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Medical Edge Newspaper Column from Mayo Clinic
RE-ENTERING THE COMMUNITY AFTER BRAIN INJURY
DEAR MAYO CLINIC: Can you provide information on the integrating of a traumatic-brain-injured teen into society? I’m thinking of support groups, other kinds of assistance and current research. My friend is high-functioning — he was able to graduate from high school. He just needs a supportive environment in which to excel. — Arkansas
ANSWER: A traumatic brain injury — usually the result of a sudden blow to the head or neck — can vary greatly in its severity and long-term impact, depending on the part of the brain affected and the extent of the damage. Some 1.5 million Americans sustain traumatic brain injuries each year, of which about 75 percent are classified as mild. Yet even minor brain injuries may cause long-term cognitive, sensory, communication or emotional problems.
People with relatively mild brain injuries can experience significant difficulty re-entering the community because their limitations may be subtle and not readily obvious to others, or even to themselves. These effects pose barriers to employment — an important kind of reintegration — because of the interpersonal requirements of most workplaces. The inability to remember a particular request, read nonverbal cues or quickly respond to a question can make the difference between success and failure in a job—unless the environment accommodates the individual worker’s needs.
A critical factor for all forms of support is education: Support mechanisms cannot be put in place if people don’t see the need. And even if the benefit of a particular service is recognized, it has to be deemed worthy of investment. Because brain injuries manifest themselves in individualized ways, support mechanisms should be flexible.
Support groups are an excellent way to connect with others who have experienced brain injury. A variety of online services also exist, and they can provide a connection to resources in your community. The Brain Injury Association of America (www.biausa.org) is a good central source of information on such opportunities, as well as on other matters of importance to patients and their families.
Numerous community-based services — such as vocational training, housing referrals, transportation and instruction in securing financial aid — exist, but few are oriented toward individuals with lasting problems following brain injury. And while virtually any subset of support mechanisms is likely to be needed somewhere and sometime, few communities — especially those in less populated areas — are able to assemble them in a coordinated way. For that reason, patients and their families must often be self-advocates in finding clinical and financial support.
Rehabilitation therapies can help people with cognitive impairment improve their abilities to live and work independently. Options include common-sense ways of doing the best with what one has through accommodating techniques or coping strategies such as paying attention to detail, asking questions and taking regular breaks. Assistive devices — including the low-tech but often highly effective calendar, day-planner or logbook — provide structure and can make a big difference in functional memory and organization.
Several organizations (including the Mayo Clinic) have published guides for the family, employer and others who interact with a brain-injured person. Our own “Understanding Brain Injury: A Guide for Employers” offers specific step-by-step advice to supervisors and co-workers on helping them deal with typical problems such as confusion, difficulty in remembering, and initiating or maintaining a conversation.
Research efforts are also underway to better discern what clinical services are important to supporting recovery after brain injury. Some of our current investigations involve gathering information about the long-term effects of traumatic brain injury, with special focus on underrepresented groups such as women and the elderly. The aim is to learn how people’s lives changed, and what services they felt were most important to them following their injury.
— Allen W. Brown, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.
Additional Resources:
Physical Medicine and Rehabilitation
Traumatic Brain Injury
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
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