An Exploratory Examination of Political Empowerment and Voting among Individuals with TBI

Christine Davis 1, Julia Nelson1, Mark Hirsch2, Flora Hammond2, Jason Karlawish3, Lisa Schur4, Douglas Kruse4, Andrew Ball5
1University of North Carolina at Charlotte, Department of Communication Studies, Charlotte, NC, USA, 2Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, Charlotte, NC, USA, 3University of Pennsylvania, School of Medicine, Penn Memory Center, Philadelphia, PA, USA, 4Rutgers University, School of Management and Labor Relations, Piscataway, NJ, USA, 5Carolinas medical Center, NorthEast Rehabilitation, Concord, NC, USA


Voting is one of the most basic rights in any democracy. Every vote counts and every voice must be heard. Voter participation rates among people with disabilities have been lower than among the general population. Scholars argue that people with cognitive and communication impairments, such as those that arise from TBI, are particularly vulnerable to possible disenfranchisement from voting. However, there is no empirical data on the experiences of voting and political participation among Americans with TBI. This National Institutes of Health sponsored study is the first research to report on the experiences of voting and political participation among those with TBI.


We used a community-based participatory research (CBPR) approach to assess the experience of voting among individuals with TBI and their caregivers and family members during the November 2007 and May 2007 General Election, and the November 2008 Presidential Election in North Carolina, USA. We conducted 55 in-depth interviews with people with TBI and 27 interviews with spouses, caregivers, and healthcare and community providers of people with TBI to discuss their experiences with political participation or voting. 63% of participants had voted in the most recent election, and we shadowed and observed them at the polls. Data was coded using a rigorous multi-step grounded theory process by a research team consisting of experts in disability and voting; people with TBI; and family members and healthcare providers of people with TBI.


Our data suggest that people with TBI vote for some of the same reasons as people without TBI – to be contributing members of society in a way that takes an active role in shaping the future of our country. However, for people with TBI voting represents a way to regain the voice and identity lost after the injury. Thus, by voting people with TBI are affirming their identity as contributing members of our society. However, unlike people without TBI, voting can require extra resources (time, effort, transportation). Often, those with TBI note challenges remembering to vote, preparing to vote, to research candidates, and to arrange for transportation to the polls. Once in the polls, some individuals note challenges navigating the polls and the ballot, and difficulty with memory involving who to vote for. However, voting also represents an opportunity to regain a sense of control. In addition, voting gives voice to people with TBI who may have difficulty in communicating or expressing their views.


Our data suggest strategies for reducing possible experiences of disenfranchisement from voting among persons with TBI: provide people with a sample practice ballot and voting machine ahead of time; help people understand the candidates and their positions; provide a special voting area with more space and time for people with disabilities and with larger, clearer ballots; provide transportation to the polls; help people make decisions between candidates; remind people to vote; and encourage and welcome people with TBI to the polls. Our research indicates that study participants view voting as a means of exercising our rights as members of society, and thus, serves as acknowledgement of societal inclusion. Every citizen has the right to vote—including citizens who have impairments due to accidents or injuries. That right to vote includes receiving assistance in voting, when a person has physical or cognitive impairments that make voting difficult or less likely. Voting is a way for all citizens to take an active role in their future and in the future of our country. Voting represents voice, expression of opinions and choices. It is both a privilege and a right of citizenship. People with TBI vote in lower numbers than non-TBI citizens because of physical and cognitive deficits resulting from the injury, extra effort required to understand the process and make decisions between candidates, and difficulties getting to and navigating the polls. People with TBI are more likely to vote if they are provided with assistance in these areas.