Published in The Canadian Independent Adjusters Association
Magazine, August 2004
The Benefits of Job Site / Cognitive Demands Analysis
for Acquired Brain Injury Clients
By Jean Turgeon BSc, BHSc (OT), OT(c), OT Reg. (Ont.) Director of Occupational
Therapy, Sibley & Associates Inc.
An important aspect of the rehabilitation plan for acquired brain injury clients (ABI clients)
who have successfully reintegrated into the community is a return to work program (RTW
program). Successfully securing and maintaining employment can result in increased selfesteem, decreased depression and feelings of worthlessness and can facilitate a healthy and
productive future. Unfortunately, the success rate of ABI clients securing employment is
only approximately 20% with the percentage even lower for those who maintain
employment for longer than 1 year.
Research reveals the success rate for community reintegration and return to work for ABI
clients is influenced by a range of factors, including age, gender, culture, date of injury,
length of rehabilitation and pre-ABI function. The obstacles to securing and maintaining
viable employment are usually a combination of physical, cognitive and behavioural issues.
As a result, when assessing which RTW approach best suits your ABI client, it is important
to review models that not only address the physical aspects of employment but also the
cognitive and behavioural aspects. Addressing these issues is imperative in order to identify
potential obstacles and to outline the necessary strategies required to accommodate the client
in the workplace.
The Role of Cognitive Demands Analysis (CDA):
For ABI clients, a CDA plays a distinct and important role in the RTW process. A Job
Site Assessment (JSA) without a CDA addresses only the physical tasks associated with a
specific job and is usually based on observation (i.e. measurements taken with calibrated
tools), interviews, and self-reporting by the client. A CDA compliments traditional JSA
methods by also investigating the cognitive demands of a job. In fact, the CDA ensures
that individuals involved in the client’s care understand what cognitive processes underlie
the physical tasks. A CDA can also help identify the often more complex cognitive
processes involved in job demands related to a team environment.
The JSA/CDA Combination – Ideal for Addressing Employment Obstacles:
As explained above, typically the JSA focuses on the physical demands of the job’s essential
tasks. To compliment the JSA, a CDA should also be conducted to assess the cognitive
demands of the job primarily through subjective reports from the employer/client/coworkers.
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Physical issues are addressed by the JSA:
 Physical deficits vary greatly between ABI clients depending on the
injured area of the brain. For example, physical issues may include:
persistent headache, impaired gross and/or fine motor movement,
photosensitivity and varying degrees of paralysis.
 Seizures and tremors may also impair the client’s ability to perform job
tasks and can be an issue related to safety.
Cognitive issues are addressed by the CDA:
 Cognitive deficits are often major obstacles to successfully retaining
viable employment. Often ABI clients have difficulty processing
information (decreased speed, accuracy & consistency), have a short
attention span, experience language deficits (difficulties expressing
thoughts and understanding instructions) and often have decreased short
and long term memory. For example, it is common for an ABI client to
have difficulty remembering the sequence of tasks and/or an inability to
remember multi-step instructions.
Behavioural issues are addressed by the CDA:
 Behavioural issues for ABI clients that are most often sited as an obstacle
in the workplace are agitation, aggressiveness, irritability, poor
emotional control, apathy (often perceived as laziness), lack of inhibition
(resulting in inappropriate social/sexual behaviours), depression and
withdrawal.
Incorporating the JSA/CDA Combination into the RTW Process:
1) Assess the Worksite Early
The JSA with a CDA should be initiated early in the process while the RTW plans are being
developed. Issues that must be identified and answered are:

Can the client return to his/her previous job? (If so, with or without
accommodation in the workplace?)
OR

Can the client return to work in an alternate job? (If so, with or
without accommodation in the workplace?)
In determining the above, the CDA investigates cognitive aspects of a job such as:

hearing, vision, perception

reading, writing, speech

attention, memory, new learning, information processing, problem
solving

decision making, judgment,

organization/planning

flexibility, reaction time

work pace, deadlines

safety awareness

interpersonal skills/ working alone or as a member of a team
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The results of the JSA/CDA provide the Health Care Professional, as well as everyone else
involved in the rehabilitation plan with a clear understanding of the physical, cognitive,
emotional and behavourial demands of a job in order to compare the client’s cognitive and
physical functioning with the findings outlined by the Neuropsychologist and Medical
Specialist(s). The CDA will determine from a cognitive perspective if the client is capable
of returning to work. Not only is the ABI client’s opportunity to secure a job greatly
improved, but with the introduction of coping strategies, the probability that he/she will be
able to maintain his/her job also significantly increases.
2) Planning the Return to Work Process
Based on the recommendations of the JSA/CDA, there are a number of RTW approaches
the Health Care Professional may chose to incorporate:
Job Matching – matching the interests and abilities of the ABI client with the skills
required for a job.
Supported Employment/On-the-job training – on-the-job training similar to an
apprenticeship where a job coach provides structured job training customized to the
specific job site.
Monitoring (as required) - after the RTW program has been completed, the ABI
client’s progress is monitored and assistance is provided (as needed) in areas where
there are difficulties.
The JSA/CDA Combination provides your ABI Clients with Maximum Opportunity for
Successful Return to Work
Although securing employment for your ABI clients is a very important goal, many
Health Care Professionals agree that the true test of an effective vocational program is not
only whether viable employment is secured – but how long clients are able to keep their
jobs. The comprehensive understanding of your ABI client’s physical and cognitive
abilities provided by the JSA / CDA combination will be beneficial in assisting your ABI
clients with viable and secure employment! Additional information about this topic is
available through Sibley & Associates’ Resource Library and Educational Seminars.
Please contact Angela Veri, Director of Customer Relations at 1.800.363.8900 (Ext. 356).
Sources:
Kreutzer, J.: Return to Work Following Traumatic Brain Injury: Communication Skill
Builders, 3128, 197199, 1994.
Wehman, Grant Revell, Kregel et. al.: Supported Employment: An Alternative Model for
Vocational Rehabilitation of Persons with Severe Neurologic, Psychiatric, or Physical
Disability, Arch Phys Med Rehabil, 72, 101-105, 1991.
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Sander, Kreutzer, Rosenthal, Demonico, Young: A Multicentre Longitudinal Investigation
of Return to Work and Community Integration Following Traumatic Brain Injury, Journal
of Head Trauma Rehabilitation, 11(5), 70-84, 1996.
Additional information about this topic is available through Sibley & Associates’ Resource Library and
Educational Seminars. Please contact Angela Veri, National Director of Customer Relat ions at
1 .800.3 63.8900 (Ext. 356).
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