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 brain injury society
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Spring 2000 Newsletter

BI Society Website
Serving Acquired (Includes Traumatic)
Brain Injured Individuals and Their Families

Mailing & Billing Address Only:
1901 Avenue N - Suite 5E
Brooklyn, NY 11230
Clinicial and Administrative Office:
1517 Voorhies Avenue - Suite 1G
Btwn Sheepshead Bay & Q Train Station
Brooklyn, NY 11235
Telephone & Helpline: 718-645-4401

Hope and Healing

Brain Injury Society


Serving Acquired (includes Traumatic) Brain Injured Individuals and Family Members

Volume 3, Issue 4

Quarterly Newsletter Spring -2000



Published quarterly

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Brain Injury Society

Mission Statement

Brain Injury Society is dedicated to serving acquired (includes traumatic) brain injured individuals, family members, professionals and all interested individuals who desire to learn about brain injury. The BISociety assists in distributing information through the Brain Injury Society publications, BISociety website and informational systems. This informational networking system will cover current information and research on acquired (includes traumatic) brain injury. Educational symposia on current issues are presented on a regular basis.

Whenever possible, Brain Injury Society will assist hospitals, facilities, therapists and professionals in the aftercare of individuals in order for them to reach new potentials during brain injury rehabilitation and the recovery period. This is the highest priority of Brain Injury Society.

Brain Injury Society is a 501 (C)(3) corporation. All donations and contributing membership is fully tax deductible.

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E-mail: [email protected] Website: http://BISociety.org © Brain Injury Society All rights reserved

Spring 2000 Contents


Edwin F. Richter III, MD


Three Part Series - Part Two

Leo J. Shea III, Ph.D.


By Marc Siegel, MD


Kayla Menucha Fogel, BS, SDS


Bruce M. Solitar, MD


Daniel T. Leav, Esq.













Articles In The Following Areas:








Musculoskeletal Injuries and Traumatic Brain Injury

 Edwin F. Richter, III, MD

When thinking about brain injuries, one might first be concerned about potential cognitive and emotional disorders. Given the remarkable abilities of the human brain, this is quite appropriate. Although computers can store vast amounts of data and perform complex mathematical calculations, artificial intelligence has not begun to approach our ability to reason, imagine, and create. Consequently, the professional and popular literature about traumatic brain injury tends to devote much attention to these issues. Patients who have experienced traumatic brain injury may, however, also face significant problems with concurrent physical injuries. These problems also require careful attention.

One of the first issues relating to head trauma is the possibility of significant injuries to the neck. Emergency personnel are trained to protect the cervical spine until serious injuries are ruled out. Even if there is no immediate evidence of damage to the cervical spinal cord, there is concern that any instability of the cervical spine could lead to future neurological damage. Since unconscious patients are unable to participate in a full neurological assessment, it is usually safest to avoid mobilizing the cervical spine until a proper evaluation is done by trained personnel. Confused patients may also be unable to report subtle symptoms, so a high degree of caution is indicated with them as well.

There is a related pitfall involving patients with clear evidence of cervical spine and/or spinal cord injury. These very serious conditions demand a great deal of medical attention. They also are likely to command the full attention of the patients and their families. Subtle evidence of brain injuries may be overlooked when everyone is attending to more obvious spinal cord injuries.

A brain injury survivor need not have dramatic abnormalities in their cervical spine radiological studies to run into problems with this area. Unless the head is held immobile during an injury, some physical forces must be transmitted through the cervical spine and the soft tissues of the neck. When neck pain lasts beyond what is normally expected from a routine strain, then various disorders may be suspected. Pain radiating to the head may be attributed to occipital nerve injury. Pathology of the facet joints of the cervical spine has been implicated in some cases. Myalgias, which are muscle pain syndromes, may be found in a number of patients after head trauma.

Cervicalgia (neck pain) causes a variety of special problems for the brain injury patient. Pain of any area can exacerbate anxiety and depression, while also impairing concentration skills. An additional concern with neck pain is that techniques to compensate for visual field losses utilize neck motion. Therapies to address vestibular disorders also utilize cervical mobility. If these aspects of a rehabilitation program are curtailed, then overall progress may slow considerably.

Many accidents involve more than one part of the body. When critical areas, such as the head and neck, are involved, then injuries to the low back or extremities will likely receive less attention. The brain injury may delay the patient’s ability to perceive or report the other problem areas. Injuries to vital organs may require surgical intervention, and the effects of anesthesia may initially cloud awareness of peripheral injuries. Some problems only become evident after the acute effects of the brain injury begin to recede, when the patient tries to resume normal activities.

Delayed perception of other injuries can lead to various problems. Some physical injuries may be aggravated by activity without proper treatment. Ability to perform tasks safely may be compromised. Belated appreciation of some physical injuries may prompt patients to complain that their condition is deteriorating. This can set up a conflict with medical personnel. Traumatic brain injury is generally considered a one-time event, as opposed to neurodegenerative disorders, like Alzheimer’s. Patients complaining of progression of their condition after a head injury may be dismissed as hysterical. In these situations, professionals should not simply focus on a seemingly illogical complaint of worsening symptoms. Careful evaluation may reveal the presence of additional injuries.

There is another process that may indeed progress over time after major traumatic brain injuries. Heterotopic ossification is the formation of bone in sites where it does not belong. The most problematic areas are usually around joints, where range of motion can become restricted. Pressure may also be applied to nerves or blood vessels. This is a subtle process, which may not initially be detected with conventional x-rays. Measurement of alkaline phosphatase levels in the blood or imaging with bone scans may help with early diagnosis.

Decreased physical activity can also lead to progressive dysfunction after brain injuries. Pain, dizziness, impaired vision, or emotional changes may discourage participation in regular exercise. Even when a brain injury did not directly affect structures that control muscle function, these other problems can lead to muscle weakness. Cardiovascular fitness may also suffer. Weight gain may complicate the picture further. These factors may increase the risk of secondary injuries. Psychosocial functioning may also worsen.

Treatment of musculoskeletal problems is clearly important for the overall well being of brain injured patients. This often has to be coordinated with other aspects of care. Judgment calls may be required when budgeting time and energy. Ethically, any injuries of brain-injured individuals deserve the same level of concern and respect as those of any other population. Conversely, the brain injury may limit some treatment options. Elective surgery under general anesthesia, for example, may need to be deferred. Ambitious exercise programs may be too complicated for some patients. Pain medications may have some difficult side effects. There are no easy solutions to these problems, but effective communication between clinicians and patients is a fundamental requirement.

There are no easy solutions to these problems, but effective communication between clinicians and patients is a fundamental requirement

Edwin F. Richter III, MD, Clinical Assistant Professor, New York University Medical School, Attending Physician; Rusk Institute for Rehabilitation Medicine, Manhattan, New York, Chairman – Brain Injury Society Medical and Community Advisory Board, Brooklyn, NY


Federal Law Definition Traumatic Brain Injury

The regulations for Public Law 101-476, the Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act, now include Traumatic Brain Injury (TBI) as a separate disability category. While children with TBI have always been eligible for special education and related services, it should be easier for them under this new category to receive the services to which they are entitled.

Traumatic Brain Injury (TBI) is defined within the IDEA as an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open and closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma. (U.S. Federal Register, 57 (189), September 29, 1992, p. 44802.)



Part 1 of 2

Daniel T. Leav, Esq.

This is the first part of a two-part article dealing generally with issues concerning the right to die. Although I am mindful that the Brain Injury Society’s goal is to help in the recovery of brain-injured individuals, the issues of health care proxies, "do not resuscitate (DNR)" orders, and competency are common to those families who have had a member suffer a serious brain injury. In our practice representing brain-injured people we have been called on to advice concerning this area of the law.

It is uniformly accepted that competent adults have the right to make decisions regarding their own health care, including decisions that authorize the termination of life-sustaining procedures. Problems arise, however, when a patient becomes incompetent and thus no longer able to make such decisions. This is often the case when someone suffers a serious brain injury and that person is not competent to make decisions

In the context of health care, New York’s Public Health law defines capacity as the "ability to understand the nature and consequences of health care decisions, including the benefits and risks of and alternatives to any proposed health care, and to reach an informed decision. Competence and capacity are used interchangeably in this article.

Generally, the law in New York is that the decision as to whether someone is competent is left to that person’s attending physician. The physician is to make the determination based on a reasonable degree of medical certainty.

In New York, a person has the right to designate an agent specifically for making health care decisions. This is commonly referred to as a "proxy." The agent has the power to make health care decisions on behalf of the principal only to the extent that such decisions are consistent with the known wishes, as well as the religious and moral beliefs, of the principal. Obviously in many brain injury cases an agent will not have been appointed prior to the injury. This situation will be address in a forthcoming article.

Clearly, the foregoing issues are complex and are often thrust upon the families of brain-inured people at the worst time. However, addressing them beforehand can alleviate many problems.

Daniel T. Leav, Esq. is a partner in the law firm of Leav & Steinberg, in Manhattan, New York. They concentrate on serious personal injury matters, including representation of traumatically brain injured people.


By Marc Siegel, MD

Of concern, among the group of TBI or Traumatic Brain Injury patients, is equal access to medical care. In these days of managed care, when medical offices are besieged with phone calls to and from insurance companies, when massive form signing sessions consume both staff and physicians, and patients wait for their doctor visits like cars lining up for the toll collector, only the most persistent and aggressive patients may command immediate and continued attention. Unfortunately, the TBI patient often requires time to be understood properly. He or she may reveal a list of medical complaints, which is, at first blush, difficult to sort through. The TBI patient may also be anxious or embarrassed about coming to the medical doctor, fearing that he or she won’t be understood properly. This problem is of course compounded if the doctor is rushed, inattentive, or dismissive.

Aside from patience and understanding, a medical doctor must have some knowledge and compassion for the special kinds of problems that affect brain injured patients. These patients want to be treated with respect, but for the most part they don’t want to be told they’re completely well, as if their brain injury didn’t happen. Special attention must of course be paid to symptoms of dizziness, headaches, blackouts, inattentiveness, incontinence, or acute anxiety.

At the same time, a medical doctor must not ignore the general medical problems that are not unique to any one population. General screening tests, mammograms and pap tests for women, prostate exam and PSA for men, colonoscopy for everyone over the age of fifty, Chest CT scans for all smokers, should be applied diligently to this population of patients as well as any other.

If the TBI patient shows an exaggeration of personality traits and anxieties that existed before the injury, at the same time, he or she may also exhibit a gratitude for being well cared for despite the brain injury. Every patient who fears being misunderstood, not listened to, or passed over, expresses appreciation when this is not the case. It may be more difficult to exact a definitive history from a brain injured patient, so a physician’s history taking may have to be more directed than usual, with more attention paid to the physical exam and laboratory tests. But this effort is worth the trouble, especially when an important diagnosis is made. The quiet or anxious or unfocused patient may present more of a challenge to an inexperienced physician, but the process of learning to overcome these difficulties and treat a very special population of patients is rewarding.

For the TBI patient, an encounter with a medical doctor may be one in many opportunities to improve communication skills. Seek out a doctor who is willing to listen to you. Don’t be afraid to call back or revisit areas that you feel need further clarification.

Keep a list or notes detailing areas to be discussed. Keep a careful record of scheduled tests and appointments. Don’t be afraid to disagree or question what your physician says to you. It is important that you understand his or her treatment plan and know how to go about following it. At the same time, pay attention to your body and the way it signals you. Change in bowel or bladder habits, pain anywhere, weakness, fatigue or weight loss should be reported right away to your physician.

Regular appointments between a medical doctor and a TBI patient may be crucial to assuring that no problem areas are missed. In addition, the medical doctor and his or her staff may help to guide the TBI patient through the various tests and work-ups and even hospitalizations that are necessary for assuring a patient’s good health. Learning to govern one’s own health care again, making scheduled appointments, taking medications on time; this may be an important part of a recovering TBI patient resuming a normal life. As in any doctor/patient relationship where the patient relies on the doctor for assistance in returning to a normal life, the doctor has the opportunity here to become more than just a doctor, but also a friend.

Mark Siegel, MD, Internal Medicine, Clinical Assistant Professor, New York University Medical School,; Manhattan, New York


The overlooked head injury disorder. As sighted beings, seeing is 80% of what we do. Even a small change in vision can have a powerful impact on cognitive and general functioning.

There are vision trauma clinics that utilize in new techniques and rehabilitation therapies. there is also holistic vision care clinic specializing in rehabilitative therapies. Both treat vision related problems resulting from head trauma, whiplash and stroke. In addition, the specialists train the individuals’ eyes to returning to a more normal sight restored and relief of eyestrain resulting from additional strain of reading and the use of computers’.

If you feel there is vision blurriness that "new" glasses and rest that has not cured, Please call our office and we will be refer you to a vision specialist.


1. The three major problems that may exist with people who sustain Traumatic Brain Injury (TBI) are:

a. - depression, ability to control emotions, and seizures. -

b. - physical, cognitive, and interpersonal. -

c. - psychosocial, physical, and cognitive -


2. Physical impairments include which of the following:

a. - limited attention span and speech -

b. - lack of fine motor coordination and headaches -

c. - judgment and difficulty relating to others -


3. TBI " is known as the "silent epidemic" because:

a. – anyone that is injured usually does not have a physical impairment

b., - all impairments usually occur at the same degrees -

c. - many children have sustained a brain in jury usually do not have visible impairments


4. Cognitive impairments include which of the following:

a. - mood swings and anxiety-

b. - impaired concentration and reading and writing skills-

c. - speech and vision-


5. Psychosocial - behavioral - emotional impairments include:

a. - spasticity of muscles-

b. - hearing and other sensory impairments-

c. - lack of motivation-

Send your answers to TBI Q&A, Brain Injury Society, 1901 Avenue N – 5E, Brooklyn, NY 11230, and/or contact us 718 645-4401



Three Part Series - Part Three

Leo J. Shea III, Ph.D.

An important aspect of neuropsychological rehabilitation process is to assist the patient in developing a full awareness of his/her deficits. While this process begins in a limited way in the hospital during the post-acute phase, the majority of awareness takes place after release from the hospital.

The primary goals of awareness is to help the patient understand what his/her deficits are (sometimes referred to as "the nature" of the deficits) and how they impact his/her daily functioning (often referred to as the "implications" or "consequences" of the deficits).

Patient awareness is only part of the rehabilitation process. It is equally important that those who interact with the patient on an ongoing basis be knowledgeable of his/her deficits. Family members (parents, spouses, children, siblings, etc.) typically spend the most time with the patient following hospitalization. Although well-meaning, family members often tend to deny, avoid or minimize their loved one's deficits. Furthermore, their perception of the patient is often biased by their concept of what the person was like prior to the injury and thus, does not incorporate the changes in the person following injury. Unfortunately, such perceptions affect one's ability to accurately judge a patient's behaviors, actions and progress (or lack thereof).

To remedy this, family members/significant others need to be educated about the nature and implications of deficits, as well as to learn how to more effectively monitor the patients and assist them in dealing with the injury (depending on the theorists, this may be referred to as "mentoring", "coaching", "shadowing" etc.). Since family members often have great difficulty in coming to terms with the neuropsychological losses of their loved one, they benefit from a structured program of psycho-education and emotional support. Family support groups are particularly helpful. Moreover, individual psychotherapy provided by a psychologist trained in brain injury may help an individual family member to more openly process feelings of grief and loss.

Friends, likewise play a crucial role in patient recovery. Often, a patient turns to a friend or friends with issues that he/she does not feel comfortable expressing to a family member or medical personnel. It is helpful to know whom the patient designates as his/her friends and to educate them about the deficits, so that they can assist in monitoring the patient's activities and intervene when necessary. With younger people, the designation of friend may apply to a larger and more varied constellation, so a group meeting may be required. Patients over age 30 typically designate fewer friends but they are friends who have a longer history with the patient, prior to the injury. For these friends, individual sessions rather than group sessions may be more productive.

It is often assumed by the general public that all medical and mental health personnel understand brain injury. That is an incorrect assumption.

With the rapid and constant advances in medical technology, as well as the expanding therapeutic psychological interventions, it is impossible for physicians (medical and mental health) to maintain current knowledge in all aspects of their respective disciplines. While it is true that a licensed M.D. is legally authorized to practice medicine, and a licensed Ph.D. psychologist is authorized to practice clinical psychology, no ethical physician (mental health or medical) would practice in a specialty for which he/she is not trained. In the same way that a urologist should not practice neurology, an educational psychologist should not practice neuropsychology.

When a patient suffers a brain injury, it is important that he/she be treated by professionals who specialize in brain injury and not assume that a general professional credential (M.D. or Ph.D.) signifies competence to treat brain injury. Furthermore, these treating professional should be fully informed about the patient's specific deficits, the implications for daily functioning and what and how various treatment modalities can benefit the patient.

An important key to rehabilitation is having one person designated as the central repository for all treatment information. Most often, this is done by a qualified physiatrist, although in some cases, the patient may wish to select another physician for a specific reason (long-standing relationship with doctor, more effective mutual communications, personality type etc.). This central repository for information regarding a patient's treatment contributes to an increase in a patient's awareness and understanding of progress in deficit areas. Furthermore, by having this central resource, the designated professional is able to provide feedback not only to the patient but also, to all other members of the treatment team, as needed.

In the early history of rehabilitation, some psychology theorists viewed neuropsychological rehabilitation as a lineal process, going from one step to the next, finishing with one and moving to the next. A patient was told that he/she was like a mountain climber, ascending from awareness through malleability, to compensation and, ultimately reaching the pinnacle, acceptance. This theory has been largely replaced by more modern thinkers who have a greater understanding of neuroanatomical mechanisms and their subtleties.

Modern rehabilitation approaches are no longer lineal but consist of a complimentary process which is both circular and spiral. Unlike the old methods, modern treatment approaches recognize that awareness has different levels and must be addressed throughout the rehabilitation process, since it is affected by task complexity and environmental changes.

Awareness is not a circumscribed, singular concept but is interdependent and interactive, evolving in tandem with the other components of neuropsychological rehabilitation.


Leo J. Shea III, Ph.D., Neuropsychologist, Clinical Assistant Professor Rusk Rehabilitation Institute of Rehabilitation Medicine, Manhattan, New York


Bruce M. Solitar, MD

Patients with brain injuries experience various different pains. Pain can often be very severe. Causes of pain include bone and muscle injures, post-traumatic fibromyalgia, underlying arthritis, and stiffness exacerbated by inactivity.

Acetaminophen (Tylenol) is usually the first choice for pain. It can be an effective and has few side effects. Over dosage can lead to liver damage, but this is uncommon. Often the mistake that doctors and patients make is to use the medication too infrequently or in too low a dose. For pain, the recommended dose is 1000 mgs. (2 extra strength tablets) three to four times daily.


For more severe pain, particularly arthritis pain, over the counter nonsteroidal anti-inflammatories can be used. These include Ibuprofen (Advil, Nuprin) or Naproxen Sodium (Aleve). For severe pain, these drugs are used in higher doses. A prescription is required. Side effects of anti-inflammatories include abdominal pain, bleeding ulcers, kidney failure, (in those with underlying kidney disease), high blood pressure or leg swelling. Two new nonsteroidal anti-inflammatories (Vioxx, Celebrex) are of a class called Cox-2 inhibitors. These drugs do not affect proteins called prostaglandin, which protect the stomach from damage. Consequently, the risk of ulcers or bleeding is much less.

For more severe pain, or for those who cannot take nonsteroidal and inflammatories (those with stomach or ulcer problems, people taking anticoagulants) various other medications can be used Tramadol (Ultrom) is a centrally acting pain medication. It works by binding to receptors in the brain, which control the perception of pain. Narcotic medications (Ulcodan, Percocet, Demeral, Morphine) also act to control severe pain. Side effects include lethargy, confusion or constipation. There is also a potential for addiction.

Other potential medications, which can be used for pain in the brain injured patient, include Neurontin, a seizure medication which inhibits Substance P, a mediator of pain. Other seizure medication such as Tegretol of Dilantin can also help with pain. Certain antidepressants called tricyclics can help with "nerve" pain.


 In addition to medication, there a various other ways to control pain, including biofeedback, massage, acupuncture, relaxation techniques, such as meditation. Adequate pain control is essential to allow, a patient to return to a normal functioning life.


The combination of medication and other pain control techniques can be great help in the patients’ recovery.

Bruce M. Solitar, M.D., Clinical Assistant Professor of Medicine, Divison of Rheumatology, New York University Medical Center, Manhattan, New York


Nutritionist: An expert in the nutritional requirements of patients. Nutritionists are also adept at various methods of feeding, for those unable to take in food and fluid by mouth.

Occupational Therapist: OTs work to improve function in the patient's hands and upper body. They become involved in the acute rehabilitation phase. The occupational therapist uses self-care, work and play activities to increase independent function, enhance development and prevent disability. This may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life.

Physical Therapist: The physical therapist evaluates components of movement, including: muscle strength, muscle tone, and general mobility. This is done initially by moving the arms and legs (called Range of Motion) and thereby exercising unused muscles in order to prevent further deterioration of physical function in the unconscious patient. The physical therapist also evaluates the potential for functional movement, such as the ability to move in the bed, transfers and walking and then proceeds to establish an individualized treatment program to help the patient achieve functional independence.

Rehabilitation Nurses: Nurses especially trained in rehabilitation techniques as well as basic nursing care. Nurses assist the patient and family in acquiring new information, developing skills, and achieving competence. They provide and coordinate all patient care, liaison to other team members and are often a patient advocate.





 A supportive atmosphere for the acquired brain injured has a foundation in Brooklyn. Esteemed medical professionals, hospital administrators and community individuals helped to forge Brain Injury Society with its continued assistance to the acquired brain injury population.

With the support of North Shore – Long Island Jewish Health System, an introduction was made to Staten Island University Hospital where a executive administrative decision was made to place Menucha Fogel o the Hospital Community Board. There Menucha offers her expert advises on community and advocacy relations.

Other brain injury rehabilitation facilities have developed relationships. On going Information Hour each month for Rusk Institute of Rehabilitation Medicine former patients and present patients is an on going program each second Tuesday in Room RR116 between the hour of Noon to 1:00 PM followed y a Peer Resource Support Group for individuals and care givers at 5:00 to 6:00PM in Room RR 425.

Menucha is as busy as ever with developing and expanding programs and services for the individuals that is informal and inviting as to assist in the recovery process. The network that Menucha has created has had major benefits on the patient who has been affected by brain injury and the families that they love but is a stranger to.


Webster’s dictionary defines


An individual who willingly enters service of their own free will and enjoys the challenge.


With the help of volunteers working together towards one united goal, grassroots organizations grow stronger and greater.

The need to assist brain-injured individuals and their families is tremendous, which is why Brain Injury Society needs volunteers like you. Call us at 718 645-4401



Recovery from an acquired, which includes traumatic brain injuries, is often positive. We often do not realize the accomplishments we have done until we have seen it in black and white. Often a goal, which at first seems impossible, such as speaking coherently to a friend, after correct rehab is again gained.

With misdiagnosis often months and sometimes years are lost . ‘Knowing that something is not right’, the research for correct evaluations begins. We speak to acquaintances that become friends along this road of recovery, which turns into successes. These friends our the first to see our successful recoveries.

Hope and recovery is each individuals daily business, hence the important call for stories on our trials, tribulations and efforts in the rehabilitation recovery process.

What is needed

A clearly written or typed one or two pages – double spaced is always best, but not necessary – indicating how your brain injury happened include the type of hemisphere and lobe injury, year it occurred, age at the time and today, sex and martial status then and today. How you researched for a rehabilitation facility, therapist, etc , experiences in recovery and how you are today. Important to include is how the brain injury has impacted and changed your life for the better or for worse. This can be written in the second party for a spouse, child or friend who is reluctant to write but who you have permission.

   SEND TO: Brain Injury Society, 1901 Avenue N - 5E, Brooklyn, NY 11230. You can also send your story via the E-mail to [email protected] or call 718 645-4401 for our fax.

Please include how I can contact you, so include your name, address. day and evening phone numbers.

We will contact you upon receipt of your story.



"What’s up Doc?" "My services.


Dr. Malingering said to his nurse, "There are nuts in my office, call someone." "OK" said the nurse and proceeded to call the visitor’ brothers, Drs. Nuts for the meeting.



We convince ourselves that life will be better after we get married, have a baby, then another. Then we are frustrated that the kids aren't old enough and we'll be more content when they are. After that, we're frustrated that we have teenagers to deal with. We will certainly be happy when they are out of that stage. We tell ourselves that our life will be complete when our spouse gets his or her act together, when we get a nicer car, are able to go on a nice vacation, when we retire.

The truth is, there's no better time to be happy than right now. If not now, when? Your life will always be filled with challenges. It's best to admit this to yourself and decide to be happy anyway. One of my favorite quotes comes from Alfred D Souza. He said, "For a long time it had seemed to me that life was about to begin - real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, or a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life. This perspective has helped me to see that there is no way to happiness. Happiness is the way. So, treasure every moment that you have and treasure it more because you shared it with someone special, special enough to spend your time...and remember that time waits for no one."

So, stop waiting until you finish school, until you go back to school, until you lose ten pounds, until you gain ten pounds, until you have kids, until your kids leave the house, until you start work, until you retire, until you get married, until you get divorced, until Friday night, until Sunday morning, until you get a new car or home, until your car or home is paid off, until spring, until summer, until fall, until winter, until you are off welfare, until the first or fifteenth, until your song comes on, until you've had a drink, until you've sobered up, until you die, until you are born again to decide that there is no better time than right now to be happy. Happiness is a journey, not a destination.

Thought for the day:

Work like you don't need money,

Love like you've never been hurt,

And dance like no one's watching.

Some people come into our lives and quickly go. Some people become friends and stay a while leaving beautiful footprints on our hearts and we are never quite the same because we have made a good friend!!

Yesterday is history. Tomorrows’ mystery. Today is a gift. That's why it's called the present!


Take a friend for a walk, jog or to the gym. Even moderate exercise help brighten your mood…Exercise can have the same mood-elevating effects as aerobic workouts. A regular schedule of moderate or mild exercise appears to be key in helping treat depression. Having a time set aside for exercise helps to ease the mind of the problems one is having.


On one occasion, when Rabbi Noson Tzvi Finkel was leading the congregation in prayer, he kept stumbling on

the pronunciation of the words. Those present were amazed, since he [Rabbi Finkel] always pronounced each word precisely. The congregants soon understood the reason for the Rabbi's uncharacteristic difficulty.

There was a mourner in the synagogue that had difficulty reading Hebrew, and when he read from the prayer book, people laughed or smiled. In order to lessen the mourner's embarrassment, Rabbi Finkel acted as if he could not read any better. Source: "Love Your Neighbor" by Rabbi Zelig Pliskin

Support Groups


Brooklyn Please call to confirm schedule and your attendance. Thank you.

Maimonides Medical Center 4810 Tenth Avenue, Brooklyn, NY 11219

2C - 2nd Floor - Administrative Building

6:00 – 7:00PM 2nd Thursday of each month Please contact: Yehuda Schwartz, Ph.D.,


MANHATTAN Please call to confirm schedule and your attendance. Thank you.

Bellevue Hospital Center, East 27th and First Avenue, Room 6E35, New York, New York 10016

6:00 – 7:00PM, 3rd Wednesday of each month Please contact: Harold Lifshutz, Ph.D. or Menucha Fogel, B.S., SDS


QUEENS Please call to confirm schedule and your attendance. Thank you

St. Mary’s Hospital for Children, 29-01 216th Street, Bayside, New York 11360

7:00 – 8:00PM, 3rd Wednesday each month Facilitator: Paul Berger-Gross, Ph.D. @ 718 281-8824 or Michelle 718 645-4401


Please call for additional Support Group Schedule. Schedule may change without notice

*Additional support groups to be announced for day and evening to accommodate schedules individual and family schedules.




Learning About Brain Injury,

Wednesday, October 20, 1999, 10:00AM to 2:00PM

Maimonides Medical Center, Maimonides Hall, Brooklyn, NY

Acquired Brain Injury and its Ramifications

Sunday, November 7, 1999, 10:00 – 4:00PM

Beth Israel Medical Center, Second Avenue and East 17th Street, Manhattan, New York

Learning Abilities and the Methodologies Utilized

in Adults and Children after Brain Injury

Thursday, December 2 1999, 8:00AM to 4PM

Bellevue Hospital Center, Rose Room, 12th Floor, Manhattan, New York


"Share your knowledge and information to all that seek it."

The next step is up to you. All written, audio, software, visual matter pertaining to head injury and trauma, we are interested in. Books, journal materials, booklets, information on all levels. Material packets on community integration, activities in daily living, etc. Call 718 645-4401 Thanks




Kayla Menucha Fogel, B.S., S.D.S

Founder/Executive President

Sandra Borenstein

Executive Secretary


Robert Hettenbach

Sidney Hirth

Sonya Strassfeld


William Barr, Ph.D.


Hillside Hospital/Long Island Jewish Hospital

Paul Berger-Gross, Ph.D.


St. Mary's Hospital for Children

Ludmilla Bronfin, M.D.


Mt. Sinai-New York University Medical Center

Leonard Diller, Ph.D.


Rusk Institute for Rehabilitation Medicine

George Fesko

Assistant to the President

United Federation of Teachers

Lisa Ganzi, MLE

Phil Gautreau

North Shore Long Island Jewish Health System

Malkah Ilovitz, C.S.W.

Neera Kapoor, M.S., O.D.


SUNY School of Optometry

Joan Gold, MD

Pediatric Psychiatrist

Rusk Institute of Rehabilitation Medicine

Maimonides Medical Center

Marshal Keilson, M.D.


Maimonides Medical Center

Harold Lifshutz, Ph.D.


Bellevue Hospital Center

Gershon Ney, M.D.


Albert Einstein Medical School

Beth Israel Medical Center - Queens

Reva Rapps, M.S.

Edwin F. Richter, III, M.D.


Rusk Institute for Rehabilitation Medicine

Jonathan Silver, M.D.


Lenox Hill Hospital

Bruce M. Solitar, M.D.


Mt. Sinai-New York University Medical Center

Hospital Joint Disease

Harold Skovronsky, Esq.

Mark Ylvisaker, Ph.D.

College of St. Rose, Albany, New York

Leon Zacharowicz, M.D.


Nassau County Medical Center



Marcia Eisenberg, Esq.



Rabbi Abraham Blumenkrantz

Rabbi Yaakov Gissenger

Rabbi Yaakov Weiner



New York City – Brooklyn

Bronx, Manhattan, Queens, Staten Island

Long Island – Nassau & Suffolk

Capital District, Rockland, Westchester



California, Colorado, Florida, Illinois, Indiana, Nebraska, New York, Ohio, Wyoming, Washington



Volunteers are always welcome.

For more information,

Call: 718 645-4401


Advocacy Services

Community & Epilepsy Issues

Lisa Ganzi, M.L.E.


K. Menucha Fogel, B.S., S.D.S.

Elliot Udell, O.P.M.

Continuing Medical Credits

Allen Bennett, M.D.


Graphics and Layout

Kayla Menucha Fogel, B.S., S.D.S.

Lisa Ganzi, M.L.E.

Gift Shop

Informational Services

Informational Symposia on Neurological and Rehabilitation Current Topics

In-Service Training

Legal Issues relating to brain injury: Estate Law, Insurance Appeals, , Personal Injury, Traumatic Brain Injury Law Social Security Administrative Law

Edward Steinberg, Esq – Chair

Daniel Leav, Esq.

Meyer Price, Esq.

Harold Skovronsky, Esq.

Marketing & Outreach

Rita Goldstein

Joan Perrier-Wyer, M.L.S.

Medicaid Waiver Provider Program Coordinator Services-Children & Adults

Medical and Facility Referral Service

Newsletter Staff

K. Menucha Fogel, B.S., S.D.S.

Joan Perrier-Wyer, M.L.S.

Peer Resource Support Groups

K. Menucha Fogel, B.S., S.D.S.

Donna Langenbahn, Ph.D.

Jenifer Levinson, C.S.W.

Harold Lifshutz, Ph.D.

Yehuda Schwartz, Ph.D.

Speakers Bureau

Vocational Planning

Reva Rapps, M.S.

Website Design and Hosting

Susan Wilson

Brain Injury Society

1901 Avenue N - Suite 5E

Brooklyn, New York 11230



Rolland Parker, Ph.D.


212 222-4543

Daniel Kuhn, MD


Biofeedback QEE Training

212 315-1755

Brain Injury Society

Serving the Acquired (includes Traumatic) Brain Injured in every way possible.

718 645-4401

Rusk Institute for Rehabilitation

Outpatient Neuropsychological Evaluations, Cognitive Rehabilitation & Psychological Services

Donna Langenbahn, PhD - 212 263-6163 or Janise Lopez - 212 263-6167



A Guide To The Medical Personnel And Their Roles In Providing Care.


A physician who administers anesthesia for surgery and other medical procedures. This physician may meet with family members before surgery.

Attending Physician

The physician primarily responsible for the care of the patient, often a neurosurgeon.

Consulting Physicians

Physicians who are specialists in fields other than neurology and neurosurgery. They may be called upon by the attending physician for their expertise on other facets of medicine, especially in the event of other injuries.


A physician who has finished medical training and is usually in the first year of training in a specialty. Interns work under the supervision of attending physicians and residents.


A physician who specializes in internal medicine. They are experts in problems of the heart, digestive tract and other internal organs, and are often consulted after a brain injury.


Physician specialist concerned with treating disorders of the brain, spinal cord, nerves and muscles.


A psychologist who specializes in evaluating brain/behavior relationships. They use a variety of techniques, including testing. Groups of tests, called batteries, can establish the location of the brain injury. Neuropsychologists plan training programs and recommend alternative cognitive (thinking) and behavioral strategies to help brain-injured people think and behave as close to their pre-injury status as possible. They also get involved in helping families to understand what is happening to their family member. In addition, they help families try to come to grips with the fact that this injury effects not only the person who is injured but also all members of the family. Neuropsychologists typically have more time to talk to patients and their families than other members of the medical team. You should feel free to ask to speak to the neuropsychologist.


Physician specialist trained to care for all varieties of nervous system problems and perform brain and spinal cord surgery as needed. This person is primarily concerned with coordinating the medical treatment of the brain injured, and deciding whether or not there is a need for surgical treatment.


Physician specialist concerned with the study and treatment of the skeletal system, its joints, muscles and associated structures.


A physician who specializes in physical medicine and rehabilitation. Some physiatrists are experts in neurologic rehabilitation. The physiatrist examines the patient to assure that medical issues are addressed; provides appropriate medical information and oversees the patient's rehabilitation program.

 Primary Care Nurse

The nurse principally responsible for the nursing care of a given patient. The primary care nurse develops and implements a care plan, participates in conferences, collaborates with the patient, the rehabilitation team, and the family, as well as evaluating the outcome of care.


A professional specializing in counseling, including adjustment to disability. Psychologists use tests to identify personality and cognitive functioning. This information is shared with team members to assure consistency in approaches. The psychologist may provide individual or group psychotherapy for the purpose of cognitive retraining, management of behavior and the development of coping skills by the patient and members of the family.


A physician who has completed medical training and is taking additional training in a specialty, such as neurosurgery. Residents work under the supervision of attending physicians.

Respiratory Therapist

Concerned with helping the patient breathe adequately as a means of preventing further complications and/or infections. If the patient is on a respirator, the respiratory therapist is responsible for maintaining the equipment. If the patient is unable to cough up secretions, the respiratory therapist may assist by lowering the head, tapping the back, and suctioning the patient.

Speech Therapist

Assists patients in their recovery of all aspects of communication skills and swallowing ability.

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