Table 2. Post-Injury Challenges and Associated Interventions

Limited access to transportation
 evaluate driving ability
 offer driver's training (rehabilitation program, Department of Motor Vehicles, AARP)
 teach client to use public transportation
 explore other transportation options (family, friends, neighbors and area resources)

Fatigue/sleep problems
 promote sleep hygiene (regular sleep schedule, limit caffeine/exercise before bed)
 manage medications (stimulants and sleep medication)
 participate in sleep study
 adjust work schedule
 create structured breaks
 complete most challenging tasks at times of peak energy level

Slowness and lack of coordination
 explore occupational and physical therapy
 offer fitness training
 encourage sports and recreational activities
 pace activities
 allow adequate time for task completion and transition between tasks
 organize and prepare environment to improve project efficiency
 set realistic timelines for task completion

Slowed reading and writing
 focus on quality versus quantity
 reduce distractions
 allow ample time for task completion
 try dictation
 provide remedial training

Depression
 offer supportive psychotherapy
 manage medications
 enhance support networks
 increase activity level and participation in pleasant activities
 encourage focus on progress
 avoid comparisons to the past
 monitor sources of stress
 encourage individual and family therapy

Low frustration tolerance and irritability
 manage stress and anger
 practice relaxation techniques
 train in social skills, such as assertiveness and conflict resolution
 manage medications 

Feeling misunderstood by others
 develop communication skills
 educate coworkers, employers and family
 offer supportive psychotherapy
 participate in support groups

Vision problems
 conduct a neuro-ophthalmologic evaluation
 prescribe corrective lenses or spectacles
 try vision therapy
 provide large print reading materials
 use a thick pen when writing notes to be read by client
 provide audiotape instructions/reading material
 use appropriate lighting; avoid glare

Attention and concentration problems
 reduce distracters (ear plugs, sit facing wall)
 avoid multi-tasking
 check work
 teach self-coaching to stay on task
 schedule breaks
 before changing tasks, record information about stopping point

Learning and memory deficits
 present multimodal information
 create to-do lists, calendars, memory notebook and other assistive devices
 practice mnemonics, imagery and repetition
 demonstrate tasks
 record and replay information

Trouble following instructions
 improve instructional format (short, simple sentences)
 simplify or reduce variety of tasks
 reduce distractions
 provide instructions in multiple formats

Difficulty making decisions
 structure problem solving
 train in assertiveness
 develop and maintain mentor relationships
 ask client how to approach task prior to beginning

- Jeffrey Kreutzer, PhD, Lee Livingston, PsyD, Laura Taylor, PhD,
and Deborah West, BA