Academic journal article The Journal of Rehabilitation

Mild Brain Injury: Critical Factors in Vocational Rehabilitation

Academic journal article The Journal of Rehabilitation

Mild Brain Injury: Critical Factors in Vocational Rehabilitation

Article excerpt

The definition of mild brain injury as used in this article is a practical rather than neurological one. It refers to resulting in a transient alteration of consciousness, and a sometimes, but not always, brief hospitalization. The trauma may involve a fall, a blow to the head, or whiplash injury from a motor vehicle accident. Two major groups of injuries, diffuse mild brain injury and focal mild head injury, are considered. Deficits associated with diffuse injuries include: reduced speed and capacity of information processing; difficulties with complex attention; impaired memory and learning; and problems with abstract thinking. Deficits associated with focal injuries are primarily in the areas of learning and memory; planning and organization; attention and concentration; and emotional control. The injuries, however, are not mutually exclusive and may both be present in the same individual (Kay, 1986).

Review of Related Literature

It has been demonstrated that mild brain injury can result in significant changes not only physically, but cognitively as well (Rimel, Giordani, Barth, Ball, & Jane, 1981 and Stuss, Hugenholtz, Richard, LaRochelle, Poirier, & Bell, 1985). In addition, O'Hara (1988) has detailed the psychosocial difficulties associated with adjustment to a mild brain injury. As may be anticipated, deficits in the cognitive, psychosocial, and physical realms significantly impact future vocational success. Despite growing evidence that mild brain injuries comprise a substantial percentage of all brain traumas (Kraus & Nourjah, 1989), little attention has been directed toward the vocational rehabilitation needs of this population.

Recently, Hallauer, Prosser, and Swift (1989) described the importance of the neuropsychological evaluation in providing vocational rehabilitation counselors with a systematic assessment of functional deficits secondary to mild brain injury. Veach and Taylor (1989) outlined the significance of job trials, physical reconditioning, and psychosocial counseling to the vocational success of these individuals. This article will go a step further by outlining a model for delivery of vocational rehabilitation to this population.

Implications of Mild Brain Injury


Physical sequelae secondary to mild brain injury may include: (a) chronic fatigue due to general deconditioning and effortful cognitive processing; (b) impaired balance and coordination; (c) seizure activity; (d) chronic pain; (e) impaired motor skills; and (f) visual difficulties. The impact of impairment in these areas on vocational potential is often significant.

Most troublesome is the effect of chronic fatigue on physical stamina and work tolerances. Work endurance of only three to four hours per day is not uncommon. Many individuals also experience chronic, debilitating head and neck/back pain that contribute to fatigue and impact the ability to work an 8-hour day. Difficulties with balance and coordination may prohibit working at jobs that require climbing, working at unprotected heights, and walking on uneven terrain. Balance problems and seizure activity may impact the individual's ability to move quickly in hazardous situations and to safely operate machinery and/or equipment. Impaired motor skills in the areas of manual and finger dexterity may impact the person's ability to proficiently complete job tasks requiring the use of the hands or fine manipulation. Lastly, blurred and/or double vision may impact the individual's ability to work at occupations which require visual acuity.


Cognitive impairments may manifest in a variety of difficulties both on and off the job. The following list, although not exhaustive, outlines some of the typical problems. Memory deficits may impact the ability to learn new information and remember job tasks. Attention/concentration problems may result in difficulty staying on task due to distractibility; difficulty paying attention to more than one task or aspect of a task simultaneously; and difficulty returning to task after an interuption. …

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