Understanding hidden disabilities (Case study)

Tanir is a new patient checking in at the neurology clinic for a follow-up appointment after experiencing a concussion. Alina, the receptionist, notices Tanir is wearing a sunflower lanyard. She knows that the sunflower is a globally recognized symbol for hidden, or non-visible, disabilities. She recalls that wearing the sunflower allows the person to request assistance without having to explain why they need help; so, instead of asking about the disability, Alina focuses her questions on how to support Tanir.

Alina: “Welcome to the clinic. How can I support you and help make your visit the best experience today?”

Tanir: “Thank you for asking. I seem to be processing things slowly recently, so I may need additional time to fill out the paperwork, and I may have a few questions.”

Alina: “That’s no problem at all. Here’s a packet of paperwork to fill out. There’ s no rush and please let me know what questions you have. I’ll also let the clinical staff know, if that is okay with you?”

Tanir: “That would be great, thank you.”

Post-concussion syndrome is one of many hidden disabilities that can cause a variety of symptoms and may fluctuate in severity throughout the day. Patients may experience headaches and fatigue, as well as cognitive symptoms like difficulty concentrating, confusion, slow mental processing, impaired ability to filter distractions, and decreased comprehension. These symptoms reflect how an injured brain processes information and can make it harder for a person to communicate, make timely decisions, remember details, or complete paperwork or electronic forms accurately. They are also typically not visible to those around them, which can cause others to think the affected person isn’t paying attention, is ignoring them, or simply doesn’t understand. So, although Tanir doesn’t have any visible symptoms to alert Alina that she may require additional assistance, wearing the sunflower symbol is a way to start a conversation about what support she needs.

Mario, the patient care technician, escorts Tanir to the exam room. He asks Tanir questions about their history and notes that Tanir is slow to reply. He also notices that Tanir appears fatigued after answering multiple questions in a row. He collects Tanir’s vital signs which are pulse 78 beats per minute, respirations 26 breaths per minute, blood pressure 126/72 mmHg, and oxygen saturation of 99% on room air. Tanir also says they have a headache with a pain level of 3 out of 10. Mario documents the information in the electronic health record, or EHR.

Before entering the room, Hiba, the nurse practitioner, reviews the progress notes from Tanir’s previous emergency room visit, their current vital signs, and Mario’s notes. While examining Tanir, Hiba asks questions clearly and slowly, providing ample time for Tanir to respond. As the visit continues, Hiba notices that Tanir seems confused at times which requires Hiba to repeat information. Based on these findings, Hiba suspects post-concussion syndrome. She lets Tanir know that Mario will bring her a tablet so she can complete a questionnaire today, and again at each follow-up visit to monitor her symptoms over time.