About Brain Injury
The brain can incur several different types of injuries depending on the type, amount, and position of force impacting the head. The impact may affect one functional area of the brain, several areas, or all areas of the brain. These factors determine what types of accommodations are effective. JAN's Effective Accommodation Practices (EAP) Series: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Brain Injury and the Americans with Disabilities Act
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Brain Injury
People with brain injuries may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with brain injuries will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and 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? Are all possible resources being used to determine possible accommodations?
- Has the employee been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Working Effectively with Supervisors:
- Provide positive praise and reinforcement
- Provide written 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 evaluate the effectiveness of the accommodation
Issues of Change:
- Recognize that a change in the office environment or of supervisors may be difficult for a person with a brain injury
- Maintain open channels of communication between the employee and the new and old supervisor in order to ensure an effective transition
- Provide weekly or monthly meetings with the employee to discuss workplace issues and production levels
Situations and Solutions:
A police officer was returning to work following surgery for a brain aneurysm.
He had partial paralysis to the left side and could no longer use both hands for word processing. Accommodation suggestions included: transferring the individual to a vacant position that involved computer research and providing a one-handed keyboard.
A professional whose work required the use of a computer returned to work following a brain injury.
As a result of his injury he was unable to read past the midline when reading from left to right. Accommodation suggestions included: changing the margin settings of his word processing program for 80 to 40 to limit right side reading or purchasing software that can split the computer screen left to right and black out the right side, redesigning his workstation to place equipment on the left, and providing task lighting.
A therapist who had short-term memory deficits had difficulty writing case notes from counseling sessions.
Accommodation suggestions included: allowing the therapist to tape record sessions and replay them before dictating notes, scheduling 15 minutes at the end of each session to write up hand written notes, and scheduling fewer counseling sessions per day.
A wounded service member was returning to his civilian office job in a manufacturing plant.
He had a traumatic brain injury (TBI), which caused seizures. He had to periodically travel through the plant and his employer was concerned about him having a seizure and getting hurt by machinery or industrial vehicles. The employer established a route of travel for all employees walking through the plant, away from machinery and separate from the industrial vehicle route of travel.
A veteran who recently returned to the workforce after spending several years overseas has Post Traumatic Stress Disorder (PTSD) and a Traumatic Brain Injury (TBI), which causes difficulty with memory and mood regulation.
He was recently hired as a customer service representative. After disclosing his disability and requesting reasonable accommodations, his employer provided him with a cubicle close to an exit, with his back facing a wall. This helped to alleviate some of his stress, but he still had difficulty with memory and emotional outbursts. The employer obtained a job coach through the Department of Veterans Affairs to assist the employee with adjusting to his new position. The job coach worked with the employer and employee to develop a customized form for taking notes from customers and a system for organizing the employee's workspace. The job coach also suggested the employee e-mail his supervisor when he has questions so he will have responses in written form that he can refer to later if he forgets something. Finally, the job coach helped the employee incorporate breaks into his day to walk and do breathing exercises to help reduce the likelihood of emotional outbursts. After the job coach comes in twice a week for three weeks, the employee is able to incorporate the job coach's suggestions into his regular routine and perform his job duties without assistance.
A court employee was having difficulty with emotions after returning to work following an acquired brain injury due to a stroke.
She was diagnosed with pseudo-bulbar affect (PBA) that caused outbursts of uncontrollable laughter at seemingly inappropriate times. The employee asked that her co-workers be educated on PBA so they would better understand what could be viewed as inappropriate behavior. The employee agreed to talk to her neurologist about the training. She was also accommodated with extra breaks to help manage her stress, a temporary lightening of her workload, and a flexible schedule to allow her time for counseling and doctor appointments.
A laborer working in a noisy factory had difficulty concentrating on job tasks.
Accommodation suggestions included: erecting sound absorbing barriers around his workstation, moving unnecessary equipment from the area to reduce traffic, and allowing the employee to wear a headset or ear plugs.