Helping to Heal Brain Injuries
Q&A with Frank Tenuta and Melanie Hay at Bayshore Therapy & Rehab, NRIO
Bayshore Therapy & Rehab, NRIO is a private brain injury rehabilitation facility that specializes in the assessment, treatment and care of individuals who have sustained a traumatic brain injury, stroke or other neurological illness. Its mission is to provide rehabilitative care that enables adults, youth and children to have greater independence and an enhanced quality of life.
NRIO provides residential treatment options, supported-living apartments, clinic-based therapy, group programming, community programs (coma stimulation, teachers), youth programs, multi/interdisciplinary therapists, teachers and more. NRIO provides a continuum of care from stimulation for comatose clients to therapies for ambulatory clients. To learn about NRIO’s work, we talked to Frank Tenuta, Clinical Director, and Melanie Hay, Senior Occupational Therapist.
Can you tell us about NRIO’s residential programs?
Frank Tenuta: We work with individuals who have sustained a brain injury and need a place to stay and receive treatment. Brain injuries can cause certain behaviours and sometimes substance abuse and / or mental health issues, which makes it difficult for people to live with their families or take part in community programs. Clients stay at our residential programs in Etobicoke, Mississauga, Hamilton or Toronto. Our multidisciplinary team helps them improve and manage certain behaviours so that one day they can go back into the community and be that much more independent. We are extremely client-centred.
Can you describe a day in the life of the residential program?
Melanie Hay: In the morning, a lot of the work here is around orientation, scheduling, cueing and making sure that clients know what to expect for their day. We start with a good breakfast, and we help people get up and get ready, including typical things you or I would do, like showering and dressing. The more independent clients might just get reminders. For others, it’s more hands-on, and they might require lifts and shower chairs. We have clients ranging from those who are non-ambulatory and require total care, to clients who are ambulatory and need constant reminders and support for their activities of daily living and executive functioning skills.
Once the clients are ready, they start their therapies for the day. That could include occupational therapy, physiotherapy, speech therapy, psychology appointments or medical appointments. It really depends on what the client’s needs are. Throughout the day, they’re also working one-on-one with our rehabilitation therapists, who make sure they get to their appointments and complete any homework they have – this is called the prescriptive model.
Around 5 o’clock, the clients help prepare supper. Evenings are the time to relax, take part in fun cognitive activities or go on community outings, such as to a movie or events that are of interest to them. The focus is on functional goals, real life and quality of life. We listen to the clients and their families and work towards their goals.
What are the program’s general goals?
Melanie Hay: In general, I think everyone’s long-term goal is to live independently. For some people that’s more realistic than others, but it usually entails things like cooking for myself, keeping my space clean and tidy, managing my own schedule, managing my own medication, managing my own finances and getting around the community. Some people might have higher-level goals such as returning to work or school, volunteering – that type of thing.
What are the risk management issues, and how do you manage them?
Frank Tenuta: Risk management is very important. It starts before clients come in and it’s ongoing. We have some clients who have significant brain injuries. We follow a rehabilitation model of care. Brain injuries can exacerbate aggression because people no longer have the same coping strategies. Some might be suicidal. There is sometimes violence. We have protocols in place, and we know our clients’ individual triggers. NRIO staff are trained in CPI, CPR and first aid to further support our clients. Client and staff safety is critical and a priority, so we ensure training is paramount.
Melanie Hay: Our staff receive training for how to respond to these behaviours, identify triggers and de-escalate. We work closely with the client’s team – such as behavioural psychology and neuropsychology – to come up with strategies to use with the client and teach those to the staff. We see what works and go forward from there.
Frank Tenuta: We also have medical doctors (neuropsychiatrist, substance abuse physician) who consult with us, and sometimes medication is used. Our approach is multi-factorial.
How do you support clients’ families?
Frank Tenuta: We try to treat families with both professionalism and empathy. They’ve been affected emotionally, and they might be dealing with great frustrations and a sense of loss for their injured family member. Families are part of the treatment team. We try to keep them involved and help them understand what we’re doing. Building trust is important, because it helps people stay hopeful.
Melanie Hay: My involvement with the families includes a lot of communication, such as weekly updates and quarterly case conferences. Depending on the situation, we also like to educate families about brain injury. Sometimes, in hospitals, the focus is so much on the client and less so on the family and helping them through this process, so we include families in treatment sessions so they understand what it’s like to live with a brain injury and what strategies might be successful. We also connect families with community brain injury associations, such as the Ontario Brain Injury Association, Brain Injury Association Peel Halton or the Brain Injury Society of Toronto, etc., for support.
Can you share an example of how NRIO’s work makes a difference?
Melanie Hay: Certain people stand out in my mind as success stories. For example, we had a young female with a high-level spinal injury. She was able to walk, but she had some paralysis in all four limbs. She also had behavioural, cognitive and psychological issues, and she was traumatized by the incident that caused her injury. Fortunately, she was able to progress from our program to a condo in the community, and since then she’s actually graduated from nutrition school.
Another client, a middle-aged woman, came to us slumped forward in a wheelchair – she had trouble even lifting her head up. She was severely cognitively impaired and incontinent, she wasn’t able to do anything for herself, and behaviour-wise there were a lot of issues, such as aggression towards staff. At NRIO, she made enough progress to walk with a cane and shower herself. Her mood improved so much. As a result, she was able to live with a family member who wouldn’t have felt comfortable taking her before. She’s doing quite well now, living with that family member, and she’s much more mobile.
Frank Tenuta: We have many more of these stories. When you see people able to walk again and ambulate without support, or gain insight and be productive in life, or even have hope for the future, it’s the greatest feeling in the world to me. Many of our clients and their families have shared their stories, and we have posted them on our website.
For more information about NRIO, please call us at 1800-561-9158.