An acquired brain injury

An acquired brain injury (or ABI) is an umbrella term for all injuries to the brain that occur at the earliest six months after birth.

🚧Challenges:

• a brain injury can have several causes and often disrupts the course of one's life. Because of that disruption, a person's life has changed and there is a time before and a time after the brain injury.
• the term 'acquired brain injury' refers only to the cause, and says little about the nature and severity of the consequences.

A brain injury can

• be the result of an external cause, such as a traffic accident or a fall down the stairs. This is called a traumatic brain injury.
• also occur because something goes wrong inside the brain, for example a blood vessel ruptures or a clot gets stuck in the brain's bloodstream (causing a stroke). This is called a non-traumatic brain injury.

The impact of the brain injury can be broad, people may have challenges at different levels, e.g. at the level of

• functioning, e.g. someone may suffer a loss of strength in the limbs or experience difficulties swallowing.
• activities, e.g. someone may have communication difficulties or the brain injury may affect their mobility.
• participation, e.g. it might be hard(er) for someone to combine different roles (such as employer, partner and friend) or it might be hard(er) to combine work activities with other live domains (such as home and hobby).
• external factors, e.g. added value of stimulus-low working space or supportive relatives.
• personal factors, e.g. how to cope with the challenges.

No.

Just as every person is different, every brain injury is different and therefore the consequences of each brain injury are also different.

Depending on

• the severity, location and extent of the brain injury, the consequences will differ for everyone (from mild to very severe). Moreover, not every person faces all the consequences.
  •  For example, one might be in a wheelchair and communicate fluently, while another person with brain injury can walk independently and needs more time to perform certain tasks.
• personal factors, such as, age, the consequences can have a different impact.
  • For example, the impact of a brain injury is different for a young person with young children compared to an older person who has a partner that needs care.
• the employment, meaning the task demands and working environment, the consequences can have a different impact.
  • For example, it can be easier for someone to fulfil routine tasks compared to performing new tasks under time pressure.

🚧Challenge: often, people with a brain injury may have difficulty coming to terms with change.

💪Opportunity: they need time and repetition to master (new) tasks.

• They can use tools to compensate for the consequences, such as,
  • using a paper diary or a calender in their mobile phone to make sure they arrive at an appointment on time.
  • using checklists or post-it notes to make sure they do not forget any tasks.
  • putting things in a fixed place to make sure they find their way smoothly. 

🚧Challenge: it may be difficult to realise exactly what the consequences are:

• What is going well?
• What could they do better or differently?

💪Opportunity: be open to feedback or support the person if they can't figure it out themselves.

🚧Certain challenges commonly faced by individuals with brain injuries include:

• Processing Loss:
  • Accepting and managing tasks that are now more challenging post-injury.
  • Adjusting to a new way of life, requiring time for both the individual and their immediate environment.

• Inconsistent Performance:
  • Functioning differently in various settings.
  • Excelling in structured environments but struggling in chaotic ones.
  • Collaboratively reviewing working conditions and tasks to identify effective strategies and tools.

• Difficulty in Taking Control:
  • Encouraging autonomy where possible.
  • Providing support when needed.
  • Assisting when necessary, always respecting the individual's capabilities.

• Challenges in Understanding Behavior:
  • Occasional inappropriate behavior, such as sharing personal details with strangers.
  • Difficulty empathizing with others' perspectives or adapting behaviors to suit different situations.

• Need for Additional Time and Repetition to Learn New Tasks.

💪Opportunity: Utilizing Tools and Strategies:

• Employing tools like agendas for task organization.
• Using checklists or post-it notes to aid memory.
• Establishing consistent routines or designated spaces for improved focus and organization.

There is no ready-made answer to this question.

• Immediatly after a brain injury occurs, there is the acute phase: the person's medical condition is not yet stable and the focus is on survival.
• This is followed by the rehabilitation phase. The person's medical condition is stable and they may start rehabilitation.
• Once the person is no longer undergoing rehabilitation and little improvement can be expected, we speak of the chronic or long-term phase.

Most progress occurs in the first few months after the brain injury. Two years post-onset, gradual, less noticeable progress is still possible. The significant progress the person achieves in the beginning and the slower progress later on are both valuable for the person.

With consent of the individual with a brain injury, reaching out to various professionals with distinct expertise can be beneficial.

Collaboratively, these professionals can provide support and devise a tailored programme suited to the individual's needs.

Consider both strengths and remaining capabilities when reintegrating someone after a brain injury, while also being mindful of potential challenges.

🤝Here are key individuals involved in the reintegration process:

• Treating Doctor/Team from Hospital or Rehabilitation Center:
  • Review any resignation letters provided by the individual to gain insights into their work options.
  • Consult the treating physician/team for expert advice on sustainable work practices post-brain injury.

• Advisory Doctor and Back-to-Work Coordinator from Health Insurance Fund:
  • The advisory doctor evaluates disability, provides guidance during incapacity for work, and supports the individual through the reintegration process.
  • The back-to-work coordinator assists in finding suitable work reintegration solutions.

• Occupational Physician (or Prevention Advisor-Occupational Physician for Employees):
  • Determines the individual's suitability for specific roles.
  • Discusses occupational reintegration options with the individual and provides health-related advice for the workplace.

Brain injuries can vary in severity, ranging from mild to severe, resulting in both visible and invisible consequences.

🚧Challenge: Individuals with mild brain injuries and only invisible consequences may not immediately exhibit obvious difficulties in functioning.

As a mediator, it is essential to be attentive to potential signals.

This vigilance aims to understand the individual's resilience and identify the necessary support for progressing towards sustainable employment.

🔀Indicators that may suggest a brain injury:

• Mental fatigue
• Sensitivity to stimuli
• Communication challenges
• Slower thinking
• Difficulty sustaining attention on tasks for extended periods
• Trouble recalling tasks/names
• Confusion
• Issues with planning and organizing tasks
• Altered emotional responses or rigidity in certain situations
• Increased time needed to learn new information
• Disruption in automatic task performance
• Visual difficulties requiring additional effort for compensation.

No, not really.
 

🚧Challenge: every brain injury is different; every person is different and every impact on communication is different.
 

💪Opportunity: adapt your communication to the person's needs. If the person has difficulty understanding verbal language or expressing themselves, the following communication tips can help:

• Don't talk about the person, but to the person.
• Opt for a quiet environment: choose a quiet and calm room and talk 1-on-1. If necessary, have a friend or family member join in, someone who knows the person well and can give communication tips or offer support.
• Support what you say with gestures, pointing, drawing or written words.
• Structure what you say: speak in short sentences, avoid complicated terms, write down the most important points.
• Check that you are in agreement: maintain eye contact and regularly check that you are understanding each other correctly. For example, you can ask the person to summarise the information.

Not in all cases.

A potential consequence of a brain injury is a reduced awareness or insight into the condition.

🚧Challenge: Individuals with brain injuries may exhibit varying levels of self-awareness, with some tending to overestimate their abilities while others underestimate them.

For instance, individuals with limited insight into their condition may:

• Downplay the challenges they face.
• Overstate their capabilities.
• Avoid discussing difficulties.
• Lack a clear understanding of their strengths and weaknesses.
• Demonstrate reduced motivation in confronting challenges.
• Struggle to establish personal boundaries.

💼 Helpful resources: Various tools are available to assess the individual's accurate perception of their capabilities and limitations.

• An example of such a tool is the Self-Awareness in Daily Life (SADL-3: Prinsen et al., 2016), which categorizes individuals into three types:
  • The passerby, who may not perceive personal challenges despite others noticing them.
  • The seeker, who may have limited awareness of their own challenges.
  • The customer, who recognizes challenges, can articulate them as requests for assistance, and collaborates on finding solutions.

💡Tip: Recognize that impaired insight into the consequences of a brain injury is a result of the injury itself and not a deliberate choice by the individual.

💪Strategy:

• Enhance the individual's awareness of their condition by engaging with experienced peers, such as those in recovery or back at work. Targeted feedback from healthcare professionals can aid in managing cognitive, physical, and emotional effects:
• Determine who provides feedback.
• Establish how and when feedback is given.
• Allow the individual to attempt tasks with minimal risk to assess successes and challenges.
• Provide positive reinforcement for achievements.
• Collaboratively evaluate outcomes afterward.
• With consent, involve the employer in evaluating the individual's performance, focusing on work pace and task independence.
• Offer specific areas for improvement to the employer for assessment.
• Note: Employers may provide more candid feedback when discussed separately.
• Encourage rest when fatigue is evident, as individuals with brain injuries may tend to overestimate their capabilities.
• Work together to understand the individual's workload, considering both work and personal responsibilities.
• Listen to both the individual's perspective and that of a loved one to compare viewpoints and find a balanced approach between work and other activities.