handful of them! We learned that we will never know everything, as frustrating as it may be. And that’s okay – because we know where to find the answer. “I don’t know, but I’ll look it up and get back to you,” is a landmark phrase during residency.
3. Feedback – You will get it…all day, every day.
   • Feedback is a natural component of learning, and incorporating that feedback is even more valuable. Not all feedback is positive feedback. The key to residency is taking constructive feedback and building something with it. As first-year residents, we have not only been able to receive feedback but also provide it to improve the program for future residents!
4. Leadership – It fuels us.
   • We both came into residency with leadership experience from pharmacy school and hit the ground running with our involvement in various committees. From creating protocols to completing Medication Use Evaluations to developing new initiatives, being leaders in our organizations has fueled us through the burnout that is inevitable during residency. Our confidence has grown, we’ve stopped saying “um” during presentations, and we do it all for the care of our patients!
5. Community – It doesn’t get better than Shepherd Center.
   • Finally, this year would not have been the same if it had not been for the remarkable people we were able to work with. This includes not just our fellow pharmacists and preceptors but every single specialty that was involved in our residency program and all the inspiring patients we were fortunate to meet and take care of along the way. Endless thank yous are necessary for everyone who was involved in our learning and for making this the most warm and welcoming environment for the most stringent year.

We hope these takeaways share our unique experience and can help prepare new residents for what to expect during a difficult but enriching and fulfilling year ahead! Finally, as we always say, teamwork makes the dream work!

You can learn more about Shepherd Center’s pharmacy residency at shepherd.org/pharmacyresidency.

By Emma Harrington, director of injury prevention and education at Shepherd Center

Falls are one of the most common causes of traumatic brain injuries and spinal cord injuries, no matter how old you are. A common misconception is that falls are a normal part of the aging process, but there are things you can proactively do to keep yourself and your loved ones safe. Follow these simple steps to reduce the risk of falling.

Top Tips to Prevent Falls at Home and in the Workplace

1. Stay healthy and active. Keep up with annual eye exams, hearing exams, and physicals, which can alert you and your doctor to problems that might make you more prone to falls. Help maintain muscle tone and core body strength by staying active.
2. Be your own advocate. Talk with your doctor if you’ve had a fall or think you are at risk of falling as he or she can provide resources. Always be extra careful when drinking alcohol and be honest about your consumption, especially if falls are occurring under the influence.
3. Review your medications. Talk with your healthcare team about the list of medications – prescription and over-the-counter – that you take. Sometimes certain medications or combinations of medications can leave you feeling off-balance.
4. Wear suitable shoes. Make sure they fit well. Ideally, shoes should have non-skid soles. Avoid flip-flops altogether and slippers where the grip has deteriorated.
5. Think twice before climbing that ladder or chair. If you must get on a ladder, please have someone else present to spot you and ensure the ladder is adequately secured. If using a step ladder at work, make sure it has sturdy grips and is locked in place before reaching up. Climbing on chairs, especially ones with wheels, is a recipe for disaster.
6. Preemptively make modifications to your home. Remove any loose rugs or cords, keep pathways clear, ditch clutter, use motion-activated night lights, and keep flashlights handy to help guide you in the dark. Non-slip mats and grab bars, if needed, can help make bathrooms safer.
7. Hire a professional. For outside jobs like cleaning the gutters or painting the house, it’s best to leave it to the experts. Spending the money to have the gutters cleaned is a lot less costly than a catastrophic injury.
8. Always wear a helmet. If you ride bikes, motorcycles, scooters, or horses, protect your head.
9. Accept assistance when you need it. If you feel unsteady or unsure, ask for help.

Scoot Safe is an innovative safety campaign designed to stem the electric scooter (e-scooter) injuries and fatalities occurring on our roadways. With generous funding from the Georgia Governor's Office of Highway Safety, Shepherd Center embarked on a targeted digital media campaign raising awareness about the risks e-scooter riders face and preventive measures they can implement to stay safe.

Through a pilot program, which included a three-month digital advertising and social media campaign, a virtual conference, direct mailings along the Atlanta Beltline and a dedicated website, we hoped to increase helmet use and decrease speed and intoxicated riding. Using Atlanta, Georgia, as our intervention group and Statesboro, Georgia, as our control group, we worked to determine if mass digital media messaging can affect behavioral change related to injury prevention and micromobility. In this case, micromobility is specific to the use of sharable, dockless electronic scooters.

We observed riders in Atlanta and Statesboro in high-traffic areas before and after the digital campaign measuring correct helmet use, excessive speed, age, gender, number of riders per e-scooter, if any conflict was observed (car, pedestrian, bike), rider location, and if the scooter rider fell or not. Our pre-observations took place in April 2021, and our post-observations took place in September 2021.

In total, we observed 496 riders in Atlanta and 108 in Statesboro before the campaign started. With our post-observations, ridership increased, and we saw 588 riders in Atlanta and 163 in Statesboro. Initial determinations provided by this observational study are the very low rate of helmet use among e-scooter users, across all sites, both genders, all age groups and all riding locations (sidewalk, road, beltline, bike lanes). This rate did not improve in the intervention group as a whole during post-observations but may have improved in some locations or zones while decreasing in others (the number of observations was too small to demonstrate statistically significant changes in specific locations).

In addition, wrong-way riding in the roadway is an issue for younger riders, and riding with two people per scooter is common despite scooter providers’ prohibitions. Finally, the use of protected bike lanes became apparent during this study. E-scooter riders are utilizing these lanes when available, especially the protected ones, suggesting that further investment in bike safety measures could help curb future e-scooter related injuries.

These observations point to obvious targets for future interventions and provide baseline data for comparison and subsequent studies. Visit scootsafega.com to learn more. You can access all the content from our virtual Scoot Safe webinar for free here.

By Kathie Kurtz, MS, CCM, case manager at Shepherd Center

This National Case Management Week, I want to share a little bit about our profession and how case managers work with patients, families and the healthcare team. I’ve been a case manager for 30 years, with the past 20 years at Shepherd Pathways. Most recently, I accepted a case management position with the Spinal Cord Injury Day Rehabilitation Program, Shepherd Center’s comprehensive outpatient rehabilitation program for people with spinal cord injury and other neuromuscular conditions.

Case management is a valued position within any Shepherd Center program. Every day, we work with a team of therapists and physicians to provide a comprehensive plan of care for the patient.

The part of my job that I most enjoy is my involvement with patients and families. Often, the case manager is the first person to meet with the family and patient upon their admission to Shepherd Center. Our families are emotionally drained after the trauma their loved one has suffered, yet they are reassured they are in the best place they can be within the Shepherd walls. Fear of the unknown and anxiety can manifest in many ways with trauma. Our job is to empathize with patients and families, remaining sensitive to the emotional struggles that they face. From day one, we identify what goals are important to them and the barriers to returning home. We gain an understanding of what supports are needed for the client to return home, available resources and insurance parameters. We also form a partnership with the external case manager, if one is involved with the patient’s care, to meet the patient’s treatment and discharge setting needs.

All of this is within the backdrop of working with the best therapists, physicians, nurses, techs and managers at Shepherd who are equally invested in working with our patients to meet their goals. Relationships are formed that remain well after the patient leaves our program. I get to witness firsthand the progress our patients make, and the difference Shepherd makes in the lives of so many. I am so proud to be a part of the Shepherd family.

Written by Zac Bradley, MS, CRC, NCC, post-acute vocational specialist at Shepherd Center

Due to lasting effects of a brain injury, there are unknowns about returning to work. The good news is: with the right support and planning, many people do successfully get back to work. Here are some tips I'd recommend.

Planning

• Talk to your doctor about returning to work.
• Know your interests and skills, as well as your strengths and weaknesses.
• Be knowledgeable of how the symptoms of your brain injury may affect you at work.
• Set realistic expectations for return to work.
• Be familiar with how working may affect your benefits (Social Security or long-term disability).

Looking For a Job

• Look for jobs you are qualified for based on education, training, work, experience, skills or licenses.
• Thoroughly search job descriptions to determine if the work setting and duties are suitable for you.
• Understanding your disability benefits and disability symptoms will help you determine if you should work part-time or full-time.
• Consider the type of accommodations you may need to do the job that interests you.

Disclosing Your Brain Injury

• Disclosing your disability is a choice. The Americans with Disability Act (ADA) states that you only have to disclose your disability if you need a reasonable accommodation(s).
• It is OK to disclose you have a disability, if asked, on an application. There's no need to address disability on your resume or cover letter (exception: If the job is disability-specific, it may be an advantage to list your disability on your cover letter).
• When you disclose, just provide basic information about your condition, your limitations and the accommodations you may need.
• Talk positively about your disability by sharing how you accomplish work tasks despite your challenges.
• It is better to disclose your disability and request accommodations before job performance suffers or other problems occur.

Resources

• Job Accommodation Network
• ADA National Network
• If you receive Social Security benefits, visit the Ticket-to-Work website at choosework.ssa.gov to learn how to return to work with help from community resources.

By Wendy Magnoli, Ph.D., Licensed Psychologist, Dean Stroud Spine and Pain Institute at Shepherd Center

In the past, we have seen pain issues as having either a physical or medical cause or a psychological cause. In other words, individuals saw pain as either “real” or “all in your head.” Fortunately, over the past several decades, this model has been replaced by the biopsychosocial model of pain, which operates on the belief that all pain experiences are a combination of physical/medical, psychological and social factors.

This is a huge shift, and this new model more fully acknowledges the complexity of the pain experience. It allows for a two-way feedback loop between the mind and the body, with each impacting the other. For example, whereas pain can contribute to the development of feelings of depression and anxiety, it is also possible for symptoms of depression and anxiety to directly affect the pain experience itself. This can become a confusing cycle over time and is just one example of how pain psychology services can help make sense of the experience of living with pain.

Chronic pain affects every area of a person’s life, which can present multiple challenges with adjusting to changes in mobility, relationships, ability to fulfill responsibilities, self-image, mood and many other factors. Pain psychology can help navigate these changes and transitions, address mood and relationship issues, and implement various pain management strategies. Whereas many aspects of pain treatment involve having things done by medical providers (e.g., injections, nerve blocks, physical therapy interventions, prescription medications), pain psychology can help individuals with chronic pain take back some feeling of control by learning strategies they can implement themselves to manage their pain. These interventions include, but are not limited to, relaxation, meditation, mindfulness techniques, hypnosis and cognitive-behavioral therapy. By learning techniques to help manage their pain, individuals can gain more control over their treatment, comfort and well-being.

The Dean Stroud Spine and Pain Institute at Shepherd Center embraces a multi-disciplinary biopsychosocial approach to pain management with team members from various professional specialties working closely together to ensure quality outcomes for those individuals we treat. We treat a wide variety of pain issues, including conditions of the spine and spinal cord, headaches, joint and muscle conditions, nerve pain, spasticity, and complex regional pain syndrome (formerly known as reflex sympathetic dystrophy). In addition to treating former inpatients of Shepherd Center, we also treat a wide range of individuals in the community and surrounding regional area. Our pain medicine physicians frequently refer the individuals they work with to pain psychology services, especially when chronic pain significantly impacts mood, activities, and/or relationships with family and friends. These referrals are not made because of a belief that the pain is “all in their head,” but because strategies can be taught to help individuals cope with pain and even reduce the pain somewhat. After the referral, the pain physician continues to provide ongoing medical care and works closely with the pain psychologist to ensure the best possible outcome.

To learn more about the Spine and Pain Institute, click here.

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About Dr. Magnoli
Wendy Magnoli, Ph.D., is a psychologist for the Dean Stroud Spine and Pain Institute outpatient clinic. She received her Ph.D. in clinical psychology from Auburn University and completed her internship at the University of Alabama at Birmingham School of Medicine. Dr. Magnoli has specialized training and experience in pain psychology as well as other areas of health psychology. She is a certified clinical trauma professional with years of experience treating individuals with both acute and chronic trauma histories. She is especially interested in the association between trauma and chronic pain.

By Deborah Backus, PT, Ph.D., FACRM  
Vice President of Research and Innovation at Shepherd Center 

One does not have to go far or search too hard to find references to “innovation” these days. To some, “innovation” has become a buzzword thrown around to gain recognition or attention, just a new way to package old ideas. 

This is why in my new role as Vice President of Research and Innovation at Shepherd Center, it is important to me to go beyond the buzzword and focus our innovation efforts on what truly matters – the patients and families we serve.  

Shepherd Center was founded based on an innovative spirit driven to fill the need for a top-tier rehabilitation hospital in the Southeast. Since then, our clinicians, researchers, staff and leadership have worked relentlessly to develop new or improved approaches to care for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other related conditions.  

Now, I’m excited to take it a step further and define what mission-driven innovation means to us: advancing the field of rehabilitation to improve the quality of life for people with disabilities at Shepherd Center and around the world – today and for generations to come.  

We will do this in a few ways. First, we will cultivate a culture that is prepared to discover and innovate, in which we nurture and reward those who think boldly and creatively. We will take a strategic approach and ensure our work is closely integrated with our clinical programs’ priorities. This will involve creating a product development strategy and defining processes for bringing ideas to reality. Finally, we will leverage Shepherd Center’s clinical and research expertise, collaborate with our patients and like-minded external partners, and educate and train future researchers and innovators. 

Since I began my career at Shepherd Center in 1989, I have witnessed first-hand how innovation can make a true impact on peoples’ lives. From a young man with a high-level cervical injury able to control his computer and TV through a smartphone, to a woman with no limbs empowered to drive because of the innovative solution created for her vehicle, to a veteran with post-traumatic stress syndrome now able to work because he has a new app to help manage his anxiety – there are so many examples of how we have helped people live fuller lives through innovation.  

Mission-driven innovation at Shepherd Center will lead to new and better ways to change “I can’t” moments into “I can” realities. I am excited about the future for Shepherd Center and the rehabilitation field, in general. Join us on our journey to being the preeminent innovation institute in rehabilitation medicine. Learn more at shepherd.org and in our recent research and innovation feature story at this link. 

It’s a sunny morning here in Maine. Spring. New life is coming up to the birdfeeders, the creek is flowing peacefully and the sounds of my family asleep create a stillness.

It’s been nine months since Jack’s accident – the same amount of time it takes a baby to grow in your belly.

Life changed in an instant at 16 years old for him. For all of us.

Jack dove into the shallow ocean in Delaware on June 27, 2020, breaking his C-5 vertebrae and drowning. He was brought back to life on that beach by off-duty paramedics whom I’ll never get to thank because it all happened so fast. My first thought when I saw him was, “Thank gosh he is breathing.” It didn’t enter my mind that he might be paralyzed until I saw them putting him on the dune buggy. I saw his arm hanging down and tried to put it back up on his chest, but it fell again. What came next is why I still have panic attacks. It’s the shaking with fear and shock that is hard to explain. It’s like this uncontrollable fire that courses through your body and it doesn’t go away. It was a blur, but in slow motion.

Ambulance…Beebe Medical Center…x-ray C5 (what does that mean?)…airlifted in a glass bottom helicopter to Nemours in Wilmington…25 days in ICU…two surgeries to stabilize his neck…tracheostomy…waiting…air ambulance to Shepherd Center in Atlanta…HOPE.

I never really experienced anything like being in a hospital for more than a couple days when I had my babies. I can tell you that the people who took care of us at Nemours are why my faith in humanity was restored. I have never met more kind, intelligent and unconditionally loving people. When our journey took us to Shepherd Center, I realized that this is what I had heard of my whole life. I had found the pulse of people that were changing the world with love.

We were at Shepherd Center from July 21 to December 10 – just shy of five months. Shepherd was where we embraced Jack’s injury. We learned that it is OK to talk about the accident, it’s OK to be scared, it’s OK to lean on new friends, it’s OK to laugh, it’s OK to cry and it’s OK to heal.

My friend who I was put in touch with just days after the accident reminded me that what sticks out in her mind was that I said to her, “I feel like I was born to do this.”

It’s those moments of remembering how incredibly strong I am, how patient and giving I am, how much love I have inside my heart, that mean so much. The hope and empathy that has emerged from my being has shown me that I am a wonderful mother. I still struggle with not feeling good enough, but my kids are happy most days, and I lean on my incredible support system and I try to center my being.

This is what I’ve come to realize is what all of us go through from time to time.

YOU ARE NOT ALONE.
Laugh.
Cry.
Howl at the moon.
Lean on others.
Be proud of yourself.
Mostly though, love and make memories that will last a lifetime.

Happy Mother’s Day to all.

By Victoria Dean, PT, DPT, NCS, ATP, a physical therapist in Shepherd Center’s Assistive Technology Center

People often overlook the positive impact of a wheelchair; however, a wheelchair allows individuals a sense of freedom and the ability to live their life. That’s why today, Shepherd Center is celebrating its first annual International Wheelchair Day.

International Wheelchair Day was founded in 2008 by Steve Wilkinson. Steve was diagnosed with spina bifida at the age of two, and after decades of trying to maintain his ability to walk, he realized the freedom a wheelchair offers. International Wheelchair Day celebrates the possibilities provided by a wheelchair for the user, honors the people who work in the wheelchair industry and advocate for accessibility, and recognizes the millions of people across the world who need a wheelchair, but do not have access. 

As Pete Anziano, peer support manager at Shepherd Center, says, “On International Wheelchair Day, I celebrate our evolving perspective on the wheelchair and the freedom mine offers my family and me to engage in life in a way meaningful beyond preconceived notions. The wheelchair gets my body there so my mind and spirit can engage.” 

Shepherd Center’s Assistive Technology Center (ATC), in collaboration with its Peer Support team, has organized the first annual International Wheelchair Day at the hospital. The ATC encompasses the Wheelchair Seating and Mobility Clinic, the Driver Rehabilitation Program, Computer Access and Environmental Control Program, and Rehab Equipment. These departments all provide vital support to new and experienced wheelchair users within the Shepherd Center community to participate in activities that matter most to them.

Shepherd Center’s Wheelchair Seating and Mobility Clinic, where I work, provides manual and power wheelchair recommendations and fittings, posture evaluations, pressure mapping, wheelchair skills training, and education on the use of wheelchairs in everyday life. With approximately 3,000 visits each year, we see individuals of all diagnoses and receive referrals from all over Georgia and surrounding states.

Before joining Shepherd Center, I was primarily an outpatient neuro physical therapist. When I was offered the Wheelchair Seating and Mobility Clinic position in 2019, I was uncertain about my ability to specialize in this field. After working in seating for the past year, I can honestly say that I couldn’t see myself anywhere else. A wheelchair offers so many of our clients the ability to function, return to their day-to-day activities, return to work, have the energy to play with their kids, gain independence with mobility and prioritize the aspects of life that are important to them. I am excited to celebrate and start the annual tradition of celebrating International Wheelchair Day at Shepherd Center!

Written by Ginger Nemenz, RN, BSN, CBIS, CCM, access case manager at Shepherd Center, for the University of Arkansas for Medical Sciences Brain Waves Newsletter

It is normal to have questions about intimacy after a brain injury. You may feel embarrassed to talk about these issues, but know that it is ok for you to talk to a doctor, nurse, therapist, or any other rehabilitation professional about it.

Fifty-eight percent of TBI survivors say that sexuality is just as important to them as before their injury, yet no one discussed this topic with them during their hospital stay. Common issues after TBI include a lack of desire, physical changes in the body, not being able to express one’s needs, and side effects of medications, just to name a few.

Suggestions for Improving Sexuality and Intimacy After TBI:

1. Get a Comprehensive Medical Examination: Your doctor can check for medical problems such as hormone imbalances or side effects of medications, which can both affect your desire or ability to be sexually intimate with your partner.
2. Seek Treatment: You might consider seeing a sexual therapist with your partner. For a list of certified sexual therapists in your area, ask your healthcare provider or visit this website. If you do not feel like being sexually intimate due to depression or anxiety, you could see a therapist. The free ARConnect hotline can help you find a mental health provider. Call 501-526- 3563.
3. Practice communicating your intimacy needs to your partner: Practice smiling, asking your partner to tell you what their intimate needs are, participate in recreational activities you and your partner both enjoy while forming deeper connections.
4. Build up your Self Esteem: Remind yourself that you are still the person you used to be, and you deserve affection and intimacy just like every other human. Look in the mirror every day, smile, and say, “I deserve love and affection and I am able to give this back in return to someone else.”

One very important reminder before you have sex is to remember to be safe. If you are a female, talk to your doctor about birth control. Consider using a condom for protection against sexually transmitted diseases. Also, you have the right to tell your partner if something they are doing makes you uncomfortable or if you do not want to do something.

For further reading about this topic, click here.

Having a brain injury doesn’t change the fact that you are a human with normal desires to be intimate and feel wanted. Don’t be afraid to talk about all of this with a healthcare provider or a loved one you feel close to.

If you feel like people are going faster than ever on the roadways and are noticing more distracted drivers on the roads, you are not imagining it. In Georgia and nationwide, we are seeing a significant uptick in fatal crashes even though many of us continue to shelter in place and forgo our usual driving routine. With wide open highways and byways, speeding has increased dramatically, leading to more force being dispersed during a crash, resulting in catastrophic injuries and fatalities. Now more than ever, it is important to control what you can as a driver, paying particular attention to your teenage drivers.

At Shepherd Center, we have seen an increase in referrals due to motor vehicle crashes. In fact, the number of patients referred to Shepherd Center due to injuries caused by car, truck or motorcycle accidents in the fourth quarter of 2020 was 22% higher than the same period the year before. Of those, there was a 44% increase in the number of patients with brain injuries, with the number of patients referred for spinal cord injuries remaining flat. Finally, the number of patients referred under age 21 due to motor vehicle crashes was more than 50% higher than the same period the year prior.

Instead of fearing the roads, I encourage everyone to take some basic, life-saving precautions that can prevent you or your loved ones from becoming part of these statistics. Here are my top tips for staying safe while driving.

1. Always wear your seatbelt and insist that everyone in your car wear one too. Unrestrained passengers can become human projectiles during a crash.
2. Leave plenty of room in between your car and the car in front of you. While dangerous drivers may use the space to zip in and out of lanes, you will have enough lead time to stop if needed.
3. Never drive in between two tractor trailers.
4. Always pass on the left!
5. When passing big trucks, make sure you can see their mirrors and leave plenty of space. Eighteen-wheelers need a lot of time and space to come to a complete stop.
6. While it may be tempting to take advantage of a clear interstate at rush hour, stick to the speed limit.
7. Focus! Take away all distractions before driving and just drive. Now more than ever, it is nearly impossible to unplug. Use your driving time as the precious alone time you rarely get!
8. Keep an eye out for the super speeders and the lane hoppers and avoid them. There is nothing wrong with driving in the slow lane!
9. Use this time to give your teen driver plenty of practice, but plan your route accordingly to avoid high-speed situations. Slowly gain confidence and skills around the neighborhood during non-peak driving hours.
10. Utilize Shepherd’s free AutoCoach® app, a tool developed to guide parents in teaching safe driving practices to teenage drivers.

A major accident or illness changes life in an instant. Individuals who experience a catastrophic injury may not only experience the trauma of the injury itself, but also the trauma of hospitalization. While hospitalization is necessary for patients’ wellbeing, many patients in the intensive care unit (ICU) can experience frightening periods of confusion called delirium. They may be unaware of their medical situation, fear that treatment may hurt them, be unable to recognize loved ones or have hallucinations. Although this is happening in their minds, the fear it causes is entirely real. At Shepherd Center, licensed mental health professionals have specialized training to recognize and treat trauma-related distress. By focusing on treating the whole person and all of their symptoms and experiences, we can improve our patients’ overall quality of life during and after their time with us at Shepherd.

Following a traumatic event, acute stress reactions such as nightmares, disturbing memories, trouble sleeping, feeling on edge and mood changes sometimes go away on their own. However, symptoms may progress to Acute Stress Disorder, and for some people, progress to post-traumatic stress disorder (PTSD) in the months that follow. Identifying and treating these symptoms early may prevent later development of PTSD.

Signs of PTSD can be missed because treating complicated physical injuries often takes priority. Predicting who is at risk for PTSD can also be challenging. This led researchers at Columbia University to develop a form of artificial intelligence that uses a program to predict possible outcomes. Developed on 377 trauma survivors in Atlanta, and tested on 221 trauma survivors in New York City, the researchers used physical and psychological biomarkers collected in the emergency department to predict development of PTSD in the year after the trauma. 90% of participants who the program predicted to be at risk for PTSD were later diagnosed with PTSD. However, a portion of participants considered to be low risk also later developed PTSD. It is unclear whether the program could be helpful for patients seen at Shepherd Center, because patients were not included in the study if they had traumatic brain injury (TBI)*, ICU admission, respiratory distress, hospital admission, surgery or severe pain. However, this interesting study was the first step in using artificial intelligence to predict who might go on to develop PTSD. 

At Shepherd Center, our team of psychologists and mental health providers work together with patients, their families and their treatment teams to identify and treat PTSD symptoms along our continuum of care. Once the survival mode ends directly following a catastrophic injury, the process of emotional healing begins. This starts with identifying symptoms of PTSD during inpatient rehabilitation by asking questions about how the trauma is impacting thoughts, feelings and even physical sensations. We help develop coping tools or strategies our patients and their treatment teams can use to reduce emotional distress. If PTSD symptoms continue, we recommend outpatient trauma-focused therapies after leaving the inpatient hospitalization.

Psychological treatment for PTSD is evidenced-based, meaning there are scientific studies supporting its effectiveness in helping reduce or eliminate symptoms. Two of the most effective evidence-based treatments for PTSD are Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). PE helps separate the memory of a trauma from its emotional experience. In other words, the memory of the trauma no longer causes the same fear as the trauma itself. CPT works by changing thoughts and feelings related to the trauma like guilt, shame and anger. Couples-based Cognitive Behavioral Therapy, coping skills training and other interventions can also effectively treat PTSD.

Without treatment, about two-thirds of those who develop PTSD will still have PTSD one year later. About half may still have PTSD 10 years after their trauma. Symptoms of PTSD can take a significant toll on relationships and work and might be complicated by depression or other anxiety disorders. Cultural background, beliefs and values can impact reactions to trauma and the help individuals seek. Talking about trauma can be scary at first, especially when opening up to a stranger. Fortunately, six out of 10 people who receive treatment no longer have symptoms of PTSD when treatment ends. The benefits of these therapies are long-lasting. One study found that 83% of people who completed PE therapy still did not have PTSD after six years. Although the effects of trauma may not be entirely erased, its impact on daily life can improve. It can exist without being personally defining, as the sharp edges dull. Over time and with the support of a psychologist or mental health provider, memories of trauma can fade away from the forefront of the mind to background noise, as people resume what is most important in their lives. With our expertise, we aim to identify and treat the psychological effects of trauma early so that our patients and their families get the most out of their rehabilitation.

*It is important to note that individuals who sustain moderate to severe TBI, such as those admitted to Shepherd Center’s Brain Injury Rehabilitation Program, are far less likely than other trauma survivors to develop PTSD. This is related to a loss of consciousness or a disorder of consciousness, as well as a greater length of post-traumatic amnesia at the time of their injury. These factors can actually prevent the brain from processing the event, meaning the memory of a traumatic injury is never formed. In these cases, we focus on providing support to the family members of these individuals, who may experience distress themselves when learning the details of their loved one’s injury.

I became a dad for the first time in 1996. I was 13 years post-injury, a college graduate and had been married for six years to my wife, Kim. Living with a spinal cord injury (SCI) for those 13 years gave me independence and confidence in my daily life of working and being a husband, but becoming a daddy was a brand new experience for me.

Parents know that having kids usually puts the parents’ needs in the back seat as you focus on what your kids need first. It can be easy to forget that we have to take care of ourselves as well. For me, a couple of times in my life stand out as helping me learn to prioritize my needs while being the best dad I could be.

When my daughter Aleah was born, I was training for the USA Adaptive Water Ski Team trials to be held the following year. She was born in October, the offseason for skiing, so for the first six months, she got all of my attention. However, when the lake filled with water and the temperature got warm enough, it was time to ski. Kim and I would take Aleah to the lake with us for ski sessions. Aleah was small and portable, easy to take to the lake! This routine continued as Aleah grew older, and her brother Braxton joined the family in 1999.

Now with two kids in tow, we had a couple of options: everyone goes to the lake or divide and conquer. It was tough at times, but my family and I agreed we could do both! Some days, I would take one or both kids to the lake with me to train and give Kim a break. On other days, I would go to the lake alone to train.

The training time paid off when I was selected to join the USA Adaptive Water Ski Team from 1997 to 2007, with trips to Great Britain, Australia, Belgium, Scotland, Ireland and many sites within the United States. The kids traveled to all the U.S. and Australian World Championships, and many of the U.S. Nationals. Through all these experiences, being flexible and having an open mind helped me be with my kids while pursuing my passion.

I also got involved with Cub and Boy Scouts when Braxton came home asking if he could join. I became a den leader for Cub Scouts for five years. We traveled to aquariums, battleships, campgrounds and many great events. While being a den leader for the young boys was very fulfilling, it was also very time consuming and wearing me out. When Braxton became a Boy Scout, I decided to back away from the Scout Leader role for my wellbeing, but also so he could travel and experience Scouting without dad. I think this helped both him and me grow.

This summer, Aleah will be attending graduate school in Minnesota. Braxton lives at home while working at QuikTrip and pursuing a rap career. As for me, I’ve rekindled my love of guitars, both playing and collecting. I have retired from competitive water skiing, but I give back by coaching the Shepherd Center Learn to Water Ski clinics and serving as the announcer for the Adaptive National Tournaments. Sharing my love of skiing and the lake with my kids is one of the most enjoyable experiences of my life. We continue our family lake outings and love being on the water.

All in all, I’ve worked hard to balance my passions and needs with being a loving dad to my kids. We’ve all grown because of it, and I wouldn’t change a thing.

By Gregory S. Brown, Psy.D., clinical neuropsychologist, SHARE Military Initiative and Complex Concussion Clinic

Imagine navigating life, always feeling that something bad is around every corner. Everyday experiences for most people become an ominous warning to you, triggering intense anxiety, fear and hypervigilance. Your mind is constantly barraged with intrusive thoughts about an experience long past, but it feels like you are frozen at that moment.

Imagine being afraid of going to sleep every night only to be awakened by your worst nightmares and then struggling to differentiate whether you are still asleep or awake. You are unable to trust anyone and are skeptical of those whom you hold most dear, leaving you feeling alone and isolated. Imagine dealing with this every single day, struggling to find a way out, but every door leads you back to that one experience that you want so desperately to forget.

You become exhausted, withdrawn, hopeless and ready to give up on life. This is just a sample of the many experiences and emotions in the daily lives of people with post-traumatic stress disorder (PTSD).

During this PTSD Awareness Month, I want to share an overview of what the disorder is and what you can do if you or someone you know may struggle with it. PTSD is a mental health condition triggered by witnessing or experiencing a terrifying or life-threatening event. Symptoms of PTSD may include intrusive thoughts, flashbacks, nightmares and severe anxiety causing significant disruption to one’s daily life. Events that may lead to PTSD include combat exposure, serious accidents or injury, physical and sexual assault, abuse (childhood and domestic), serious health problems or the unexpected death of a loved one.

Almost everyone experiences at least some symptoms of PTSD in their lifetime in response to a traumatic event. For most people, however, the symptoms are short-lived once the event has passed. With PTSD, individuals are unable to process their emotions and cope, resulting in a persistent state of psychological distress.

Although commonly associated with military veterans and active duty service members, PTSD is a disorder that affects a wide range of people. According to a 2018 report by the National Center for PTSD, 11% to 20% of veterans who served in Operations Iraqi Freedom and Enduring Freedom have PTSD. About 8 million adults in the general population have PTSD in a given year. PTSD affects more women (10 of every 100) versus men (four of every 100). About 3% to 15% of children and teens who have experienced a trauma will develop PTSD, with the greatest prevalence in girls.

The road to recovery from PTSD is a gradual and ongoing process. If you suspect that you or a loved one has PTSD, seek help right away. Effective treatments for PTSD include evidence-based talk therapies and medications. Trauma-focused therapies, such as prolonged exposure and cognitive processing therapy, have been shown to be most effective.

While professional treatment and intervention is recommended, it is important for you to be actively engaged in your healing outside of the therapy space. Reach out to friends and loved ones for support. While you may be tempted to continue to withdraw and isolate from others, staying connected with people who love and care about you is an important component of managing your symptoms. Taking the initiative to learn about trauma and PTSD, joining a support group and volunteering your time to help others are all avenues to overcome feeling helpless and powerless, which are commonly associated with trauma recovery. Support PTSD treatment by making healthy lifestyle choices: Take time to relax, eat healthy, avoid alcohol and drugs, exercise and get enough sleep.

Most people with PTSD do not get the treatment and support they need. Everyone with PTSD, whether they are veterans or civilians, needs to know they are not alone, and there are effective treatments that lead to a better quality of life. You can help others by spreading the word.

Gregory S. Brown, Psy.D., joined the Neuropsychology Department at Shepherd Center on January 15, 2018, as the clinical neuropsychologist for the SHARE Military Initiative and the Complex Concussion Clinic. Dr. Brown earned his doctoral degree in 2014 from the Georgia School of Professional Psychology. He completed his internship at the Central Arkansas VA with a concentration in neuropsychology and a two-year APPCN postdoctoral fellowship in neuropsychology at Shepherd Center. Prior to his return to Shepherd Center, Dr. Brown worked as a neuropsychologist at Madigan Army Medical Center in Tacoma, WA in the Army Intrepid Spirit and Traumatic Brain Injury Program. His current clinical focus is neuropsychological assessment and intervention of mild traumatic brain injury in both veteran and civilian populations. Dr. Brown also currently serves as a Major League Soccer consulting neuropsychologist for Atlanta United.

Psychotherapy and counseling can be mysterious. From confidentiality laws to the stigma surrounding mental illness, there are multiple reasons that people may not know what happens behind the closed doors of a therapy office. Because of this lack of familiarity, seeking out therapy can be uncomfortable, if not downright intimidating. Roughly one in five people meet criteria for a mental illness, and only about half get treatment. At Shepherd Center, many of our patients receive therapy for a variety of reasons including depression and anxiety, adjustment to injury, chronic pain, post-traumatic stress disorder (PTSD) and more. As the saying goes, “Knowledge is power,” so let’s get to know the basics of psychotherapy!

Psychotherapy is not “one size fits all.” In fact, there are many different types of psychotherapy. Some are specifically designed for certain mental health conditions; others can be adapted to a wider range of conditions. Here are a few examples:

• Cognitive Behavioral Therapy (CBT) addresses the relationships between our thoughts (cognitions), feelings (emotions) and actions (behaviors). CBT gives us tools to deconstruct and examine our thoughts, and ultimately replace unhelpful thoughts (“Nobody likes me.”) with more realistic or adaptive thoughts (“I am important to close friends and family who care about me.”). CBT has been shown to be very effective in treating a range of mental health conditions, including anxiety and depression, as well as problems with pain and insomnia.
• Exposure therapy comes in several formats, designed for conditions like specific phobias (e.g., fear of public speaking, fear of flying), and PTSD. Exposure is just what it sounds like. These treatments expose us to something that we fear – either in real life or in our imagination – until our brain no longer sees that thing as a threat. It’s not easy, but it’s highly effective.
• Acceptance and Commitment Therapy (ACT) often includes mindfulness-based skills and teaches that we can create meaning in our lives and be present in the moment, in spite of stress, pain or suffering. Acceptance of circumstances beyond one’s control and commitment to actions that are consistent with one’s values are components of this treatment approach. ACT has been used successfully to treat depression, anxiety, obsessive-compulsive disorders, and substance abuse and dependence.

If you’re considering seeking treatment for a mental health condition, there are a number of different professionals who may be able to help. A few types of specialists are indicated below. It is important to note that each state may have different ways to define the scope of practice of mental health professionals and their qualifications. Relevant information may be obtained from your state government (e.g., Department of Health and Human Services).

• Psychologists have obtained doctoral degrees (Ph.D. or Psy.D.) and are trained in the assessment, diagnosis and treatment of mental health conditions. Psychologists’ licenses are maintained by the state(s) in which they practice.
• Psychiatrists hold medical degrees (M.D. or D.O.) and have completed specialized training though residency in psychiatry. Psychiatrists are able to prescribe medications for mental health conditions, as well. Psychiatrists are licensed by the medical board in the state in which they practice.
• Other professionals who have earned master’s degrees (M.A. or M.S.) in psychology or a related mental health field (e.g., marriage and family therapy) may also provide mental health services such as counseling. Licenses and certifications for counselors vary by state, but may include licensed professional counselors (LPC), licensed clinical social workers (LCSW), and licensed marriage and family therapists (LMFT).
• Other related professions include, but are not limited to, social workers, peer specialists and pastoral counselors.

If this still feels overwhelming, that’s okay! There is not one “right answer” to what may work for you. This may come as a surprise, but diagnosis, treatment type and what kind of provider you see are not the most important factors in the success of therapy. Your relationship with your therapist is! The “right provider” for you will be someone who earns your trust, who you feel comfortable with and who sees you as who you are, not your diagnosis.

Ask your primary care provider (PCP) if you are interested in finding a psychologist or counselor. If you would like more information on mental illness and treatment options, you can visit organizations like the National Alliance on Mental Illness (nami.org) or your state’s psychological association (e.g., gapsychology.org).

By Wendy Magnoli, Ph.D., licensed psychologist at Shepherd Center

The quality of our sleep is often one of the first things to be impacted when we’re under stress. And as we’ve all experienced, when we are unable to get a good night’s sleep, many aspects of our daily lives are negatively affected, including our mood, ability to concentrate, energy level and relationships with others. During these stressful times, we could all benefit from some hints on how to get a better night’s sleep!

Do:

1. Go to bed at the same time each day.

2. Get up from bed at the same time each day. Try to maintain something close to this on weekends.

3. Get regular exercise each day, preferably in the morning. There is good evidence that regular exercise improves restful sleep. This includes stretching and aerobic exercise.

4. Get regular exposure to the outdoors or bright lights, especially in the late afternoon.

5. Keep the temperature in your bedroom comfortable.

6. Keep the bedroom quiet when sleeping. If this is difficult to do, you may prefer to sleep with some background noise. There are multiple free apps available to provide white noise as you rest.

7. Keep the bedroom dark enough to facilitate sleep.

8. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime may include a warm bath or shower, aromatherapy, reading, or listening to soothing music.

9. Use a relaxation exercise just before going to sleep or use relaxing imagery. Even if you don’t fall asleep, this will allow your body to rest and feel relaxed. There are many relaxation apps you can try. Different things work for different people, so try several and see what works best for you!

10. Keep your feet and hands warm. Wear warm socks to bed.

11. Designate a time in the late afternoon or early evening a few hours before bedtime to write down problems and possible solutions. As you write, do not dwell on any one thought or idea – merely jot something down and put the idea aside to think about tomorrow.

12. Avoid screen time 30 to 60 minutes prior to bedtime. The blue light from screens can interfere with the brain’s signals to the body that it is time for sleep. If you just can’t give up your screen time, try some blue light blocking glasses.

Don't:

1. Avoid exercise three to four hours prior to bedtime, as it may be too activating to allow you to relax enough to go to sleep.

2. Avoid engaging in stimulating activity just before bed, such as playing a competitive game, watching an exciting program or movie, or having an important discussion with a loved one.

3. Don’t use your bed for activities like paying bills, talking on the phone, working or watching TV. This can prevent your body from associating your bed with sleep.

4. Don’t have caffeine in the evening (coffee, many teas, chocolate, sodas, etc.)

5. Don’t read something exciting or watch television in bed.

6. Avoid using alcohol to help you sleep. It actually interrupts your sleep cycle.

7. Avoid going to bed too hungry or too full.

8. Do not take another person's sleeping pills.

9. Do not take over-the-counter sleeping pills without your doctor's knowledge. Tolerance can develop rapidly with these medications.

10. Avoid taking daytime naps. If you do, keep them to no more than 20 minutes, eight hours before bedtime.

11. Avoid commanding yourself to go to sleep. This only makes your mind and body more alert.

12. Do not watch the clock or count minutes. This usually causes more anxiety, which keeps you up.

13. Don’t lie in bed awake for more than 20 to 30 minutes. Instead, get up, go to a different room (or different part of the bedroom), participate in a quiet activity (e.g. non-excitable reading), and then return to bed when you feel sleepy. Do not turn on lights or sit in front of a bright TV or computer – this will stimulate your brain to wake up. Stay in a dark, quiet place. Do this as many times during the night as needed.

14. Avoid succumbing to maladaptive thoughts like, “Oh no, look how late it is. I’ll never get to sleep” or “I must have eight hours of sleep each night. If I get fewer than eight hours of sleep, I will get sick.” Challenge your concerns and avoid catastrophizing. Remember that we cannot fully control our sleep process. Trying too hard to control it will make you more tense and more awake.

15. Don’t change your daytime routine the next day if you didn’t sleep well. Even if you have a bad night’s sleep and are tired, it is important that you try to keep your daytime activities the same as you had planned. If you avoid activities or stay in bed late because you feel tired, it can reinforce the insomnia.

16. Avoid increasing caffeine intake the next day if you are tired. This can keep you up again the following night.

Being a mother has always been my greatest pleasure and honor, but like most mothers (and fathers) would agree, it’s not always easy. There are challenges along the way. Our family faced one of its greatest challenges in November 2016 when our son, Grant, who was a freshman in college, broke his C-5 vertebrae in a fall and became a quadriplegic, paralyzed from the shoulders down. During his six months of rehabilitation at Shepherd Center and the years following, Grant has worked hard to regain much of his independence, and our family has been there to support him. During the time immediately following his injury, my husband, Benny, our daughter, Emily, and myself were full-time caregivers. As Benny transitioned back to our hometown of Albany, Georgia, for work and Emily went back to school in Athens, I was the one who remained in Atlanta at the hospital and stayed with Grant during the week. The two of them came back on weekends. Many of the days were long and hard, and it wasn’t long before I realized that in order for me to be at my best for Grant and our family, I had to do things for my own health and well-being.

One of the first things that I came to learn was that even though I was the caregiver with Grant during the week and I knew the ins and outs of his daily schedule and routine, I was NOT the only person who knew how to care for him and help him. The truth was that just as much as I needed a break to re-charge from time-to-time, Grant needed a break from ME, too! I soon realized that even though other family members’ ways of doing things might not be the same way that I might do things, they loved and cared for Grant just as much as I did, and they were fully capable of doing the things he required for his care. And sometimes, they were even better at handling things than I was. For example, I have the distinction of being the only one who managed to let Grant end up on the floor while transitioning from his bed to his wheelchair!

It was also important for me to take time away from caregiving responsibilities so that Benny and I could re-connect over a bite of dinner or by going for a walk. During these occasions, Grant had the opportunity to see “fresh faces” in the form of friends and other family members which always helped lift his spirits.

Another thing that helped me as a caregiver was to connect with other patient families who were going through something similar with their loved ones. Being able to talk with fellow Shepherd families who were learning the ropes of dealing with a traumatic injury and the emotional toll that it takes, helped our family and me realize that we weren’t alone. In addition to the initial benefit we gained from these interactions, we still count these friendships as some of the greatest blessings to come from this experience and our time at Shepherd.

As much as I needed the connection to other people during this time, sometimes in order to re-charge, the thing I needed most was alone time. One of my favorite breaks while at Shepherd was to go to the garden behind the Woodruff Family Residence Center and sit in the sunshine and just BE STILL. Sometimes I would read or pray, and sometimes I would just take in my surroundings. Some days, I would take a walk on the BeltLine that wasn’t too far away or just linger for a few moments over a cup of coffee in the family lounge. Even if it was 15 minutes, I knew that by giving myself whatever I needed most in that moment, I was making it through another day and enabling myself to be there for Grant and my family when they needed me the most.

May is Mental Health Awareness Month, and it's a great time to remember the importance of taking care of ourselves! Here are some simple ideas to consider for facilitating your own self-care:

• Breathe. Take a moment to catch your breath.
• Get enough sleep.
• Pray or meditate.
• Get some movement in every day. Practicing yoga can be a great exercise as well as a way to disconnect and meditate.
• Utilize social media to stay connected. Share a meal, play a game or watch a movie “together.”
• Take a long bath or shower.
• Pamper yourself at home by giving yourself a facial, manicure, pedicure or anything else that you consider a treat.
• Read, blog or journal.
• If you can, take time off work to unplug, refresh and renew. Even if you are working from home, unplugging with a day off can make a big difference.
• Start a recipe chain with others for new and creative ideas, and share favorite take-out spots.
• Get support and give support. Talk with colleagues. You are not alone!
• Meet with your supervisor if you’re feeling burnt out or overwhelmed.
• Many organizations have an Employee Assistance Program through human resources. This resource is available for all issues including stress, loss and finding a place to start, and are available via telehealth.

Social distancing related to the COVID-19 pandemic is allowing families to reconnect with the great outdoors and find ways to explore areas close to them without getting too close to others. With far less traffic and fewer cars on the road, many families are dusting off their bikes, scooters and pull-along carriers to ride again. Take advantage of the increase in exercise and family time, but remember to stay safe. Here are some tips and reminders on how to properly fit helmets both for yourself and your little ones.

If you have a helmet already:

1. Do not wear a used helmet if you can avoid it. Of course, anything is better than nothing, but avoid this if you can. Helmets should be like shoes – fit specifically for your own head.

2. Check your helmet when dusting it off for dings, dents and deterioration. Deterioration can include the padding coming loose inside. Helmets with worn-out interior pads are at least one to two sizes bigger than when they were new.

3. Inspect the actual helmet for its labels. Check the manufacture date, and double-check to make sure it has not been recalled. Technically, helmets do not expire, but a good rule of thumb is to replace them every five years.

4. Has it been in a crash or sustained any damage due to trauma? If so – throw it out. Do not donate it because it is no longer safe to use, even if it physically looks fine. Check local resources because sometimes, you can recycle old helmets.

For a new helmet:

1. Measure the circumference of your child’s head. Oftentimes, you will have to order children’s helmets online to make sure you get the best available. Measure first, and go to a local store that may have a few options in stock. Try those on for fit if possible.

2. Do your research. There are plenty of online resources that will help you find the right helmet in your budget.

3. Brand sizing varies. The chart below shows the sample sizing numbers. Different brands use different molds – if possible, try before you buy, but always check the circumference measurements online.

4.In between sizes? Go with the smaller size. It is possible for your child to wear a small adult size and vice versa for the proper fit. Good helmets are expensive, and you will have to buy several of them as your child grows.

5. Your helmet should be on your head, not resting at the back of your skull or loose enough where you can shift it on your head by nodding. It always has to be strapped as well, but it should not be uncomfortable.

6. The front edge of your helmet should be about an inch above your eyebrows to protect the frontal lobe. Just like car seats, if your helmet shifts more than one inch in any direction, it is too loose.

7. Consider a brightly colored helmet to increase visibility. Consider using reflective tape to the back of the helmet for added visibility.

8. There are several certification bodies for helmets, the most rigorous being the Snell Foundation, an independent testing body. Do your research – not all helmets are created equal. Try to buy the best you can afford. Brands do matter here.

General sizing:

Extra small: below 20" (51cm)

Small: 20"–21.75" (51cm–55cm)

Medium: 21.75"–23.25" (55cm–59cm)

Large: 23.25"–24.75" (59cm–63cm)

Extra large: above 24.75" (63cm)

Three are three basic types of bike helmets: Road bikes, mountain bikes and recreational bike helmets. 

Getting the right fit:

1. Adjust the tightness first. Twist the adjustment wheel until you get a snug fit. This is called the rachet system or retention system.

2. Buckle and tighten the chin strap. The straps should form a V under each ear.

3. Open your mouth wide – it should be tight, but not uncomfortable. As you open your mouth, the helmet should press against the top of your head. Adjust accordingly if it does not. Keep tightening until it does.

4. You should be able to fit two fingers between the strap and your chin.

5. Be mindful of pressure points – if any part of the helmet feels uncomfortable or annoying, it is the wrong shape or size.

6. If you wear glasses or sunglasses with your helmet, make sure they also fit before you buy a helmet. The same logic applies for a ponytail. There are helmets created with specific ponytail accommodations called hair ports.

Check out this helmet fit test from Safe Kids Worldwide_®

New technology:

1. As new and better protection becomes available on the market, there is even more reason to replace and upgrade your old helmet.

2. There is new helmet technology available called the Multi-Directional Impact Protection System (MIPS). MIPS protects against rotational forces. Many children’s helmets have this feature available now. It is more expensive, but well worth the added protection.

3. WaveCel: Found on some Bontrager helmets, this technology features a honeycombed liner material that is engineered to create a sophisticated “crumple zone” that absorbs both primary impact forces and rotational energy from an impact.

4.SPIN: Found on POC helmets, Shearing Pads Inside (SPIN) technology features silicone-injected pads in a structure that moves inside the shell to redirect rotational forces during an impact.

5. If your child resists wearing a helmet, it may be because it is uncomfortable. Lighter, cooler helmets exist with more ventilation. These enhance the wind flow over your head, and also make the helmet a lot lighter.

Helmet care:

1. Do not store your helmet in a place that gets very hot because it may damage the integrity of the helmet. If you see bubbles on helmet parts, it has been damaged by heat. Do not wear it.

2. Do not loan your helmet out. You need to know where it has been and if it has had any major trauma, including being dropped. Treat your helmet like you would a car seat.

3. Avoid cleaning your helmet with chemicals because this could cause the helmet to disintegrate. Mild soap and water should work well.

Modeling and monitoring:

1. Modeling safe and proper helmet wearing starts with you. Model the behavior you want to see in your children, friends and family members. Have a strict rule that helmets are to be worn for anything on wheels – no exceptions. Children should wear a helmet while on their trike, balance bike, scooter or hoverboard. Set a good example early on by always wearing a helmet when your child rides on the back of your bike.

2. Make it one of your family’s big, non-negotiable rules. No exceptions – especially when riding in the carriers low to the ground!

Sources include: SafeKids Worldwide, Spirit Sports, Snell Foundation, Bike Exchange, REI Bike, CDC Bikes

EMMA HARRINGTON is the director of injury prevention and education services at Shepherd Center. Previously, Emma started the injury prevention program at Grady Memorial Hospital in the Trauma Department. She holds a master of education degree in international education policy from Harvard University. Originally from Boston, Emma is a licensed social studies teacher.

The American Hospital Association estimates that throughout the COVID-19 (coronavirus) pandemic, 960,000 patients will require intubation and the use of a ventilator. These lifesaving pieces of equipment will help thousands of patients breathe. Being intubated involves a tube passing between the vocal cords into the windpipe; therefore, it can make it very difficult for patients to communicate verbally.

For decades at Shepherd Center, we have been caring for patients with spinal cord and brain injury who are unable to speak due to intubation, vocal cord paralysis, tracheal stenosis and other conditions. They all have this in common – the desire to communicate. The inability for a patient to communicate can add extra stress to a patient who is already in crisis mode. In fact, several studies have reported that a patient's inability to communicate can cause or further exacerbate feelings of psychological and emotional distress, anxiety, panic, fear, frustration and helplessness. Looking at it another way, a patient's ability to communicate when intubated also can decrease complications stemming from a lack of communication with members of their healthcare team.

With the rate of intubation on the rise due to COVID-19, I have received several requests from healthcare providers and peers around the country asking for advice and resources on how to help hospitalized patients with limited ability to speak. Here are my suggestions for helping people with COVID-19 find their voices.

Keep it Simple – While we all love our high-tech communication tools, sometimes simpler is better. If a patient is intubated and unable to speak, but is still able to use his or her hands, try to communicate with pen and paper. You can also use a whiteboard and dry erase markers. A Boogie Board LCD writing tablet is also a good option if you have access to one. Of course, make sure to disinfect anything you use to communicate.

Use Yes and No – Establish a sound system of “yes” and “no” based on the patient’s capabilities. This can be as simple as thumbs up for “yes” and thumbs down for “no.” Other options are to nod your head up and down for “yes” and side to side for “no” or blink once for “yes” and twice for “no.”Then, ask targeted questions to investigate what the patient may need. Always confirm that what you think the patient is saying is correct. Make a note in the patient’s record or in the patient’s room of what their “yes” and “no” system is so that other providers can use it as well. Once you establish your yes and no system, communication will become much more manageable.

Communicate with a Board – Try using a communication board. These boards can simply say “yes” or “no,” or they can include various words such as “pain,” “thirsty,” “I’m cold,” or “What is that medication?” To use one, you'll want to:

• Print out and laminate the communication board.
• Establish a reliable “yes” and “no” system with the patient.
• Place the board so that it is visible to the patient.
• If the patient can point, have them point at what they’re trying to say on the board.
• If they cannot use their hands to point, point to each row in order and ask: “Is it in this row?” or say “Row 1,” “Row 2,” etc.
• Once the patient makes a row selection, point to each successive box in the row and ask, “Is it this one?” or read the text in each box.
• Be sure to modify your speed according to the individual patient’s needs.
• Disinfect the board.

Test Technology – There are dozens of mobile apps available to help with non-verbal communication, including Vocable, which tracks head movements to facilitate communication. There are also apps that will act as a whiteboard. When there is time for training on both the patient and provider side, these apps can be invaluable. But in a time when hospitals and care providers are likely overburdened, simpler might be better. Also, keep in mind that in many healthcare facilities, Wi-Fi coverage may be spotty, which makes many apps and online tools difficult and frustrating to use. If this is the case, see above and keep it simple.

During these unprecedented times, I understand that there may be no time to use some of these tools. If that’s the case, I recommend simply using the whiteboard or writing the alphabet on a piece of paper.

For additional information regarding communication strategies for hospitalized patients with limited ability to speak, please visit these resources:

• Patientprovidercommunication.org
• COVID-19 Communication Board
• Partner Assisted Communication Video
• Vocable App

For more information, you can contact me at adina.bradshaw@shepherd.org.

ADINA BRADSHAW, MS, CCC-SLP, ATP, is a speech-language pathologist in the Assistive Technology Center at Shepherd Center. She has worked at Shepherd Center for more than a decade. She has a bachelor’s degree in speech pathology and audiology and a master’s degree in speech pathology from Miami University in Oxford, Ohio. Bradshaw also has a teaching certificate, multiple state speech pathology board certifications, ASHA certification and RESNA assistive technology certification.

For most of us, the last few weeks have been unlike any other period in our lives. The COVID-19 (coronavirus) pandemic has challenged all of us to change the way we operate, and Shepherd Center is no different. In a time of rapid change and constantly breaking news, we remain guided by our concern for the health and wellbeing of our patients, their caregivers, our staff and community. With that in mind, I'd like to share with you the many ways we're working to keep them – and you – safe.

Our team has planned for the impact of COVID-19 on all business operations. We have assessed staffing and prepared for absences so that our patients continue to receive the care they need and deserve. We have been and will continue to screen all of our patients, families, visitors and staff for illness so that we can help keep those both inside and outside our doors healthy. We made the difficult choice to limit visitation in our inpatient units and day program gym to lower risk of transmission from outside of the hospital and are working with patients and families to provide options for communicating electronically.

For our outpatients, though most clinics are closed, we're using telemedicine when at all possible so that there is as little disruption to care as possible. Our Apothecary has also started offering a drive-up service so that patients can continue to get their medications. It's not exactly business as usual, but I have been heartened by how our team has come together even more so than usual under challenging circumstances.

We have developed a plan so that our staff can continue to work despite closing most outpatient clinics/single-service therapy visits. We are cross-training employees, as well as developing new and different ways of functioning to adjust to our new environment. We are allowing more flexible work arrangements, when possible, including working remotely, flexible work hours, increasing teleconferencing and using other tools to minimize employee, patient, family and visitor exposure.

We continue to provide information that is relevant and timely to our patients, families and staff through our social media channels and at shepherd.org/COVID19 We know our patients have specific concerns about how COVID-19 will affect their health, so we launched an e-mail address and phone number for patients to use to get their questions answered by a Shepherd Center staff member. If you have general inquiries related to Shepherd Center's actions related to coronavirus, you may send an email to COVID19@shepherd.org or leave a message at 404-350-7662. We will respond as quickly as possible.

These are unprecedented times that will require all of us to be even more caring, thoughtful, diligent, nimble and resilient. Please take care of yourself and others.

SARAH A. MORRISON, PT, MBA, MHA, is president and CEO of Shepherd Center. She joined Shepherd Center in 1984. Morrison has served in various leadership roles at Shepherd Center, including vice president of clinical services, director of the Spinal Cord Injury Program, director of the medical/surgical and ICU programs, manager of the spinal cord injury day program, a physical therapy supervisor and a physical therapist.

• As a best practice, you should have at least 30 days of supplies and medications on hand at all times, but especially during times when travel and social interaction is restricted.
   
• Keep a list of all of your necessary medications and supplies, and make sure a caregiver and/or family member also has access to your list should they need to do the ordering for you.
   
• Check with your medical supply vendor now regarding the availability and expected delivery dates for the items you need on hand to manage your health for the next 30 days.
   
• Many items require a medical provider’s order, which should be written for a 30-day supply or more when permitted.

• Because many items are made outside the U.S., there may be delays related to the coronavirus (COVID-19).
   
• Request refills of your medications from your pharmacy with plenty of time before your prescription runs out. Some pharmacies may be able to provide you with an early refill if you are not yet due for one. Some insurance companies have waived restrictions on how much of a medication an individual can get at a time.
   
• For Atlanta area customers, the Shepherd Apothecary, located inside Shepherd Center, is open during its regular hours of 8 a.m. to 6 p.m. weekdays. Given the current visitor restrictions at Shepherd Center, customers will be screened at the entrance. Alternatively, customers may call the Apothecary at 404-350-7743 to pay for their prescription medications by credit card. They can let the Apothecary staff know when they will arrive at the hospital’s front circle driveway by the Terry Lee statue. Then, an Apothecary staff member will deliver the prescription to the customer’s car. Another option for some customers is to have the Apothecary ship medications via UPS. Normal delivery is two to three days, but shipments could be delayed.
   
• Follow proper cleaning protocol for all supplies and equipment to lengthen their period of usefulness and to prevent infection.

Laura O’Pry, RN, BSN, CCM, CRRN, is the Transition Support Program Manager at Shepherd Center. She leads a team of healthcare professionals who help prevent patient rehospitalization, improve health and safety outcomes, and promote patient and family autonomy once a patient is discharged from Shepherd Center. Learn more here.

With coronavirus (COVID-19) in the news right now, many people with multiple sclerosis (MS) are seeking to learn more about the illness and how it may affect them. Coronavirus causes a respiratory illness that results in a fever, cough and shortness of breath. The severity of the illness varies greatly from person to person, with some people having no symptoms at all. Unfortunately, there have been deaths from coronavirus, typically in the elderly or those with other underlying health problems.

The average person with MS should not be at any higher risk for contracting coronavirus than the general public. Exceptions may include people with MS who are on medications that could theoretically lower their resistance to viruses. I want to emphasize “theoretically.” These medications include Ocrevus, Rituxan, Tecfidera, Lemtrada, Gilenya, Mayzent, Mavenclad and Aubagio. As part of your MS care at Shepherd Center, we monitor your immune function through regular lab testing. It is important that you continue all of your medications.

Your best protection against coronavirus is handwashing and more handwashing – 20 seconds of vigorous handwashing. Or, in situations where handwashing is not possible, you may use a hand sanitizer containing at least 60% alcohol.

The transmission of coronavirus is most likely from viral particles that have been left on a surface by a cough or sneeze. If you touch that surface and then touch your mouth, nose or eyes, you may introduce that virus into your body. The virus could also be potentially transmitted directly by a person’s cough or sneeze if you are within six feet of the infected person.

While masks are generally not needed by the general public, I might consider wearing one if you are in close proximity to people, such as on a plane or public transportation. As per CDC guidelines and as a precaution, our team advises people with MS against any air travel or cruises unless it is essential.

If you have symptoms suspicious of COVID-19 infection, have traveled to a high-risk area or have been in close proximity to a person who meets one of those two criteria, please call your primary care provider for further instructions. If you fall into one of those groups and have an appointment at the MS Institute, please contact our Call Center (for current patients only) at 404-603-5031 so we can reschedule your appointment.

BEN THROWER, M.D., is the medical director of the Andrew C. Carlos MS Institute at Shepherd Center. He recently received the 2019 Healthcare Provider of The Year award from the Georgia Chapter of the National Multiple Sclerosis Society.

Ever since I was little, I’ve loved the arts and found great joy in my own creative process. In both painting and drawing, the arts have been an escape for me, a way to express what’s in my heart, and to understand and reflect on the world around me.

In 2017, I experienced a near-death accident that resulted in a traumatic brain injury (TBI), changing the course of the rest of my life. I spent two months at the hospital in critical care, then moved to Shepherd Center, then to Restore Neurobehavioral Center and finally, as my brain and my body healed, I was able to return home. My rehabilitation became my full-time job.

After my injury, my mom brought paint and canvases to the hospital, hoping we would paint together. Due to my injury, I wasn’t able to paint at first, but I took classes to help me regain my hobby. As my brain and body healed, I became more and more confident in my innate abilities as an artist. It’s funny how you can forget almost everything about yourself and your own life, but the instinctual, innate ability to be creative persisted.

Even though I still struggle with my memory, art is – and will always be – my passion. Not only has it been an outlet to express my feelings and thoughts, but it’s also become an important part of my healing process.

In the future, as my brain and body continue to heal, I hope to return to school and finish my education. I am so grateful to art for its power to transform, transcend and heal, and I know that the creative process will continue to inspire and enrich my life.

You can view more of Rakan's art here.

Follow Rakan’s story on his mother’s Instagram: @majdamajoda

When Jorge and I began dating, there were Post-It notes all over his apartment – on his desk, on the doorway to his bathroom closet and bedroom, on the bathroom mirror, fridge – reminders ranging from due dates for bills, phone numbers, his bank, appointments, school test dates, even when to do the laundry.

It had been a year since he returned from deployment in Iraq. While there, he was exposed to two improvised explosive devices (IEDs) that left him with hearing loss, a closed-skull traumatic brain injury, back fractures, post-traumatic stress and other injuries that later included seizures. Those Post-It notes were among the first clues I had that Jorge’s injuries, invisible to the untrained eye, ran deep.

Invisible Wounds

When Jorge came back from Iraq, he returned to his job as a surgical tech at the Groton Submarine Base in Connecticut. A year later, as the impact of his injuries became more apparent, he was honorably discharged from the military and referred to the veterans’ hospital in New Haven.

Over the next several years, Jorge’s cognitive and physical condition continued to deteriorate. I left my nursing career to care for my husband full-time. By early spring of 2015, despite multiple therapies a week, including occupational therapy, speech therapy, physical therapy and counseling, Jorge’s mental, physical and emotional wellbeing declined further. He became more forgetful and easily agitated.

He started shuffling when he walked and began to lose the ability to speak in full sentences. Often dizzy, Jorge experienced frequent migraines and began having seizures that left him unable to drive. As I watched him continue to decline, I searched for ways to help. Pointing to his deteriorating condition, I challenged the doctors, but my voice was like an echo into the abyss. The head neurologist of the VA hospital told us there was nothing more they could do for him.

The worst moments were those times when I could see he was losing all hope for getting better. As we sat at the table the night before he started the SHARE Military Initiative program at Shepherd Center in Atlanta, Jorge said, “I don’t think anything will help me.”

A Nurse Named Sue, SHARE and Shepherd's Men

After eight years in the VA healthcare system with no improvement in Jorge’s condition, our two-fold miracle came in the shape of a nurse named Sue Lado from the Navy Marine Relief Society. She referred us to the SHARE Military Initiative at Shepherd Center in Atlanta and the Shepherd’s Men, a group of veterans and patriots who help raise money to enable men and women like Jorge to participate in the life-saving program.

Without SHARE, Jorge said he would not be here today. When he said this, it scared me to the core. I realized then, that if we hadn’t gone to SHARE, my husband could have been one of the 22 veterans lost to suicide each day.

The SHARE Military Initiative is a unique program that helps post-9/11 service members suffering from TBI and PTS receive cohesive, tailored, multidisciplinary care and therapies all in one place. Their full-immersion approach has helped nearly 600 veterans develop the tools they need to adapt and cope with their disabilities. SHARE’s success has gained national attention and is now a model for other therapeutic centers across the country.

After the three-month program at SHARE, my husband was walking, talking in full sentences and able to engage in community activities with better focus and retention. SHARE gave us support, understanding, new treatments and counseling. All of this bridged the gap between a war zone and a way home. SHARE validated, diagnosed,and treated my husband’s injuries that others dismissed. The people at SHARE inspired Jorge to give 110 percent to the program and succeed in his treatment goals.

SHARE Support of Veterans, Their Families and Caregivers

In most cases, the veteran can attend SHARE independently and live near the Shepherd Center campus for the length of his or her treatment. If a veteran has injuries that require a caregiver, the staff is very helpful and mindful to include the veteran’s caregiver in their care plan. Because of Jorge’s care needs, they asked me to go with him to SHARE.

We were a young family with two little girls, so our journey to SHARE became a family affair. Being a full-time caregiver for my husband and caring for our family while at a veteran-centered program had its obstacles as I fought with isolation and burnout. SHARE offered counseling for me, enhancing my ability to provide self-care while being a caregiver.

Jorge and I realized early in treatment that his love for his family was a motivator, and SHARE used that to develop tasks and goals centered on his family contributions. Our love and support for Jorge became part of his care, too. SHARE worked with me and provided support for us that made our family feel like we were healing together.

Now, we only use Post-It notes to write “I love you” because at SHARE we learned how to use adaptations like an iPhone with labeled alarms, and our synched digital calendars for reminders and schedules. SHARE’s innovative life coach program helped us integrate new routines and adaptations at home, encouraged Jorge to focus on his goals, and gave him inspiration to try new hobbies. When rough days happen, he now has tools that help him. We are tremendously grateful to Sue, Shepherd’s Men and the medical staff at SHARE for all they have given us. SHARE gave Jorge a life with hope, gave me my husband back and our little girls their daddy back.

JESSICA RODRIGUEZ is a former nurse and now a full-time caregiver and wife living with her veteran husband, Jorge, and their two daughters in Griswold, Conn. Jessica is a 2017 Elizabeth Dole Caregiver Fellow for Connecticut.

National Volunteer Week was established by President Richard Nixon in 1974 to honor the efforts of volunteers. Since then, this celebration has grown and changed its meaning to not only honor volunteers, but to also encourage others to get out and volunteer in their communities. Every April, organizations around the world recognize volunteers and foster a culture of service.

For the past two years, in my role as the coordinator of volunteer services, I have had the pleasure of meeting and working with the most selfless individuals. My profession has allowed me to meet and interact with a plethora of volunteers, some who have a connection to Shepherd Center and others who just want to help in any way they can. Our volunteers range from ages 15 to 90, both men and women, of different ethnicities, nationalities, religions and interests. You can imagine the different personalities we encounter while working with such a vast demographic, but it says a lot about our rehabilitation center when we’re able to find a good fit for all our volunteers.

A few examples of the important ways volunteers contribute to Shepherd Center include gym runner volunteers who provide ongoing gym and program support by assisting in the gyms during therapy sessions, meal feeder volunteers who assist patients with their meals, fitness buddy volunteers who aid ProMotion members during work out/fitness sessions, and Family Support Services volunteers who provide help to families of inpatients by getting acclimated to Shepherd Center when they first arrive. Shepherd Center would not be able to provide such quality service to our patients and clients without the support we receive from our volunteers.

I asked a few volunteers to share what their favorite thing is about volunteering at Shepherd Center, and below are the touching responses I received.

• Laura Barnard (sports teams and horticulture): “My favorite thing about volunteering at Shepherd Center is the people I’ve met and the friendships that have formed. I love what I do!”
• Helene DeLoach (Family Support Services visitation/driver/mail): “I love everything I do at Shepherd Center! I look forward to volunteering each week.”
• Stanis McKinney (gym runner): “I enjoy helping patients and staff, they’re the nicest people I have ever known.”
• Tom Leahy (ABI Peer Visitor): “The best part of volunteering at Shepherd Center are the people and the positive energy that everyone displays.”
• Jean O’Halloran (locomotor assistant): “I love the sense of community and seeing many patients improving over their therapy time.”
• Emily Brunson (gym runner and meal feeder): “It’s great working with the therapists and patients. I love taking part in and observing various therapy sessions.”
• Liz Bell (ABI Peer Visitor): “I’m grateful to give inspiration to caregivers and family members of traumatic brain injury patients.”
• Frances O’Brien (Assistive Technology): “I enjoy the feeling I get when helping others in an environment that is positive and professional.”

Our volunteers bring hope and happiness to their roles which also leads to spiritual and emotional growth for our patients, families and staff. The unconditional support we receive from our volunteers cannot be bought with any amount of money. We appreciate you, thank you!

Learn more about volunteering at Shepherd Center here.

ALAINA CASE is coordinator of volunteer services at Shepherd Center.

As a new year approaches and we look back on 2018, it is truly amazing to see all of the accomplishments that we – volunteers, board members, staff, donors, patients and families – have made together. Here’s a look at Shepherd Center’s top 10 accomplishments of 2018.

10. Shepherd Center was once again ranked among the top 10 rehabilitation hospitals in the nation by U.S. News & World Report. Our #9 ranking stems, in part, from the number and quality of professional presentations/publications, awards and national committee work done by many of our clinicians, as well as the world-class, specialized medical and rehabilitation care we provide for people with spinal cord and brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions.

9. Due to a generous donor, Shepherd Center’s CT scanner became operational in August 2018. As of late November 2018, having a CT scanner in house has saved about 400 hours of nursing staff time by eliminating the need to move patients to the adjacent Piedmont Atlanta Hospital for these scans. This allows our nurses more time to be on the rehabilitation units with our patients.

8. The Georgia Hospital Association presented a Hospital Heroes Award to Minna Hong, who retired in spring 2018 as Shepherd Center’s SCI peer support manager.

7. Shepherd Center was voted as one of the Best Places to Work by the Atlanta Business Chronicle in the extra-large organization category, and it was the only healthcare organization recognized in the top eight.

6. Shepherd Center launched two successful community outreach efforts: 1) We launched the NeuroRehabilitation Learning Institute to offer interdisciplinary professional education to support treatment of complex neurological conditions such as brain and spinal cord injury. We are committed to sharing our expertise with clinicians nationwide so that our patients receive informed care to meet their needs once they return to their communities. 2) In partnership with the Georgia Governor’s Office of Highway Safety (GOHS) and IT management consulting firm CapTec, Shepherd Center launched AutoCoach 2.0. The updated version of this popular app for parents teaching teen drivers provides expert guidance on how to teach new drivers with disabilities.

5. The Washington Post posthumously published a half-page letter from the late Charles Krauthammer, a Pulitzer Prize-winning columnist and former Shepherd Center patient, on his incredible experience at Shepherd Center. This is a testament to our staff who directly and indirectly work with our patients and families. The commitment of our staff also leads to consistent patient satisfaction scores of 94 to 98 in ranking the likelihood of recommending Shepherd Center to others.

4. Shepherd Center Director of Multiple Sclerosis Research Debbie Backus, PT, Ph.D., began research funded by the hospital’s largest research grant to date – a PCORI grant of $5.7 million over four years to study the delivery and effects of exercise for people with MS. This grant signifies the commitment of our Crawford Research Institute in securing grants that directly improve the care we provide our patients. Shepherd researchers have garnered current multi-year grants that total more than $17 million.

3. Shepherd Center Foundation set two records: 1) The Legendary Party honoring Harold and Alana Shepherd raised $6.2 million; 2) The employee giving campaign (ShepherdCares) raised more than $190,000 with 85 percent of Shepherd Center staff contributing to the campaign. The commitment of the Foundation, volunteer program and all Shepherd employees allows the continuation of our differentiating, value-added services.

2. Shepherd Center acquired 2.6 acres of land to expand our family housing program. Shepherd Center is committed to reducing the financial and emotional burden our families experience during one of the most challenging times of their lives. This housing expansion will allow for our families to stay with their loved one for as long as they are at Shepherd Center.

1. The naming of the J. Harold Shepherd Parkway section of Peachtree Road honored Shepherd Center co-founder, the late Harold Shepherd. This is a testament to the incredible contributions Harold Shepherd made to Atlanta and beyond, as well as to the community support for the Shepherd family and the recognition of Shepherd Center’s ability to provide its patients with hope, dignity and independence.

SARAH MORRISON, PT, MBA, MHA, is president and CEO of Shepherd Center. Since 1984, Morrison has served in various leadership roles at Shepherd Center, including vice president of clinical services, director of the Spinal Cord Injury Program, director of the medical/surgical and ICU programs, manager of the spinal cord injury day program, a physical therapy supervisor and a physical therapist.

Mentorship is a funny thing when it comes to fatherhood. If you are lucky, you have a dad or another father figure to emulate when the time comes to be a dad yourself. When you are a father with a physical disability, it may seem like no one can possibly know your concerns or trepidations. Rest assured, you can do this. Many of us – I call us wheelchair daddies – are proof that it can be done.

It is difficult to believe my kids are in their teens. Time goes by so fast from diapers to dating. Like many fathers, life tends to be a whirlwind of have to’s and must haves – late nights at the office, bills to pay and marriages to maintain and nourish.

Yet, there are plenty of memories more worth placing in the forefront of your brain. Those precious thoughts of holding your son for the first time, your daughter’s first ballet recital and being the adhoc photographer at every major event in their lives.

Most fathers have these thoughts in common, but in my case, there is a wheelchair present in every one of these memories. You see, being a wheelchair daddy is paradoxical. It is just the same as being any other dad, yet completely different.

My kids rarely thought of me as a wheelchair user except for the times the world around them was ever ready to remind them of this fact. There were moments when my kids would be sheepish in introducing me to their school friends or times that my son said he wished I could play soccer with him like other daddies. I won’t lie, those moments stung, but they were the exception, not the rule.

I remember how both my children were understanding and helpful, always ready for the push up a hill or help off the floor from a bad transfer.

My fatherly advice centered on familiar territory that resonates with most dads.

“Try your hardest.”

“Never throw the first punch.”

“Respect your mother.”

“Look people in the eye when you talk to them.”

However, due to the uniqueness of their dad being a chair user, some of our talks centered on the specificity of treating ALL people with respect and dignity, being aware of those different from ourselves and our collective responsibility to assist others when there is a need.

There were also times that they saw their dad unashamed of his disability, celebrating his “uniqueness” as a Paralympic hopeful in wheelchair fencing. They were young when I was still competing, but even if memories weren’t readily available, they now know that I had pushed myself for something greater in life – because of my disability.

During these teenage years, there isn’t a lot of talk about the origin of my disability. There are no in-depth discussions on those touch and go hours in the ER, the struggles of rehabilitation or the years of perseverance to become as independent as I could be. Maybe chalk it up to these self-focused years of adolescence.

But there will be a time when my hardships and lessons learned will come in handy during the difficult days that my kids will undoubtedly face growing up into adulthood. I will be there with words of encouragement -- the same words that seem a bit cliché but nonetheless true: Never give up, appreciate what you have, avoid focusing on what is missing and find strength in yourself, but know that no one can do it all alone.

I smile as I write this because these are the words from my dad while I was battling through rehabilitation over 30 years ago. I guess the past is truly prologue.

My advice to new wheelchair daddies is not to overthink it. Your kids will love you for who YOU are.

It just so happens that your brand of fatherhood is conducted from a chair.

Your life experiences, tough as they are (or were), are blessings for your family. As your children grow, they will see these life lessons embodied in your actions and love of life.

Keeping it rollin’, wheelchair daddy. You’ll do fine.

PETER COLLMAN  lives in Prague, Czech Republic and is raising two great kids. He is a technical writer for a software and mainframe company. When he is not writing, he works on his photography. As a former United States Paralympic hopeful and member of the U.S. Wheelchair Fencing Team, he was exposed to the adventures of international travel. He enjoys discovering new places and learning about other nation's respective histories.

The opening sentence of her essay reads, “Heroes do not need super powers; they simply need to show up when it counts. They need to be there in the good times and in the bad times.”

At the time, I did not see myself a worthy subject for this winning essay, “Who is your Superhero?” written by my daughter, Amelia. But now, working at Shepherd Center, I have the privilege of seeing mothers every day who are so worthy of the superhero title. I observe mothers give their all to help their child – whether that child is an adolescent or a grown adult. These mothers show up, endure sleepless nights, utter many prayers and show incredible strength every single day. In fact, the very foundation of Shepherd Center was built from the vision of a strong mother (and father) who saw an unmet need when their son, James, sustained a spinal cord injury. They wouldn’t take no for an answer, and they continue to show up every single day – literally and figuratively!

I am blessed to be the mother of two incredible daughters – Amelia and Megan. My oldest daughter, Amelia, has faced incredible health challenges since birth, requiring many surgeries and hospitalizations. For more than 20 years, my husband and I have lived the reality of worry, uncertainties related to surgery decisions and many unplanned emergency room visits. Amelia’s most significant health challenge came in the form of a post-operative brain stem stroke two years ago, which led us to seek brain injury rehabilitation at Shepherd Center and Shepherd Pathways.

Through the years, I have learned that medical issues affect the whole family, not just the person who has sustained the injury. Keeping sight of the needs of the entire family is often difficult to do, but necessary, as it is easy to lose focus of the big picture and only see the family member with the most critical needs. For my younger daughter, Megan, when I was spending months at a time in the hospital with Amelia, I tried to encourage her with notes, texts and little surprises. We also relied heavily on our strong faith and made the conscious decision to adopt the motto of #choosejoy. My efforts could not replace my presence, but Megan did know that I was thinking of her and that she was not forgotten.

Amelia’s essay went on to say, “Like my mom did for me, heroes need to see you at your worst and know they can help you return to living the wonderful, fulfilling life you once had. They can acknowledge the chaos and help you emerge on the other side a stronger, more insightful, more appreciative person for the life you have been given.”

That life may look very different from the life your child had pre-injury, but the new normal can still produce a meaningful and joyful life. Much of that depends on how you choose to look at the situation. The most important piece of advice I could offer to a mother beginning this journey would be to focus on the “cans” instead of the “cannots.” Celebrate every small victory – the wiggle of a toe, the movement of a finger, the correct response to a question. Every single move forward is worthy of celebration!

This journey to acceptance of the new normal after a traumatic injury can be exhausting and overwhelming. There are certainly still some days since my daughter’s brain injury that I feel that way. Fortunately, in the eyes of our children, simply showing up and never giving up are the most important qualifiers for superhero status.

Happy Mother’s Day weekend to all of the superhero mothers at Shepherd Center. Being the parent of a child with a brain or spinal cord injury is not an easy assignment, but as I learned from my daughter, mothers don’t need to be perfect – just present. Hero mothers, put on your capes this weekend – today and every day, you truly are super!

CLAIRE HOLLEY is the Family Peer Support Program Coordinator for the Acquired Brain Injury Program in the Transition Support Department at Shepherd Center. Claire is a former preschool teacher, a registered nurse, a wife of 27 years to her high school sweetheart and the proud mother of two adult daughters, Amelia, 20, and Megan, 19.

Ann Boriskie, founder and director of the Brain Injury Peer Visitor Association, as well as several caregivers, have provided the following tips for supporting your loved one during the rehabilitation process.

1. You may feel frustrated or impatient. Talk with the doctor and other healthcare providers to learn what to expect. While it’s great to encourage your loved one to be self-sufficient, resist the urge to set unrealistic goals.
2. Ask for help. Caregiving may be a new role for you. It takes time and help from others to learn how to be a good caregiver.
3. Let your loved one do as much as possible. As a caregiver, you try to do everything to help. But as time passes, it’s a good idea to let your loved one take over as much as they can.
4. Do not speak for the person unless absolutely necessary or interrupt the person while they are speaking.
5. Try not to talk about the person with a brain injury in his or her presence. Lack of speech does not mean a lack of comprehension.
6. It is OK for your loved one to have some time without you at their bedside. One of the most important things you can do for yourself and your loved one is to make time and space for yourself.
7. Try to be patient with the injured person. Remember that they want to be better as much as you want them to be better.
8. Accept the reality of what can and can’t be controlled.
9. Stay in touch with friends and family members, and reach out to others for help.
10. Join a support group. Don’t try to go it alone. Talking with other caregivers helps you feel less isolated and more in touch with life.

Visit shepherd.org/more/resources-patients for more information for patients and families.

1) When attending holiday events and parties please designate a driver or call an Uber or Lyft -- even if you only have one or two drinks.

2) When hanging outdoor lights, think twice about getting up on a ladder. Falls can have serious consequences and are the leading cause of death for people ages 65 and older.

3) If you MUST get up on a step stool to hang decorations, make sure it is sturdy and has a handle, with all safety bars in the locked position. If possible, have someone spot you. Do not stand on railings, chairs or tables to hang décor or to reach spots above your head. 

4) If you are on vacation in a tropical paradise, always enter water feet first. Never dive!

5) If sledding or snow tubing is on your holiday agenda, remember to sled feet first. Breaking a leg is far better than hitting your head.

6) Keep presents stashed completely under your tree and keep lighting cords out of the way to avoid trip hazards in the home.

7) If you plan on riding an off-road vehicle or ATV, remember that children under 16 should not be driving one for any reason. All drivers over 16 should take a safety course and wear a helmet whenever riding on an ATV.

8) If you will be bike or scooter riding over the holidays, make sure you wear your helmet and obey all traffic laws. Even if you are over 15 years of age, modeling the behavior you want to see in your kids is key to keeping everyone safe.

9) Buckle up – even when you’re in in the backseat or just going a short distance. Unbuckled passengers can become projectiles in a crash.

10) If you are going to go skiing or snowboarding, wear your helmet. It keeps you warm and safe!

11) If you are going on a road trip to see family, make sure to stock your car with emergency supplies, including water, non-perishable snacks, blankets, a shovel, reflective triangles, a first aid kit, a flashlight and extra batteries. Remember the kitty litter for tire traction in slick road conditions, especially if you are headed to colder climates!

More information about Shepherd Center's Injury Prevention Program is available here.

EMMA HARRINGTON is the director of injury prevention and education services at Shepherd Center. Previously, Emma started the injury prevention program at Grady Memorial Hospital in the Trauma Department. She holds a master of education degree in international education policy from Harvard University. Originally from Boston, Emma is a licensed social studies teacher.

The last few months of the year – and also the first few of the next one – give us the opportunity to both reflect in gratitude of the year passed and also to anticipate the promises of the year ahead.

At Shepherd Center, we are grateful for so much. Personally, I am thankful for the patients and their families who choose and trust Shepherd Center during what is undoubtedly a difficult time in their lives. I am grateful to share in their hope for progress and recovery, and I am constantly humbled by their spirit and tenacity.

Theodore Roosevelt once said, “No one cares how much you know until they know how much you care.” This quote reminds me of our team here and how they truly embrace each patient and each family. Patients and families often tell me their entire treatment team not only provides care to them, but also truly cares about them. I am grateful that our staff is committed to providing top notch healthcare to patients from their first days in our ICU continuing to their emotion-filled graduation ceremonies and beyond. The staff invests in each patient as an individual with endless potential on their path to rehabilitation.

I also give my genuine thanks to our volunteers and donors who are so gracious with their time, treasures and talents, especially with the ever-quickening pace of all of our lives. It means so much that you choose to spend your time with us, and we don’t take it for granted.

As we look toward 2018, my gratitude guides me with a renewed investment in reaching higher goals, making a bigger impact and expressing my thanks more often to those at Shepherd Center and beyond. As always, thank you for your support of Shepherd Center. Best wishes for a happy and healthy holiday season!

JAMES H. SHEPHERD, JR., is the chairman of the Board of Directors and chief strategy officer for Shepherd Center. He co-founded Shepherd Center in 1975 with his parents, Harold and Alana Shepherd, and David Apple, M.D., the hospital’s first medical director. Read James' bio here.