Mild TBI Compensations and Strategies for Successful Work Re-entry and Home Independence

Transcription

1 Mild TBI Compensations and Strategies for Successful Work Re-entry and Home Independence Susan K. Kime, OTR/L Arizona Neuropsychological Society April 5, 2014

2 Objectives Who is appropriate to refer to occupational therapy? Identify common tools and strategies used to compensate for cognitive deficits at home and in the workplace Consideration of other factors that influence successful home independence and return to work after TBI

3 Classic Symptoms Headache Dizziness Irritability/Anger Anxiety/Depression Poor Motivation Memory Disturbance Judgment Problems Pain Poor Attention Decreased Information Processing Easily Fatigued Aggravated by Noise/Light

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5 Home Independence Initiates basic ADL (showering, dressing, grooming) Medications (daily routine to refills) Bill paying financial decision making Appointments Housework Yard work Meal planning & prep Time management Child care

6 Work Re-Entry There are 4 basic work re-entry categories: Working, but experiencing difficulties Return to current job Begin new job Volunteer work

7 Therapist s Role The Therapist is like a Project Manager Lead home independence/work re-entry efforts Communicate effectively with all parties Consultant to patient/family/workplace Must have strong organizational skills Must be Objective Must be Flexible Role Model

8 Is the Patient Ready to Return to Work? Neuropsychological Evaluation Awareness of deficits Stamina physical and cognitive Success with activities of daily living On time for appointments Using any compensatory tools/strategies successfully Completing assignments on time/accurately Aware of errors and initiates correcting Compare daily activities to job duties

9 Other considerations Impact of physical complaints Sleep How are they spending their day (productive)? Level of Anxiety

10 Typical Compensatory Tools Day planners Procedural forms and checklists Wristwatch with an hourly chime/alarm Electronic spell checkers Calculators

11 Common Compensatory Strategies Self talk Slow down accuracy versus speed Double checking work Minimizing Distractions Organizing day and prioritizing tasks Consideration of cognitive fatigue

12 Patient s Work History Time in current position Physical demands Complexity Work hours Old vs. New learning demands

13 Work Re-Entry Process Trial of work activities in the clinic Real work tasks Simulate a work project Return to work script Trial vs. Paid Employment Specific # of hours to be worked Under supervision of therapist Phone call to supervisor to set up a meeting at the workplace

14 Workplace Meeting Including Volunteer Work Therapist brings an agenda and leads the meeting All necessary members must be present Opportunity to make initial assessment of work environment Job demands Pace of work Climate of the company

15 Need to clarify Work hours Workplace Meeting What job duties will patient perform? Who will provide feedback/assist patient if needed? How will productivity be measured? How often will therapist be available on-site? Over what time frame will patient s responsibilities be increased? Flexibility of workplace

16 Workplace Considerations Noise Level Distractions Where does patient perform duties? Organization of work space Personality of supervisor/co-workers Available company resources

17 Observation of Patient Timeliness Speed of work Accuracy Organization Compensations currently used Additional compensations required Amount of supervision required A single observation in the workplace is never enough

18 How Long To Follow? Depends on complexity of the work Need to ensure patient meeting productivity standards for several months (at least) Clinic Visits Worksite Visits Phone calls to patient/supervisor

19 Who to Refer? Level of cognitive complaints Experiencing difficulty managing at home Back to work and experiencing difficulties High level job demands even subtle deficits impact performance

20 Patient Aware of problems and willing to participate Uses compensatory strategies and tools Therapist Manages the work re-entry process Displays an organized approach Facilitates communication Objective and flexible approach Successful Work Re-entry Work Place Willing to adapt Assists in establishing goals Encourages patient s efforts Provides constructive feedback Medical Staff Understands and Promotes Treatment