[P100]Patients With Traumatic Brain Injury

Traumatic Brain Injury. It's one of the signature wounds of the conflicts in Iraq and Afghanistan, and by many accounts, a great deal of returning service members will be coping with the effects of TBI as they transition to civilian life. For employers, that brings up some important questions - among them, what should they expect from employees with TBI, and how can they support them in the workplace?

It's true that veterans - and anyone experiencing the effects of TBI - may face day-to-day difficulties in their work environment. However, employers can play a vital role in these individuals' recovery by recognizing the challenges associated with TBI and making adjustments and reasonable accommodations to help ensure workplace success. And disabled veterans aren't the only ones that stand to benefit from the implementation of workplace supports. Veterans are known to make excellent employees, so helping them succeed on the job can not only contribute to the veteran's recovery - it can positively impact a business's bottom line.

People with TBI may experience some of the limitations discussed in this article, however they seldom will develop all of them. The severity of the TBI and degree of limitation will vary among individuals. Employers should be aware that not all people with TBI will need accommodations to perform their jobs, and many others may only need a few accommodations. However, in many cases, simple, inexpensive workplace supports can make all the difference toward a successful employment experience.

Employers should also know that unless the employee reveals, or makes available information, that they have been diagnosed with TBI, the employer will not necessarily know whether the condition is present. In fact, job applicants do not have to disclose a disability on a job application, or in a job interview, unless they need an accommodation to assist them in the application or interview process.

Key Questions

Prior to implementing workplace accommodations for employees with brain injuries, employers should ask themselves the following questions:

- What limitations is the employee with TBI experiencing, and how do these limitations affect the employee's job performance?

- What specific job tasks are problematic as a result of these limitations?

-What accommodations are available to reduce or eliminate these problems?

-Has the employee with TBI been consulted regarding possible accommodations?

- Do supervisory personnel and employees need training regarding TBI and workplace accommodations?

Accommodation Ideas

Once they have considered these questions, employers and human resource professionals will be poised to identify appropriate workplace supports that can help their employees with TBI succeed on the job. The following represents only a sample of the types of accommodations and/or adjustments an employer might consider for an employee with a brain injury.

Physical Limitations:

- Install ramps, handrails and provide designated parking spaces

- Install lever-style door handles

- Clear pathways of travel of any unnecessary equipment and furniture

Visual Problems:

- Provide written information in large print

- Change fluorescent lights to high intensity, white lights

- Increase natural lighting

- Provide a glare-resistant screen for computer monitors

- Consult a vision specialist, particularly for an employee who has lost part of or all of their vision

Maintaining Stamina During the Workday:

- Permit flexible scheduling, allow longer or more frequent work breaks

-Provide additional time to learn new responsibilities

- Increase natural lighting

- Provide backup coverage for when the employee needs to take breaks

- Allow for use of supportive employment and job coaches

- Provide for job sharing opportunities

- Allow part-time work schedules

- Avoid scheduling more challenging tasks at the end of the work shift when fatigue is more likely to be a factor

Maintaining Concentration:

- Reduce distractions in the work area, including clutter in the employee's work environment

- Provide space enclosures or a private office

- Allow for use of white noise or environmental sound machines

- Encourage the employee to focus on one task at a time

- Divide large assignments into smaller tasks and steps

- Restructure job to include only essential functions

Difficulty Staying Organized and Meeting Deadlines:

- Encourage the employee to use daily TO-DO lists and check items off as they are completed

- Provide a special calendar to mark meetings and deadlines

- Remind the employee of important deadlines via memos or e-mail or weekly supervision

- Provide a watch or pager with timer capability

- Provide electronic organizers

- Divide large assignments into smaller tasks and steps

- Assign a mentor to assist employee in determining goals and provide daily guidance

- Schedule weekly meetings with supervisor, manager or mentor to determine if goals are being met

- Recognize that emotionality and irritability can be common following some TBIs

- Recognize that the individual's ability to manage stress can be impacted by a TBI

Memory Deficits:

- Allow the employee to tape record meetings

- Provide typewritten minutes of each meeting

- Provide notebooks, calendars or sticky notes to record information for easy retrieval

- Provide written as well as verbal instructions

- Limit verbal instructions to shorter, manageable chunks of information

- Allow additional training time

- Provide written checklists and use color-coding to help identify items

- Post instructions close to frequently used equipment

Problem Solving Deficits:

- Provide picture diagrams of problem solving techniques (e.g., flow charts)

- Restructure the job to include only essential functions

- Assign a supervisor, manager or mentor when the employee has questions

Working Effectively with Supervisors:

- Provide positive praise and reinforcement

- Provide written job instructions

- Write clear expectations of responsibilities and the consequences of not meeting them

- Allow for open communication with managers and supervisors

- Establish written long term and short term goals

- Develop strategies to deal with problems before they arise

- Provide written work agreements

- Develop a procedure to routinely evaluate the effectiveness of the accommodation(s)

Difficulty Handling Stress and Emotions:

- Provide praise and positive reinforcement

- Refer to counseling and employee assistance programs

- Provide sensitivity training to coworkers

- Allow the employee to take a break as a part of a stress management plan

- Recognize that emotionality and irritability can be common following some TBIs

- Recognize that the individual's ability to manage stress can be impacted by a TBI

Attendance Issues:

- Provide flexible leave for health problems

- Provide a self-paced work load and flexible hours

- Provide part-time work schedule or job sharing arrangement

Issues of Change:

- Recognize that a change in the office environment or of supervisors may be difficult for a person with a brain injury

- When transitioning supervisors, maintain open channels of communication between the employee and the new and old supervisor

- Provide weekly or monthly meetings with the employee to discuss workplace issues and production levels