Nutrition and Recovery from Brain Injury

It’s easy to make the case that the brain is one of our most important organs, perhaps the most important. When the brain gets damaged, it can affect how we speak, behave, move, and eat. As a registered dietitian, nutrition is my passion – so let’s take a closer look at how nutrition can affect our ability to heal and recover from a brain injury.

There are two main types of brain injury – traumatic and non-traumatic. Traumatic injuries include just that: trauma, such as falls, car accidents, sport injuries, and more. Non-traumatic brain injuries include strokes, seizures, infections, and lack of oxygen to the brain.

With either type of brain injury, it can become difficult, dangerous, or simply impossible, to eat. But, your body (and your brain!) still needs nutrition to survive. In fact, the body’s protein and calorie needs can rise to double the normal resting requirements after a brain injury. We also know that early ‘feeding’ is critical to good outcomes. So how do we do this?

A feeding tube can be critical for survival when a patient cannot safely eat by mouth. Best practice guidelines recommend early use of enteral nutrition – optimally in the first 72 hours after the injury. This is associated with improved outcomes. Tube feeding can provide the body with the protein and calories it needs to slow breakdown of lean body mass, and help control the extent of the body’s inflammatory response. There are specialty tube feed formulas that your clinical dietitian may use to help manage this response. Nutrition needs, along with fluid and electrolytes requirements, may change and fluctuate frequently during the immediate days and weeks, and require close monitoring.

In the recovery phase, it is time to start evaluating whether the patient can eat and drink by mouth again. Depending on the part of the brain that was affected, dysphagia, or difficulty swallowing, is common. Patients may work with a speech therapist to help them start eating and drinking safely. This phase may also still require nutrition support, tube feeding, or nutrition supplements, until the patient is able to eat and drink enough on their own to meet their nutrition needs.

So, what can we do to help ourselves and our loved ones in the event of a brain injury?

Good nutrition before the injury happens is linked with better outcomes. So take a few moments to evaluate your nutrition, and reach out to a registered dietitian if you need support. Once in the hospital, advocate for your (or your loved one’s) nutrition – find out what the nutrition plan is and speak with the clinical dietitian at the facility. Good nutrition before, during, and after a brain injury can help support healing, strength, and improve outcomes.

Kate Nelson, MS, RD, CNSC is a Clinical Dietitian at Vibra Hospital of Denver. She is passionate about clinical nutrition and recently passed her Certified Nutrition Support Clinician (CNSC) exam in April of this year. She has also worked in acute care and skilled nursing facilities, and had a previous career as a Park Ranger with Colorado State Parks. At home, she spends her time cooking delicious meals for family and friends, cheering on the Denver Broncos, and spending time with her husband and beloved Boxer pup, Nemo. 

Read More

Concussions in Youth Sports

In the world of sports, a mild traumatic brain injury is also known as a concussion. Despite the word “mild” and the frequency with which we hear the term, concussions should be taken seriously.

If your child competes sports, take some time to speak with your coaching staff about concussions. This is especially important with contact sports. To stay informed on how the coaches manage a suspected concussion, ask the following three questions.

1. What is your procedure if you suspect someone has suffered a concussion, either in practice or a game setting?

It is important to know how this is managed in practice, as well as a game setting. Game settings tend to be more formal as compared to practice, but the risk can be the same in both settings.

2. Do you have a concussion management protocol?

This would be something that spells out clearly how they manage someone they suspect has suffered a concussion. It should cover from the suspected injury through a return to competition.

3. Do you have staff on site during practice and games that are trained in assessing for concussions?

Make sure you know the signs and symptoms of a concussion, as well. They include:

  • Slowed thinking, or feeling that you’re in a fog
  • Trouble concentrating
  • Trouble remember new information
  • Constant headache
  • Changes in balance
  • Lack of energy
  • Mood changes
  • Increased anxiety
  • Change in sleep patterns, sleeping more or less than usual

The ultimate goal is to be confident that if your loved one suffers a concussion, they can be properly treated and safely return to competition. If you suspect your child has suffered a concussion, follow up with your physician, or another care provider trained in managing concussions.


Kevin Nicholson, PT is the Director of Therapy Services at Vibra Rehabilitation Hospital of Amarillo. He is passionate about stepping out of the normal “therapy box” to help patients improve and return home. He has also worked as a PT assistant prior to becoming a PT, and has a combined 31 years of experience in the field of physical therapy. In his off time he enjoys watching professional basketball and mixed martial arts, and he enjoys barbell training.


Read More

Concussion Facts: True or False?

Mild traumatic brain injuries, also known as concussions, are the most common form of brain injury. Yet, there are many misconceptions regarding concussions. Unfortunately, this can lead to undiagnosed and untreated brain injuries.

To help raise awareness about concussions, we’ve assembled this short quiz. How much do you know about concussions? Test your knowledge of concussion facts with the “True or False” questions below.

True or False: A concussion is defined as a blow or jolt to the head that causes changes in brain function?

True. Our brains use nerve impulses to talk to different parts of the brain. When there’s a jolt or blow to the head, it can cause changes in the flow of those impulses, which then causes changes in brain function.

True or False: You can only get a concussion if you play sports?

False. While it is true that concussions can happen during sports, they can also happen to anyone, at any age, at any time. A few examples of where brain injury occurs is in falls, both in the elderly and in children, motor vehicle accidents, and even bike accidents in children.

True or False: You must “black out” in order to have a concussion?

False. Losing consciousness happens in only approximately 20% of concussion cases. Some signs to watch out for besides the “blacking out” include loss of memory of the events before, during or after the event, and feelings of confusion or even slowed thinking.

True or False: It is possible to have a concussion and not realize it?

True. Sometimes, changes in the brain following a concussion will not show up on brain imaging. However, there are several signs to watch out for after a concussion. They include:

  • Slowed thinking, or feeling that you’re in a fog
  • Trouble concentrating
  • Trouble remember new information
  • Constant headache
  • Changes in balance
  • Lack of energy
  • Mood changes
  • Increased anxiety
  • Change in sleep patterns, sleeping more or less than usual

If you feel like any of these things pertain to you or a family member, speak to your primary care physician about your concerns. He or she may refer you to a speech language pathologist, a physical therapist or occupational therapist who are trained to help those following brain injury.

Eva Baltz is a speech-language pathologist at Elkhorn Valley Rehabilitation Hospital in Casper, Wyoming. She obtained her bachelor’s degree in Speech, Language, and Hearing Sciences from the University of Wyoming and her master’s degree in Communication Sciences and Disorders from Rockhurst University. Eva is passionate about providing individualized treatment of aphasia and traumatic brain injury. She is an educator at heart and constantly seeks opportunities to promote education of her field. In her spare time, Eva enjoys exploring new places and photography.

Danielle Nielsen, OTR/L, CMPT is an Occupational Therapist at EVRH. She completed her master’s degree in Occupational Therapy from the University of North Dakota in 2016. She enjoys providing the best care for each and every one of her patients. Danielle is passionate about everything she does and always strives to find the fun in life. She is a Certified Manual Trigger Point Therapist, completing her dry needling certification in 2018. In her spare time, Danielle enjoys spending time with her friends, family and her dog, Franklin.

Colleen Powers is a speech-language pathologist at EVRH. She obtained her bachelor’s degree Communicative Sciences and Disorders and master’s degree in Speech-Language Pathology from the University of Montana. Colleen focuses on providing personalized and evidence-based therapy for people with communication, cognition, and/or swallowing disorders. Outside of work, Colleen enjoys skiing, hiking, and traveling.

Read More

Living with MS: 5 Ways Rehabilitation Can Help

According to the National Multiple Sclerosis Society, rehabilitation is “an essential component of comprehensive MS care.” This starts at the time a person is diagnosed with multiple sclerosis, and can be used to achieve many goals.

Here are some ways rehabilitation can help a person living with multiple sclerosis:

Walking and Mobility

Individuals living with MS often find difficulty with walking and mobility. These problems can manifest in a variety of ways. They include balance issues, muscle tightness or spasticity, numbness, weakness and fatigue. Physical therapy helps to address these issues, reducing the risk of falls that might cause further injury.

Activities of Daily Living

Multiple sclerosis can also pose challenges when it comes to caring for oneself. Many of the same symptoms that affect mobility can make it difficult to complete tasks we often take for granted. Occupational therapists work with patients to insure they can safely groom and bathe themselves, get dressed and cook their meals.


MS can affect speech in several different ways. Lesions in the brain can cause changes in speech patterns, while muscle weakness in the mouth and tongue might result in words being slurred. Speech disorders are known as dysarthrias. Speech language pathologists provide therapy to address dysarthria and improve verbal communication.

Additionally, speech language pathologists work with patients to treat issues with swallowing. Difficulty swallowing is known as dysphagia. Because speaking and swallowing involve many of the same muscles, it’s not uncommon for a person living with MS to also suffer from dysphagia. Speech language pathologists treat dysphagia by strengthening the tongue and swallowing muscles. They do this through targeted exercises and other treatments, such as VitalStim.

Overall Conditioning

Improving your overall conditioning is one of the most impactful things you can do to limit the effect of MS on your daily life. Doing so can decrease fatigue, improve muscle strength and stability, and reduce pain. The goal is to achieve optimal function at home, at work and in your community.

Read More

5 Rules for Managing Congestive Heart Failure

Congestive heart failure is an entity that affects many individuals, and is related to many different causes.

The best way to manage congestive heart failure can be quite simple. Its five simple rules:

Rule #1: Manage your liquid intake

Average liquid intake for people with congestive heart failure should be around two liters per day.

Rule #2: Take your medications

It’s very important to consistently use the medications that your doctor or caregiver has prescribed for you.

Rule #3: Weigh yourself every day

Make sure to weigh yourself at the same time of day and record it. Watch for a weight gain of five pounds over three days. This may mean that you need to adjust your medications, and should speak with your care provider.

Rule #4: Manage your sodium intake

This doesn’t just apply to the salt on the table. Look at the sodium content on the nutrition labels of the foods you are buying, as well. Processed meats and cured items are a couple examples of food items with a lot of sodium in them.

Rule #5: Exercise!

Get out and use your heart muscle to help it stay strong. Remember, your heart is a muscle, and it needs to be exercised like any other muscle.

With these five simple steps, managing congestive heart failure can be a lot easier, and you can improve your quality of life significantly.

Dr. Sheldon Goldberg is a Board-Certified Specialist in Physical Medicine and Rehabilitation. He has a special interest in the area of wound healing and pain management. He is currently the Medical Director of Vibra Rehabilitation Hospital of Denver. Dr. Goldberg is a Clinical Assistant Professor of Medicine at the University of Colorado at Denver Medical School. He has done research in the area of sound healing and pain management in the past. He is graduate of the Autonomous University of the City of Juarez and his undergraduate background includes national certification as a Physician’s Assistant with special interest in cardiology, rheumatology, and orthopedic surgery. He also holds a degree in Dietetics and Nutrition.

Read More

Deb’s Heart Attack Story: From Director of Therapy to Therapy Patient

Unfortunately for Deb Campbell, suffering a life-threatening heart attack on April 2nd was not an April Fool’s joke.

Deb is the Director of Therapy Operations for Northern Colorado Rehabilitation Hospital and Northern Colorado Long Term Acute Hospital in Northern Colorado. An occupational therapist, herself, Deb never thought she would

Deb Campbell is the Director of Therapy Operations at Northern Colorado Rehabilitation Hospital & Northern Colorado Long Term Acute Hospital

be a heart attack survivor just a few days before her 47th birthday.

Deb’s father suffered a heart attack, which led to her interest in heart health and education. “I’ve always known that women often have abnormal symptoms when having a heart attack,” Deb noted. “I have educated many patients on eating a healthy diet and exercise. When it came time to recognize my own symptoms, I did not trust my gut feeling.”

Deb had been experiencing symptoms of being extremely tired, feeling her heart flutter, and burning chest pain on-and-off for months. She “kept talking myself out of it,” thinking it was heartburn, stress or a virus.

While on a boat in Costa Rica, Deb could no longer ignore the symptoms. She thought she was getting sea sick and laid down. Next thing she knew, Deb woke up to a stranger screaming for her to open her eyes.

Deb’s heart had stopped beating, and she was unconscious.

Eventually aroused, Deb was taken to a local hospital. Doctors found the primary artery sending blood to her heart was 96% blocked. The medical staff treated the blockage and she left for home 10 days later.

Upon returning home, Deb started a 12-week-long intensive cardiac rehab program. She admitted to “feeling embarrassed,” recalling she was the youngest one there. “However, I knew I could trust the therapists to get me back to my life.”

Deb knows this experience has affected the way she cares for patients. “I have more empathy and relate to what they are feeling at a visceral level,” she said. “I understand being scared and nervous. I understand the discomfort of moving from one hospital to another. I can appreciate the behaviors of families and patients – appreciate that they are coming from a place of fear and concern.”

Deb tells anyone with symptoms of a heart attack–but especially women–to “trust your instincts. If you are trying to talk yourself out of thinking you’re having a heart attack, you should seek medical attention immediately.”

Deb knows she is lucky to have survived. She has a holiday celebration on the anniversary of her heart attack. “I celebrate life,” she said with tears in her eyes. “I trusted the therapists and doctors, so I wasn’t afraid. I learned to take advantage of my life now – you never know when it may end.”

Read More

Your Data Privacy Rights as a Patient

The Health Insurance and Accountability Act (“HIPAA”) has been providing federal protections for your medical information since 1996. Under HIPAA, you are the driver of how your healthcare provider uses your medical information. It is thus important that you know your medical privacy rights and your healthcare provider’s responsibilities when it comes to your medical information.

As a patient, you have the right, among others, to:

  • Decide if you want your care provider to talk about your medical information in front of your family or friends, or if you would like to talk in private
  • Decide if you want your family or friends to see your medical record or if you want us to keep it private
  • Request access to, or a copy of, your medical record, or authorize that we provide a copy of your medical record to another person or company
  • Request that we amend your medical record if you believe it is wrong or request that we place a written correction in your medical record if we cannot amend your medical record
  • Tell us how you want to be contacted or request that we restrict the way that we contact you
  • File a complaint with the facility or provider that treated you or with the Health and Human Services, Office for Civil Rights

Ernest uses your medical information, as allowed by HIPAA, in a number of ways that assist us, and others, in providing care for you. Some of the ways that HIPAA allows us to use your medical information when providing care are:

  • For your treatment and care coordination
  • To pay doctors and hospitals for your health care
  • With your family, relatives, friends, or others you identify who are involved with your health care or your health care bills, unless you tell us not to
  • To make sure doctors give good care and nursing homes are clean and safe
  • To protect the public’s health, such as by reporting when the flu is in your area
  • To make required reports to the police, such as reporting gunshot wounds

There are certain times when HIPAA requires that we ask you before we share your medical information. Some of the times we are required to ask for your permission before sharing your medical information include:

  • Before we share your medical information with your employer
  • Before we use or share your medical information for certain research purposes
  • Before we use or share your medical information for marketing or advertising purposes

In order to ensure that your medical privacy is protected according to your wishes, it is important to know your privacy rights as a patient and to inform your healthcare providers of how you want your medical information used or shared. It is also important that you review your medical records periodically to ensure that they are complete and accurate. Should you identify what you believe to be an error in your medical record, you should contact the healthcare provider that authored the medical information to find out how to request amendment to your medical information.

Knowing your medical privacy rights puts the power in your hands to control who can see and hear your medical information, as well as how your healthcare providers can use and share your medical information!

*For more information on how Ernest uses and shares patient medical information please request a copy of your Ernest facility’s Notice of Privacy Practices.

Angelique Culver, Esq. has been an Attorney for 15 years, specializing in Healthcare Compliance and the privacy and security of patient information for last 9 years.  She is the Chief Compliance and HIPAA Officer for Vibra Healthcare.  She has long been an advocate for patients’ rights, serving as a member of the bio-ethics committee of an urban academic medical center and the Georgia Department of Public Health’s Health Information Exchange Legal/Ethical Workgroup.  She currently serves on the Board of Directors for WITF, Inc., a Central Pennsylvania public broadcasting company committed to increasing cultural access and knowledge, extending public education, and strengthening community life through all channels and platforms, including broadcasting, online, social media, print, and in person events.

Read More

Why Donate Blood?

Every two seconds, someone in the U.S. needs blood. And while many donate blood frequently, there hasn’t been enough supply to meet demand.

But why should you donate blood, if you are able?

You can save a life

Donating blood is an easy, selfless way to help others. People with all kinds of health issues need blood for a variety of reasons. Some examples include:

  • Cancer patients who cannot produce platelets due to treatment
  • Trauma patients suffering blood loss
  • Patients undergoing heart surgery and organ transplants
  • Sickle cell patients, who require frequent transfusions
  • Burn patients, needing plasma to help maintain blood pressure
  • Patients with chronic diseases

There’s an urgent need for blood donors

Unfortunately, there has been a consistent shortage of blood donations across the nation. At the time this blog was written, the American Red Cross has issued an emergency need for blood donors. A blood shortage can lead to delays in providing medical care to patients, which in many cases is lifesaving. There is a particular need for Type O blood, which is often in high demand.

You may have a rare blood type

There are eight common blood types, but many more rare blood types. For a safe transfusion, there are very specific ways in which blood types much be matched. For example, someone with Type O blood can donate to all other blood types. However, they can only receive Type O blood.

To donate blood, you can find a Blood Drive near you on the American Red Cross website. Additionally, many of our hospitals host blood drives regularly, and usually announce them on Facebook.

If you haven’t donated blood before, check out these common concerns for first-time donors.

Read More

3 Brain Safety Tips for Winter Sports

The winter months bring many wonderful things. The start of a new year. A beautiful, fresh fallen snow. Fun on the slopes.

But the winter also brings something of great concern: a spike in traumatic brain injuries.

Despite the drop in temperature, many still enjoy the outdoors during winter by participating in sports like skiing, snowboarding, ice skating, sledding and ice hockey. But winter sports pose a legitimate danger to your brain if you do not take proper care to protect yourself.

To fully enjoy these winter activities, it is important to understand and respect the risks that winter sports pose, including concussions. Know these winter sports safety tips to enjoy all winter has to offer.

Wear a Helmet

Protecting your brain starts with wearing a helmet. Be sure to choose a helmet that fits properly, and is designed for the sport you’ll be participating in. Regularly check your helmet for damage, including dings and scratches that may limit its effectiveness.

Know Your Surroundings and Limitations

When planning a trip to the slopes, look at the weather forecast. Try to plan for optimal conditions to reduce the risk of injury. Know how the trail is laid out, and where the boundaries are. Stay near the center to avoid obstacles, and try to avoid crowded areas. Headphones are a big no-no, as they won’t allow you to hear what’s happening around you. Don’t opt for an advanced trail or equipment if you’re a beginner. Before getting started, know where medical help is available. The same goes for skating rinks and sledding trails.

Know the Signs of Concussion

The signs and symptoms of a concussion may appear immediately after a hard fall, or not for days or even weeks afterward. And it doesn’t always require a direct hit to the head for a concussion to occur. Symptoms of a possible concussion include:

  • Headache
  • Weakness
  • Numbness
  • Dizziness
  • Balance/coordination issues
  • Confusion
  • Slurred speech
  • Ringing in the ears
  • Nausea and/or vomiting

If you or a loved one are experiencing any of these symptoms, seek medical attention within 24 hours. Sometimes, a person loses consciousness after suffering a concussion. In that event, call 911 or seek emergency medical help, immediately.


Read More

7 Myths About Long-Term Acute Care Hospitals

Long-term acute care hospitals (LTACHs) are designed to help patients advance their recovery when traditional hospitals may not have the time or resources to help them. But, when it comes to long-term acute care, there are many misconceptions. From the services provided to admissions requirements and insurance coverage, we’ve taken some of the most common myths about long-term acute care hospitals and clarified them below.

Myth #1: Long-term acute care hospitals are nursing homes

Fact: Long-term acute care hospitals provide a much higher level of care than nursing homes and skilled nursing facilities (SNFs). An LTACH is similar to an intensive care unit (ICU). Because LTACHs are hospitals, they have 24-hour physician coverage along with many specialized services on-site, including:

  • Full nursing staff
  • Physical, occupational, speech and respiratory therapy
  • Dietary
  • Pharmacy
  • Laboratory
  • Radiology

Long-term acute care hospitals are uniquely designed to provide care for patients with complex medical needs.

Myth #2: Patients admitted to an LTACH are required to stay 25 days

Fact: The amount of time a patient stays in an LTACH is dependent upon their illness or injury, complications and goals. Every patient is different because every human is different. In an LTACH, physicians collaborate with patients and their loved ones to create an individualized plan of care to achieve those unique goals.

Myth #3: LTACHs are where people go to get hospice care

Fact: Most patients do not receive hospice care while staying in an LTACH. Long-term acute care hospitals focus on getting patients back to their life in their community. Patients and their families choose LTACHs because they offer aggressive treatment for the disease or injury.

Myth #4: Patients don’t get physical therapy or occupational therapy at an LTACH

Fact: While most patients in an LTACH are quite ill, early mobility is essential to a patient’s long-term outcome. LTACHs have therapists on staff who provide services specific to this level of care. Patients in an LTACH may begin receiving physical and/or occupational therapy even while on a ventilator. The physical and occupational therapists will create a therapy regimen appropriate for each patient.

Myth #5: LTACHs can’t accept ICU-level patients or patients on an IV drip

Fact: Much like an intensive care unit, LTACHs focus on critical care of patients. Nurses and staff are specially trained to care for patients who are critically ill or have a complicated medical history.

Myth #6: A patient must spend at least three nights in an ICU before admitting to an LTACH

Fact: There are no stay requirements for LTACH patients. Patients can admit from a doctor’s office or even their home, if needed.

Myth #7: Insurance won’t pay for an LTACH

Fact: Most LTACHs have contracts with numerous insurance companies. LTACHs work directly with insurance providers to ensure coverage prior to a patient’s admission.

Read More