Professional Profiles, News & Events


NeuroInternational TBI Programs

Creating a niche for managing complex neurobehavioral and post-acute neuromedical cases.

NeuroInternational TBI Program in Florida

Company Specializes in Workers’
Compensation & Michigan No-Fault

Nestled in a serene upscale community setting, NeuroInternational – Sarasota has to be one of the neurorehab industry’s best kept secrets. The post-acute brain injury program is in close proximity to some of the world’s most beautiful beaches and at the heart of Florida’s arts and cultural epicenter.

From this setting serious work is being done. “The NeuroInternational team has a niche for managing the most complex neurobehavioral and post-acute neuromedical cases,” said Neal Flannery, Senior Vice President.

“The experienced team of brain injury specialists at NeuroInternational have quite a following in the worker’s comp industry, and we are earning the reputation of being Florida’s premiere post-acute brain injury program,” Flannery added.
“Our Sarasota-based neurobehavioral, neurorehab, and supported living programs have grown by over 300% this past year alone, mostly due to repeat business within the Florida Work Comp and Michigan No-Fault industry. Adjusters and case managers have learned to turn to us when they have a complex case that others can’t manage,” Flannery emphasized.

When asked about working with people with severe auto and work injuries, Flannery replied “our team members have decades of knowledge and experience in navigating and managing the multifaceted issues associated with challenging TBI cases.

“When these catastrophic injury cases come to us they often have pending litigation, financial dilemmas, complex emotional and behavioral issues, medical management needs and family/survivor relationship strains. Case managers, attorneys, families and survivors can trust we have the experience to provide necessary treatment and appropriate supporting documentation…team members and I have literally worked with hundreds of these cases,” he added.

“Our exclusive partnership with Comprehensive Medpsych Systems, Fl’s largest behavioral medicine group, and our contracted behavioral hospital program enables us to offer the industry’s most diverse TBI services.

“We have 22 behavioral doctors and clinicians who function as part of our team. In addition to post-acute neurobehavioral care, we focus on inpatient detox, substance abuse, PTSD, pain management, and other specialty services. We can even facilitate Baker Act admissions to our locked hospital program.

“When we get a referral we provide the adjuster or case manager with a phone list so they can speak to our satisfied customers; workers’ compensation adjusters, case managers, guardians, families, and clients who have benefited from our specialty services. When they tour our Sarasota programs and meet our staff professionals they see first hand the investment that has been directed toward client care,” Flannery concluded.

He pointed out that the management team, lead clinicians, and referral evaluators are accessible to stake-holders 24-hours-a-day, including weekends and holidays. “We pay attention to detail and work hard to ensure our clients are receiving the research-informed clinical care. We are very responsive to requests made by our payers and other customers, strive to ensure our clients are healthy, happy and safe. Managing that goal for some of our more difficult cases is a big task and it takes tremendous dedication ”

Flannery said that survivors and their families are on an emotional roller coaster following a traumatic brain injury. “It is easy to understand how they get beat down and lose trust in the recovery process, especially considering the financial, relational and emotional strain that is put on survivors and families.

“By standing true to our word and fulfilling all commitments, we have been tremendously successful in helping survivors and families learn to trust again. We have also helped adjusters and case managers make their client dissatisfaction issues disappear. Simply put, clients, families and other stake-holders have come to expect more from us,” Flannery said.

The key to the company’s success?: “We offer boutique-level services and deliver exceptional outcomes on a consistent basis. We work hard every day to make a difference and we stay optimistic that we can help change peoples’ lives for the better.”

Ed. Note: If you would like more information about NeuroInternational visit their website at www.neurointernational.com, or call Neal Flannery at 813-451-9539.

Personal Testimony
Provides Insight

One of NeuroInternational’s current clients personally attests to the quality of care provided. Jeffrey Besemann, a current client at NeuroInternational stated “I have a TBI due to a train hitting my car while delivering pizzas in my late teens. My life changed for the worse and I found myself in need of a residential brain injury program.

“I have been in other programs here in Florida over the past five years. I was very unhappy and felt like my life was going nowhere – it was in constant turmoil.

A few months ago I came to NeuroInternational and my life has completely changed ever since. I worked my way into an apartment offered by NeuroInternational and I have regained my independence. I feel cared for by the people here – they are like family to me – and I am making progress towards my work and educational goals. They focus on the positive stuff I do … the other places were not that way at all. I finally feel like my life has meaning and value again. I have seen many other clients come to NeuroInternational since I have been here and they have had the same positive experience as me.”


Traumatic Brain Injury Drug Program Promotes Training and Education

The team at Communicare, Inc. in Clearwater, FL, is working together to help individuals overcome drug addictions and misuse.

TBI Drug Program

Promotes an Emphasis On Training & Education

Communicare, a program which provides for persons with acquired brain injury and other neurologic impairments, began an innovative teaching program at its Clearwater campus.

Under the direction of Gordon J. Horn, Ph.D., Director of Programs and Clinical Services, the program will provide ongoing training and education for all staff members to make them aware of signs of substance abuse. “We will be educating everyone from the management level down through the line staff,” Dr. Horn told the Voice.

Traumatic brain injury and the potential for substance abuse are tied closely together. Studies have shown that as much as 80% of accidents leading to TBI involved drug and/or alcohol abuse. Dr. Horn said that it has also been demonstrated that individuals who used drugs and other substances prior to their injury, were likely to return to their baseline use within two years after their TBI.

Dr. Horn has been working closely with Communicare’s in-house Licensed Mental Health Counselor, John Gallagher, M.Ed., LMHC. Dr. Horn stated that Gallagher provides an integrated approach of counseling, substance abuse relapse prevention, and cognitive-behavioral techniques to treat the whole person and the complex problems following TBI and substance abuse.

Gallagher added that he and Dr. Horn work well together and “there is great communication.” His approach is also closely linked with the cognitive specialists and behavior services within Communicare.

Gallagher said that problems associated with substance abuse in TBI patients are similar to those found in the general population, but for TBI patients the problems are often more entrenched and specific. “When we have a new patient, we do a complete bio-psycho-social history and then we tailor a treatment plan for each individual,” Gallagher said.

The training program for Communicare staff is designed to provide the tools to identify potential “trigger points” and to notice changes in behavior patterns that might lead to substance abuse relapse. The program ties in with the Communicare philosophy which integrates every employee into the social fabric of the facility; helping residents adapt to their surroundings and in their transitions back into the community.

“It is very hard to find mental health counselors who understand and work with the traumatic brain injury population,” Dr. Horn pointed out. “John is unique in his drug and alcohol abuse program in that he has modified it to meet the special needs of traumatic brain injury patients with cognitive impairments.”

For his part, Gallagher was drawn into his chosen profession for a very clear and simple reason. “We are helping to improve people’s lives and while it can be often challenging there is a great personal payoff when we can make a difference.”

Ed. Note: More information about Communicare is available by calling 866-802-9191 or visiting www.communicareabi.com. The company has residential, community based and outpatient services, and has opened a home and community-based and outpatient program in Royal Oaks, MI. John Gallagher, M.Ed., LMHC also has an office in Orlando where he sees patients on a full range of mental health topics. He can be reached at 407-579-2070.


SportsAbility Program for Everyone

Family members, health professional and consumers can all get into the act at this annual event.

SportsAbility for Everyone

The Florida Disabled Outdoors Association is making waves. And also kicking up dust and kicking soccer balls and much more. The organizations, based in Tallahassee, FL is dedicated to “enriching lives through accessible, inclusive recreation and active leisure for all.”

Getting the word out is a constant effort and the annual SportsAbility program is one of the effective ways the group makes a name for itself. The next SportsAbility event will take place April 15-18, 2010 in Tallahassee, so mark your calendars and get your sports groove on.

The event begins with an Active Leisure for Life banquet on April 15. Things become more physical on April 16 with indoor accessible, inclusive recreation experiences and an Expo. On Saturday, April 17, the venue will be the Ochlochonee River State Park for the outdoor experiences. Things wind up on April 18 with baseball and power soccer at the Miracle Field grounds.

To learn how you can become a sponsor or register to participate visit www.fdoa.org.


Former NFL Player Takes on Challenges of Brain Injury with Help of League

Gene Breen is taking the initiative and, with the help of NFL funding and the proactive approached at Communicare, Inc. in Clearwater, is putting together A Plan For Life.

Playbook for Life

Former NFL Player Battles Brain Injury with Help of League

By Ray Brasted
Gene Breen played professional football for Vince Lombardi, coach of the Green Bay Packers. It was Lombardi who said: “You’ve got to pay the price. Winning is not a sometime thing; it’s an all time thing.”

Now, at the age of 68, Breen is continuing to pay the price of competing for five years as a pro player with Green Bay, the Pittsburgh Steelers and the Los Angeles Rams. Like virtually all players, he threw his body, and his head, into every play to win, not only the game, but the admiration of his coaches and the fans.

Breen is part of an early wave of players who have qualified for funding to assist athletes who have experienced brain injury symptoms, including earlier onset of cognitive difficulties which is higher in numbers than the national norm and that some studies have associated with concussions experienced on the field of play.

“I had twelve concussions that I remember,” Breen said during a recent interview conducted at Communicare Inc., a brain injury treatment program in Clearwater, FL. The congenial Breen is an inpatient in the residential program where he is undergoing a comprehensive intervention to help him cope with his inability to control his impulses.

Gordon Horn, Ph.D., Director of Programs & Clinical Services and Marc Reiskind, MD, Medical Director at Communicare, have been working closely with Breen, and together they have designed a “game plan” that incorporates precise control of medications along with social and cognitive skills training, diet and physical exercise/ training.

“Gene has had to work to understand how his negative behavior impacts the lives of others. Self monitoring has been difficult for him. All of the testing we have conducted and the confrontations he has had in the community are consistent with frontal lobe syndrome,” Dr. Horn said.

In Breen’s football career he sustained repeated blows to his head over a long period. He played football at a time when less was known about head trauma associated with the game and “playing hurt” was just part of being a team player. If you “got your bell rung” you usually just shook it off and it was expected you would quickly get back on the playing field.

Frontal lobe syndrome represents cumulative injury resulting in damage to the frontal lobes, with each “hit” contributing to the syndrome’s long term affect.

After his playing days Breen coached for a time and then sold sporting goods. His affable ways and his people pleasing demeanor made him the top salesman in his territory. But there was a mentally dark side blending with his outgoing personality that over the years manifested itself with brushes with the law and society. More and more he was overstepping boundaries of normal behavior. It all came to a head in 2004 in the Orlando area community where he and his wife Nancy lived.

“I had issues with my neighbors and one day after I drank too much alcohol I went down and threatened the President of our neighborhood association,” Breen recalled in the same matter-of-fact tone that he used to describe his playing days. He was carrying a knife that day and when the police came he was placed into the local hospital for behavioral treatment.

Over the next five years Breen was able to return home and continued to be treated on an outpatient basis, but his obsessive approach to life, whether bike riding ten hours a day, or collecting various objects such as golf balls or food condiments, continued to create potential legal problems.

“Gene was engaging in punding behaviors,” Dr. Horn explained. The term is used when someone engages in a seemingly normal behavior, but engages in the behavior to excess with a sense of euphoria and then rationalizes the need for the continuation of that same behavior.

For example, picking up items from the road is for purposes of keeping the road clean, but the repetitiveness of the behavior continues without understanding the risks involved such as possible risk of being hit by an oncoming vehicle.

For the last five years Dr. Horn has been working with Dr. Herndon Harding in Orlando to treat Breen and beyond that, there wasn’t much else that could be done. Then along came the National Football League’s “88 Plan” to help care for players diagnosed with injury related complications.
The plan was named after the number worn by Hall of Fame tight end John Mackey, one of the first of the former players who qualified.

From articles written on the plan, it appears that the program was designed to help pay for the care of former players. There was little proactive about the concept, which may possibly reflects the lack of understanding of brain injury in many quarters, even today.

Communicare’s approach is to provide Breen with the tools to function more normally, slow down the effects of injury and live a productive and happy life in society, not hidden from it. As such, Breen’s case could become an example of how the NFL’s 88 Plan funds could assist players with their needs.

“I don’t believe yet that the NFL has a total grasp of what is going on,” Nancy Breen told the Voice in a phone interview. She pointed out that it was just her opinion, but it comes from a very personal perspective. She and Gene have been married for 30 years and the former player says that his wife is his “rock”.

For her part, Nancy Breen believes that Communicare is providing the type of program and personal care that her husband needs in order to return to the community. “I just marvel at his positive approach to his therapy in the facility. He has never missed an appointment or a therapy session or resisted treatment,” she said.

Dr. Horn agreed that Breen is a very motivated patient. The former player, in turn, sees Dr. Horn as his “coach” and the relationship is productive and even enjoyable for Breen.

He produced a 16-page outline to help guide his therapy. It’s title, “My Playbook for Quality of Life.” The table of contents is simple and direct: Exercise for the Body and the Mind; The Connection which means putting it all together; Nutrition which is important for many reasons but in Gene’s case, caffeine, sugars and carbohydrates can be a dangerous combination in high concentrations. The Conclusion, a balanced life can help lead to a happier life.

“For the spouse it is not easy,” Nancy Breen said. “Communicare and Gene have the same goal and I would love it if his case helps other players and their families,” she concluded.

Ed. Note: With the development of technology, increased communication and awareness, the study of long term brain injury has been moving forward. In coming issues the Voice will look at some of these developments.

Communicare Inc. is based in Clearwater, Florida and specializes in post acute neurorehabilitation through inpatient services as well as home, community and outpatient services. Visit their website at www.communicareabi.com or call 866-802-9191 to learn more about this story or their services.


Mending a Broken Wrist

David Blum, M.D. loves what he does as specialist in upper extremity orthopaedic care. He repaired Pat Uber’s dominant left wrist allowing her to return to her work and activities with flexibility and without pain.

Mending a Broken Wrist

Sometimes You Just Have to Start All Over

There are many demands for space on the desk of David A. Blum M.D. Notes, reports and files compete for his attention, but every once in a while he picks up a Christmas card sent this last December from one of his patients. The card is from Pat Uber of Margate who included a heartfelt note thanking Dr. Blum for his medical care and helping her get her “life back”.

“I keep it on my desk. It reminds me of why I do what I do,” said the physician who specializes in surgical and non-surgical upper extremity care. Uber came to him because of pain and lack of flexibility in her left wrist which she had broken in a fall a year earlier.

Following the injury, the wrist had been treated non-surgically and Uber went through extensive rehabilitation to try and regain her former strength and flexibility. As a practitioner of the martial art, Taekwondo, and an accomplished guitar player, she found herself unable to pursue either avocation.

Referred to Dr. Blum, Uber, a code enforcement officer for the City of Coral Springs knew right away that she had made a good decision. “When I sat down with Dr. Blum the first time, he gave me his undivided attention,” Uber recalled. “I felt he really wanted to understand my needs.” After a thorough exam it was time for a recommendation. “I asked Dr. Blum, what do you want from me?, Uber said. “He said he wanted to break my wrist and put it back together and I said okay.”

Uber had fallen during a karate session and sustained what is called a distal radius fracture of her dominant left hand. This type of fracture is painful and impacts the movement of the wrist because it occurs very close to the wrist joint. The treatment decision is complex and proper diagnosis is critical to a good outcome.

Although Uber was a highly motivated patient and worked hard on her physical therapy, the bones in her wrist needed to be properly aligned if she was to regain her former strength and flexibility. “I broke the radius bone outside of the joint and then made the bone longer through adjustment and the use of a bone graft,” Dr. Blum stated. A plate and screws completed the restoration.

Following the surgery Uber returned to her occupational therapy regime. “It is important to get the wrist in motion as soon as possible,” Dr. Blum pointed out. That wasn’t difficult for Uber who was soon back to playing guitar in her church and returning to martial arts classes.

More importantly she could enjoy her family. Uber smiled as she recalled her five-year-old granddaughter’s observation that her grandmother was “back to normal”.

Dr. Blum likes to hear positive stories. “This is one of my favorite surgical procedures. It is technically challenging and rewarding because it helps patients return to their lives,” he stated.

“I needed to have my hand back, and Dr. Blum did that for me. I love the office and the staff,” Uber added. “He did a world of good for me and that is why I sent the card.”

Ed. Note: David A. Blum, M.D. is Board Certified, American Board of Orthopedic Surgery and Fellowship Trained, Certificate of Added Qualifications in Hand Surgery. His office located at 301 N.W. 84th Av., in Plantation, FL. He can be reached at 954-888-1400.


Case Management… A Grand Opportunity

TCS Healthcare Technologies presented a check to provide seed money for the CMSA Foundation, a nonprofit arm of the organization. From left, Cheri Lattimer, CMSA Ex. Dir.; Esther and Rob Pock, founders of TCS; Margaret Leonard, CMSA President and Jeff Frater, Immediate Past President of CMSA.

Consumer Advocacy
A Motivational Force

The future of the case manager in health care is secure and the profession is poised to be part of the trend toward consumer advocacy in their own treatment plans, according to an expert in the profession. Jeff Frater, President of the Case Management Society of America (CMSA) for the past year, told the Voice that the “need to get accurate information in order to make informed decisions” will draw on the expertise of case managers in the new era of health care.

The success rate of a particular surgeon in a specific procedure, the cost involved and the quality of service will be among factors consumers will take into account as they seek to direct their health care. “Consumers will be looking for help as they evaluate their findings,” Frater maintained.

“I believe biggest role for CMSA is education and the development of the Case Management Adherence Guidelines (CMAG) was instrumental in giving case management a major voice in healthcare,” Frater said. (Developed in 2004, CMAG provides a comprehensive approach to addressing issues relating to adherence to therapies.)

Case managers are often facility-based with some working independently and others with case management companies. Frater anticipates the day when case managers will also be part of the medical team in physician practices, coordinating treatment plans and patient adherence to those plans.

“Health plans are not asleep at the wheel,” Frater pointed out, in terms of providing value added services to their clients. Positioning case managers as patient advocates is a trend he believes will continue to evolve in the insurance industry. “We are moving in a bunch of directions,” he added.
That does not necessarily include a rush to embrace new technology. Frater said that there are still many excellent case managers who are not maximizing their skills because they have a fear of the computer age. “There are case managers who do embrace and effectively use technology,” Frater said, but more professionals need to make the transition.

Case management will continue to evolve as a patient advocate profession, working as part of a team with insurers, physicians, providers and consumers to develop “value based” services, Frater predicted.

“I love being a case manager. I love the process and the opportunity to give back through CMSA. We have a vision that is breaking from the past and moving toward the future,” Frater concluded.

Ed. Note: Jeff Frater, RN, BSN will conclude his term as CMSA President at the annual conference in June. He has experience in virtually all areas of health care administration including commercial health plans and small state Medicaid managed care organizations. He also has experience as an independent consultant working with long-term care insurance policies and case management software development.

Currently he is a Clinical Trainer for Milliman Care Guidelines.
His professional interests emphasize the patient as a “consumer of healthcare having full ownership of the process, medical record and ultimate outcome.”


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