Returning to work

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 capabilities in this regard. People often feel they are ready to go back against the advice of family and health professionals. This can be due to a lack of awareness, or denial in relation to impairments. 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 the areas of difficulty that will need to be addressed in returning 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.

The ability to hold a job is one of the most potent measures of community integration. The single most important factor in predicting return to work is active participation in rehabilitation and in the therapeutic community. The second best predictor is the injured person’s self-awareness. The ability to manage emotions is also a significant factor in employability.

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
• a lack of opportunities for people to demonstrate capabilities
• poor control over emotions
• fatigue and other physical problems, e.g. dizziness and headaches
• experiencing a loss of self-confidence after unsuccessful attempts
• loss of motivation

Employment support agencies and rehabilitation services might provide programs that focus on the person returning to their previous position. However, this is not usually possible straight away. The results of different assessments can give insight into what a person is capable of with regard to their employment potential. 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 may be organised 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.

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 of impairment might benefit from which form of recovery and adjustment:

• 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 work places 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

Some individual characteristics that may influence the level of achievement include self-awareness, motivation, determination and adaptability.

People who are assessed as being unready for work may wish to pursue volunteer work (e.g. at a charity organisation) to improve their skills and experience, and gain greater awareness of their capabilities. However, for some people employment may not be a realistic option after brain injury.

Accepting this situation can be very distressing for people who have often spent most of their lives building a career. It is important that people are supported to pursue other avenues for achievement, satisfaction and productive use of their time.

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 may need assistance to ensure the right practices are in place to support those returning to work.

Read more about managing fatigue

After rehabilitation some people manage to return to their jobs, only to lose them soon after. There may be grounds for objecting to this on the basis of discrimination. In Australia, the Disability Discrimination Act 1992 specifies that people with a disability have equal opportunity to gain employment and that their disability should only be taken into consideration when it is fair to do so.

The act also states that employers should make reasonable adjustments to accommodate the needs of someone with a disability. This means the employer must examine the physical and organisational barriers that may prevent the employment, limit the performance or curtail the advancement of people with disability.