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Returning to Work

One of the main hopes and expectations people have when leaving hospital is that they will return to the work or study they were involved in prior to the brain injury.

What to consider

For many people returning to pre-injury employment is an important milestone towards regaining a sense of identity and purpose. However, it is very common after a brain injury to have unrealistic expectations about one’s readiness and ability to return to work. People often feel they are ready to go back against the advice of family and health professionals. Returning to work too early can result in fatigue and overwhelm, which can be disappointing, and feel like a step backwards.

If a neuropsychological assessment took place during rehabilitation, this should provide some indications about areas that will need to be worked on to return to work. For some people, returning to pre-injury employment may never be feasible, and options for retraining into a different vocation may need to be considered.

A very important factor in predicting return to work is active participation in rehabilitation and in the therapeutic community. A very predictor is the injured person’s self- awareness and ability to regulate emotions.

Potential barriers

Some of the barriers in returning to work are:

  • an individual’s desire to work being greater than their actual readiness
  • problems accessing support, e.g. being linked with the right employment support agency
  • cognitive impairment
  • poor emotional regulation
  • fatigue and other physical problems, e.g. dizziness and headaches
  • experiencing a loss of self-confidence after unsuccessful attempts
  • reduced motivation.


Employment support agencies and rehabilitation services might provide programs that focus on the person returning to their previous position when the time is right (not usually possible straight away). Rehabilitation professionals can provide insight into a person’s capacity for employment in different areas. Sometimes a meeting can be organised for the person who was injured, family members, the employer and rehabilitation professionals to discuss a gradual return to work plan. A work trial is another option, to assess how well the person can cope with the demands of different tasks. On-the-job training provides the opportunity for people to relearn previously acquired skills or learn new skills.

Strategies for building capacity at work

Understanding the different forms of recovery and adjustment becomes particularly important when people return to work after their injury.

It can be helpful to consider which areas might benefit from capacity building strategies.

Remediation involves relearning skills with practice until a certain level is achieved e.g. practising typing speed.

Substitution requires maximising previous skills or learning a new one to overcome a difficulty e.g. using self-instruction to improve concentration.

Accommodation relates to the adjustment of goals and expectations in line with capabilities, e.g. aiming for a position with less responsibility and a reduced workload.

Assimilation involves modifying the environment and expectations of other people, e.g. introducing specialised equipment, supportive workplaces and educating employers and colleagues about the nature of support required.

Some common recommendations for returning to work include having:

  • plenty of rest periods
  • routine and structure to tasks
  • flexibility
  • reduced hours
  • supervision and support.

Volunteer work

People who are assessed as being unready for work may wish to pursue volunteer work to improve their skills and experience, and to better understand their capabilities. However, for some people employment may not be a realistic option after brain injury.

This can be very distressing for people who have often spent most of their lives building a career.

It is important that this loss and grief is acknowledge and accepted, and that, when ready, they are supported to pursue other avenues for achievement, satisfaction, and a meaningful use of time.

Managing fatigue

Fatigue is very common after brain injury, and it can be a significant barrier to returning to work particularly when intense concentration or fast-paced decision making are required. Survivors will often manage a workload if they can approach one task at a time, work in a quiet environment without distractions, and have a flexible schedule for rest breaks when needed. Employers should provide assistance to ensure the right practices are in place to support those returning to work.