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Learning About Hidden Disabilities and the Workplace Presented by: Sherry Stock, ABD, MS, CBIS. 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 - PowerPoint PPT Presentation
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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
PO Box 549Molalla OR 97038
503.740-3155800.544.5243
Fax: 503.961-8730www.biaoregon.org
