Staying in work with a brain injury

Returning to work is an important step in the rehabilitation process. Staying in work with a brain injury is often even more challenging. People with brain injuries, once they return to work, are more likely to get stuck in a reintegration process and leave the workplace early.

During a return to work invisible consequences sometimes become visible, such as a reduced endurance for tasks or a need for a longer recovery time after some tasks. 

🚧 Challenge: there is often a fragile balance between workload and the ability to handle this workload in the (working) environment. Some examples of changes that can cause an imbalance:

• a physical change in the working environment, such as moving the person to an open plan office.
• an emotional change in the working environment, such as a change in manager for the person who has a different communication style.
• a cognitive change in the working environment, such as the person takes on increasingly difficult tasks.
• a change in their home situation, such as the person ages or loses a family member.

💪 Opportunity: work mediation does not stop when the person with a brain injury  finds work.

Challenges may arise months or years after a successful initial return to work, as a result of one or more of the following 

🚧 Challenges can occur at different levels:

• the person: the person  may: 
  • need (more) recovery time than prior to the brain injury.
  • fatigue may build up (more) quickly due to the greater effort required to perform the same task.
  • be absent from work (more) often.
  • be (more) irritable and find it hard(er) to work in a crowded environment.
  • become irritated (more) easily.
  • be less flexible.
  • find it (more) challenging to remember (new) information.
  • find it (more) challenging learning (new) tasks.
  • become (more) easily overloaded due to an accumulation of new information.

• the task: the person  may:
  • make more mistakes.
  • find it hard(er) to notice mistakes.
  • need more time to perform tasks.
  • work less quickly.

• interaction: the person  may:
  • find it (more) difficult to communicate.
  • find it (more) difficult to adapt to change, e.g. departure of familiar colleague or supervisor.
  • be (more) socially isolated.
  • be (more) emotionally vulnerable, depressed and/or anxious.

• friends and family  may be concerned about how the person is functioning at home and/or at work.
• the employer  notices that there are frictions at work.

⚠️Be aware that failure at work can often drain self-confidence and belief, undermining both future attempts to return to work and overall adjustment. 

Individuals with brain injuries face a higher risk of encountering challenges during the return-to-work process, potentially leading to premature departure from the workplace.

Invisible consequences of brain injuries, such as reduced endurance or increased need for recovery, may only become apparent once work resumes.

How can premature work failure be prevented?

💡Tip 1: Recognize Overload and Signals

• Be vigilant for signs of overload at different levels: individual, task, and interaction.
• Collaborate on prioritizing tasks and create structured to-do lists.
• Adjust tasks and work context as needed, considering the individual's total workload.
• Allow time for adaptation and avoid sudden changes or excessive responsibilities.

💡Tip 2: Monitor Environmental Changes

• Stay alert to positive or negative changes in the work environment that may impact the individual's workload.
• Schedule demanding tasks when the individual is most energized.
• Communicate concerns with relevant professionals and develop a relapse prevention plan.
• Ensure ongoing assessment of the balance between skills, job requirements, and working environment.

💡Tip 3: Provide Support and Resources

• Implement work support measures, compensation strategies, and encourage peer support.
• Offer tools like adapted equipment, structured task planning, and colleague assistance.
• Assist in learning to manage long-term changes in workload capacity effectively.
• By proactively addressing these factors and providing tailored support, individuals with brain injuries can enhance their chances of a successful and sustainable work.

• Do this by keeping good records of the (partial) return to work.
• Which tasks were not performed or not performed correctly (even though the person themselves may be convinced it went well)?  

It can take time for the person  and their loved onesto understand the impact of the brain injury, the limitations it entails and how to cope with them.

Do this in a calm, clear and tangible way.

A subtle or general instruction, such as 'act normally', may not always be understood by the person or may have little impact

Some examples:

• give five interchangeable tasks, but organise the tasks logically and let the person do them one by one.
• provide a fixed structure and make days predictable, e.g. lunch break is always between 12pm and 1pm.

You can do this by turning a cluttered desk into a 'storage area' and an empty work area, removing a ticking clock from the room, closing windows and doors, or avoiding using lots of perfume.