Roy was diagnosed with Post Concussive Syndrome/Mild Traumatic Brain Injury and his restrictions were his condition caused him to be sensitive to light and sound. There were limited records available at the time of the referral, but I thought my first plan of action was to investigate why return-to-work was not an option with the employer of injury.

I met with Roy and learned the challenges that would lie ahead as the tapping of keys on my laptop during the initial meeting caused him great pain. It was at this time that I and supervisor Adele Doering decided that this would need Extended Occupational Analysis and would take a little longer to obtain the relevant information. Finally, after completing the initial vocational assessment, I advocated with the carrier for a formal vocational evaluation, to assess Roy’s aptitudes and competencies in simulated work situations. After obtaining authorization, I referred Roy to Pam Hollingsworth of Vidant Occupational Health to this effort. The evaluation took approx. 2 days.

After receiving Pam’s report and recommendations, I telephoned the North Carolina Assistive Technology program and inquired if the program would be beneficial for Roy. I contacted the referral source again advocating for assistive devices, all of which were authorized right away. The NC Assistive Technology Evaluator met with Roy (at his home) immediately and conducted a one day interview and one day evaluation and recommended specific noise canceling earplugs and glare shields.

Protocol for the manufacture of earplugs, necessitated that impressions of the ear canal be taken. Roy went to a local hearing center in his area (Avada) and impressions were taken. While there, Avada suggested to Roy that it was “more practical to order the earplugs from them instead from a recommended provider from the Western part of the country.” Subsequently, Roy was fitted for the noise-canceling earplugs (suction increases with sound and decreases without sound). In the interim, Roy was provided several job leads. He applied for a position with a local Rental Property as an Air Filter Changer and got the job!! His pre-injury wage was $8.80 per hour, this position offered $11 per hour to start, but it was only part time. He began work expressing some challenges related to tolerance, as he has been out of work for four years. His duties consisted of driving from location to location changing the air filter in each AC unit. We still had not ordered the glare shields. Independently, I ordered the recommended glare shields, only to learn that Roy did not like them “they make me look like a bug…..I can’t wear these and they are digging into my cheeks.” I therefore met with Roy and we ordered the replacement glare shields together. He received the replacement shields on September 5, 2013. Roy was informed that his Air Filter Changer position is expected to become full time this month.

Vickie Hyman, MS, CRC, LPC

Mr. C is a 44-year-old Hispanic male who was working as a general laborer in landscaping.

He was referred for medical case management after an accident the previous day when a large tree branch fell striking his neck and upper back. He sustained T4 paraplegia and bilateral hemothorax. Major spine surgery was performed to remove fragments from the spinal canal, realign the spine and to fuse T5-10. This resulted in no sensation from mid-chest to his feet, with neurogenic bowel and bladder. Later in the year he was hospitalized for intracerebral bleeding secondary to Lovinox, a blood thinner and blood pressure spikes. On another occasion for H. Pylori gastritis.

After six weeks in a rehab facility with his petite wife by his side, Mr. C was released to go home. They were exemplary students during this training process and I met with them about every 2-3 weeks. They had lived in the US for more than 10 years with a beautiful rural home in Ashe County, NC. They had 2 daughters, 8 and 12 years old at the time. On day of discharge we learned the pharmacy did not have adequate information to fill his prescriptions late in the afternoon. I traveled to meet Mr. C at home, stopping to negotiate with a kind and conscientious pharmacist who provided partial fills for all the necessary medication. About 10 family members were waiting for Mr. C’s arrival at home but we had to stop to perform a catheterization in the car before he could exit the vehicle. A temporary ramp was the sole home modification and luckily the double wide was open inside for wheelchair mobility.

Mr. C and his wife quickly learned to establish a daily routine. They learned about his medications. After several urinary tract infections his condition stabilized and he takes no medication for prevention. Mr. C is nearly independent requiring assistance with his bowel program primarily. He reads, studies the Bible, watches TV and enjoys being outside on a deck around the home. On several occasions he went a little too far on the gravel driveway and was stuck. His wife arrived home from work to assist him with little delay. He made an extra slide board for transfers and a small foot stool to go in front of the toilet. He can drive an Arctic Cat around the property and the car occasionally but he has no drivers’ license. I have been amazed at his adjustment to this life changing event. Mr. C would like to be able to work again but he faces a long list of barriers to accomplish this goal. He does enjoy the simple things and the love of his family.