Learning About Hidden Disabilities and the Workplace Presented by: Sherry Stock, ABD, MS, CBIS

Learning About Hidden Disabilities and the Workplace

Presented by: Sherry Stock, ABD, MS, CBIS

Learning About Hidden Disabilities and the Workplace

Presented by: Sherry Stock, ABD, MS, CBIS

What are “hidden disabilities”?What are “hidden disabilities”?

Any impairment causing limitations not obvious to the naked eye, not easily discerned by others, or not noticeable in the person’s speech, behavior, or mobility

The impairment may affect the: brain circulation respiration muscular or skeletal system stamina sensory abilities

Any impairment causing limitations not obvious to the naked eye, not easily discerned by others, or not noticeable in the person’s speech, behavior, or mobility

The impairment may affect the: brain circulation respiration muscular or skeletal system stamina sensory abilities

Some “hidden disabilities”Some “hidden disabilities”

ABI/TBIEpilepsyAIDS/HIVCancerHeart ConditionsVision LossHearing Loss

ABI/TBIEpilepsyAIDS/HIVCancerHeart ConditionsVision LossHearing Loss

ADDSleep DisordersMigraine HeadachesChronic PainDepressionPTSDLearning Disabilities

ADDSleep DisordersMigraine HeadachesChronic PainDepressionPTSDLearning Disabilities

All of these can either cause or be a symptom of a brain injuryAll of these can either cause or be a symptom of a brain injury

Types of Brain InjuryTypes of Brain Injury

Acquired Brain Injury is an injury to the brain that has occurred after birth

Acquired Brain Injury is an injury to the brain that has occurred after birth

Too little oxygen or blood flow in the brain (examples: heart attack, stroke, carbon monoxide poisoning, near suffocation)

Infections, tumors and surgery of the brain

Toxic exposure(examples: chemo therapy, substance abuse, ingestion of lead, sniffing glue)

Traumatic Brain Injury - a blow to the brain caused by an external physical force ( blast injuries, assault, shaken baby, motor vehicle accidents, falls)

Too little oxygen or blood flow in the brain (examples: heart attack, stroke, carbon monoxide poisoning, near suffocation)

Infections, tumors and surgery of the brain

Toxic exposure(examples: chemo therapy, substance abuse, ingestion of lead, sniffing glue)

Traumatic Brain Injury - a blow to the brain caused by an external physical force ( blast injuries, assault, shaken baby, motor vehicle accidents, falls)

            What are the signs and

symptoms of TBI?   

            What are the signs and

symptoms of TBI?   

 There are various levels of TBI, including mild and moderate or severe TBI.

There are various levels of TBI, including mild and moderate or severe TBI.

Mild TBI:Mild TBI:

Symptoms of mild TBI include headache; confusion; lightheadedness; dizziness; blurred vision or tired eyes; ringing in the ears; bad taste in the mouth; fatigue; a change in sleep patterns; mood changes; and trouble with memory, concentration, attention, or thinking. The injury may or may not result in a brief period of unconsciousness.

Symptoms of mild TBI include headache; confusion; lightheadedness; dizziness; blurred vision or tired eyes; ringing in the ears; bad taste in the mouth; fatigue; a change in sleep patterns; mood changes; and trouble with memory, concentration, attention, or thinking. The injury may or may not result in a brief period of unconsciousness.

Moderate or Severe TBI:Moderate or Severe TBI:

Symptoms of moderate to severe TBI may be similar to symptoms of mild TBI, but they may also include a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the arms or legs, loss of coordination, increased confusion, restlessness, or agitation.

Symptoms of moderate to severe TBI may be similar to symptoms of mild TBI, but they may also include a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the arms or legs, loss of coordination, increased confusion, restlessness, or agitation.

Brain Injury Dangers

Percentage of Average Annual Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths, by External Cause, United States, 1995-2001

Falls, 28%

Motor Vehicle-Traffic, 20%

Struck By/Against, 19%

Assault, 11%

Unknown, 9%

Other, 7%

Pedal Cycle (non MV), 3%

Suicide, 1%

Other Transport, 2%

Injury and Disability Prevalence Rates

500,000 with Cerebral Palsy

2 million Americans with Epilepsy

3 million with Stroke disabilities

4 million with Alzheimer’s Disease

5 million with persistent mental illness

7.3 million Americans with mental retardation

National organizations’ web sites, 4/2000

400,000 w/ Spinal Cord Injuries

5.3 million with TBI disability

Brain Injury in OregonBrain Injury in Oregon

Approximately 8,000 adults and children each year are hospitalized or die as a result of a traumatic brain injury.

More than 17,000 people are treated each year in doctor offices or emergency rooms for TBI.*

* Conservatively extrapolated from national data

Approximately 8,000 adults and children each year are hospitalized or die as a result of a traumatic brain injury.

More than 17,000 people are treated each year in doctor offices or emergency rooms for TBI.*

* Conservatively extrapolated from national data

25% of brain injuries are severe enough to require medical and rehabilitation care following injury

25% of brain injuries are severe enough to require medical and rehabilitation care following injury

People with more severe brain injuries have significant problems returning to work

People with more severe brain injuries have significant problems returning to work

Mild Brain Injury

75% of all brain injuries

are mild

• A mild brain injury is also known as a “concussion”

• Brief (less than 15 minutes) or NO loss of consciousness

• A dazed, vacant stare right after the injury

• A normal neurological exam

Mild Brain Injury

• Delayed response to questions or commands

• Disorientation and foggy memory

Headaches, dizziness or nausea

Slurred speech

Ringing in ears/blurred vision

Mild Brain Injury Symptoms

2/3 of people with mild brain injury return to work with few or no problems

2/3 of people with mild brain injury return to work with few or no problems

1/3 of people with mild brain injury will quit or get fired from their job after injury

1/3 of people with mild brain injury will quit or get fired from their job after injury

Most workplace difficulties are the result of cognitive functional limitations such as remembering, organizing, learning, and planning skills.

Most workplace difficulties are the result of cognitive functional limitations such as remembering, organizing, learning, and planning skills.

Imagine that a cognitive Disability is like the color spectrum

Think of all the colors that exist in the spectrum

Cognitive Disabilities are different for every person

Imagine that a cognitive Disability is like the color spectrum

Think of all the colors that exist in the spectrum

Cognitive Disabilities are different for every person

Some Reactions about Hidden Disabilities

Some Reactions about Hidden Disabilities

Hidden disabilities are not believable

Hidden disabilities are downplayed – not as severe as obvious disabilities like mobility impairments

Hidden disabilities are hard to accommodate because the need is not obvious

People with hidden disabilities do not need accommodations

Hidden disabilities are not believable

Hidden disabilities are downplayed – not as severe as obvious disabilities like mobility impairments

Hidden disabilities are hard to accommodate because the need is not obvious

People with hidden disabilities do not need accommodations

Some Famous People with Hidden Disabilities Include…Some Famous People with

Hidden Disabilities Include…

George Clooney

Actor, DirectorBrain Injury

George Clooney

Actor, DirectorBrain Injury

Judy Garland

Singer, actress, entertainer

depression

Judy Garland

Singer, actress, entertainer

depression

Tom Cruise

Actor and entertainer

Learning Disability

Tom Cruise

Actor and entertainer

Learning Disability

Danny Glover

Actor, entertainer, advocateEpilepsy

Danny Glover

Actor, entertainer, advocateEpilepsy

Lou Ferrigno

Actor

Hearing Impairment

Lou Ferrigno

Actor

Hearing Impairment

Henry Winkler

Actor, director

Learning Disability

Henry Winkler

Actor, director

Learning Disability

Marilyn Monroe

Singer, actress, entertainer

depression

Marilyn Monroe

Singer, actress, entertainer

depression

James Earl JonesActorSpeech Impairment

James Earl JonesActorSpeech Impairment

Carrie Fisher

ActressLearning DisabilityDepression

Carrie Fisher

ActressLearning DisabilityDepression

Edgar Allen Poe

American poet,writer“The Raven”“The Fall of the House of Usher”“The Tell-Tale Heart”

bi-polar disorder

Edgar Allen Poe

American poet,writer“The Raven”“The Fall of the House of Usher”“The Tell-Tale Heart”

bi-polar disorder

Activity Time!

What is it like to have a cognitive disability?

Activity Time!

What is it like to have a cognitive disability?

Disability Simulations

Why engage in a disability “simulation?”

Individuals who are not disabled may have difficulty understanding the limitations of a person with a disabilitySome individuals have little (or no) real-life experiences relating to people with disabilities

Disability Simulations

Why engage in a disability “simulation?”

Individuals who are not disabled may have difficulty understanding the limitations of a person with a disabilitySome individuals have little (or no) real-life experiences relating to people with disabilities

What is a “simulation?”

A disability simulation is a learning activity that momentarily allows someone experience a physical, sensory, or cognitive impairment A disability simulation is not intended to degrade or stereotype people with disabilities

What is a “simulation?”

A disability simulation is a learning activity that momentarily allows someone experience a physical, sensory, or cognitive impairment A disability simulation is not intended to degrade or stereotype people with disabilities

The Wright Family StoryThe Wright Family Story

Can you read this

sign?

Can you read this

sign?

Behaviors and Strategies

Behaviors and Strategies

MemoryMemory

Memory is both complex and sensitive. It is frequently the first function to be notably impaired and one of the last functions to be regained in the recovery process.

Memory is both complex and sensitive. It is frequently the first function to be notably impaired and one of the last functions to be regained in the recovery process.

Memory deficits Memory deficits It can make it difficult to understand or remember rules or directions

Management strategies: Rules or directions should be explained slowly, step

by step – Rule of 5Ask the person to repeat the steps and encourage

him or her to write down the informationProvide examples and ask the person to provide

their own examples Teach the person to ask when he or she doesn’t

understand

It can make it difficult to understand or remember rules or directions

Management strategies: Rules or directions should be explained slowly, step

by step – Rule of 5Ask the person to repeat the steps and encourage

him or her to write down the informationProvide examples and ask the person to provide

their own examples Teach the person to ask when he or she doesn’t

understand

MemoryMemory Define the goals or exact needs the system will

be meeting Designate separate sections based on specific

needs, for example, monthly appointment calendar, daily schedule, medication sheet, “things to do” or a personal information section

Use a format and style that the individual prefers Encourage use of one system that is taken

everywhere

Define the goals or exact needs the system will be meeting

Designate separate sections based on specific needs, for example, monthly appointment calendar, daily schedule, medication sheet, “things to do” or a personal information section

Use a format and style that the individual prefers Encourage use of one system that is taken

everywhere

MemoryMemory

Timers, wrist watch alarms or talking watches can provide prompts

Use check off sheets (they allow the individual to self-monitor and reference back)

Post simple reminder signs for prompts to turn off appliances, lights etc.

Label drawers and cupboard fronts indicating their contents

Timers, wrist watch alarms or talking watches can provide prompts

Use check off sheets (they allow the individual to self-monitor and reference back)

Post simple reminder signs for prompts to turn off appliances, lights etc.

Label drawers and cupboard fronts indicating their contents

MemoryMemory

Post step by step directions for appliances such as coffee maker, microwave etc.

Post-it notes can be used to augment a system, for example place a post it note on the car dash to cue to pick up milk on the way home from an appointment

Provide written outlines to aid in note taking

Provide written as well as verbal instructions

Post step by step directions for appliances such as coffee maker, microwave etc.

Post-it notes can be used to augment a system, for example place a post it note on the car dash to cue to pick up milk on the way home from an appointment

Provide written outlines to aid in note taking

Provide written as well as verbal instructions

MemoryMemoryColor code to help with recall and identification

(folders, storage boxes etc.)

Use tape recorders to record meetings

Allow for repetitive training or instruction when reintroducing functional activity into the daily schedule, and with all activities requiring new learning

Encourage note taking at meetings, appointments etc.

Color code to help with recall and identification (folders, storage boxes etc.)

Use tape recorders to record meetings

Allow for repetitive training or instruction when reintroducing functional activity into the daily schedule, and with all activities requiring new learning

Encourage note taking at meetings, appointments etc.

InitiationInitiation

Poor initiation a reduced ability to initiate or begin activities can be a consequence of brain injury. Often misinterpreted as disinterest, initiation problems can be directly related to damage to one of several different areas of the brain.

Poor initiation a reduced ability to initiate or begin activities can be a consequence of brain injury. Often misinterpreted as disinterest, initiation problems can be directly related to damage to one of several different areas of the brain.

InitiationInitiationMany individuals respond well to structure and

consistent routines. Encourage client participation when developing schedules

When preparing daily and weekly schedules be specific. Designate specific times for activities to be performed. In addition to using a general concept such as ‘clean the kitchen’ list specific tasks

Begin with lighter demands that promote success. The complexity of demands can be increased as proficiency is demonstrated

Many individuals respond well to structure and consistent routines. Encourage client participation when developing schedules

When preparing daily and weekly schedules be specific. Designate specific times for activities to be performed. In addition to using a general concept such as ‘clean the kitchen’ list specific tasks

Begin with lighter demands that promote success. The complexity of demands can be increased as proficiency is demonstrated

InitiationInitiation

Provide training and cues when introducing a new or updated schedule

Accept close approximations of the desired behavior during initial training

Use positive reinforcement for all successful follow through

Engage the client in a problem solving approach when addressing areas of difficulty

Provide training and cues when introducing a new or updated schedule

Accept close approximations of the desired behavior during initial training

Use positive reinforcement for all successful follow through

Engage the client in a problem solving approach when addressing areas of difficulty

Communication Receptive DeficitsCommunication

Receptive DeficitsMinimize background noiseSlow your rate of speechSimplify sentence structure for

clarityPause between sentences or

topics to allow for processingRepeat key words or conceptsRephrase if needed

Minimize background noiseSlow your rate of speechSimplify sentence structure for

clarityPause between sentences or

topics to allow for processingRepeat key words or conceptsRephrase if needed

Fatigue is a common complaint following brain injury. Fatigue can accentuate deficits. It is important to consider energy conservation and work simplification principles when planning daily and weekly schedules.

Fatigue is a common complaint following brain injury. Fatigue can accentuate deficits. It is important to consider energy conservation and work simplification principles when planning daily and weekly schedules.

Fatigue

Activity ToleranceActivity Tolerance

Make a list of weekly activities to be completed. Prioritize beginning with the most important items

Some activities may need to be eliminated from the weekly schedule

Schedule high demand/time consuming tasks throughout the week versus performing all heavy activity in a single day

Alternate between high and low demand activity on the daily schedule. Remember that cognitive activities can be very tiring for some individuals

Make a list of weekly activities to be completed. Prioritize beginning with the most important items

Some activities may need to be eliminated from the weekly schedule

Schedule high demand/time consuming tasks throughout the week versus performing all heavy activity in a single day

Alternate between high and low demand activity on the daily schedule. Remember that cognitive activities can be very tiring for some individuals

Activity ToleranceActivity ToleranceSchedule priority or high demand activities during

peak performance timesAllow for a 15 – 30 minute rest period mid morning,

noon and mid afternoonTake short breaks during high demand activityAvoid rushing, schedule enough time for each

activity to be performed at a steady and reasonable pace

Acknowledge when fatigue will most likely occur and institute more supportive compensations for deficits during those times of day.

Schedule priority or high demand activities during peak performance times

Allow for a 15 – 30 minute rest period mid morning, noon and mid afternoon

Take short breaks during high demand activityAvoid rushing, schedule enough time for each

activity to be performed at a steady and reasonable pace

Acknowledge when fatigue will most likely occur and institute more supportive compensations for deficits during those times of day.

Attention Deficits Attention Deficits It may make it difficult to focus on directions

Management strategies:Ask the person to repeat what you have

said in order to confirm that they have heard and understood your directions.

Encourage the person to write down steps for task

Allow extra time for the task to be done Clear or reduce environmental

distractions

It may make it difficult to focus on directions

Management strategies:Ask the person to repeat what you have

said in order to confirm that they have heard and understood your directions.

Encourage the person to write down steps for task

Allow extra time for the task to be done Clear or reduce environmental

distractions

Slowed verbal and physical responses

Slowed verbal and physical responses

It may be interpreted as uncooperative behavior

Strategies to compensate: Directions or questions need to be

asked slowly and repeated if necessary

Additional time should be given for the person to respond

It may be interpreted as uncooperative behavior

Strategies to compensate: Directions or questions need to be

asked slowly and repeated if necessary

Additional time should be given for the person to respond

Irritability or anger Irritability or anger

It may be difficult to control

Strategies to compensate: Avoid arguing with the person Try re-phrasing the problem,

breaking it down into parts Reinforce positive behaviors

It may be difficult to control

Strategies to compensate: Avoid arguing with the person Try re-phrasing the problem,

breaking it down into parts Reinforce positive behaviors

Uninhibited or impulsive behavior

Uninhibited or impulsive behavior

including unacceptable sexual behavior

Strategies to compensate: The person should be told calmly

that the behavior is unacceptable Assistance may be sought from

mental health professionals

including unacceptable sexual behavior

Strategies to compensate: The person should be told calmly

that the behavior is unacceptable Assistance may be sought from

mental health professionals

Physical Changes

Possible Changes after a Mild Brain Injury

Headaches

Dizziness

Balance problems

Fatigue and/or weakness

Sleep disturbance

Clues to a hidden disabilityClues to a hidden disability

Form to complete is not filled out“I left my glasses at home”“Can you write that down for me”Reaction to perfume, etc.Sketchy work or education historyDifficulty answering questionsDistractible

Form to complete is not filled out“I left my glasses at home”“Can you write that down for me”Reaction to perfume, etc.Sketchy work or education historyDifficulty answering questionsDistractible

What do you do when an employee has…

What do you do when an employee has…

Difficulty paying attentionDifficulty answering questionsDifficulty making decisionsLack of follow throughForgotten appointmentsDifficulty controlling emotions

Difficulty paying attentionDifficulty answering questionsDifficulty making decisionsLack of follow throughForgotten appointmentsDifficulty controlling emotions

Issue: Difficulty paying attention – appears uninterested

Issue: Difficulty paying attention – appears uninterested

Move to quiet area with less distractionsShorten length of sessionProvide information in writingAsk employee to repeat informationAsk – “You appear distracted. Is there

some way I can help?”

Move to quiet area with less distractionsShorten length of sessionProvide information in writingAsk employee to repeat informationAsk – “You appear distracted. Is there

some way I can help?”

Concentration:Concentration:

Reduce distractions in the work area

Provide space enclosures or a private office

Allow for use of white noise or environmental sound machines

Allow the employee to play soothing music using a cassette player and headset

Reduce distractions in the work area

Provide space enclosures or a private office

Allow for use of white noise or environmental sound machines

Allow the employee to play soothing music using a cassette player and headset

Concentration: (Cont.)Concentration: (Cont.)

Increase natural lighting or provide full spectrum lighting

Reduce clutter in the employee's work environment

Plan for uninterrupted work timeDivide large assignments into

smaller tasks and stepsRestructure job to include only

essential functions

Increase natural lighting or provide full spectrum lighting

Reduce clutter in the employee's work environment

Plan for uninterrupted work timeDivide large assignments into

smaller tasks and stepsRestructure job to include only

essential functions

White NoiseEnvironmental Sound Machine

Accommodation Ideas for Concentration Deficits

Accommodation Ideas for Concentration Deficits

Panel and Desk Systems

Accommodation Ideas for Concentration Deficits

Issue: Difficulty answering questionsIssue: Difficulty answering questions

Simplify questions – ask one thing at a time Change from open-ended to close-ended

questions Provide choices Provide information in writing Slow down your rate of speech Take time to listen

Simplify questions – ask one thing at a time Change from open-ended to close-ended

questions Provide choices Provide information in writing Slow down your rate of speech Take time to listen

Issue: Difficulty following throughIssue: Difficulty following through

Establish time frames for completing tasks Encourage the use of a notebook or calendar

to set specific deadlines Break down tasks into simple steps Develop a structured routine for the job

search Offer praise for accomplishments

Establish time frames for completing tasks Encourage the use of a notebook or calendar

to set specific deadlines Break down tasks into simple steps Develop a structured routine for the job

search Offer praise for accomplishments

Issue: Difficulty making decisionsIssue: Difficulty making decisions

Encourage the person to “stop and think” Help identify options Write down options Discuss advantages/disadvantages of

each option Role play to prepare for various situations

Encourage the person to “stop and think” Help identify options Write down options Discuss advantages/disadvantages of

each option Role play to prepare for various situations

Issue: Forgetting appointmentsIssue: Forgetting appointments

Make sure employee has an appointment book

Make sure employee writes down appointments

Have employee repeat information verbally

Make sure employee has an appointment book

Make sure employee writes down appointments

Have employee repeat information verbally

Memory: Memory:

Allow the employee to tape record meetings

Provide type written minutes of each meeting

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

Allow the employee to tape record meetings

Provide type written minutes of each meeting

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

Memory: (Cont.)Memory: (Cont.)

Provide written as well as verbal instructions

Allow additional training timeProvide written checklistsProvide environmental cues to assist

in memory for locations of items, such as labels, color coding, or bulletin boards

Post instructions over all frequently used equipment

Provide written as well as verbal instructions

Allow additional training timeProvide written checklistsProvide environmental cues to assist

in memory for locations of items, such as labels, color coding, or bulletin boards

Post instructions over all frequently used equipment

Organization: Organization:

Make daily TO-DO lists and check items off as they are completed

Use several calendars to mark meetings and deadlines

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

Use a watch or pager with timer capability

Use electronic organizers

Make daily TO-DO lists and check items off as they are completed

Use several calendars to mark meetings and deadlines

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

Use a watch or pager with timer capability

Use electronic organizers

Organization: (Cont.)Organization: (Cont.)

Divide large assignments into smaller tasks and steps

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

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

Divide large assignments into smaller tasks and steps

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

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

Problem Solving:Problem Solving:

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 to be available when the employee has questions

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 to be available when the employee has questions

Gross Motor Impairment: Gross Motor Impairment:

Modify the work-site to make it accessible:

Provide parking close to the work-siteProvide an accessible entrance Install automatic door openersProvide an accessible restroom and

break roomProvide an accessible route of travel to

other work areas used by the employee

Modify the work-site to make it accessible:

Provide parking close to the work-siteProvide an accessible entrance Install automatic door openersProvide an accessible restroom and

break roomProvide an accessible route of travel to

other work areas used by the employee

Modify the workstation to make it accessible:

Modify the workstation to make it accessible:

Adjust desk height if wheelchair or scooter is used

Make sure materials and equipment are within reach range

Move workstation close to other work areas, office equipment, and break rooms

Adjust desk height if wheelchair or scooter is used

Make sure materials and equipment are within reach range

Move workstation close to other work areas, office equipment, and break rooms

Issue: Difficulty controlling emotionsIssue: Difficulty controlling emotions

Expect the unexpected Remain a model of calm assurance Take the person to a quiet area and give time

to calm down Provide feedback in a gentle supportive

manner Redirect behavior to a different topic or

activity Use humor in a positive, supportive manner

Expect the unexpected Remain a model of calm assurance Take the person to a quiet area and give time

to calm down Provide feedback in a gentle supportive

manner Redirect behavior to a different topic or

activity Use humor in a positive, supportive manner

Fatigue/Weakness: Fatigue/Weakness:

Reduce or eliminate physical exertion and workplace stress

Schedule periodic rest breaks away from the workstation

Allow a flexible work schedule and flexible use of leave time

Allow work from home Implement ergonomic workstation design Provide a scooter or other mobility aid if

walking cannot be reduced

Reduce or eliminate physical exertion and workplace stress

Schedule periodic rest breaks away from the workstation

Allow a flexible work schedule and flexible use of leave time

Allow work from home Implement ergonomic workstation design Provide a scooter or other mobility aid if

walking cannot be reduced

Work Effectively with Supervisors:

Work Effectively with Supervisors:

Provide positive praise and reinforcement

Provide written job instructions Write clear expectations of

responsibilities and the consequences

Allow for open communication to managers and supervisors

Provide positive praise and reinforcement

Provide written job instructions Write clear expectations of

responsibilities and the consequences

Allow for open communication to managers and supervisors

Work Effectively with Supervisors: (cont.)

Work Effectively with Supervisors: (cont.)

Establish written long term and short term goals

Develop strategies to deal with problems before they arise

Provide written work agreementsDevelop a procedure to evaluate

the effectiveness of the accommodation

Establish written long term and short term goals

Develop strategies to deal with problems before they arise

Provide written work agreementsDevelop a procedure to evaluate

the effectiveness of the accommodation

Stress: Stress:

Provide praise and positive reinforcementRefer to counseling and employee

assistance programsAllow telephone calls during work hours

to doctors and others for needed support Provide sensitivity training to coworkersAllow the employee to take a break to

use stress management techniques to deal with frustration

Provide praise and positive reinforcementRefer to counseling and employee

assistance programsAllow telephone calls during work hours

to doctors and others for needed support Provide sensitivity training to coworkersAllow the employee to take a break to

use stress management techniques to deal with frustration

Attendance Issues: Attendance Issues:

Provide flexible leave for health problems

Provide a self-paced work load and flexible hours

Allow employee to work from home

Provide part-time work schedule

Provide flexible leave for health problems

Provide a self-paced work load and flexible hours

Allow employee to work from home

Provide part-time work schedule

Issues of Change: 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 to ensure an effective transition

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

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 to ensure an effective transition

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

Limitations with:Cognitive Disabilities

Limitations with:Cognitive Disabilities

Person’s intelligence can be average, or above average

Difficulty understanding or using language, whether written or spoken

Imperfect ability to listen, think, speak, write, read, spell, or do mathematical calculations

Person’s intelligence can be average, or above average

Difficulty understanding or using language, whether written or spoken

Imperfect ability to listen, think, speak, write, read, spell, or do mathematical calculations

Person has average to above average intelligenceletter reversalsletter transpositionomission of letters or words, poor spellingillegible handwriting

Person has average to above average intelligenceletter reversalsletter transpositionomission of letters or words, poor spellingillegible handwriting

Spelling AccommodationsSpelling Accommodations

“Talking” Dictionary

ElectronicDictionary

Person has average to above average intelligence

interferes with reading abilities

sees letters or words reversed

sees letters or words transposed

omits letters or words when reading

Person has average to above average intelligence

interferes with reading abilities

sees letters or words reversed

sees letters or words transposed

omits letters or words when reading

Person has average to above average intelligencedifficulty with numbersspatial problemsdifficulty placing numbers into vertical columnsdifficulty performing calculations

Person has average to above average intelligencedifficulty with numbersspatial problemsdifficulty placing numbers into vertical columnsdifficulty performing calculations

Math

Talking Calculators

Math Math

Auto-measure spice rack

Talking Scale

Limitations with: ADD / ADHD

Limitations with: ADD / ADHD

difficulty staying organizeddoesn’t pay attention to detailis forgetful of daily activities

loses thingsis easily distracteddoesn’t seem to listen when spoken to

often interrupts others

difficulty staying organized

doesn’t pay attention to detailis forgetful of daily activities

loses thingsis easily distracted

doesn’t seem to listen when spoken to

often interrupts others

Limitations with: Auditory Processing Limitations with: Auditory Processing

Has difficulty recognizing or interpreting information obtained through the sense of hearing

Phonological awarenessAuditory discriminationAuditory memoryAuditory sequencingAuditory blending

Has difficulty recognizing or interpreting information obtained through the sense of hearing

Phonological awarenessAuditory discriminationAuditory memoryAuditory sequencingAuditory blending

Limitations with: Visual Perception Limitations with: Visual Perception

Has difficulty recognizing or interpreting information obtained through the sense of seeing

Spatial relationVisual discriminationVisual closureObject recognitionWhole/part recognition

Has difficulty recognizing or interpreting information obtained through the sense of seeing

Spatial relationVisual discriminationVisual closureObject recognitionWhole/part recognition

Visual Perception

Indicator Dots

Copy holder

Touch screen

ruler

paperclips

Visual Perception

Vision Impairment:Vision Impairment:

Provide written information in large print

Change fluorescent lights to high intensity, white lights

Increase natural lightingProvide a glare guard for computer

monitorsConsult a vision specialist

particularly

Provide written information in large print

Change fluorescent lights to high intensity, white lights

Increase natural lightingProvide a glare guard for computer

monitorsConsult a vision specialist

particularly

Situations and Solutions:

Accommodations for Employees with Hidden Disabilities

Situations and Solutions:

Accommodations for Employees with Hidden Disabilities

Situation #1

Disability: LD - dyscalculaPosition: Cafeteria worker

Duties: Baking cookiesLimitation: Cannot count

in sets of 12

Situation #1

Disability: LD - dyscalculaPosition: Cafeteria worker

Duties: Baking cookiesLimitation: Cannot count

in sets of 12

Solution #1

Accommodation: Make a 12-cookie template as a counting guide

Effectiveness: Employee always makes 12 cookies when she

fills templateCost: Under $20

Solution #1

Accommodation: Make a 12-cookie template as a counting guide

Effectiveness: Employee always makes 12 cookies when she

fills templateCost: Under $20

Situation #2

Disability: Memory deficitsPosition: Stock person

Duties: Stocking shelvesLimitation: Cannot

remember to wear uniform

Situation #2

Disability: Memory deficitsPosition: Stock person

Duties: Stocking shelvesLimitation: Cannot

remember to wear uniform

Solution #2

Accommodation: Take picture of employee in full

uniform. Allow him to use it as reference when

preparing for work. Effectiveness: Employee can independently get

ready for work.Cost: $0

Solution #2

Accommodation: Take picture of employee in full

uniform. Allow him to use it as reference when

preparing for work. Effectiveness: Employee can independently get

ready for work.Cost: $0

Situation #3

Disability: Sleep ApneaPosition: I.T. personnel

Duties: on-demand tech supportLimitation: falls asleep at desk

Situation #3

Disability: Sleep ApneaPosition: I.T. personnel

Duties: on-demand tech supportLimitation: falls asleep at desk

Solution #3

Accommodation: Use over-ear alarm to alert employee when she

falls asleep. Relocate office so employee is near others.

Effectiveness: Employee stays awake due to various stimuli.

Cost: Under $50

Solution #3

Accommodation: Use over-ear alarm to alert employee when she

falls asleep. Relocate office so employee is near others.

Effectiveness: Employee stays awake due to various stimuli.

Cost: Under $50

Example 1Example 1

Nurse following mild brain injury

Nurse following mild brain injury

Thinking Changes Memory problems

Poor concentration

Easily distracted

Difficulty making simple decisions

Problems with organization

Possible Changes after a Mild Brain Injury

Example 2Example 2

Auto mechanic following mild brain injury

Auto mechanic following mild brain injury

Possible Changes after a Mild Brain Injury

Personality and Behavioral Changes

Lack of motivation

Sad and/or depressed

Anxiety

Irritability

Example 3Example 3

Construction worker following mild brain injury

Construction worker following mild brain injury

BIAORBIAOR

The Brain Injury Association of Oregon is the only state, nonprofit organization dedicated to the mission of creating a better future for people with traumatic brain injury (TBI) and their families through prevention, research, education and advocacy.  

The Brain Injury Association of Oregon is the only state, nonprofit organization dedicated to the mission of creating a better future for people with traumatic brain injury (TBI) and their families through prevention, research, education and advocacy.  

BIAOR MissionBIAOR Mission

Creating a better future through brain injury prevention, research, education, and advocacy.

Creating a better future through brain injury prevention, research, education, and advocacy.

BIAOR VisionBIAOR Vision

A world where all preventable brain injuries are prevented, all unpreventable brain injuries are minimized and all individuals who have experienced brain injury maximize their quality of life.

A world where all preventable brain injuries are prevented, all unpreventable brain injuries are minimized and all individuals who have experienced brain injury maximize their quality of life.

BIAOR ActivitiesBIAOR Activities

serve as a clearinghouse for community resources;

facilitate 34 support groups across the state;

encourage programs to prevent brain injuries;

host education programs and conferences; participate in legislative advocacy.  In Oregon, we offer a helpline at 1-800-

544-5243.

serve as a clearinghouse for community resources;

facilitate 34 support groups across the state;

encourage programs to prevent brain injuries;

host education programs and conferences; participate in legislative advocacy.  In Oregon, we offer a helpline at 1-800-

544-5243.

Brain Injury Association of Oregon

Brain Injury Association of Oregon

PO Box 549Molalla OR 97038

503.740-3155800.544.5243

Fax: 503.961-8730www.biaoregon.org

biaor@biaoregon.org

PO Box 549Molalla OR 97038

503.740-3155800.544.5243

Fax: 503.961-8730www.biaoregon.org

biaor@biaoregon.org