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REHABILITATION

                Many suffering neuropsychological damage are assessed in the vicinity of being able to cope with perhaps only one or a few hours work per day.  Comments such as: “attempts to return to employment will be unsuccessful if she/he is pressured to return to work too quickly, placed into inappropriate settings, or fatigue levels exacerbating cognitive difficulties are not recognised and taken into account” abound.  Pressure should not be put on these people to undergo rehabilitation  or find a new job earlier than they can manage.  A return to their previous jobs is generally out of the question as exposure to even the slightest trace of chemicals can induce symptoms and further brain damage.  “The weight of evidence point[s] strongly to the conclusion that exposure to solvents over many years can leave workers permanently disabled by impaired memory concentration and mental function, and ... the risk of neurotoxic effects increases as the level of cumulative exposure increases."[1]

Employers and compensation authorities who force people to return to an unsafe-for-them work environment which further damages their health may be liable.  People with past exposure to volatile chemicals have an internal exposure source stored in body fat that can be released gradually into the blood.  Factors that mobilize body fat stores - such as weight loss, exercise - can increase chemical release into the blood. This body burden can aggravate illness in chemically compromised people.  Hard  physical/manual work is usually ruled out[2] because of this and the fatigue factor.

                Finding  “safe”  alternative employment is a huge problem.  On the other hand some people who have worked hard to find alternative work to make themselves useful to society,  upon showing their employers their neuropsychological reports, are faced with such decisions as:  “It is with reluctance that in the light of the report of  31st December 1998 from  [your neuropsychologist], that we are unable to continue your employment as a Teacher Aide.  The safety of yourself and the [autistic] student you are working with is our prime concern.... we feel it is in your best interest to cease working with the student.”  Concerns with OSH were similarly quoted by  IHC   (Peter Lenz,  <lenz@xtra.co.nz> ).

This is also a further and extremely serious issue for nurses and radiographers involved in the safety/care/ treatment/diagnosis of patients.  Under the NZ Nurses’ Act 1977,  it is mandatory to notify the Health and Disability Committee of a mental or physical disability.  A nurse may be suspended if it is in the public interest to prevent him/her practising or they may be permitted to work under “restricted practice”.  “The committee sees its role as ensuring the safety of the public.”

                “TREATMENT OF PATIENTS EXPOSED TO TOXIC CHEMICALS”.  Kevin Arnold.  The Ohio Psychologist. March 1997.  [Paper available CIIN,  0219-ARNO-97-005].   An excellent article which covers the specific areas of damage - multiple task and simultaneous processing, and certain forms of memory dysfunction which result in disruptions to word recall during verbal expression; headaches, pain, weakness, and fatigue.  CT scans may not clearly show the disorder - PET or SPECT evaluations will help identify localised damage.  The importance of treating the emotional results which often mimic Post Traumatic Stress Disorder (PTSD), and additional emotional problems eg depressive-like symptoms, panic and worry.  Necessity of the psychologist, patient and family understanding the impact of toxins on on the CNS and - the physical aftermath as well as the shattering of the basic assumptions upon which one lives one’s life.  Treatment must combine physical medicine, neuropsychological rehab and psychotherapy.  Importance of all having up-to-date information.  Interventions  can range from development of behaviours to over come poor organisation to working on improvement of memory functions.  Importance of creating reasonable expectations.  Extra effort will be required to help patient complete out-of-therapy exercises.  eg enlisting family, writing out notes and taping sessions....

                Dorothy Gronwall reports a pilot study in Sweden of a rehabilitation programme for the effects of 10 yrs exposure to neurotoxins was positive.  Subjects had no exposure in the 3 months before the study.  Patients took part in group sessions with 4-7 people in each group, and were taken through cognitive rehabilitation and group therapy  sessions.  Neurophysiological measures assessed the effects and patients and families were given questionnaires .  Positive results were found with each type of measure.  The authors conclude the aim should be to improve the patient’s adaptation to the brain dysfunction and the secondary consequences,  and the patient’s self-confidence, self-conception, and everyday functioning. [3]

                One SNFTAAS member who failed in the High Court v ACC to achieve compensation for MCS from her exposure to photographic chemicals while working for a daily newspaper,  has been working as a postie for 3 years.  She says the almost daily requirement to sort mail and put the letters in the right box has almost completely restored her brain function.  As long as she keeps away from chemical exposures her health is not too bad. 

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