Assume fatigue is always an issue.
No matter what else you know about a job seeker with a brain injury, assume that fatigue is always an issue. This is true whether the injury was from trauma, stroke, or other causes. In one of her free videos, brain injury coach Nathalie Kelly explains why fatigue is such a huge problem by borrowing a metaphor describing three types of batteries:
- A Battery—the most efficient battery and the one most people use for their day-to-day activities. It is normally charged after eight hours of sleep.
- B Battery—the “backup” battery that kicks in when the A Battery runs down. It takes longer to recharge this battery.
- C Battery—the “crisis” battery, which is used only after both A and B have been used up. It lasts only a very short period and take days to restore the depleted energy.
Processing sights and sounds can drain the primary battery.
For someone with a brain injury, almost all of the energy from the A Battery has to be used just to process the things they see and hear. They don’t have the usual filters to help them focus only on incoming sights and sounds that are important in the moment; 
consequently, they can be easily overwhelmed by all that is taking place in their environment and expend all their energy. To make matters worse, poor sleep at night is also a common problem, and the inadequate sleep results in the A Battery not fully recharging.
Because the A Battery drains so quickly through sensory overload, the B Battery must fuel everything else that the individual with a TBI does. This includes grocery shopping, driving, figuring out what to wear, and remembering any earlier instructions.
When the B Battery runs out, the C Battery is all that’s left. Unfortunately, when it kicks in, a true crisis is on its way. It takes days to recharge when the C Battery takes over. And yet, it can occur in an instant, even surprising the individual whose brain doesn’t notice warning signs any more.
Avoiding the battery crash can preserve energy.
For that reason, others who do notice signs of fatigue, such as slowed speech or response time, must take quick action before the C Battery kicks in. Remove the person from the situation as quickly as possible and move them into a quiet, dark, and restful place.
Over time, the brain will slowly heal, and the A Battery can be charged for longer and better use. Meanwhile, wearing such things as sunglasses, colored syntonic (therapeutic) glasses, and earplugs or noise-cancelling earmuffs can lower the intensity for individuals with brain injury.
Check out all of Brain Recovery Coach Nathalie Kelly’s Free Video Library explaining a variety of common issues for persons with TBI.
Managing fatigue influences successful employment.
Because of the very problems described above, The Brain Injury Association of America (BIAA) suggests that going back to a previous job must first involve the following considerations with the employer:
- Returning to work gradually; for example, starting at three mornings a week or even working from home for a period of time
- Returning with shorter hours
- Taking more breaks throughout the day
- Returning to a lighter workload
- Taking on a different role
Gordon Johnson of TBI Voices recommends only working in two-hour increments. These may be separated by quiet, restful breaks, or may be all that the employee with a TBI can tolerate at first.
Once you understand the primary issue of chronic fatigue, you can explore workable options for each job seeker with a brain injury; this will help you to concentrate your efforts to determine other accommodations for their specific functional needs.
Resources:
- American Stroke Association
- Brain Injury Association of Indiana
- Brain Recovery Coach
- Brainline
- CardioSmart
- Journal of Vascular and Interventional Neurology
- Shepherd Center
- Stroke Connection
- Synapse
- TBI Voices Accommodating Traumatic Brain Injury at Work video
- The Brain Injury Association of America
- WebMD