Understanding TBI: How Brain Injuries Affect Work Performance

0:00:09 - Shane Smith
Hey, I'm Shane here with Mind Matters: Navigating Head injuries and Concussions. I'm here with John, one of the attorneys here at Shane Smith Law who's in our concussion and brain injury group. This is our podcast, Mind Matters, where we talk about all things TBI. Our topic today is brain injuries and how it impacts your career and ability to work, right John?

0:00:27 - John Mobley
Correct. Yeah, Shane. So we wanted to just kind of zero in on this portion of brain injury, since it really affects so many people. Just giving a little bit of background for some of the folks who are just tuning in that don't know the basics. You know, TBI, traumatic brain injury, very, very, very common in slip and falls and motor vehicle accidents, almost up to 40% of all accidents potentially.

0:00:50 - Shane Smith
Wow, I mean and we'll talk about that 40%. You know you're talking about it from the brain injury people. We look at some of the studies where they're saying this happens in 40% of cases. Just people don't always treat for it, they minimize it or it's a a minor TBI that heals itself, but it still happened.

0:01:07 - John Mobley
That's absolutely correct and you know that number we think is vastly underreported, for that exact reason that you mentioned, that sometimes they just aren't even diagnosed and we don't have the the data's in numbers when we don't get the diagnosis.

0:01:20 - Shane Smith
And I know one thing we've talked about in the past when we say just a minor TBI, or it just healed and went away, we talked about the fact that if you've had one concussion and you have another one, the symptoms are much, much worse on almost every single grading scale, aren't they?

0:01:36 - John Mobley
That's correct, and once you have one you actually have a higher likelihood to sustain a later concussion, later concussion and then after that, even more Honestly, why we see a lot of times athletes and quarterbacks you know quarterbacks from the past that have taken a bunch of repeated head trauma we see that they continually get concussed and eventually they get pulled by medical professionals saying you should probably think twice about continuing your career.

0:01:59 - Shane Smith
So there is no just minor, you know, just a concussion that healed. It's a permanent injury.

0:02:04 - John Mobley
It makes you much more susceptible to stuff later on Absolutely Increases your lifetime chances for dementia. A whole host of real nasty things. And even the terminology is a little bit misleading when we see mild TBI. There is nothing mild about a mild TBI. The symptoms and what happens in the neurological deficits are very, very, very serious. That's just the unusual term that they decided to give it.

0:02:28 - Shane Smith
All right. Well, I would agree with you. There's nothing mild about it and it's permanent life changing, which you know. We're talking about returning to work after you've had a traumatic brain injury or TBI, and I think what first comes to people's mind is oh, he has a TBI, has a brain injury, he can't work at all. You know, that's the image. Or, if he is working, he didn't really have a TBI. How do we deal with that issue? I guess Right.

0:02:49 - John Mobley
So you know, with traumatic brain injuries we have a whole huge host of symptoms and the reason is because what area of the brain you injure impacts what symptom you have. You know you can have things like forgetfulness, an inability to stay focused on a task. That's huge in the workplace, right, If you can't stay focused on a task, or inattention, that's tremendously difficult. Memory it's hard to, you know, make it to work and remember those meetings and the appointment you have if you can't remember that you had them in the first place. Same with vision issues. I don't know if anyone at home or watching has ever had a migraine or a headache that is so bad it impacts your vision and causes visual disturbances, but it sure makes looking at a computer screen and being a top-notch employee very difficult.

So these brain injuries present with a lot of symptoms that really make work and work life difficult for a whole lot of people. And because the range of brain injury symptoms is so vast, you're right, Some people can go back to work and see like a minor, you know, impact on their ability to their job If it was less severe. Some people can't go back at all. Some people can't even get medically clear by a doctor to go back to work and they say no. It's like you know, we see a lot with some of our clients that have cdls or operate big trucks. They never get to go back to work and that's probably a good thing that is.

0:04:15 - Shane Smith
Yeah, it is not for every light of it, but obviously you know cdl is huge. During those massive rigs we've seen the damage they can do on both sides of the spectrum, from plaintiffs, attorneys and from victims. What's all the research show? I mean, got a TBI job. Do most of these people ever go back to work? Do most never go to work? What's sort of the spectrum Sure?

0:04:33 - John Mobley
So the studies are. You know it's not a great outlook. The numbers have been put at as high as after one and even two year, marks that you know around 40% of people have returned to work. So it is. It is a very, very serious thing that really impacts people's abilities to do their jobs and that's why it's taken so seriously, especially on our legal end and by our medical doctors as well. And that's a really concerning number when you think about it, because you know some people could be returning back to work but not fulfilling their job duties or maybe getting the promotions or seeing the career advancement that they got or were headed for before the accident.

0:05:12 - Shane Smith
You know, have they looked at all about? And maybe this is where the studies come into place. I can easily see where people have a head injury. They think they're mostly okay and then they go back to work and they don't get fired, but they no longer thrive. You know they, like you say, they don't get the promotions. They don't. They're not who they were before, but on paper they sort of look okay. I mean, is that how they started investigating that more? Are we seeing more of that?

0:05:36 - John Mobley
Absolutely is the answer to that. And what we see is that when we have especially we see it with high performing clients and people that, and victims really, who have experienced a traumatic brain injury, we're thinking like CEOs, huge managers, people that have really big responsibilities in their roles at work, you know, and their jobs may require a tremendous amount of brain power. They may be especially gifted or incredibly smart. So it's hard to say like and see that the TBI in the crash had a huge impact on them, but only people around them would say you know, we definitely see that this person is now struggling in their role, you know, but they were so elevated and so high up and so smart before the accident that's hard to see that you know they're not functioning Okay. So we really have to compare who they were before the accident and who they were after, and that's going to vary with each person. Some people it'll be slightly noticeable and other people it will be very noticeable.

0:06:31 - Shane Smith
So sort of the difference in skill level like they're still doing it now they're struggling Makes me think of athletes who you know when they're. Every sport usually has that age where you're you know the most successful, as then, as you age, you become less successful on the professional side. But, that being said, I could take probably a 70-year-old basketball player who's retired from the NBA and they could just wipe the floor with me because I'm terrible at it, but he's still so far below where he was when he played sports.

0:06:57 - John Mobley
right, that's a great analogy and it's like your favorite football player, soccer player, whatever sport you follow. It's like when they tear an Achilles or come back from an ACL tear. They're just not the same. Yeah, really, it's a perfect analogy for brain injuries whereas they're there, but it's just not that same, you know before the injury or before the accident.

0:07:17 - Shane Smith
Emojo or the X-factor, whatever you want to call it. X-factor, what are sort of the predictors of whether you're going to have a good outcome or a bad outcome?

0:07:25 - John Mobley
Right. So you know the main predictors that will give us some sort of indication that the outcome is probably not going to initially. And they use an ER too to initially assess the degree of the head injury and the person's responsiveness. If we see really bad Glasgow coma scores, it typically is an indicator of long-term poor outcomes. Also, we see if the victim is higher in age they don't bounce back as well.

Young children, babies it's been shown that their brains can heal to a certain degree and bounce back much better, much more pliability to bounce back, than a elderly person who sustains something like this. It can be a downward spiral for an older person at that point. Also, we see lower levels of kind of pre-injury education or lower level occupation. They typically have poor outcomes and that isn't so much based off, like you know, the person themselves and their body, but it's mainly based off their ability to access good, you know treatment, medication, care and basically have the background and education to know where to go to get this help. And you know, I think that's one of the key and education to know where to go to get this help.

0:08:45 - Shane Smith
And you know I think that's one of the key things. You know you talk about blowing lower socioeconomic brackets. I guess that care is more limited. You know they don't have as many options as maybe some other people. I mean, if anybody has any resources for those or knows where people can find good care in these areas, despite or whatever their socioeconomic background, I mean we'd love to see that in the comments. If you can put it down below, it might help some other people out.

You know where they can get the medical care. I know when I knew somebody who had a brain injury we were able to get them. You know the Medicaid and Medicare plans quicker by going to the system and then talking to our local representatives. You know our local state and house representatives. They were able to get them on those state plans and they got much more treatment faster. But I know there's some other groups out there. So if any of our listeners know of any, plug it down below. We're always looking to help our listeners out. Oh, any other big symptoms that are going to say, hey, it's going to be tough to get ahead?

0:09:35 - John Mobley
Well, you're mentioning people to drop some information in the comments as a perfect segue to the next point, which is that you know there's also poor outcomes we see for people when they have less social support and that can be from friends, family, churches, others, people that have those you know support and have that access to either information or help, they tend to thrive and be better. We've had clients where they're big active members in their church and the whole congregation did. Meal drop-offs and deliveries allowed them really to focus on the things that matter during that very important right after the accident healing stage, instead of worrying about how am I going to get fed tonight. You have support there stage. Instead of worrying about how am I going to get fed tonight. You know you have support there someone to get you to the appointment, someone to follow up. Maybe if you can't get your meds, go and help you get your medications. It's a very you know it's. You can't underestimate that.

0:10:29 - Shane Smith
Yeah, oh, I hadn't thought about that. But yeah, I mean, I know lots of churches. Our church would take people you know around a doctor If you couldn't go. They would take people to doctor's visits and bring food and things like that after any major crisis, and I know that's a very common thing for churches to do.

0:10:42 - John Mobley
And the final thing that kind of can predict poor outcomes is any history of substance abuse. Main thing being there is that, first, substance abuse can interact with the brain. We know this now. Even high consumption of alcohol can cause shrinkage in the brain. It's all interrelated. But more importantly, if you have a history of substance abuse it tends to worsen or you become more reliant on that after a brain injury and it can really impact your ability to stay compliant with the treatment when you're a substance abuser. So that's the main reason we see worse outcomes, people with heavy substance abuse is that they just they don't comply, they don't do the therapy, they don't heal like other people.

0:11:24 - Shane Smith
I was going to say double-edged sword, but it's even worse than that. I guess because they had a substance abuse problem, but maybe it was under control, they get a brain injury which somehow worsens it. Plus, they're having more difficulty and issues right, which generally drives people to abuse their substance of choice more. And then, because they're doing that, they're not following the treatment guidelines, which also keeps them from getting better.

0:11:43 - John Mobley
I said that just the whole around situation is just terrible, even another element in that terrible vicious cycle is that when you injure your brain you can actually have a reduction in impulse control. So those days where you said, you know, not, today, I'm not going to partake If you have a reduction in impulse control. So those days where you said, you know, not, today, I'm not gonna partake. If you have a substance abuse problem that may be gone after a head injury, it might just be up consumption, consumption, consumption. Whatever your vice was your brain because it was injured. We see that all the time with clients that all of a sudden family members will be like you know, they used to bite their tongue, now it's like they're just saying whatever about anything. In any social situation that's one of the prime symptoms we see.

0:12:19 - Shane Smith
I had not thought about the fact that it destroys your impulse control, which is going to then impact your substance abuse issue. That's really awful, actually. So we talked about the things that are going to project a worse outcome or less likely to have a good outcome. What are some of the other issues they struggle with? Getting to doctors work? How does work usually treat these issues? Some of the other issues they struggle with Getting the doctors work. How does work usually treat these issues?

0:12:39 - John Mobley
You know some of the other hurdles that we see that people need to be prepared and aware of if they've sustained a brain injury. Have a family member that sustained a brain injury is, you know, a key thing just being something as simple as transportation. So how am I going to get to work? And the reason is is because when you have a brain injury, what does it affect? It can cause vertigo, dizziness, vision issues things you don't want to hear when someone's operating a 4,000 pound vehicle, right, so you know that's where that support structure comes in, or a you know, some sort of setup to access public transportation, or a friendly co-worker that can ride share with you. These are the creative solutions that, unfortunately, these victims have to seek out and I could see public transportation.

0:13:21 - Shane Smith
Depending on where you live and how complex that route would be, that could be difficult also because I know, like in Atlanta, some places if you're not on the MARTA line itself to get on a bus, you might have to change buses, get on another bus, then get on a train. Swap trains, get on another bus, then get on a train, swap trains, get on another. You know what I mean. I can see that alone being difficult and confusing for anybody, but certainly somebody who has memory issues or there's higher functions of damage. So they're not at their best.

0:13:47 - John Mobley
That's right, Even if it's accessible, like if you live in a rural area, which it's usually not. Once you even have access to it, it may be difficult. Like you said, you should navigate it.

0:13:56 - Shane Smith
Any support out there to help people get back to work? I guess what do we have for that? Yeah, so how would they seek help?

0:14:09 - John Mobley
Absolutely Well. One thing, too, is that you know, having a conversation sometimes with your employer about any sort of accommodations that need to occur, like, obviously, if someone is having issues with transportation due to their TBI symptoms, maybe a hybrid or remote work setup might make sense. You know, there's just like various little examples that may increase that person's not only returning to work but staying employable, which is the second half of the issue is. Step one is getting you back to work, to where you can even work, and step two is maintaining your job, because all these things can add up and be difficult and decrease your ability to be a productive employee. We also encourage people if they are trying to get back into the job sector with a very serious TBI is you really owe it to yourself or to a family member to engage and consult with what's called a vocational rehabilitation counselor or expert?

These are people that their sole job is to kind of review and look at what sort of injuries and symptoms you've sustained and then figure out what it's going to take for you to work, determine A can you even go back to your job If you can, what needs to be changed at your job so that you are set up for success and it can help you, help the person get those questions answered that they might not even know how to engage with a job or an employer, to basically be like look, this is all I need. I just need you to send me an outline of what I need to do today, because I can't remember things, but that's my only issue so.

0:15:32 - Shane Smith
But this is not the neurologist who's treating you. No, this is a totally separate person who's familiar with types of jobs and the duties associated with it. So your neurologist is going to say here's everything that's going on, here's what the symptoms are and stuff, and they're going to take it to this secondary person and you're going to have to tell them about your job, or they're going to research it and then they're going to help you. Have a plan sort of.

0:15:54 - John Mobley
That's it. That's exactly it. The neurologist is going to get the medical diagnoses and go through the symptoms, and this person is more equipped to understand the interaction between the diagnosis and then the job accommodations and what you can and can't do.

0:16:10 - Shane Smith
And are these people, are they good for-- I mean this, everybody who's trying to get back to work, who's got strong symptoms.

0:16:14 - John Mobley
They need to go through somebody like this yeah, typically for people that have had moderate brain injuries and above, it would not hurt to consult a vocational rehabilitation expert or counselor, simply because it could make your life so much easier. Now, that's not to say you can't do it on your own, but this is not necessarily a thing. If it's not your area, that you want to just kind of you know wing it.

0:16:38 - Shane Smith
I know this is a tough question. I mean most neurologists pushing clients to go through this vocab know this rehab person to to do it, or most of them like hey sort of I mean and obviously you have good neurologists or patient advocate, neurologist versus non-patient advocate colleges, but is it totally common for them or is it something clients need to be thinking about and family members need to be thinking about, I guess?

0:16:59 - John Mobley
Client and family members need to be thinking about it and if their neurologist hasn't already recommended it, they need to push for it or have the discussion. We see a lot with neurologists that we occasionally work with that are really good. They're almost always recommending this on serious cases. It's not every case, like for minor concussions or some of the lower end TBIs, but for the more serious ones they're absolutely making that recommendation.

0:17:25 - Shane Smith
John, we've talked about saying you're a vocational rehabilitation specialist and stuff. What are people who've lost their job or they didn't have a job. How do they need to incorporate this part into the job search? What happens there when they incorporate it in? Yeah, I mean so. Do they need to tell a new boss what's going on? Or how do they even bring up the conversation of hey, these are my accommodations.

0:17:45 - John Mobley
Yeah, so that's a conversation that it's honestly better to have on the front end, so that everyone's expectations are clear as to what the employee can or can't do and the employer is even aware, so that they know the extent of the injuries, what the symptoms are and what sort of tools they need to now be given in order to be successful. And that is a thing that can be helped with the vocational rehab expert. You know having those hard conversations, but they are truly necessary conversations, especially because you know if you have these symptoms and your employer is not aware, then it can really impact your ability to maintain that job long-term.

0:18:22 - Shane Smith
So what are some accommodations we would sort of have? What would happen?

0:18:26 - John Mobley
Yeah, so just small things. You know if there was someone that had struck the part of the brain that controlled memory and now you know they're otherwise highly the same, high functioning person but the memory is gone. It may be something as simple. As you know, they receive a special report in the morning or outline of what tasks need to be done sent to them. So it's not always these like crazy complex, expensive things. Sometimes it can be very basic things that you know it can be outside of the norm of your jobs or your employers, kind of typical systems and what they do. But you know, if you have an understanding employer, it certainly helps if they're going to be employing you, to have these things so that you can succeed.

0:19:07 - Shane Smith
So let's say we have a receptionist and you know she's at work, she's having issues with motor skills and she's having trouble taking phone messages. What would sort of be an accommodation related to that?

0:19:17 - John Mobley
Yeah, so like a receptionist that was having issues taking notes because you know motor skills have been reduced, you you know accommodations could be something like voice assisted notation software, things that make it easier. I mean, these are simple fixes. They might cost a small amount of money, but it might be crucial for someone that now has a brain injury defect that they get this sort of accommodation to make their job successful like the old dragon dragon speaking software.

0:19:44 - Shane Smith
I mean, yeah, you know, he's a child my age, but that right.

0:19:47 - John Mobley
Exactly the talk to text. It's so common now.

0:19:50 - Shane Smith
But back in the day it wasn't, it wasn't-- okay. I mean, let's just say you were like a file clerk. You suffered that injury where you know you get angry fast, or you at least appear angry. That's how you take, right? You're angry. I can see where that's going to create huge issues, right? No boss likes to be yelled at by their employee right.

0:20:07 - John Mobley
What do they do there? Sometimes it may be for something like that. You know a system of like check-ins and evaluations because a lot of times, shane, these brain injury survivors aren't completely aware of what they're doing, so it has to be spelled out for them. You know, when we see a lot of our clients lose their temper, can't control emotions, you know being patient as an employer and checking in with them and having kind of evaluation sessions to say is this going well? Is this, is there something we need to do to tweak things, to improve things? These are all small but very important potential changes that can help for long-term success.

0:20:45 - Shane Smith
If somebody suffered a brain injury serious one, who's going to be on this team that's going to help them get back to work? What's their winning team look like?

0:20:53 - John Mobley
First and foremost it's going to be healthcare providers, so the doctors that they see, the specialists I mean the quarterback on any major brain injury case is going to be the neurologist who's kind of dictating everything else what sort of treatments need to occur, monitoring medication, beyond that very important vocational rehab expert or counselor that we kind of talked about in depth in terms of your success at getting back to your job, staying at your job and continuing to be able to earn.

And then you know, believe it or not, us, your lawyer, we know a lot of these doctors. We know we see these cases all the time. We know when you know treatment has completely gone off the rails or is just not occurring whatsoever. You know, and sometimes it's not always these doctors fault, sometimes it's that the brain injury is so bad that and maybe a person with that brain injury doesn't have a family member that can go to all the visits with them they're not accurately telling their primary care that all their symptoms because they don't know how to relay that information because their brain injury is so bad. So you know you need to have this discussion with your doctor and just say these are my symptoms.

0:21:57 - Shane Smith
Tell them, not us, and we've seen that before. I mean, one of our protocols sometimes, in TBI case in particular, is to ask the person, but also ask the family member they spend the most time with, because we found that the answers differ Not all the time but a lot of times. So yeah, I mean the lawyer when we're talking to neurologists too. You know I'm a firm believer all neurologists are super smart. But I want a neurologist who works on concussions, you know, or TBIs, a lot of times. Some neurologists do other things. Some, you know, work on a few TBIs, but not a lot.

I want the guy or gal who this is what they do all day long and is most familiar with TBIs and concussions, because they're going to be best equipped to deal with this. Because I got to talk to one doc and he dealt with a lot of TBIs. So when the client got mad and yelled at him in his face, he just took it like that's just part of the day, you know, kind of. But I've talked to another doc who fired a client because he yelled at him and I'm like dude, you know, he's got a TBI Right, you know. So I always want the TBI specialist or doc who does a bunch of those or concussions. If I can pick my doctor, anybody else we know. On the team we've got the health care professionals the neurologist, who's the concussion expert, vocational rehab professional, the lawyer who else?

0:23:06 - John Mobley
Any family friends, like we discussed, that can provide support, but also and since we're talking about returning to work the help and support from employers and any coworkers that can assist with some of the things we went over, like simplest transportation, ride shares to work, accommodations in your job, even support if you see someone who's a victim of a TBI struggling. These are very difficult things, so it can be a positive thing, though, too, to end on a positive note. I mean, when you give people the tools that they need to succeed, they can have great long-term outcomes.

0:23:41 - Shane Smith
Yeah, I mean I was Texas Beach, that's easy right.

I mean it would make a huge difference if that person aren't posting notes everywhere or an outline to work. So all right, John, thanks for being on the show today. We appreciate it. If you've got a question or you've got some of those support groups, plug them down below, especially on helping clients get healthcare and medical care. Those resources, we'd love to see them in the comments. If you like Mind Matters, hit like and subscribe and hit the bell for notifications and if you've got a question for John, you can send it to info@shanesmithlaw.com. And remember if you're in pain, call Shane 980-999-9999.