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One of the main roles we fill in life, and subsequently one of the chief ways in which we define our identities, is through our jobs. Work is also incredibly important as it provides the money needed to cover the expenses of daily life. Further it is one of the primary ways we spend our time during the week, taking up at least 40 hours per week for most employed adults. When a person receives a brain injury, he or she often struggles with being out of work. Staff at TLC will commonly be asked by a patient “When can I return to work?” However, this question is far more complex than it appears on the surface. This post will address some of the issues involved in returning to work following a brain injury.
Jobs differ greatly one from another. The skills necessary and education required to become a lawyer are completely different from benchmarks met on the journey to a career as a plumber. Both are highly skilled positions, but each has a very different set of job demands. For instance, if a plumber lost functioning of his hands he would not be able to return to his job as relying upon excellent hand coordination is an essential aspect of that job. However as a lawyer’s job generally does not require much or any mandatory use of the hands, that job could be more easily modified to allow the injured lawyer to return to work. As one example, the task of typing reports could be replaced with use of voice recognition computer software. The first question that needs to be asked regarding such a return to work is whether the survivor’s current skills are sufficient to facilitate that return, and within that consideration it must be determined what level of modifications might be appropriate. Does the survivor have the requisite skills to fulfill the demands of the job? This is a different question than whether the survivor remembers how to do the job. Most people who have worked the same job for a few years can recite their job requirements in perfectly accurate detail. This is generally true for brain injury survivors as well. Following a brain injury, a survivor will more often than not have a functionally intact memory of life prior to his or her injury and therefore be able to easily describe the job activities engaged in that pre-injury life. The issue is not whether the survivor remembers the job, but whether he or she possesses the skills to do the job right now.
To help determine whether the survivor is capable of meeting the challenges posed by a given job, it is often helpful to make a list of job requirements to be set against a list of the survivor’s strengths and weaknesses. Each task making up an essential part of the job should be listed. Often, employers will make available job descriptions and/or task analyses that can help in this process. Next, survivors should write down their current strengths and weaknesses. During this activity many survivors tend to report what they excelled at in their lives pre-injury, as the injury itself will generally do little to change that innate understanding of one’s self. Keep in mind though that the past is in the past; the pertinent question at hand regards what skills the survivor retains at present. Also, the survivor and his or her loved ones should not attempt to take into account how skills might soon improve when creating this list. As the future is ultimately unknown, it is vital to complete this task listing only the skills the survivor has today. As weaknesses that may affect job performance are identified, the survivor and loved ones should attempt to identify whether there are ways to remediate a given weakness. For instance, if a survivor’s wheelchair will not fit under a worktable, perhaps lifts can be placed under the legs of the table so as to raise the table and enable the front of the wheelchair to fit under. In employment law parlance, these relatively minor remediations are generally called “reasonable accommodations.” It is as a rule mandatory for employers to provide these reasonable accommodations to employees once notified of need. (For those interested in learning more about these laws, please click on this link to Americans with Disabilities Act: Questions and Answers http://www.ada.gov/q&aeng02.htm)
Unfortunately, not every brain injury survivor can return to a former employment situation. In some cases, the survivor’s injury deficits may provide simply too great an obstacle to achieving the level of success once enjoyed by that survivor in his or her pre-injury career. In other cases, a survivor may have been let go by an employer post-injury. Additionally, some survivors may have been unemployed at the time of their injuries. To find a new job, the survivor and his or her loved ones need to consider the matching of the survivor’s strengths to possible employment positions. An important part of this process is listing the survivor’s strengths. One way of doing this is by creating an employment skills inventory. It is helpful to break up the various skills into categories. One such breakdown is as follows:
Cognitive/Physical/Sensory Skills (For example: Walking or Speaking)
Skills and Areas of Knowledge Gained at Previous Jobs (For example: Using a cash register)
Skills and Areas of Knowledge Gained through School/Training (For example: Algebra)
Skills and Areas of Knowledge Gained from Family Members and Friends (For example: Speaking Spanish)
When creating an inventory, it is important to identify each particular skill and area of knowledge as specifically as possible rather than writing them down as more broad statements. For example, a survivor might want to add to the list skill as a salesperson. However sales positions are often made up of many distinct component parts such as selling items, servicing customers, completing billing, collecting money and using computerized inventory software. Each and every skill and area of knowledge should be listed independently regardless of how unimportant one may seem. Once all of the skills and areas of knowledge are listed on the inventory, survivors and their families can see how these skills and areas of knowledge can combine to match different lines of work. For instance, a survivor may list that he or she naturally has good speech and organizational skills, has well-developed managerial skills after having served as an officer in the military, has substantial inventory skills gained while working as a clerk in a factory and is fluent in Spanish due to growing up in a Spanish-language home. In assembling these once disparate facts, it suddenly becomes clear that this survivor may be a strong candidate for a bilingual inventory manager position in a warehouse.
With all of this in mind, it is still not easy to return to work. Many survivors have been out of work for months or even years prior to attempting a return to the workforce. It is generally recommended that a survivor return to work on a part-time basis and then slowly move toward a fuller schedule. There are a few very good reasons supporting this approach. First, after being out of the employment scene for quite some time, most people lose to a certain degree their “work hardiness.” Many survivors find that when they first return to work, they become tired far more easily than expected. It is often necessary for them to build up their strength over time in order to enable them to physically and mentally stay on task for an extended period of time. Second, by working a shorter day it is easier to identify and correct any possible areas of difficulty that a survivor may encounter due to his or her injury. As example, if a survivor is working four hours a day and finds that attention deficits are negatively impacting performance, he or she can simply try different methods designed to assist in blocking distractions. If the survivor is working ten hours a day, it is hard to discern if poor performance is due to injury deficits or is rather due to the unavoidable fatigue that comes with working long hours. If the survivor is beginning a new line of work (particularly if that work earns the survivor less money or carries less prestige than the survivor’s former employment), it is important to encourage the survivor. Just getting back to work after a serious brain injury is a tremendous accomplishment. Further, the first job after a brain injury does not have to be the survivor’s “forever” job any more than a first job out of high school was necessarily his or her “forever” job. These first jobs can be seen as stepping stones to greater employment success in the future. Overall, patience is vital in its role central to any successful return to work.
Unfortunately, some brain injury survivors may simply never reach the point at which a return to paid employment becomes feasible. However, there may be volunteer opportunities that the survivor could engage in which can both occupy his or her time and bring a missing sense of accomplishment and contribution to the larger community into his or her life. Volunteers are the lifeblood of many charities, hospitals and religious organizations. Volunteering also provides a useful opportunity to practice post-injury work skills in a safe environment in anticipation of future employment.
There are several organizations that can help a survivor through the post-injury employment process. In the State of Texas, the Department of Assistive and Rehabilitative Services (DARS) has a Vocational Rehabilitation (VR) department that can help provide therapy and support for brain injury survivors who are strong candidates for employment (http://www.dars.state.tx.us/drs/vr.shtml). In fact, the Moody Neurorehabilitation Institute often works with VR candidates from DARS in order to help those individuals return to employment in their post-injury lives. The Job Accommodation Network offers excellent information for both employment seekers and employers looking to facilitate the return-to-work process (http://askjan.org/).
Hopefully this post helped outline a few of the considerations important to a post-injury return to work. Please leave me a comment below with any questions, thoughts or ideas!
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