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Employees with TBI

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According to the Disability Statistics Center report from 1996 there are an estimated 1.9 million new traumatic brain injuries (TBI) each year. About half of these injuries result in at least short-term disabilities and varying degrees of functional impairment. (http://dsc.ucsf.edu/UCSF/ - Abstract 14)

For an individual already in the workforce, a TBI incident is likely to place his/her job in jeopardy. Possible job loss or an unanticipated change in employment compounds the recovery and adjustment that individuals face. Discussions with employers, a thorough job/task analysis, consultation with specialists familiar with problems that may occur with traumatic brain injury, and most importantly, detailed and ongoing discussions with the individual may be able to avert unnecessary change in employment status.

For individuals who are not yet in the workforce, a serious TBI incident will create challenges to finding and maintaining employment. This is particularly significant, since the highest incidence rate for TBI is among young persons, especially males under the age of 18 (often as a result of motor vehicle accidents).

Work-related problems will be varied, but typically include difficulties with organization, recall of information and instructions, following procedures, communication, maintaining expected levels of quality, mobility and balance, and overall stamina. Cognitive therapy and retraining are normal treatment strategies for TBI cases. Simple problem solving and applications of assistive technology may also be successful in eliminating or minimizing work-related problems.

Several problem areas and suggested strategies are outlined below.

Memory / Organization: Impaired memory is a problem with most TBI cases. Memory is a complex affecting one's abilities involving smell, taste, touch, music, language, vision, hearing and movement. Immediate, short-term and long-term are general classifications of memory function. Immediate memory refers to the ability to restate or recall something that was said, read or occurred recently. Short-term memory, the most common problem area for TBI cases, is the ability to remember information or recall instructions from several minutes to several hours or days past. Long-term memory is typically not a problem area for people with TBI.

People function and learn better when they are organized. Individuals with TBI typically have difficulties with organizational skills. The following suggestions for getting organized will help with short-term memory deficits.

  • Place things in the same place. For example, hang keys on a hook by the door or place them in a desk drawer.
  • Break tasks down. For tasks and activities that involve multiple steps or components, try breaking these down into smaller groups. For example, recalling telephone numbers is easier when the numbers are grouped in two sets of three numbers followed by four numbers.
  • Use association. Associate things that must be remembered, such as names, with something unique.
  • Use a daily planner or PDA. The standard day planner with calendar and tabbed sections for notes and information is an old stand-by. The evolution of PDAs – Personal Digital Assistants – has taken the planner to new heights, but these more complicated devices can be confusing for some individuals with TBI. The standard daily planner is probably a good place to start, but either of these aids could be useful, given enough time and training to develop proficiency.
  • Write things down. A benefit of the daily planner is that it offers a place to write notes and store information. PDAs also allow this, but the methods for keying in information or using a graffiti-style note system can be tricky. It is important to write things down while the information and details are fresh.
  • Follow "to do" lists. It is important to keep them short and manageable. For example, the list may only include five items at one time, and one item must be completed before others can be added.
  • Use dry erase boards or post-it notes. Keeping important information in plain view may be helpful.

Getting Overloaded: A common problem for many persons with TBI is handling multiple activities and large amounts of stimulation and information. Almost everyone can have problems adapting to new environments and excessive numbers of activities; persons with TBI are especially susceptible to being overloaded with choices and information. Distractibility and off-task behaviors can be a concern. Strategies to help workers concentrate better include:

  • Taking breaks
  • Wearing ear plugs or a headset with music to mask background noise
  • Wearing dark glasses to reduce harsh glare
  • Changing schedules
  • Adding sight barriers such as partitions to reduce visual distractions

Mobility/Reach/Balance Problems: Physical problems with mobility, reach or balance can often be addressed with the use of mobility aids, which sometimes are needed only on a temporary basis.

  • Walkers with wheels and a basket aid both balance and carrying.
  • Electric scooters enhance worker stamina when long travel distances are part of the work setting.
  • Stools with wheels or portable steps with handrails can provide support and seating in the work area.

Work supports such as a job coach can be very helpful. Simple accommodations such as schedule changes, transfer or sharing job duties, or temporary light-duty assignment can also alleviate some problems. Involvement of the employer and immediate supervisors in the development of return to work or initial employment orientation is a key to success.

For any of these strategies, it is always important to have full involvement of the individual in selecting what to use. For persons with TBI, acceptance and follow-through can be a very real concern. For example, if someone is not comfortable with an electronic aid, the likelihood that he/she will continue to use it is doubtful. The opportunity to try different strategies and have follow-up assessments is important.

While most of these suggestions are not typical uses of assistive technology, they are simple ideas and strategies that add options to enhance effective problem solving.

The following guide is a good general resource on TBI that is available on the Internet:

Traumatic Brain Injury Survival Guide Dr. Glen Johnson Clinical Director of the Neuro-Recovery Head Injury Program 5123 North Royal Drive, Traverse City, MI 49684 http://www.tbiguide.com


Author: Tony Langton
Affiliation: Originally published in the July 2002 TC Direct Newsletter for the NIDRR-funded Tech Connections project.