Serving Customers who have a Brain Injury

Possible Symptoms

*Physical: slurred speech, paralysis, fiddling, insomnia or other sleep problems, aggression and violence, impulsivity, disinhibition, acting out, inappropriate sexual activity, and alcohol or drug abuse or addiction.  Usually show a string of short-term jobs after the injury.

*Cognitive: difficulty reading and writing, incompletion of forms or tasks without knowing it (such as leaving blanks), noncompliance,difficulty storing or retrieving information, difficulty making decisions, inability to process multiple information (man crossing a street cannot focus on the walk sign, traffic and when to walk at the same time and may walk out in front of traffic without knowing it), easily distracted, no sense of time, lack of concentration, cannot multi-task, difficulty organizing or sequencing, and loss of memory.

*Emotional: depression, apathy, anxiety, irritability, anger and frustration (cannot understand why he or she cannot do what they did before), paranoia, confusion, agitation, mood swings, social inappropriateness, emotional outbursts, childish behavior, impaired self-control, impaired self-awareness, inability to take responsibility or accept criticism, and egocentrism.

Possible Accommodations

Ask what works best for them (issues will depend on which part of the brain was effected)

• Meet them in a private room
• Keep tasks and schedules simple
• Minimize distractions
• Provide step-by-step instructions in writing
• Tell them when they are acting inappropriately
• Be flexible and patient
• Ask them to write in a daily planner
• Help them to keep everything in one notebook with well designed labels
• Write everything down that you need them to remember
• Have the customer repeat what you said or explained and what they need to do
• If possible, give them a reminder phone call the day before and the morning of an appointment
• Use the”tell, show me, let me do it and tell me how I did” strategy
• Let them do things as many times as they need to get it
• Ask open ended questions in order to get as much information from them as possible
• Use a variety of memory aids such as color-coding, labeling, timers/clocks, etc.
• Remember that communication is the key!
• If you would like further advice on serving customers who have brain injuries, please call the Office of Vocational Rehabilitation at (503) 378-3587 or (503) 378-2483.

Updated April, 2007 by Sheila Johnson, Disability Program Navigator.