Vocational Rehabilitation, Traumatic Brain Injury, and the Power of Networking Rosalind R. Zuger, Margaret Brown, John O’Neill, Robert Stack, and Hannah Amitai, Mount Sinai Medical Center Page 1 of 6

Multimedia

• 
  Mt. Sinai's Dr. Wayne Gordon introduces one mother's powerful story about the importance of accurate diagnosis. Transcript of this video.
• Brain Interrupted: The Story of John's Traumatic Brain Injury
• 
  Listen to BrainLine's exclusive interview with Dr. Nathan Zasler who talks about diagnosis and care post-TBI. Produced by BrainLine.org. Transcript of this video here.
• BrainLine Talks with Dr. Nathan Zasler About Diagnosis and Care After TBI

Overview

Why is this booklet needed?

 In this manual, we have tried to pull together in one place diverse insights into the vocational rehabilita­tion of individuals with TBI. We believe that many resources and innovations can be brought to the complex task of helping people who have experi­enced brain injuries enter or reenter the world of work. We believe that much is to be gained in our sharing ideas that have worked for us. At minimum, the reading of this manual should help all who work in the vocational rehabilitation arena obtain a few more ideas for their tool kit. We most urgently want to ‘sell’ the idea of networking — a sharing of responsibility, a pooling of resources, a gathering-place for problem solving — as an alternative to the vocational rehabilitation worker’s taking too much on his or her own shoulders when trying to help the person with a brain injury define and reach a voca­tional goal.

What is traumatic brain injury (TBI)?

Traumatic brain injury (TBI) refers to damage or destruction of brain tissue due to a blow to the head, such as occurs in an assault, a car accident, a gunshot wound, a fall or the like. The damage associated with the two types of injury that occur (closed head and open head injury) is described below.

In closed head injury, damage occurs because the blow to the person’s head whips it forward and back or from side to side, causing the brain to collide at high velocity with the bony skull in which it is housed. This jarring bruises brain tissue and tears blood vessels, particularly where the inside surface of the skull is rough and uneven; damage occurs at (and sometimes opposite) the point of impact. Thus, specific areas of the brain — most often the frontal and temporal lobes — are damaged because of this harsh shaking/rotating of the gelatinous brain tissue within its jagged casing. This localized damage often can be detected through MRI and CAT scans.

The rapid movement of the brain can also stretch and injure neuronal axons — the long threadlike arms of nerve cells in the brain that link cells to one another and that link various parts of the brain to each other. This diffuse axonal injury interrupts functional communication within and between vari­ous brain regions. However, this type of diffuse damage cannot be detected through currently avail­able imaging technology.

In sum, after a closed head injury, damage can occur either in specific brain areas (due to bruising and bleeding) and/or can be diffused throughout the brain (due to stretched or destroyed axons).

Open head injuries, the second type of TBI, occur when the skull is penetrated, for example by a bullet. Damage following open head injuries usually is focal, not diffuse. The effects on the individual's functioning (see page 2) are likely to be more limited because damage is not spread throughout the brain.

Typically with TBI, loss of consciousness (LOC) occurs — for anywhere from a few minutes to several months. Sometimes LOC does not occur at all, and only a sense of confusion, dizziness or the like signifies the brain’s immediate reaction to trauma.

From TBI-Net, the Mount Sinai Medical Center Department of Rehabilitation Medicine. Used with permission. www.mssm.edu/tbicentral/

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