conference 2009

The 7th Annual Pacific Northwest

Brain Injury Conference 2009

Living with Brain Injury:

Emerging Partnerships

Sheraton Portland Airport Hotel 

Portland, Oregon

March 5-7, 2009

Sponsored by

The Brain Injury Associations of

Oregon and Washington

This conference was sponsored in part by The Oregon Competitive Employment Project, part of the Oregon State Department of Human Services, Office of Vocational Rehabilitation Services, which is funded through a Medicaid Infrastructure Grant from the U.S. Centers for Medicare and Medicaid Services (CFDA #11-P-92415-0/03).

Thursday, March 5

Behavioral Challenges After Brain Injury

Harvey E. Jacobs, Ph.D.

Psychologist / Behavior Analyst

Partner, Lash and Associates Publishing/Training

 Overview

 The purpose of this workshop is to provide a broad overview regarding relationships between brain injury and the behavioral challenges that may follow.  While neurological, physical and cognitive changes that occur following an injury clearly affect behavior, social and environmental factors often have equal or greater influence.  This is especially true in day, residential, community based and other program formats.  Oftentimes, the manner a person is regarded and treated, regardless of their brain injury, can contribute more to problem behaviors than most other factors.  The settings in which people live and interact, the roles and functions of all people in their lives and the supports they have to help them succeed are all critical.

 The workshop will detail these factors and discuss how they apply in home, community and professional service settings.  There will be a special emphasis on promoting positive supports to help all individuals succeed.  This is not only relevant for people who experience disability following brain injury, but also for caretakers, providers and other members of a person’s circle of support.

As a result of this workshop, participants will be able to:

 · Provide clear and comprehensive definitions of behavior in diverse situations;

· Identify the difference between behavior disorder and behavior dysfunction;

· Clarify and prioritize salient factors contributing to presenting behavior challenges;

· Understand the relationships between functional capacity, social reciprocity and environmental context as they relate to behavioral success;

· Specify key factors of programming that rely on positive behavioral supports;

· Learn how to involve the person who experiences disability, family members, staff and other involved parties into successful programming;

· Create and sustain positive support plans for all involved parties;

· Understand how to collect and analyze data;

· Create personally relevant productive activity and living patterns for involved parties;

· Understand the role of adjunctive therapies, such as medication, when addressing behavioral challenges;

· Identify key times and situations when extra help is needed.

 Handouts:

Aint Misbehaving

Chapter 2: What is Behavior.PDF

Neurobehavioral Crisis Hospitalization

Stop Treating the Brain Injured

Sponsors:

The Teaching Research Institute-Eugene  (Maternal and Child Health Bureau Grant)

The Brain Injury Association of Oregon

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The Northwest Permanente Department of Clinical and Leadership Education, Kaiser Permanente Northwest Region, accredited by the Oregon Medical Association, and the Brain Injury Association of Oregon. This activity has been approved for AMA PRA Category I Credit^TM.

Friday, March 6

8:15 a.m. - 9:15 a.m.

Keynote Speaker

Harvey E. Jacobs, Ph.D., Psychologist / Behavior Analyst, Partner, Lash and Associates Publishing/Training

The purpose of this presentation is to review relationships between brain injury and behavioral challenges that may follow.  While changes in neurological, physical and cognitive changes that occur following an injury clearly affect behavior, social and environmental factors often have equal or greater influence.  Oftentimes the manner a person is regarded and treated, regardless of brain injury can contribute more to problem behaviors than most other factors.  The settings in which they live and interact, the roles and functions of all people in their life and the supports they have to help them succeed are all critical.  This presentation will identify some of these factors and promote a philosophy of positive supports to help all individuals succeed.  This is especially relevant for people who experience disability following brain injury, caretakers, providers and members of a person’s circle of support. As a result of this presentation, participants should be able to: Identify the difference between behavior disorder and behavior dysfunction; Specify key factors of programming that relies on positive behavioral supports; and Understand the relationships between functional capacity, social reciprocity and environmental context relate to success.

9:30 a.m. - 10:30 p.m.

Track 1: Mt. Hood A

Pain Management Following a Brain Injury

Andy Ellis, PhD, Director, Brain Injury Rehabilitation Center, and Catriona Buist, PhD, Director of PRA Pain Center

Moderator: Heather Schlessman

Track 2: Mt. Hood C

Serving Behavioral Needs after Brain Injury

Debra Braunling-McMorrow, Ph.D., Vice President ABI Service Diversification, The MENTOR Network
Often following brain injury a person with brain injury may experience behavioral issues, which may significantly interfere with their lives. While an unfortunately common issue, many providers feel inadequate in addressing the often complex and dangerous behaviors that a person may demonstrate. This presentation is intended to provide an overview of contemporary behavioral interventions applicable to a variety of behavioral issues and settings. In addition, the attendee will learn practical strategies in providing least restrictive treatment alternatives. Sample Personal Intervention plans utilizing contemporary and least restrictive treatment alternatives will also be discussed. In addition, the importance of understanding behavioral sequences and the importance of windows of opportunities in determining when to provide support will be discussed.

Moderator: Danielle Erb, MD

Track 3: Cascade A & B

Controversies in Post-Concussion Syndrome

Mark Tilson, PhD, Neuropsychologist, Legacy Rehabilitation Services
Dr. Tilson will review issues of continuing clinical and legal debate regarding post-concussion syndrome.  These include the role of psychological factors; symptom validity and malingering; vestibular symptoms; and the distinction between subjective symptoms and objective functional impairment.

Moderator: Zach Bayer

 10:45 a.m. - 12:00 p.m.

 Track 1: Mt. Hood A

Understanding MRI's and their use in Evaluating Brain Injury in both Adults and Children

Sam Browd MD, WA

Moderator: Zach Bayer

Track 2: Mt. Hood C

The Idaho Vet Model

Mary Kelly and Russ Spearman, 

This presentation will focus on the work accomplished via Idaho's TBI Implementation Grant and will include an overview of Idaho's new partnership grant with a focus on returning service members and their families.

Moderator:  Bruce McLean

Track 3: Cascade A & B

Medical Legal Issues for the Brain Injury Professional

The Effective Use of Demonstrative Evidence in BI Litigation

Michelle Peterson: Medi-Visuals, Medical Illustrator/Animator Consultant

Demonstrative aids can make a significant difference in the amount of recovery obtained in a brain injury case.  In cases where liability or coverage limits the types of demonstrative aids that can be developed. More simple and less expensive demonstrative aids can be developed.  The lecture will demonstrate the most severe of brain injuries and as well as the most subtle.  Because more subtle brain injuries are tht e most difficult to prove, those types of cases benefit the most from demonstrative aids-the presentation will explain the medical and technological reasons why this is.

Moderator: Tom Boyd, PhD

12 noon - 1:00 p.m.   Mt Hood B - Lunch  Video Presentation

Right to Risk
Common perceptions of disability consistently and dramatically underestimate virtually every measure of competence, productivity and quality of life. These misperceptions and assumptions about what the 54 million people with disabilities in our society can and cannot do, result in reduced opportunities, lowered expectations, and barriers to full participation. “Right to Risk” is a one-hour documentary that chronicles a 15-day, 225-mile whitewater rafting adventure through Grand Canyon by eight individuals with disabilities. The film is distributed by American Public Television to more than 350 member public television stations through 2009.

1:00 p.m. - 1:45 p.m.

 Track 1: Mt. Hood A

Co-Occurring Disorders: Identification and treatment—Issues in Psychopharmacology

Ron Heintz, MD, Psychiatrist, Oregon State Hospital 

This presentation will review the complexity of identification of psychiatric syndromes in TBI patients and review common psychopharmacologic approaches to treatment of psychiatric syndromes,. Including risks and potential benefits.

Moderator:  Danielle Erb, MD

Track 2: Mt. Hood C

Outcomes: a ten year retrospective analysis 

Debra Braunling-McMorrow, Ph.D., Vice President ABI Service Diversification, The MENTOR Network
As inpatient, hospital-based rehabilitation stays for persons with brain injuries have decreased, people re leaving the hospital quicker and post-acute providers have been expected to serve people with greater rehabilitation needs. In a study by Kreutzer et al., 2001, acute care length of stays declined from 1990 – 1996 at an annual average rate of 2.25 days and post acute rehabilitation reducing on aveage 3.65 or 8% annually. With shorter acute stays, persons entering post-acute programs typically have more significant medical, cognitive, physical and behavior issues than even a decade ago. At the same time, both insurance and public payers have become more discriminating in providing financial support for persons with brain injuries to enter post-acute rehabilitation programs.. These issues point to the importance of measuring both the effectiveness of post-acute rehabilitation and the “value” (or return on investment) for all consumers to help guide future decision making on access to care This presentation will focus on measuring what matters and share outcome information including the relevance of time post injury in accessing rehabilitation.

Moderator:  Paul Cordo, PhD

Track 3: Cascade A & B

Medical Legal Issues for the Brain Injury Professional - The change in Medicare and what it means to you and your case

James Coon, JD, Swanson Thomas and Coon
The training will provide you with medical, assessment and treatment information helpful in representing your clients with mild-moderate brain injuries.

Moderator:  Zach Bayer

2:00 p.m. - 2:45 p.m.

Track 1: Mt. Hood A

Co-Occurring Disorders: Identification and treatment—Issues in Psychopharmacology (Continued)

Ron Heintz, MD, Psychiatrist, Oregon State Hospital 

Moderator:  Danielle Erb, MD

Track 2: Mt. Hood C

The ABI Clubhouse

Harvey Jacobs, PhD

The purpose of this presentation is to provide an overview of the ABI Clubhouse model including its origins, history of development and present status; including the recent development of the International Brain Injury Clubhouse Alliance (IBICA). This presentation will provide an overview of the concepts of person directed services, productive daily activity patterns, and community basis, and their applications within the ABI Clubhouse model. Special attention will be devoted to the IBICA ABI Clubhouse standards, which have been recently adopted, as well as distinctions between ABI Clubhouses and more traditional day activity and day treatment approaches. Information will also be shared on how different groups have established such programs and the various steps required in this process, including assessing if such a model is the most appropriate resource for an existing community’s needs.

Moderator: Zach Bayer

Track 3: Cascade A & B

Medical Legal Issues for the Brain Injury Professional

Cognitive Problems Associated with ABI Jan Johnson, MS, CCC-SLP; Jeri Cohen, BS, JD, Job Coach.  Review of cognitive problems associated with acquired brain injuries and treatment.  Co-presenter, Jeri Cohen, a brain injury survivor an inactive attorney will provide specific examples of how her ABI affected her cognitively and her practice.  The training will provide you with medical, assessment and treatment information helpful in representing your clients with mild-moderate brain injuries.  

Moderator: Heather Schlessman

3:00 p.m. - 3:45 p.m.

Track 1: Mt. Hood A

Brain Injury and Mental Illness: A Dangerous Intersection

Thomas Boyd, PhD, ABPP, Neuropsychologist

How Brain Injury and Mental Illness Overlap
Traumatic Brain injury (TBI) Disrupts Thought Processes ; TBI Can Lead to Personality and Affective Changes ; Characteristic Symptoms of Schizophrenia; Psychosis and TBI: What’s the Brain ‘Connection’? ; Misidentification and Duplication Syndromes

Brain Injury and Mental Illness: A Vicious Cycle
TBI Increases Vulnerability to Psychiatric Illness ; Risk Factors for Post-TBI Psychosis;  Psychiatric Problems Increase Risk of Brain Injury; Risk Factors for TBI and Genetic Risk for Schizophrenia Interact ; Violence, Abuse and Neglect after TBI; Societal Impact

Treatment Models and Approaches
Treatment Models ; Treatment Strategies;  Importance of Psychiatric Consultation; What Is Needed?

Moderator: Zach Bayer

Track 2: Mt. Hood C

A Multi-Modal Approach to School Re-entry for the Brain Injured Student and Under-identification of Students with TBI - Pat Sublette, PhD, Oregon TBI Education Coordinator and Vicki Bernard, Supervisor of Special Programs, Southern Oregon ESD

Reentry to school following a TBI can be a pivotal time for setting up supports, schedules and planning to create the flexible program often needed for students with TBI.  This presentation will outline a set of strategies that are often useful for school reentry and discuss under identification of students with TBI and resources available in Oregon.

Moderator: Heather Schlessman

Track 3: Cascade A & B

Medical Legal Issues for the Brain Injury Professional

Functional & Cognitive Vision Problems Following Brain Injury - Carol Marushich, OD, MS, FCOVD
Vision plays a vital role in rehabilitation. Specialized testing for ABI identifies those areas of ocular and cognitive visual function which can enhance overall recovery. Ocular disease must be stabilized, compensatory Optical treatment can address structural vision limitations and vision rehabilitation therapy can provide the opportunity to improve visual comfort and efficiency as well as relearn functional vision skills including visual information processing.

Moderator: Jeri Cohen

4:00 p.m. - 5:00 p.m.

Track 1: Mt. Hood A

The Impact of Exercise on Mood after TBI

Jeanne M. Hoffman, Ph.D., University of Washington, Department of Rehabilitation Medicine
Exercise is encouraged for everyone to improve health and wellness. In a recent study we sought to identify potential positive impacts of exercise on mood and wellness after TBI. This presentation will include an overview of the results of that study and how exercise can have a positive impact for individuals with TBI.

Moderator: Zach Bayer

Track 2: Mt. Hood C

The Northwest Brain Injury Alliance

Gene van den Bosch

Moderator: Heather Schlessman

Track 3: Cascade A & B

Study of Undiagnosed Brain Injuries In Wyoming’s Prison Population - Dorothy Cronin, ED BIAW

Wyoming completed a Brain Injury Survey Questionnaire (BISQ) assessment of 200 inmates in Wyoming Department of Corrections facilities.  The 17 page survey relied on self-reporting signs, symptoms, and causes for potential brain injuries.  The results were scored according to likelihood of brain injury per individual.   Presentation will describe the tool used, the process and completion of the project, as well as outcomes and recommendations for the Department of Corrections.

According to jail and prison studies, 25-87% of inmates report having experienced a head injury or TBI  as compared to 8.5% in a general population reporting a history of TBI.  See the attached CDC publication entitled Traumatic Brain Injury in Prisons and Jails: An Unrecognized Problem.

In Wyoming, prison populations had never before been screened for brain injuries.  When the Department of Corrections (DOC) was approached about the project, they were very willing to consider that this population was likely to have brain injuries, but DOC had no screening tools to attempt to identify those inmates with such a history. The Centers for Disease Control and Injury Prevention state by state comparison data from 1999 stated that Wyoming had the highest per capita incidence of brain injury in the nation at 3%, compared with the national average of 2%.  It might figure then that Wyoming had a potentially larger prison population living with brain injury as well. Although the sample population was screened using a self-reporting tool, the Brain Injury Screening Questionnaire (BISQ), that identifies potential brain injury based on history and reported symptoms, it is not a definitive test for brain injury and will result in a report only of the LIKELIHOOD of inmates to have a brain injury.  Therefore, it is important for DOC to recognize that those whose results indicate a moderate to high likelihood will require additional testing, such as a neuropsychological evaluation, to confirm a diagnosis of brain injury.

The presentation will discuss the findings, recommendations for future screening, and follow up completed to date.

Moderator: Sherry Stock

 Saturday, March 1 

Conference Speakers (Alphabetical Order)

Keynote Friday, March 6

Harvey E. Jacobs, Ph.D., has a long history of serving people seeking opportunity who are challenged by disability following neurologic, psychiatric, developmental, medical or physical impairments.  Now in private and consulting practice for individuals and programs, he previously served on the faculty of the Johns Hopkins University School of Medicine, UCLA School of Medicine, and Temple University.  He is also a partner in Lash and Associates Publishing/Training which creates practical educational and training materials for care providers, direct care staff and other people assisting people who experience disability.

Throughout his career, Dr. Jacobs has worked on-staff, in administrative roles, academic positions and as a consultant to numerous facilities (medical, rehabilitation, community, assistive living programs and nursing homes) across the country.  He received his doctorate in psychology from Florida State University in 1979, and was a Post-Doctoral Fellow at the Johns Hopkins University School of Medicine.  He was awarded a Mary Switzer Research Fellowship from the National Institute on Handicapped Research (NIDRR) in 1983-84.  Dr. Jacobs’ current interests include behavioral rehabilitation for neurological, psychiatric, medical and developmental disorders; brain injury; severe behavior dysfunction; rehabilitation outcomes research; vocational rehabilitation; family systems; staff training; and community integration.  Throughout his practice, Dr. Jacobs has worked with diverse ages, ranging from pediatrics to geriatrics.  He has a special interest in organizational and systems management as it relates to developing and operating comprehensive programming in both business and clinical settings.

Dr. Jacobs has numerous research publications, texts and other scholarly contributions.  His new book, due shortly is titled DON’T DON’T:  Understanding Almost Everybody’s Behavior After Brain Injury.  He has received millions of dollars in grants from federal, state and private foundations for his work.  He is noted for his practical and innovative approaches to challenging situations, both in his clinical/organizational work and in his research. 

Keynote Saturday Morning, March 7

Soldier’s mom becomes voice  for wounded warriors  - Cynthia Lefever and Rory Dunn

Cynthia Lefever is intimately aware of the devastating effects of blast injuries. Her son, Rory Dunn, a 2000 graduate of Liberty High School, was nearly killed four years ago by a roadside bomb in Fallujah, Iraq. The bomb exploded above his Humvee, killing two of his friends. His forehead was crushed from ear to ear, leaving his brain exposed. Shrapnel destroyed his right eye and his hearing was severely damaged.

He was flown by helicopter to a hospital in Baghdad, where doctors worked to save him. Five days later, he was flown to a hospital at Landstuhl Regional Medical Center in Germany, where family had gone on “imminent death orders” to say their goodbyes.  “Doctors gave him a 2 percent chance of survival,” Lefever said. Despite the grim prognosis, Dunn did survive. One day after he arrived in Germany, he was transferred to Walter Reed Medical Center in Washington, D.C., still in a coma. “When he arrived at Walter Reed, neurosurgeons said Rory’s injuries were the worst they had ever seen,” Lefever said.

The journey for mother and son the past four years has been a study of perseverance — Dunn defying the odds each step of his recovery and Lefever battling the Army to ensure he continued to receive critical care from Reed’s top-notch surgeons. Almost six weeks later, Dunn emerged from his coma.  “Within days of coming out of a coma, Army leadership was at his bedside putting a pen in his hand to start the discharge process with the ultimate goal of getting Rory off the books,” Lefever said. “When we let these wounded warriors languish in bed and presume that all that can be done is to change their diaper and turn them regularly and get them out for fresh air, that’s ridiculous. I just think it’s immoral and unethical.”

Cynthia Lefever is working to educate communities across the state about traumatic brain injury. She said she wants police, firefighters and emergency responders to recognize the signs of traumatic brain injury, so they can respond appropriately in an emergency. She got the Veteran’s Administration to provide medical alert tags for all severely wounded veterans, especially those with traumatic brain injury and post-traumatic stress. 

Meanwhile, her son has regained his life, she said.  “He’s walking, talking, hunting and fishing,” she said. “In May, he jumped out of an airplane and he’s preparing to go to college.”  Healing comes slowly   Family members also suffer symptoms of post-traumatic stress. Lefever said she has had nightmares of her 10-month ordeal at Walter Reed Medical Center.  “I’m at Walter Reed coming around a corner, coming face- to-face with a soldier who looks like he’s a 14-year-old, beautiful, baby-faced and his arms and legs are gone. That image will haunt me until the day I die.”

Post-stress trauma is a normal reaction to the abnormal circumstances of war. Soldiers are trained to be killing machines; they’re supposed to be strong, but it comes with a cost, she said.  “When you have watched civilians being run over by a tank under orders, I don’t see how anybody can be OK,” Lefever said.  On another occasion, an Iraqi man who was helping the U.S. military was shot, his body blown into two pieces. Dunn and other soldiers were ordered to return the man’s body to his family.

“Rory thinks about the wife and the children that were screaming and crying as he deposited the two halves to the family,” Lefever said.

Families of wounded warriors and the community need to know that traumatic brain injury is a physical injury, not a mental disorder, she said.

Lefever fears history may soon repeat itself.  “Unless our society is educated and informed about traumatic brain injury, we’re going to see our veterans again retreat into the mountains and hills, become homeless, fail at relationships, become unemployed and we’ll have a repeat of what we saw when the soldiers returned from Vietnam,” she said.

Keynote, Saturday afternoon, March 7

Dr Jim Chesnutt, M.D, is the Medical Director for the OHSU Sports Medicine Program and has been an Assistant Professor at OHSU for 14 years.   He is full time faculty in the Orthopeadics and Rehabilitation and Family Medicine departments.  Jim has been a Team Physician for 15 years and teaches and practices sports medicine full time.  Jim grew up in Portland.  He attended  Stanford for his undergraduate, and went to OHSU Medical School and had his residency with the Air Force.  Jim was the President of the Oregon Academy of Family Medicine from 2004-5.  He is a member of the OSAA Medical Aspects of Sports Committee, that governs Oregon HS sports.  Jim is the co-director of the Oregon Concussion Awareness and Management Program.

Presenters

Rob Bovet, JD, currently serves as the District Attorney for Lincoln County, Oregon. Prior to being elected District Attorney, Rob served as a lawyer for Lincoln County, beginning in 1992, with a primary focus on legislation and public health and safety.  Since 2000, Rob has also served as legal counsel for the Oregon Narcotics Enforcement Association. Rob is the author of Oregon’s meth lab control laws, and helped author federal laws to control international diversion of meth lab chemicals.  Rob is co-founder and President of the Oregon Alliance for Drug Endangered Children.  Rob created the Lincoln County Meth Initiative, focusing on science-based prevention, enforcement, and treatment.  Rob recently authored a law review article entitled Meth Epidemic Solutions, 82 North Dakota Law Review 1195.  Rob serves as Chair of Oregon’s Meth Task Force, and is a member of other task forces and prevention coalitions.  Rob has provided nearly 400 presentations regarding drug policy, and has appeared on  numerous programs and special reports, such as Good Morning America, National Public Radio, and PBS NewsHour and FRONTLINE. Rob is the recipient of the 2006 Governor’s Gold Award for outstanding public service, and the 2008 NMCI national “Impact” award.  Rob is married and has four children – two in college and one in high school – so Rob is aging a bit faster than normal.

Thomas M. Boyd, Ph.D. ABPP, obtained a Bachelor’s degree in Psychology at the University of Virginia and a doctoral degree in Clinical Psychology at the University of New Mexico. He has 28 years of experience in neurological rehabilitation. He has worked at the Oregon Rehabilitation Center of Sacred Heart Medical Center since 1988. He consults at Community Rehabilitation Services of Oregon and at Teaching Research-Eugene. Dr. Boyd serves on the Board of Directors of the Brain Injury Association of Oregon and is a Diplomate of the American Board of Clinical Neuropsychology.

 Samuel R. Browd, M.D., Ph.D. is an Assistant Professor and an attending neurosurgeon at Seattle Children’s Hospital, Harborview Medical Center and the University of Washington Medical Center. Dr. Browd received his M.D., Ph.D. through the Medical Scientist Training Program at the University of Florida in 2000. He then undertook a seven-year Neurosurgery Residency at the University of Utah, and in 2007-2008 completed his Pediatric Neurosurgery Fellowship Training at the University of Washington/Seattle Children's Hospital. While at the University of Utah, he also completed a research fellowship focusing on functional magnetic resonance imaging. Dr. Browd's specialties are with children who have hydrocephalus, brain & spinal cord tumors, pediatric cervical spine, spina bifida, chiari malformations, spacticity.

 Catriona Buist, PsyD, has been the Clinical Director of the multidisciplinary pain program at Progressive Rehabilitation Associates (Portland, OR) for 3 years.  She is a member of the Pain Society of Oregon and has presented to munerous organizations locally and regionally about pain management.  Before PRA she did a 2 year post-doc at Duke University Medical Center conducing research on the impact of trauma (PTSD and maltreatment) on children’s brain development.  Dr. Buist is a licensed psychologist in Oregon and North Carolina.

 David Clarke, MD,  received his B. A. in psychology from Williams College (Phi Beta Kappa), and his medical degree from the University of Connecticut in 1979. Since then he has successfully cared for thousands of patients with stress illness, often sent to him after other doctors were unable to help them. He has been a visiting professor at several international hospitals, including Oxford. He was also named a Top Doctor in the Portland Monthly magazine physician review in 2005 and 2006.  Dr. Clarke is a Clinical Assistant Professor of Medicine with Oregon Health and Sciences University, a Clinical Instructor at Pacific University, and a member of the Academy of Psychosomatic Medicine. He is board-certified in Gastroenterology and Internal Medicine, and has practiced in Portland, Oregon since 1984. He is a Gastroenterologist at Kaiser Sunnyside Medical Center, he is Ethics Director at Northwest Permanente, and he is Nutrition Support Team Director at Kaiser Sunnyside Medical Center.  David Clarke has received numerous awards for excellence in patient care. He developed and presented a monthly seminar on stress illness, and local doctors have given their patients 50,000 copies of his brochure on this topic. He lives in Happy Valley, Oregon, which is near Portland.

 Jeri-anne Cohen, JD, is a native Oregonian and an inactive member of the Oregon State Bar Association. She earned her B.S. Degree in Psychology from the University of Oregon in 1971 and her J.D. degree from the University of Oregon School of Law in 1975. She was a practicing attorney for 27 years until a traumatic brain injury sustained in a 2001 auto accident resulted in the termination of her law practice. She is a current member of the Brain Injury Association of Oregon Board of Directors.

Mike Colson, PhD, (vettrauma.org) is a former Navy Commander, combat veteran and Senior Special Staff Officer now conducting clinical outreach and advocacy for returning Iraq and Afghanistan military and Department of Defense veterans. He is a National Service Fellow, a recipient of the Meritorious Service Medal, was awarded the Iraq (and) Afghanistan War on Terrorism Campaign Medals, and is a significantly disabled American veteran. Dr. Colson's academic training includes a BSc. in Education from Eastern Michigan University, a Masters of Arts in Educational Psychology and Counseling from Western Conservative, and a Ph.D. in Clinical Human Services and Sociology from Walden University. He has worked for over 25 years in a variety of challenging military and humanitarian assignments holding positions as a public school teacher and principal, adjunct college professor and Foreign Service Officer. He served for 14 years in war torn Southern Africa assisting with drought relief and refugee programs, started with his wife an orphan support facility that he advocates for today, and continues to travel extensively. He uses his speaking and writing a means of community activism, addressing myriad challenges faced by youth, professional providers, veterans, and those with disabilities.  Past accomplishments include several books: "The Paradox of Underachievement" from EMI that explores youth and military dissonance in a benefit-laden society; "In Irons" from Bookmasters that is a humorous diatribe on the art of living well; and “We are Mysterious” that looks at the explorer in all of us. He speaks at dozens of events per year, volunteers in schools and with other agencies, assists veterans countrywide using vettrauma.org, is an advocate for HIV/AIDS relief in Africa, and regularly fund-raises for this an other youth concerns. He has been married to Jane, a successful public school principal and educator, for 30 years. They live on  Camano Island in Washington State and the Big Island of Hawaii. They have two sons who are both successful university scholars, athletes, and community servants.

James S. Coon, JD, graduated from Yale University in 1971 and Lewis and Clark Law School in 1977, having served as Editor-in-Chief of the law review. He spent a year as a law clerk to the Hon. Robert C. Belloni in Federal Court before beginning private practice. Jim has devoted his practice since 1978 to representing individuals, labor unions and non-profit public interest groups against government agencies, employers and insurance companies. He has taught at the Lewis and Clark Law School and speaks at conferences for lawyers on social security and the coordination of public and private disability benefits. Jim is a member of the bars of the Oregon Supreme Court, United States Supreme Court, Ninth Circuit Court of Appeals, Federal Circuit Court of Appeals and United States District Court. He lives in Portland with his wife and two children.

 Dorothy Cronin, CBIS, Executive Director, Brain Injury Association of Wyoming, has worked in social services in Wyoming since the early 80’s.  She has developed an extensive knowledge of social service programs and supports.  She is currently responsible for project leadership for the Brain Injury Association of Wyoming’s contract with the Wyoming Department of Health, Division of Developmental Disabilities; Project B.R.A.I.N. a contract with the Department of Workforce Development Division of Vocational Rehabilitation; Vice-Chair for the Wyoming State Independent Living Council,  and in her spare time Dorothy writes grants, supervises a staff of five, travels extensively, and manages general operations for the Brain Injury Association of Wyoming.  Dorothy was recently married, and honeymooned in the Mexican Riviera where she experienced para-sailing for the first time.

Rebecca Curtis, MS, State of Oregon Mental Health, Addictions and Mental Health (AMH), works with patients in the state hospital. Rebecca and Mike Moore, who is also part of the older adult psychiatric unit, have been meeting with counties to try to promote collaboration between the Seniors and People with Disabilities and the county mental health departments.

 Laurie Ehlhardt, PhD, is an assistant fellow with the Teaching Research Institute-Eugene and a speech-language pathologist with over 20 years experience serving individuals with cognitive disabilities due to acquired brain injury.

Dr. John Epley is most widely noted for his "Canalith Theory" as the cause of Benign Paroxysmal Positional Vertigo (BPPV), and for development of the "Epley Maneuvers" (Canalith Repositioning Maneuvers) for its treatment. This treatment and the supporting concepts are regarded as one of the greatest breakthroughs in the vestibular field in this century.  Dr. Epley attended medical school at the Oregon Health Sciences University, interned at the University of Miami Medical School in Florida, served 3 years with the Strategic Air Command at Vandenberg Air Force Base in California and did a 4-year residency training program in otolaryngology at Stanford Medical Center in California. He is certified by the American Board of Otolaryngology. Soon after he began medical practice in Portland, Oregon, he became concerned over the number of people disabled with vestibular disorders and the lack of medical knowledge for treating it. Since that time he has dedicated his career to the research and development of treatment for vestibular disorders. To carry out this plan, he established the Portland Otologic Clinic.  Apart from his clinical work, Dr. Epley is a well-published researcher and frequent lecturer at conferences and symposia. He is internationally known for his bold and innovative approaches to the diagnosis and treatment of vestibular disorders, and he has devised new surgical techniques and patented several medical inventions. He is a member of the American Neurotology Society, American Otological Society, International Barany Society, Prosper Meniere Society, American Academy of Otolaryngology, American Medical Association, Oregon Medical Association and Medical Society of Greater Portland.

Fred Flynn, DO, FAAN, a neurologist, is the medical director of the TBI center at Madigan Medical Center. Dr. Flynn notes that the Army has been dealing with soldiers with TBI for a long time – primarily those who suffer moderate to severe cases. “Anyone would say in hindsight that we could have done better” in responding to the growing numbers, Flynn said. “But we are screening every single soldier who comes back for this specific problem.” The new programs are part of the Army “Medical Action Plan,” which arose after media reports of problems at Walter Reed Army Medical Center in Washington, D.C. Combat medics early this year received new guidance for how to assess and treat soldiers who might have concussions. At Fort Lewis, soldiers returning from Iraq and Afghanistan are now required to complete an online questionnaire designed to find those at risk for mTBI. The 3rd Brigade is the first major unit at Lewis to go through it. Through the end of October, 2,325 of the brigade’s 3,800 soldiers have done so. Of those, 1,000 were found to have likely suffered an mTBI and were recommended for secondary screening at Madigan, which consists of further tests of their cognitive abilities and an appointment to talk with a senior physician or a psychologist. Of those 1,000, so far 205 soldiers have been referred to further treatment because they continue to suffer signs and symptoms. The figures include some of the 204 soldiers who were diagnosed with mTBIs while the brigade was in Iraq, brigade officials said. Flynn said all 3,800 soldiers in the brigade will be screened again in three to six months. Army medical officials acknowledge that their service was slow to recognize and respond to the growing numbers of soldiers at risk for mTBI as insurgent bombs struck with greater power and frequency across Iraq. Research into the “civilian” form of mTBI – generally caused by concussions – shows that most people will fully recover over time with rest and by avoiding additional concussions. But experts aren’t sure that injuries caused by blasts heal the same way. While much is known about the way the brain reacts to concussions caused by car accidents or sports injuries, researchers are only beginning to examine its response to explosions. Recent studies suggest that blasts might slowly kill brain cells over months and years, leading to permanent loss of function. Those whose symptoms don’t go away, and the people close to them, have to learn to live with the condition. ...

Ron Heintz, MD, Medical Director, DHS Mental Health and Substance Abuse Services in Oregon.

Jeanne M. Hoffman, Ph.D., is an Assistant Professor at the University of Washington, Department of Rehabilitation Medicine, specializing in Brain Injury, Psychology, Rehabilitation Medicine, and Spinal Cord Injury (SCI).  Her clinical interests are traumatic brain injury, spinal cord injury, adjustment to disability, and pain management.  Her research interests include access to inpatient rehabilitation, and the development and evaluation of interventions to improve quality of life in patients with traumatic brain injury and spinal cord injury.

 Jan Johnson, MS, work has combined administrative as well as case management expertise in her role as Clinical Coordinator. She has served as Program Coordinator at the Center for Neuro-Educational Therapies as well as Sacred Heart Medical Center's Brain Injury Vocational Program. She has served on the Executive and Advisory Boards of the Brain Injury Association of Oregon, and is CRSO's primary liaison with the client, family, clinical team, insurer, physicians, and adjunct professionals. As a speech pathologist Jan's expertise has been primarily in the area of managing cognitive deficits resulting from acquired brain injury, specifically memory and attentional disorders. She has published innovative instructional materials and worked across all settings including acute care, medical rehabilitation, schools, and community reentry. She developed and coordinated the Brain Injury Vocational Program at Sacred Heart Medical Center and coordinated the Vocational Program at CRSO. Her Brain Injury Assessment Model was published in the Journal of Head Trauma Rehabilitation. . She is the owner and director of Community Rehabilitation Services of Oregon.

 Mary Kelly LTC AN (Ret), is a Masters prepared Registered Nurse is the Transition Assistance Advisor for the Idaho National Guard, and is a direct liaison to the Veterans Administration for returning OIF/OEF soldiers.  Mary’s professional years have been spent at the bedside, as a student nurse instructor, Public Health Nursing, in Nursing Administration, and as a nurse in the Idaho Army National Guard.  She attained the rank of Lieutenant Colonel, and was Chief Nurse of the Idaho Army National Guard. 

Mary W. Lu, M.D. holds an A.B. from Harvard University and an M.D. from Stanford Medical School. She is Board Certified in Psychiatry, having completed her residency in psychiatry at Oregon Health & Sciences University. Dr. Lu's current research and clinical work focus on treatment of post-traumatic stress disorder.

 Carol Marusich, OD, MS, FCOVD is board-certified in vision development and therapy. She completed her Masters Degree in Sensory Physiology at Northwestern University and her Doctorate in Optometry at the Illinois College of Optometry.  Dr. Marusich has been in private practice in Eugene, Oregon since 1981.  Dr. Marusich has been recognized as Optometrist of the Year by the Oregon Optometric Physicians Association and the Great Western Council of Optometry and has served as President of both.  A former Lane County Woman of the Year, Dr. Marusich was the 2006 Named Gift Honoree for the American Association of University Women, a recipient of the People First Award, and is a Distinguished Practitioner of the National Academies of Practice.  She currently serves on the Health, Disabilities & Social Services Advisory board for Head Start, and is past Chair of the International Examination and Certification Board for the College of Optometrists in Vision Development.  Dr. Marusich holds an adjunct faculty position for the Pacific University College of Optometry and lectures internationally on the topics of infant vision, vision and eye health concerns of special populations, learning related vision problems, and  vision rehabilitation following acquired brain injury.

 Bruce McLean, MA, CRC, CDMS, CBIS Level I, has worked for the last 25 years as a private vocational rehabilitation counselor in southern Oregon.  He is published in the Journal of Cognitive Rehabilitation (1989).  He is a Certified Brain Injury Specialist Level I-Basic.  Most of his practice involves him working with individuals who have been injured on the job and who are eligible for vocational rehabilitation services through the Oregon worker’s compensation system.

 Debra Braunling-McMorrow, Ph.D. is Vice President of ABI Service Diversification for The MENTOR Network, a position that allows her to bring services to more people with brain injury across the United States. She served as Vice President of Quality Assurance for the Mentor ABI Group, as well as lead operations for the Center for Comprehensive Services for 12 years, a member of The MENTOR Network. She has designed and continues to direct the Mentor ABI Group’s outcome and quality measurement systems. She is a Licensed Clinical Psychologist and has her master’s degree in Behavior Analysis and Therapy. Dr. McMorrow is a CARF surveyor for Medical Rehabilitation Programs and has served on the Brain Injury Association of America’s board of executive directors as the Vice-Chair for Program Outcomes. She is the past chair of the American Academy for the Certification of Brain Injury Specialists AACBIS. Additionally, Dr. McMorrow has served on several national committees and editorial boards as well as on a number of Peer Review Panels including for the U.S. Department of Education NIDRR and the Department of Health and Human Services HRSA. Dr. McMorrow has published in numerous journals and books and has presented extensively in the field of brain injury rehabilitation.

Senator Bill Morrisette is the former mayor of Springfield (1989-1999). He taught Social Studies at Springfield High School for 28 years until retiring in 1990. He earned a bachelor's degree in Economics and Political Science from Carroll College in Helena, Mont. and a master's degree in Education from the University of Oregon. Sen. Morrisette and his wife, Janice, have eight children, 14 grandchildren and four great-grandchildren. In addition to being mayor of Springfield, Sen. Morrisette has served on the Springfield City Council and the Lane County Council of Governments. He has also sat on the Lane Regional Air Pollution Authority, the Metropolitan Waste Water Commission and the Metropolitan Policy Committee. He also worked as a Municipal Prosecutor and an Assistant District Attorney.  His governmental experience includes the Oregon House of Representatives; Eugene Police Commission; Oregon Law Commission; University of Oregon Student Conduct Hearings Officer; Precinct Committeeperson; BLM Timber Sale Advisory Board.  Sen. Morrisette currently serves as chair of the Senate Human Services Committee and also serves on the Senate Health Policy and Education Committees, as well as the Joint Ways & Means Subcommittee on General Government. He chaired the Senate Education Committee in the 2003 session, and was a member of the House Education Committee in the 2001 session, and sponsored numerous education-improvement bills in all three sessions.

Among other bills, he sponsored one in the 2003 session and again in the current session to require schools to phase out sales of junk food to kids in school. In the 2003 session he was one of the leaders in a successful effort to establish health education standards for Oregon, and he is backing a current bill to set minimum requirements for physical education in elementary and middle schools. In February of 2005, he was one of three Oregon citizens and the only legislator to be named a School Health Champion by the Healthy Kids Learn Better Coalition.  Sen. Morrisette has been the recipient of numerous other awards and honors. He was Springfield Chamber of Commerce Distinguished Citizen of the Year in 1997, Oregon Mayor of the Year in 1994 and Lane County Elected Official of the Year in 1992.  In 2007 he was named as the President of the Northwest Territories on the television series Jericho.

 Adam Nelson, PhD, received his Ph.D. in Clinical Psychology from the California School of Professional Psychology in Fresno, California, in 2005, and completed a two-year post-doctoral residency in Neuropsychology at the VA Northern California Health Care System in Martinez. He is a staff member of the Neuropsychology Service at the Portland VA Medical Center, and has been focusing the majority of his time on evaluating the neuropsychological functioning of veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom. He has been actively involved in coordinating Mental Health services for brain injured veterans at the PVAMC, and will continue to be involved in clinical and research efforts relating to rehabilitation services for veterans with TBI.

 Michelle Peterson, BFA, MS, is a medical illustrator who has worked with surgeons and therapists at the Medical College of Georgia Hospital to develop educational illustrations and interactive animations that assist surgeons, physicians, therapists and students in studying/understanding a wide range of medical subjects: cardiology, neurology, orthopedics, obstetrics, ophthamology, anatomy, histology, pathology, dentistry, and physical and occupational therapies. Michelle worked with medical illustration department at Barrow Neurological Institute and pediatric neurosurgeons to develop an animation demonstrating occluding hydrocephalus in infants.  Michelle worked with Children’s Hospital, Atlanta, and Emory University: School of Medicine to create an animation used to educate families with children who need bone marrow transplants, and children that are donors for the procedure.  She represents MediVisuals, Inc., a medical visuals firm by exhibiting and lecturing at numerous legal/medical conferences throughout the United States. Liaison between experts/attorney clients and in house medical illustrators during the process and production of creating demonstrative evidence.

 Larry Sherman, PhD, is Senior Scientist in the Division of Neuroscience and an Associate Professor in the Department of Cell and Developmental Biology and in the Neuroscience Graduate Program and the Program in Molecular and Cellular Biology at the OHSU School of Medicine. He received a B.A. in 1986 and an M.A. in 1987, both in Biology from Reed College, then went on to receive a Ph.D. in Cell Biology and Anatomy from OHSU in 1993. He conducted post-doctoral research at the Institut für Genetik at the Forschungszentrum in Karlsruhe, Germany, then became an Assistant Professor in the Department of Cell Biology, Neurobiology & Anatomy at the University of Cincinnati School of Medicine in 1998. He joined the center in 2002. He serves on a number of national grant review boards, is on the editorial board of the journal GLIA, and is the President of the Oregon Chapter of the Society for Neuroscience.

Russell C. Spearman M.Ed. is the Project Director for Idaho's Traumatic Brain Injury Partnership Implementation grant from the Health Resources Services Administration, Maternal and Children's Health Bureau. Since August 2000 Russ has been employed by the Institute of Rural Health at Idaho State University- Boise. Prior to this Russ was responsible for developing and implementing all aspects related to Idaho's 1915 C Medicaid Home and Community Based Services Waiver for adults with a traumatic brain injury. He is the former Executive Director for Idaho's Governor's Council on Developmental Disabilities. He is the lead author of "The Use of Medicaid Waivers and Their Impact on Services". Russ was instrumental in developing and transitioning Idaho's nationally recognized Home of Your Own Initiative, a single family secondary mortgage program, that today has assisted over 75 people with disabilities realize their dream of home ownership and received national recognition for his vision and leadership in this area in 1997. Russ received his undergraduate degree from Manhattan College and his Master's degree from the College of Idaho. He is married with two children, one who experienced a traumatic brain injury in 1993. Russ was recognized by the National Association of Social Workers - Idaho Chapter in 2002 as the public citizen of the year for his work with people with disabilities. For the past twenty two years Russ along with his wife Terry, have served as adult family home providers to a gentleman with a developmental disability who is competitively employed.

 Patricia Sublette, PhD, is the Oregon TBI Education Coordinator.  Formerly, she worked as a regular, special education and consulting teacher and school psychologist.  Pat has been instrumental in writing the content for the website www.TBIED.org and is the co-author of book chapters in the Handbook of School Neuropsychology and the Handbook of School Psychology on identification, eligibility and interventions when working with students with brain injury.

 Mark Tilson, PhD, is a neuropsychologist and rehabilitation specialist with Legacy Rehabilitation Services and the Rehabilitation Institute of Oregon in Portland.  He specializes in working with traumatic brain injury survivors and their families.  He has special interests in mild traumatic brain injury, post-concussive syndrome, and psychopharmacological treatment of brain disorders.

 Paul van Donkelaar, Ph.D., is a Assistant Professor, Department of Human Physiology at the University of Oregon.  Paul van Donkelaar's research focuses on the neural control of human movement. He has approached this issue using behavioral, transcranial magnetic stimulation, and functional magnetic resonance imaging studies in healthy humans and in patients suffering from a number of different neurological syndromes including stroke, concussion, and cerebral palsy. The aim is to provide a better understanding of the processes by which sensory and motor systems interact with the hope that this knowledge can be used to develop better rehabilitative therapies for patients with a variety of motor deficits. Dr. van Donkelaar received a Ph.D. in clinical neuroscience from the University of Calgary in Canada in 1994. He spent the following year as an NSERC post-doctoral fellow at the Universite de Provence in Marseille, France. Prior to coming to the University of Oregon, he held a position as post-doctoral research scientist from 1995 to 1997 in the Department of Physiology at the University of Oxford in England.  Paul van Donkelaar is on the Editorial Board of the Journal of Motor Behavior and is a reviewer for many different journals including the Journal of Neuroscience, Cerebral Cortex, Brain, Journal of Neurophysiology, Journal of Physiology, and NeuroImage. He is also a panelist on the Motor Function, Speech, and Rehabilitation NIH Study Section.  He  has published over 50 research articles that have appeared in journals such as the Journal of Neuroscience, Brain, Cerebral Cortex, Journal of Neurophysiology, and Experimental Brain Research. He has also given invited presentations at a variety of universities and research institutes including INSERM, France; University of Wales; Simon Fraser University, Canada; University of Queensland, Australia; Queen’s University, Canada; University of Maryland; University of British Columbia, Canada; and University of Bern, Switzerland;. His research has been funded by the National Science Foundation, American Heart Association, Centers for Disease Control, and the NIH. 

 Bruce R. Wojciechowski, O.D, FCOVD, received his Doctor of Optometry in 1981 and has practiced in the Portland area since completing his education. He is a Fellow of the College of Optometrists in Vision Development (FCOVD) and is a member of the American Optometric Association (AOA), Optometric Extension Program (OEP), and the Neuro-Optometric Rehabilitation Association (NORA). Dr Bruce serves as an executive board member for the Brain Injury Association of Oregon and is an adjunct professor for the College of Optometry at Pacific University. Dr. Bruce has lectured nationally to professionals involved in the treatment of head injured patients. He also lectures to non-professionals groups, such as stroke support groups and other community organizations.