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Survival, struggle, and success.

I am a 1980 honors graduate of Montana State University in Bozeman, Montana with a Bachelor of Science degree in Business Marketing and a strong concentration in the foreign languages of French, German, and Spanish. I was subsequently employed by the Cutler-Hammer Products division of the Eaton Corporation as an area sales engineer in Seattle, Washington. This developed as a challenging, successful career and I was promoted and transferred to southern California in 1982. Hy life path abruptly and unexpectedly changed on May 15, 1983 when I was involved in a car accident that resulted in a closed head injury. Other than a single broken collarbone, the physical damage was isolated to the brain tissue within the skull. Primary, life-saving medical care was received at Loma Linda University Medical Center in Los Angeles, California. I physically stabilized after nine weeks in coma and was able to be transferred by air ambulance to my parents' hometown of Great Falls, Montana. The comatose state endured for another four weeks, so the clinically reported length of time in coma is twelve weeks. The extent and completeness of my recovery is considered miraculous by medical practitioners and clinicians.

Except for a brief stay in Spokane, Washington at Sacred Heart Medical Center for independent living skills training, my comprehensive rehabilitation has taken place in Great Falls under the direction of physiatrist Dr. Bill Tacke and a capable team of therapists at the Montana Deaconess Regional Rehabilitation Center. Dr. Tacke is the medical director of this program. These practitioners were my initial inspiration for graduate preparation in human services. They guided me with expertise and caring in the redirection and refocus of life plans and supported and encouraged my efforts at every step of the way.

One of the major goals of this recovery was the completion of the Master of Human Services program at the College of Great Falls. I completed the program requirements for the Master of Human Services curriculum from the College of Great Falls recently with the oral defense of my final project, Survival, Struggle, and Success. This degree was earned under a general emphasis with program content derived from elderly, community, counseling, rehabilitation, and social service course-work.

As a portion of my preparation, practicums were completed with a private rehabilitation counseling company, the state rehabilitative services division, and a facility providing rehabilitation services. Each was very vocationally oriented and I gained a degree of insight to these services by approaching it in this manner that presented an "inside-looking out" view of the industry to complement my client views. I was selected at the completion of my second internship with the state in Fall 1988 to be the recipient of the Significant Achievement Award for the first annual Great Falls DisAbility Day in recognition of this design and the successful management of a comprehensive rehabilitation.

My study of rehabilitation science has confirmed the importance of pre-injury characteristics and background. These traits form the foundation upon which a rehabilitation program develops. I credit my parents with laying the firm foundation of strengths that were an asset in the recovery process. They were a steady, continuous source of support and encouragement that never lagged during this arduous rehabilitation process. I personally take enormous pleasure in beating the odds and am convinced that this victory is energizing and a primary motivator. I also firmly believe and publicly promote that as personally invigorating as the success of my story is, it should not be regarded as a fluke. It occurred only through direct intention, detailed planning and identification of goals tempered with realism, professional guidance and counseling, and careful follow-through of the plans. My rehabilitation is replicable. With the path laid in the 1980s, I hope to contribute to the sciences of the direction and management of medical challenges in the decade of the 1990s. The future is bright and I anticipate a decade that will be rewarding and successful.

Trauma, or injury, has been reported by the Surgeon General to be the leading cause of death and a significant cause of acquired disability that requires comprehensive rehabilitation for young adults under the age of 34 in the U.S. Injuries of the central nervous system (CNS) occur to both components of this system: the brain, responsible for coordination and management of the CNS and the spinal cord, whose main function is to conduct nerve impulses originating in the brain to body parts outside the CNS via the peripheral nervous system. The peripheral nervous system is responsible for receiving and transmitting information within the nervous system. According to reliable and consistent epidemiological studies, closed head injury is the most common serious neurological disorder in the United States.

In addition to evident cranial fractures, contusions, and lacerations, the most significant and lingering damage is borne by the brain tissue in the skull. Sports injuries and automobile accidents are the two most common antecedents to head trauma. Other causes are falls, assault, and internal disorders such as stroke or aneurism. The damage may occur in two ways. The first is a result of sharp, intrusive impact and the second is caused by a blunt, nonintrusive blow that causes internal damage as a result of brain tissue moving and tearing within the skull.

Although the human brain is not completely understood by researchers and theorists, its function is reasonably predictable. The lobar sections of the brain control distinct senses but do not function independently of one another. Rather, all interact and are interdependent. Because of this interaction, malfunctions and deficits of one particular area are frequently displayed as and mistaken for disorders of another type. The ultimate goal of the rehabilitation process is to aid an individual to achieve practical goals that maximally achieve independence through the recovery process. Economic self-sufficiency is possibly one of the clearest perceived social indicators of independence. The process of vocational assessment which involves diagnosis and prediction of outcomes of client development through the vocational rehabilitation process, delineates a course of action for the disabled individual that may range from steps toward competitive employment to effective productivity within the client's home.

Independent living is a specialty that developed recently in the decade of the 1980s and has grown as a response to a gap in head injury rehabilitation services. The philosophical base of independent living services is still in the process of being established, but it is derived from a coordination of the medical model of traditional acute-care rehabilitation services and community-based services. Historically, independent living was established as a consumer movement whose principles follow:
* Consumer Sovereignty: Persons with
 disabilities as the consumers are the
 best judges of their own needs.
* Self-Reliance: Persons with disabilities
 must rely primarily on their
 own resource and ingenuity to acquire
 rights and benefits to which
 they are entitled.
* Political/Economic Rights: Persons
 with disabilities are entitled to freely
 pursue their interests in a variety of
 political and economic areas.

The ultimate goal of rehabilitation is to maximize independence through mastery of physical, linguistic, cognitive, and psychosocial skill. Professional medical, therapeutic, psychological, educational, vocational, and social expertise should be tapped through the development and completion of a managed plan, but the ultimate indicator of outcome can be found within the individual. The old saying that says "You can lead a horse to water, but you can't make it drink" encompasses the message of this article. All the expertise available can be delivered to the client, but unless it is absorbed in a cooperative manner, it will remain just that detached expertise. The Independent Living Movement has been effective in the process of translating independent living theory into reality by promoting appropriate support services, accessible environments, and pertinent information and skills.

To be beneficial, persons with disabilities need to be accepting of treatment. An observation regarding coping with the destructive effects of illness and disability is that medical technology has advanced to a point that physical life is able to be preserved in spite of tremendous trauma. However, the inherent meaning of the word "living" is not able to be achieved through the process of rehabilitation without cooperation of the client with the various providers of service. Although no human being should be forced to handle the havoc caused by a disabling condition, life does not always mold neatly to human desires. When faced with a tragedy like severe illness, a position of determination to endure can help a person conquer the survival, struggle, and success cycle. Determination can enable a person or family to cope with complex situations that seem impossible to deal with at first glance.

Some observations on the stress imposed by a disability follow:
* No one is completely prepared for
 illness or disability.
* Illness changes a family and challenges
 its resources.
* The illness process brings out the
 best and worst in people.
* Disability can deplete resources as
 well as create them.
* Often the only support is the family.
* All people do not have families they
 can rely on.
* Not all families are capable of
 responding to the illness and disability
 of a family member.
* Coping with chronic disability is an
 ongoing developmental process.
* Existing health care resources can
 help as well as hinder adjustment.
 (Dell Orto, 1984)

The concept or stress is possibly one of the most misunderstood matters in human life. It is commonly recognized as a negative condition accompanied by nerves and aggravation. In actuality, stress is an inner, physical reaction of the body that mobilizes energy needed to overcome problems and difficulties. When stress cannot be avoided, it should be viewed as an ally rather than an adversary. Stress can strengthen defenses, stimulate greater productivity, and sharpen resolution to overcome difficulty. A certain amount of controlled stress is, in fact, considered a key to performing well in many situations. A critical adjective used in this interpretation of stress is controlled. By keeping anxiety in check consciously, a very useful tool can be accessed. A few conscious efforts that are suggestions from experience and observation follow.

Coping with Unavoidable

Stress in Rehabilitation
* Take careful, frequent inventories of
 self. Honestly, yet realistically identify
 quality characteristics as well as
 annoyances and shortcomings. A
 suggestion here is to keep a journal
 that reflects not just daily events and
 details as a memory aid, but also feelings
 and attitudes. A journal does
 not talk back or disagree and the
 process of becoming your own best
 counselor can be quite healing.
* Share responsibility. Don't take on
 commitments that can't be shared
 with moderate ease. Remember that
 you are but one person.
* Exercise regularly. Aerobic exercise
 that increases the body's intake of
 oxygen rejuvenates a person mentally
 as well as physically.
* Maintain a sensible, well-balanced
 diet. This will not only keep a harmonious
 internal environment, but
 does wonders for self-image by improving
 external appearance.

In addition to these suggestions for dealing with unavoidable stress, a method for lessening dependency on others is to compensate for existing deficits. Initially, learning compensation may seem ridiculous and extreme, but it becomes automatic and second-nature. This can be achieved to such a point that compensating techniques for shortcomings are not evident. Date books, calendars, and notes are just handy reminders used by the everyday citizen. At any rate- simply make it a daily intention and commitment to use such aids (as opposed to having them handy in a drawer) and actively exercise the memory- it will improve. The reward for these minimal efforts will be increased independence and self-reliance.
Biscup, Kathleen M. The Power of
 Belief.- The Professional's Greatest
 Ally. First Annual Neuro-Rehab.
 Symposium. 1986: Great Falls, Montana.
DeLisa, Joel A. (Ed.) et al. (1988).
 Rehabilitation Medicine. Philadelphia,
 J.B. Lippincott Co.
Dell Orto, Arthur E., Ph.D., CRC.
 (1984). Coping with the Enormity of
 Illness and Disability. Framingham,
 Massachusetts: National Head Injury
 Foundation (NHIF).
Freud, Clement, Ph.D. The Individual,
 the Professional, and the Community.
 First Annual Neuro-Rehabilitation
 Symposium. 1986: Great Falls, Montana.
National Head Injury Foundation.
 (7/87). Trauma: The Silent Epidemic.
 Southborough, Massachusetts.
North Central Independent Living Services.
 (1988). NCILS. Great Falls,
Pixley, Charles C., Lt. Gen. (1980).
 United States Surgeon General's
 Report. Washington, D.C.
COPYRIGHT 1990 National Rehabilitation Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Biscup, Kathleen M.
Publication:The Journal of Rehabilitation
Article Type:editorial
Date:Jan 1, 1990
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