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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
Rene Magritte, 'Le-Paysage-de-Baucis' (1966), etching on woven paperMuch of the content here on the TBI blog -- especially lately -- focuses on attention devoted by the media to traumatic brain injuries suffered on the modern battlefield. But veterans' hospitals and medical tents are far from the most likely places where you'll encounter someone suffering from TBI. Indeed, you may have to look no further than the next cubicle, desk, assembly-line station.

That's part of the message of a brief publication put out by the Job Accommodation Network (JAN) at West Virginia University. (124KB PDF version also available.)

Never heard of JAN? From their "About" page (emphasis added):
The Job Accommodation Network is a service of the Office of Disability Employment Policy (ODEP) of the U.S. Department of Labor... JAN's mission is to facilitate the employment and retention of workers with disabilities by providing employers, employment providers, people with disabilities, their family members and other interested parties with information on job accommodations, self-employment and small business opportunities and related subjects. JAN's efforts are in support of the employment, including self-employment and small business ownership, of people with disabilities. JAN represents the most comprehensive resource for job accommodations available. JAN's work has greatly enhanced the job opportunities of people with disabilities by providing information on job accommodations since 1984. In 1991 JAN expanded to provide information on the Americans with Disabilities Act.
Yeah: since 1984. Twenty-three years of something very like invisibility, and darn those big-government bureaucracies anyway. [Sarcasm off.]

The invisibility of JAN parallels the invisibility, for the most part, of brain-injured workers. Someone who's been in an automobile accident or suffered a football or boxing injury may or may not evidence physical symptoms, like scars, broken limbs, and other alterations in their appearance. But there's nothing intrinsically visible about a TBI. From the JAN site:
...There are several different types of TBI (TBI Recovery Center, 2006):

Concussion: A concussion is the most minor and common type of TBI. A concussion is caused when the brain receives a somewhat minor trauma from an impact, such as a hit to the head by an object or person or from a sudden change in momentum, such as a fall. It may or may not result in a short loss of consciousness (not exceeding 20 minutes) and can be diagnosed by observing common symptoms such as headache, confusion, and vomiting. Difficulty with thinking skills (e.g., difficulty "thinking straight," memory problems, poor judgment, poor attention span, a slowed thought processing speed) (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Skull Fracture: A skull fracture occurs when the skull cracks or breaks. A depressed skull fracture occurs when pieces of broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull and injures the brain (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Contusion: A contusion is bruising or bleeding of the brain (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).

Hematoma: A hematoma is a collection of blood inside the body (Brain Injury Association of America, 2006a; TBI Recovery Center, 2006).
With the possible exception of a skull fracture, in other words, everything going "wrong" with a TBI victim is going wrong inside:
...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 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.
Even those TBI symptoms which are observable can be easily dismissed as symptoms of something else: not enough sleep, drunkenness or hangover, a bad chunk of pork in the lunchtime takeout.

Furthermore, the above list scarcely addresses the most potentially debilitating conditions resulting from a TBI:
  • Depression about not being able to get help with your problem.
  • Depression, for that matter, about not being able to describe your problem adequately so help can be obtained in the first place.
  • The misery of knowing that you know something critical to your job function but can't quite put your finger on it, and the guilt and embarrassment that may go along with that failure.
  • Isolation from your co-workers who have no notion of what you're experiencing.
The JAN site's page on TBI-disabled workers is meant to assist supervisors in making accommodations for these employees. That said, it's worth a visit by anyone with an interest in TBI. It's brief, but eye-opening. And -- not to put too fine a point on it -- you won't be able to see anything at all as long as your eyes are closed.

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