Understanding Hidden Disabilities in the Workplace

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

2. 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

3. Some “hidden disabilities” • ABI/TBI • Epilepsy • AIDS/HIV • Cancer • Heart Conditions • Vision Loss • Hearing Loss • ADD • Sleep Disorders • Migraine Headaches • Chronic Pain • Depression • PTSD • Learning Disabilities All of these can either cause or be a symptom of a brain injury

4. Types of Brain Injury • 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)

5. What are the signs and symptoms of TBI? • There are various levels of TBI, including mild and moderate or severe TBI.

6. 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.

7. 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.

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

9. Injury and Disability Prevalence Rates 400,000 w/ Spinal Cord Injuries 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 5.3 million with TBI disability 7.3 million Americans with mental retardation National organizations’ web sites, 4/2000

10. Brain 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

11. 25% of brain injuries are severe enough to require medical and rehabilitation care following injury

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

13. Mild Brain Injury 75% of all brain injuries are mild

14. Mild Brain Injury •  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

15. Mild Brain Injury Symptoms •  Delayed response to questions or commands •  Disorientation and foggy memory •  Headaches, dizziness or nausea • Slurred speech • Ringing in ears/blurred vision

16. 2/3of people with mild brain injury return to work with few or no problems

17. 1/3 of people with mild brain injury will quit or get fired from their job after injury

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

19. 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

20. 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

21. Some Famous People with Hidden Disabilities Include…

22. George Clooney • Actor, Director • Brain Injury

23. Judy Garland • Singer, actress, entertainer • depression

24. Tom Cruise • Actor and entertainer • Learning Disability

25. Danny Glover • Actor, entertainer, advocate • Epilepsy

26. Lou Ferrigno • Actor • Hearing Impairment

27. Henry Winkler • Actor, director • Learning Disability

28. Marilyn Monroe • Singer, actress, entertainer • depression

29. James Earl Jones • Actor • Speech Impairment

30. Carrie Fisher • Actress • Learning Disability • Depression

31. Edgar Allen Poe • American poet,writer • “The Raven” • “The Fall of the House of Usher” • “The Tell-Tale Heart” • bi-polar disorder

32. Activity Time!What is it like to have a cognitive disability?

33. Disability Simulations Why engage in a disability “simulation?” • Individuals who are not disabled may have difficulty understanding the limitations of a person with a disability • Some individuals have little (or no) real-life experiences relating to people with disabilities

34. 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

35. The Wright Family Story

36. Can you read this sign?

38. Behaviors and Strategies

39. Memory • 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.

40. 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 5 • Ask the person to repeat the steps and encourage him or her to write down the information • Provide examples and ask the person to provide their own examples • Teach the person to ask when he or she doesn’t understand

41. Memory • 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

42. Memory • 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

43. Memory • 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

44. Memory • 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.

45. Initiation • 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.

46. Initiation • 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

47. Initiation • 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

48. Communication Receptive Deficits • Minimize background noise • Slow your rate of speech • Simplify sentence structure for clarity • Pause between sentences or topics to allow for processing • Repeat key words or concepts • Rephrase if needed

49. Fatigue • 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.

50. Activity 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