The document discusses a heuristic study on returning to work after experiencing a traumatic brain injury (TBI). The researcher conducted the study to understand their own experience returning to work after a motorcycle accident caused a severe TBI, and to learn from other TBI survivors' experiences. Key findings included: TBI survivors experienced loss of identity from not being able to work, social issues as relationships changed, and economic stress; they wished employers understood that a TBI does not make them dangerous or impaired, and that information processing may take longer. The study provided insights into challenges TBI survivors face in returning to work and recommendations to help support their success.

1. GETTING BACK TO WORK: A
TBI SURVIVOR’S EXPERIENCE
THE LIVED EXPERIENCE OF RETURNING TO WORK AFTER
TRAUMATIC INJURY: A HEURISTIC STUDY
ELIZABETH R. (YORK) HERNANDEZ, PH.D.
HAROLD ABEL SCHOOL OF SOCIAL AND BEHAVIORAL SCIENCES
CAPELLA UNIVERSITY

2. WELCOME
AND THANK YOU
This study is dedicated to those who have
experienced trauma and survived, those
whose struggle to regain normalcy often
goes unnoticed and unknown, often with
injuries that are invisible to the outside
world. Their courageous efforts to continue
to be productive members of the
organizations that employ them inspire and
deserve acknowledgment.

3. Why was this study done?
• The importance of studying traumatic brain injury
• What is the value of work? Why does it matter?
My experience in getting back to was surprising in many ways. It led
me to wonder if my experience was unique. Did other TBI survivors
experience the same things I did, or were their experiences different,
unique to them?
• What happens when we can’t work?
• How can TBI survivors get back to work?

4. About the study:
• Methodology
• Why a heuristic study?
• Participants
• Gathering the data
• Analyzing the data
• Themes and characteristics
• Limitations of the study

5. • My experience getting back to work
• About me
• My accident
• What changed
• Findings:
• What I discovered from my own experiences
• What I learned from other TBI survivors
• What TBI survivors wish others knew

6. • RECOMMENDATIONS:
• For Organizations:
• Training for Human Resources
• Training for managers and supervisors
• Training for employees, coworkers and peers
• For TBI survivors
• For Caregivers, family and friends
• Recommendations for further research
• Conclusion
• Questions and Answers

9. Traumatic brain injury is all too common, affecting 1.7 million people each
year*. TBIs sustained from falls, motor vehicle accidents, domestic abuse,
exposure to IEDs, assaults, and sports injuries can recovery make recovery
challenging. For many, TBI means finding a "new normal".
In 2012, an estimated 2.36 million people were injured in motor vehicle traffic
crashes in the United States, according to the Fatality Analysis Reporting System
(FARS). In the western world, the most common cause of death after trauma is a
severe brain injury. One study by researchers at the European Brain Injury
Consortium (1999) found that 52% of head injuries were related to motor vehicle
accidents (MVAs) and that surviving patients with brain injury are more impaired
than patients with injuries to other parts of the body.
Clearly, anything that happens with such frequency, that affects such a large
portion of the population, warrants investigation.

10. The value of work
Ask any one who has a job why they work, and they are likely to tell you that they work to earn a paycheck, to
pay the bills, to put a roof over their family’s head, food on the table, to be able to buy the things they need to be
happy. But studies have shown that work provides much more than just a paycheck. For most people, work
provides:
• A social structure:
• The majority of our social interaction is with coworkers
• Many meet their best friends, girlfriends, boyfriends, future spouses through work
• We tend to interact socially with those who do the same work we do
• Our identity:
• When asked to describe ourselves, we will often start with our professional identity.
• We identify ourselves by what we do
• our source of intellectual growth:
• Work often encourages us to seek new information, inspires curiosity
• We attend school to learn more about what the work we do, in order to gain skills
• our source of self esteem
• Our work gives us a sense of pride if we are doing well
• Our esteem and personal perspective are bolstered when we receive praise, a raise, a promotion

11. What happens when we can’t work?
So much of selves is connected to our work. When we are injured and can’t work, every
aspect of our lives in affected. Injury can mean:
• Loss of personal identity
• Economic set - backs
• Changes in social structure
• Delays or interruption in learning – school, training, skill building
• Loss of sense of control over one’s life – feelings of helplessness
• Changes in family dynamics – i.e. no longer the breadwinner
These and other changes that happen if we can’t work can lead to anxiety, depression,
and stress. These can often hinder or interfere with recovery.

12. Methodology: The chosen method for this research is Heuristic study. This
method was chosen after considering the existing research on the subject
of returning to work after a traumatic injury.
• About the existing research: An extensive review of the research on
the subject of returning to work after a traumatic injury was
undertaken. It was discovered that while the subject has been
studied extensively, the majority of the existing studies:
• Focused on rehabilitation as related to a particular type of injury
• Were observational: the researcher had not personally
experienced traumatic injury
• Focused on the injured employee, but not the organization or
its culture
About the Study

13. Why a heuristic study?
• Heuristic research is a form of
phenomenological research that
emphasizes the personal experience
and insights of the researcher (Patton
M., 2002). It is designed to understand
the essential meanings of the human
experience (Robson, 2002). The
researcher creates an interpretation of
the data that is unique to them – their
experiences, their individual biases,
values, and interests, their unique
perspectives.
• Heuristic research differs from other
research, in much the same way that
watching a movie about ziplining
through the Grand Canyon differs from
the experience of actually ziplining
through the Grand Canyon.

14. About the participants
15 people came forward to participate in the study. Of these, 8 courageous men and women shared
their stories about traumatic injury. The population included both men and women, ages ranging
from 20s to 70s, and injuries from motor vehicle accidents, sports, falls, and work injuries. These
included:
• A woman in her 70s who had a car accident in the early 90s whose traumatic brain injury
eventually led to her changing jobs;
• A man with 30 years as a successful entrepreneur whose car was rear-ended by a large truck at 60
mph;
• A man in his 20s whose car accident affected his military service and position as an MP;
• A man who experienced multiple sports concussions that still affected his work in his 50s;
• A woman who slipped on the ice and lost consciousness for an unknown amount of time;
• A man who experienced an auditory blast while working as phone tech support;
• A man with 40 years experience riding motorcycles, whose accident affected his marriage and job;
• A woman fell down a steep flight of stairs while working in an industrial environment;
Initially the study was to focus on traumatic injury in general, but heuristic research tends to find its
own path. Over time, the study focused itself on TBI.

15. About the data
Each participant was asked, simply, to tell their story. This was done with as little
interruption as possible, to allow each to talk about those things that were
important to them. It is through this open and unstructured discussion that this
researcher hoped to learn:
• How did the traumatic injury affect each participant’s ability to work?
• What perceptions did each have about interacting with coworkers, supervisors, or
customers?
• How did the participant’s personal perception of themselves change after the
traumatic injury?
• What skills or abilities changed after the injury?
• Did the injury affect the participant’s home life or personal interactions outside of
work?
The information gathered was then organized to see what common themes
emerged.

16. Mindmap of emerging themes

17. Limitations of the study
The subject of returning to work after traumatic injury is a broad and complex one. This
study revealed a great deal of valuable information. However, due to many constraints,
this study did not include:
• Broader range of participants
• Larger population, more participants
• Focus on particular type of injury cause such as sports, falls, work injuries specific
to a particular group
• Veterans, children, seniors, or any other specific group
• Individuals with complex conditions such as C-PTSD, psychological but not physical
trauma, Post Concussive Syndrome
• Secondary trauma or proximal trauma such as caregivers, emergency responders,
disaster witnesses
• Restrictions on time periods

18. About me In a heuristic study, the primary researcher explores their own experience, looking
for insight. Rather than observing or hearing about another’s experiences second hand,
the researcher delves deeply into the experience to see what can be learned. These
personal and intimate insights are then shared to help others understand the subject in a
way that may not be available to them through other means.
To this end, I will tell you who I was before my accident:
• I was the Emergency Preparedness Logistics Manager for Hawaii State Civil Defense,
under contract of Homeland Security/FEMA. I built and guided teams in their disaster
response efforts.
• I was an accomplished artist. My work was exhibited throughout Hawaii, and I won
awards for my work.
• I served as president of the Association of Hawaii Artists, and served on the boards of
several other artist associations
• I gave workshops and seminars for artists, I managed exhibitions, and curated galleries
and shows
• I was an active in Kendo
• I was pursuing my doctorate in Industrial/Organizational Psychology, and just
beginning my dissertation work
• I was a wife and mother, and my husband and I rode motorcycles every weekend.
• I am the mother of two, a son and a daughter, and I am a grandmother.

20. My accident
The morning of July 21, 2011, was
typical for a day in Hawaii – warm,
sunny, with balmy breezes blowing in
from the ocean. I said to my husband,
“Let’s take the Harley up to Hale`iwa
and walk around the art festival.”
Nothing suggested that a few short
hours later, I would be lying on hot
asphalt, drifting in and out of
consciousness, with paramedics
working to put me on a stretcher and
get me into an ambulance. Thus, began
a journey that many others have also
taken – the journey to find normalcy
with a brain that will never be
“normal” again.

21. The motor cycle crash I experienced that day in 2011 resulted in 12 broken
ribs, several broken bones in my hands, skull fracture, and concussion. I laid
unconscious in the hospital for the first five days and was finally released a
week after the crash.
While the broken bones have since healed, the severe traumatic brain
injury (STBI) drastically changed my level of functioning in many areas.
Returning to normal functioning in the area of work has been the most
challenging.

22. What changed
While the physical injuries made life difficult, the greatest challenges came from the
effects of the traumatic brain injury:
• My short term memory disappeared. I was unable to retain even the smallest bits
of information even for short times. I would immediately forget what I read, the
conversation I had just had, what I was doing. This made the research on my
dissertation almost impossible.
• My comprehension suffered I would stare at a page and have no comprehension
of what the words meant. This happened off and on, mostly off. It meant that
writing my dissertation took a very long time.
• My ability to process information was affected. I would either process information
very slowly or not be able to think linearly at all. I could not figure out how to get
to points B, C, and D, from point A.

23. • My balance and coordination was gone. Kendo became arduous, difficult,
laborious.
• I had emotional instability. At times I would laugh uncontrollably, or cry as if my
world was ending, or suddenly feel terrified, but not know why. Things that
never used to bother me made me suddenly angry. All this meant that I never
knew who I was going to be on any given day.
• The crash resulted in Complex PTSD. PTSD symptoms from the crash experience,
the anxiety of not being able to think, and fear of not being able to function.
These symptoms were additionally compounded by the fact that my husband was
also injured in the crash. He has hospitalized for 2 weeks with a broken back,
shattered shoulder, and severe traumatic brain injury. Not only could he not work,
his personality changed completely. I became his sole caregiver for over 6 months.

25. Returning to work after my injury
Returning to work after 3 months was an eye-opening experience. I found I was completely unprepared for what I
encountered:
• Misinformation about TBI: Most people who have never experienced TBI or known someone close to them
with TBI, have little concept about the condition.
• Bias and assumptions: the lack of information prompts people to make assumptions. Some of the common
ones I encountered are:
• The TBI survivor is psychotic. Likely to go “ballistic an any moment” and commit a Xerox shooting.
• TBI is a mental illness.
• The TBI survivor can’t do anything they were able to do before. Their skills are gone.
• The TBI survivor is now regressed to a child-like state of thinking.
• The TBI survivor has lost his moral compass due to the injury. They are likely to steal, lie, cheat, even
become violent and hurt others.
• Lack of resources for TBI survivors, to help them get back to work. The Americans with Disabilities Act requires
employers to make REASONABLE ACCOMMODATIONS for injured workers. Most organizations do not know
how to accommodate a TBI survivor, leaving the TBI survivor responsible for creating their own
accommodations.
• Inadequate Employee Assistance Programs: Most EAPs do not offer enough of or the right kind of counseling,
or therapy.

26. What was gathered from listening to others tell their stories
The participants in this study courageously shared their stories with me. They talked about how their lives
had changed after their accidents. While their stories were all different, they shared some things in
common:
• Loss or change in identity: they all talked about how not being able to work meant they were no longer
who they were before their accidents. One participant, a successful entrepreneur who had started
several small businesses, felt at loose ends because he couldn’t figure out how he was going to survive
if he couldn’t manage his businesses.
• Social issues: they all told about how their TBI changed their relationships with loved ones and friends.
All talked about how family members seemed angry with the TBI survivor for not being the same as
before the accident. Others talked about how friends who didn’t understand the changes, or how to
deal with a TBI survivor just disappeared from their lives. For some, the change is dynamic – going
from leader to someone needing the help of a caregiver – changed their relationships with spouses
and children.

27. • Economic stress: All participants discussed the changes that occurred when they lost
or changed their jobs. Most had difficulty with insurance as many insurers are not
well-trained in the challenges faced by TBI. One participant, a young man in his 20s,
had to move in with his mother because his insurance ran out. This strained his
relationship with his family. His brother resented the fact that he now needed help.
• Fear and anxiety: All participants bravely shared how having a TBI was a frightening,
sometimes terrifying, experience – one that few understand unless they have
experienced it. For many, the fear of not being the same person was overwhelming.
All told about how the cognitive, psychological, emotional, economic, medical, legal
issues resulted in a level of constant anxiety.

28. One more noteworthy thing came out of this study. All participants report
experiencing Posttraumatic Growth.
What is posttraumatic growth? It is positive change experienced as a result of the
struggle with a major life crisis or a traumatic event. This is the idea that human
beings can be changed by their encounters with life challenges, sometimes in
radically positive ways.
All participants report noticeable positive changes after their accidents. These
changes include:
• Discovery of new talents or skills not noticed prior to their accidents
• Increased self esteem from the realization of what they have survived
• Changes in social structure that include deeper, more meaningful, more
connected relationships
• Recognition of resiliency and a new perspective of what is possible
• Changes in priorities and values
• New or different religious convictions

29. TBI Issues that complicate returning to work:
• Memory issues, slower cognitive processing, lost or diminished skills
• Anxiety about performance
• Fear of failure
• Keeping TBI secret
• Denial about scope and complexity of condition
• Grief
• Misinformation about TBI
• Bias and assumptions about TBI survivor’s behavior
• Depression
• Medications
• Lost work time due to doctor visits, PT, OT, legal & administrative issues

30. What TBI survivors wish they could say to the people in the work place:
• Having a TBI does not make me crazy, dangerous, or stupid. Give me a chance to show you this.
• If I seem like I’ve “checked out”, give me a minute. I’ll come back. I’m processing information. It
takes me a little longer than others.
• I’m grieving. I’m trying to accept that who I was before is gone. You may see me going through:
• Denial: My brain wants to believe that I can return to who I was before my accident.
• Anger: It’s not fair what happened to me. I didn’t ask for it. I don’t deserve it. I’m trying to
come to grips with this.
• Bargaining: Sometimes I think that if I just do certain things, try to relearn what is now
missing, try harder, I’ll be able to get back to who I was before my accident.
• Depression: I’m sad that I’ve lost the person I was before. That person is gone. It’s like the
death of a loved one.
• Acceptance: I’m learning that I will never be who I was. I’m learning to like who I am now.

31. • I’m embarrassed and sometimes ashamed that I’m not who I was.
• I’m exhausted. Physically and mentally. Studies show that it takes 40% more
energy to build new neural pathways than is expended doing physical activity.
My brain injury means that parts of my brain are damaged. My brain is building
new pathways to access the information stored in it and I’m learning new skills
or relearning old skills.
• I am still a valuable employee. I just need a little accommodation at times. I’ll
perform my job well given a chance to do so.
• Ask me what accommodations I need. I’ll tell you.

32. Recommendations to help get the valued employee back to work
For organizations:
• Training and coaching for supervisors and managers to help them provide the
accommodations a TBI survivor needs.
• Access to resources to enable supervisors, managers, and human resources
professionals to provide help for TBI survivors
• Awareness training to educate supervisors, managers, HR, and coworkers about TBI,
what to expect when a TB I survivor returns to work
• Work with an I/O Psychologist to develop training programs and workshops
• Consult with an I/O Psychologist to identify at-risk or high-risk employees
• Work with an I/O Psychologist to develop viable Employee Assistance Programs

33. For TBI survivors:
• TBI coaching to provide assistance and support in returning to work
• Training on how and when to discuss their TBI with supervisors, managers
and coworkers
• Training in knowing what accommodations to ask for on how to make the
request
• Training in building coping strategies and communication skills to make
returning to work easier
RECOMMENDATIONS FOR TBI SURVIVORS

34. Questions?

35. Thank you for your consideration and for taking the time to listen to this
presentation. I hope that this has given you a new perspective and perhaps will
inform your interactions with TBI survivors.
If you are interested in reading the full research report, a source is provided in the
hand out. If you would like to receive the report electronically, or would like a copy of
this PowerPoint, please leave your business card or contact me:
Elizabeth R (York) Hernandez, Ph.D.
Industrial/Organizational Consultant
erh@erh-busconsultant.com
Please visit my website at:
Erh-busconsultant.com