Are all TBIs the same? What are the symptoms of TBI?

“TBI” is an umbrella term that spans a wide continuum of symptoms and severity. In fact, the large majority (80%) of combat head injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom are mild concussions as opposed to severe, debilitating TBI. Symptoms can include: poor concentration, irritability, fatigue, depression, memory problems, headaches, anxiety, trouble thinking, dizziness, blurry/double vision and sensitivity to bright light. For people with brain injuries, the most rapid recovery occurs in the first six months after the injury, and in milder cases, patients will often be back to normal within three months. When several symptoms persist for three months or longer, the diagnosis of post-concussion syndrome can be considered.

Are TBIs disabilities under the Americans with Disabilities Act?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. Therefore, some people with TBI will meet the criteria for having a disability under the ADA and some will not. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, visit www.eeoc.gov/policy/docs/902cm.html.

Are employees (or applicants) with TBI required to disclose their disability to their employers?

No. Employees need only disclose their disability if/when they need an accommodation to perform the essential functions of the job. Applicants never have to disclose a disability on a job application, or in the job interview, unless they need an accommodation to assist them in the application or interview process.

Can an employer ask an employee with TBI to submit to a medical examination?

Yes, if the need for the medical examination is job-related, consistent with business necessity and conducted after an offer has been made. People with brain injuries (or any disability) do not have to submit to a medical exam, or answer any medical questions until after they have been conditionally offered a job.

Why does employment play such an important role in the recovery of returning service members with TBI?

Employment enables many people with disabilities, including those with TBI, to fully participate in society. For example, employment provides income that is key to individual and family economic health and general well-being, and builds skills for the future. It also provides greater social interaction and connections that can reduce isolation and build social capital. Finally, employment provides a valued social role in our society and helps create a sense of personal efficacy and social integration that contributes to greater life satisfaction. According to the National Council on Disability, people who regain employment following the onset of an injury and/or a disability report higher life satisfaction and better adjustment than do people who are not employed. For these reasons, gainful employment can be one important component in the recovery and rehabilitation of returning service members with TBI.

What challenges might people with TBI encounter in the workplace?

Although recovery from mild brain injuries (concussions) is generally uncomplicated and complete, some individuals continue to experience cognitive or mood difficulties. Most workplace difficulties associated with TBI are related to attention span, short-term memory, and organization. For some, headaches and mental fatigue may persist.

What sorts of jobs are well-suited for people with TBI?

Because the effects of TBI vary widely, there are no occupations that any particular person with TBI is disqualified from pursuing. Individuals with TBI are finding jobs in a variety of settings, including information technology (IT) companies, healthcare facilities, veterans service organizations and government agencies. However, certain characteristics provide the greatest potential for workplace achievement and success:

• Regular daily schedules
• Routine tasks
• Low levels of distracting noise and light
• Regular breaks
• Access to memory aids (such as voice recorders and task checklists)

How can employers help people with TBI do their jobs more effectively?

Though the time period needed for workplace accommodations can often be short, a variety of promising practices can help people with TBI succeed in the workplace. These include the following:

• Schedule-reminders (telephone, pagers, alarm clocks)
• Scheduled rest breaks to prevent stimulus overload and fatigue
• Work task checklists and clipboards
• Tape recorders as memory aids
• Stop watches for time management
• Job coaches who make frequent, scheduled site visits
• Supportive phone calls after work
• Role playing exercises related to the job
• Periodic evaluation forms completed by supervisors and/or job coaches
• Job-site accommodations including adaptive technology
• Job sharing with another employee
• Mentoring by a co-worker or retired worker
• Setting reasonable expectations for task completion
• Limiting multi-tasking
• Scheduling more difficult or challenging tasks at the beginning of the work shift to account for fatigue
• Recognizing accomplishments through positive reinforcement

(Note: Those with mild TBI generally do not need all of these adjustments or accommodations.)

What resources are available to help employers meet the needs of employees with TBI?

The America’s Heroes at Work Web site-www.AmericasHeroesAtWork.gov-features numerous tools and resources to help employers and workforce development professionals understand and address the needs of employees with TBI. The Web site offers additional fact sheets on TBI-related job accommodations, as well as links to the Web sites of other agencies and organizations such as:

• The Brain Injury Association of America
• Computer/Electronic Accommodations Program (CAP)
• The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
• The Defense and Veterans Brain Injury Center
• Employer Support of the Guard and Reserve
• The Job Accommodation Network
• VetSuccess