Return to work after a brain injury
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
However, it is very common for a person to feel that they are
ready to return to their previous position well before everyone
else thinks they are. The individual's unrealistic expectations are
often due to the poor self-awareness or denial that can occur after
a traumatic brain injury and similar brain disorders.
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
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 individual'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
- Accessing support e.g. being linked with the right employment
- Cognitive impairment
- A lack of opportunities for people to demonstrate what they are
- Poor control over emotions
- Fatigue and other physical problems e.g. dizziness and
- Experiencing a loss of self-confidence after unsuccessful
- Loss of motivation.
Employment support agencies and rehabilitation services often
provide programmes that may focus upon the person returning to
their previous position. However, this is usually not possible
straight away. The results of different assessments can gather
information about the person's strengths and deficits to provide
guidelines regarding employment potential. Sometimes a meeting can
be organised between 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.
STRATEGIES FOR MANAGING IMPAIRMENTS
Understanding the different forms of recovery and adjustment
becomes particularly important when people return to work after
their injury. It is often helpful to consider which area of
impairment might benefit from which form of recovery and
This involves relearning skills with practice until a certain
level has been achieved e.g. practising typing speed.
Substitution requires maximising previous skills or learning a
new skill to overcome a difficulty e.g. using self-instruction to
improve concentration skills.
This is when a person adjusts their goals and expectations to
match their level of capability e.g. aiming for a position with
less responsibility and a reduced work load.
Assimilation is modifying the environment and expectations of
other people e.g. introducing specialised equipment, supportive
work environments and educating employers and colleagues about the
nature of support required.
Some common recommendations for returning to work include having
plenty of rest periods, a routine and structure to tasks,
flexibility, reduced hours, supervision and support. Some
individual characteristics that may influence level of achievement
include self-awareness, motivation, determination and
Individuals who are assessed as not being ready for work may
wish to pursue volunteer work (e.g. at a charity organisation) to
improve their skills, awareness of personal capabilities and level
of experience. However, employment may not be a realistic option
for many people after acquired brain injury. Accepting this
situation can be very distressing for people who have often spent
most of their lives building a career. It is hoped that people can
pursue other avenues for achievement, satisfaction and productive
use of their leisure time.
Fatigue is a very common outcome after a traumatic brain injury,
and it has a serious impact on someone's ability to resume work,
especially in jobs needing intense concentration or fast paced
decision making. Often survivors can 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 if
needed. The problem, of course, is that many work environments
won't allow some, or possibly any, of these to happen.
A related fact sheet, Information for Employers, provides tips
for employers to help employees with a brain injury.
After rehabilitation some people manage to return to their jobs
only to be fired shortly after-there may be grounds for objecting
on the grounds 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
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 which may prevent the employment, limit the
performance or curtail the advancement of people with disability. A
related fact sheet, Discrimination in the workplace, provides
further information in this area.