Thinking about work

It is hard to say.

🚧 Challenges: there are several challenges to returning to work after an acquired brain injury (ABI).

• You,  as someone with an ABI, have to learn to cope with the changes in how you function.
• Your professional environment,  including your manager, supervisor and/or your colleagues, also has to learn to cope with your changed capacity (load).

In several scientific studies the rates for returning to work vary.

Reasons for this include:

• did the study population contain people with a mild or severe brain injury?
• how did the researchers define 'returning to work': was this a full-time or part-time return to work?
• how long after a brain injury did the researchers examine whether someone had returned to work? 

Reference is often made to a Dutch study in which about 40% of people with an ABI returned to the workplace two years after their brain injury.

Whether or not you return to work depends on many factors such as:

• the severity of the brain injury,
• the consequences of the brain injury,
• the impact of these consequences on how you function,
• the personal significance of work,
• the expectations or required tasks of the job
• the employer's openness to your return to the workplace.

💪 Opportunity:  returning to work can be a rehabilitation goal.

several relevant parties can support you, including your employer , your friends and family , a job coach  or the rehabilitation team .

🤝 Together: you can discuss this with your doctor and/or rehabilitation team .

Certainly.

💪Opportunity: the doctor and rehabilitation team

•  have a detailed picture of your abilities.
• if during your rehabilitation programme you have also worked on vocational goals, they have information about your targeted employment:
  • where do you want to go?
  • what demands does that job have?
  • what can support you to perform that job?
•  it can be useful to include a comparison of your abilities with the required tasks for your job in the consultation with the employer or the occupational doctor , e.g.:
  • the rehabilitation team may recommend aids that will reduce your challenges.
  • they may also suggest physical or cognitive adjustments to the working environment to increase the success of your return to work.

🫶Together: the rehabilitation team can inform you about (the impact of) your brain injury and work with you to find an appropriate professional to help you progress.

Certainly.

Your relatives (such as your partner, family, friends, or neighbours) play a significant role in your life and you have trust in them. They are often well-acquainted with your circumstances and firsthand experience what is effective and what isn't.

🤝Together: You can engage in discussions with them on adjusting your home environment upon your return to work.

• For instance, you may arrange to have household tasks managed on weekdays while contributing on weekends.
• It can be beneficial for your loved ones to participate in consultations with your healthcare provider (care actor) and/or workplace.
• Their insights into your home life can aid in identifying solutions and arrangements that support your success at work.

🚧Challenge: Research indicates a heightened risk of early discontinuation when resuming work post-brain injury.

💪 Support: Your loved ones can play a crucial role in monitoring your well-being. They can respond to signs of excessive or insufficient workload:

• Overload occurs when your employer places excessive demands on you, such as assigning numerous tasks in a hectic environment. 
• Underload arises when your employer expects too little from you, limiting you to routine tasks.

The conversations you have with (occupational) doctors , your employer, your manager, etc. can raise questions and challenges.
This is normal because work is important to you and it is often unclear how such an interview will go.

Preparation also helps you to consider what you need for a successful return to work.

💡Tips & tricks that can help you prepare yourself beforehand:

• 💡Tip 1. Before the interview, make notes about what you want to talk about:
  • write down what you think it is important to say during the interview.
  • then, during the interview itself, you can be sure that everything is covered.

• 💡 Tip 2. In advance, consider what information you want to share about living with a brain injury.
  • Consider talking about the invisible consequences, such as fatigue or overexcitability.
  • It is good idea to talk about any support that can help you to cope with these invisible consequences.
  • For example:
    • limiting the number of hours per week,
    • taking longer breaks
    • wearing headphones so you can concentrate better at work.
  • Your employer and occupational doctor can work with this information.

• 💡Tip 3. In advance, contact with peers , other people with an ABI who returned to work. Talk to them in advance about any questions.

💡Tips & tricks that can help you during the interview:

• 💡Tip 1. Take someone with you to the interview.
  • Take a friend or relative with you.
  • They know you and have experienced the (impact of the) ABI on you.

• 💡Tip 2. Take notes during the interview, there are several options:
  • write down key words.
  • let the person accompanying you take notes during the interview.
  • ask the doctor to summarise what you have discussed.
  • ask to have the conversation recorded, so you can listen to it again later and then take notes.

• 💡Tip 3. Give a realistic picture of your situation during the interview.
  • State your abilities and aspirations.
  • Indicate what takes a lot of your energy and where you need support.

• 💡Tip 4. Ask additional questions.
  • If something is not entirely clear, keep asking until you have an answer you can fully understand.

• 💡Tip 5. Ask for a report.
  • Such a report gives you a good picture of the current situation and any agreements you have made.

• 💡Tip 6. Ask for a follow-up appointment.
  • If your employer is not familiar with (the consequences of) a brain injury, a follow-up appointment can be useful.
  • It gives your employer , the occupational doctor and you time to think about your work situation and your options in the workplace.
  • If it is not entirely clear what will happen or when you can expect a response or decision, ask directly.

• 💡Tip 7. Ask for the contact details of the occupational doctor.
  • An interview is a snapshot in time.
  • The situation may change or things may not be quite what you imagined.
  • Ask for a contact person and make a note of their details (name, e-mail, phone number).

• Your attending physician is your choice.
  • It can be your general practitioner or a specialist physician.
  • The treating doctor examines you, treats you, and monitors the consequences of your brain injury.
  • This physician issues a medical certificate or a statement of disability.
  • This document does not automatically entitle you to a replacement income.

• The advisory physician of the health insurance fund assesses your work disability.
  • This physician advises and informs you about your return to work.

• If your advisory physician judges that you are unfit for work, your employer has the right to have your work disability examined by a control physician.
  • The control doctor will check whether you are really unfit for work. 
  • The control doctor can examine you throughout the period of incapacity for work.
  • This doctor is not involved in the reintegration process.
  • If the control doctor judges that your absence is not justified, he or she will agree with your treating doctor. If you do not agree with the decision, you must initiate an arbitration or appeal procedure.

It is difficult to answer this definitively.

This is a personal choice and depends on

•  the relationship you have with your employer
•  what you feel comfortable with.

💪Opportunity: it is important to maintain good communication, especially if you want to return to your employer eventually.

• It is important to pay attention to your employer/colleagues .
  • In the acute phase, your friends and family may take over.
  • They can keep your employer informed about how you are doing.
• You can choose to inform your employer about the progress of your recovery.
  • For instance, you can inform them about the content of your therapy, the improvements in how you function or the challenges you are still experiencing. Your employer will then get a better idea of how you are doing and when you might be able to return to the workplace.
  • Remember that this is not an obligation.
• It depends on how you look at your recovery and/or contacting your employer yourself. You can also choose to keep contact brief.

🤝Together: further on in the rehabilitation process, you can inform the employer about the length of your absence and the suitability (or not) of the work, reintegration options and possibilities for additional support.

• Together with the employer , you can look at the possibilities for adjusting tasks, roles, benefits...?
• To what extent can tasks and roles be replaced or shifted? Is adapted work possible? If so, what agreements do you make about this? What procedures are in place for adapted work and what are your colleagues' views on adapted work?

By keeping in touch, you can find out what your employer's attitude is towards your return to work. Your employer may also have many questions and be looking for support to enable you to return to work.

• 💡Tip 1:  Opt for a gradual return to work.
  • It is better to start with fewer tasks and hours and build it up slowly.
  • If you immediately start working full time, you might become discouraged because it is hard to succeed.

• 💡Tip 2. Be optimistic, but realistic.
  • Optimistic means that your goal is to return to work, that you review your abilities and that you choose the best option.
  • Realistic means that you know what you can do, what the challenges might be and how you can deal with these challenges.
  • Find a balance between optimistic and realistic.

• 💡Tip 3. Consult relevant parties that can support you when you (return to) work.
  • It is not always easy to form an accurate idea about your abilities, aspirations and challenges.
  • Consult others because they know about how you function.
    • They support you by identifying your strengths.
    • They work with your to consider feasible and meaningful activities.
    • They look for solutions with you.
  • 💪Opportunity: keep your personal network active. They can support you, when needed.

• 💡 Tip 4. Know your own strengths and challenges.
  • Monitor good distribution of your available energy.
  • People often use the battery metaphor to describe living with a brain injury. The battery can no longer be fully charged and it also drains faster because activities take more energy .
  • 🤝Together with your friends and family , monitor that you still have the energy to do things besides work, for example at home.
  • How can you do this? Make a list of the physical, emotional and cognitive consequences of your brain injury. Ask a friend or relative to do the same. Compare lists.

• 💡Tip 5. Complete any required arrangements in time.
  • Complete arrangements on issues such as sick leave, benefit entitlements and legal rights.

• 💡Tip 6. Look for help.
  • With your colleagues and/or manager, make arrangements that can help you at work.
  • For instance, you can agree to write down tasks so you can remember them. You can then check the tasks yourself and, if in doubt, you have something to fall back on.

• 💡Tip 7. Do not over- or underestimate yourself.
  • After a brain injury it can be hard to estimate what you can do, how you can combine work and other areas of life, ...
  • It might be hard(er) to assess the consequences of the brain injury. For example you may be able to perform a certain activity today, but the same activity can be hard tomorrow. It takes time to get an accurate picture of your abilities.
  • Do not overestimate yourself: it might be that you are too careful, too worried or too anxious to return to work.
  • Do not underestimate yourself: you may want to return to work so much that you move too quickly.
  • The key word is measurement.

• 💡Tip 8. Prepare yourself for an interview and take someone with you. Before you return to work, you liaise with the different relevant parties. This is how you can prepare yourself:
  • Before the interview
    • Know the purpose of the interview: who is involved? What is this person’s role?
    • Write down your thoughts and questions. This will give you a clear understanding.
    • Write down aids/people that can support you when you (return to) work.
  • During the interview
    • Ask if you can record the interview or ask the person to write down the most important information. This makes it easy for you to review the information.
    • Share your strengths, aspirations and challenges.
    • Give practical examples of the impact of the brain injury.
    • Be honest.
    • Check that you understood everything correctly.
  • After the interview
    • Reflect on the arrangements, the advice, the upcoming steps with your doctor.

• 💡Tip 9. Keep all the information together in a physical binder or using a digital tool.
  • You might need it at a later stage.
  • Sometimes you need to complete an online form. When you have completed it, download and save it.

• 💡Tip 10. Rehearse a structured programme at home.
  • Draw up a structured programme that corresponds with a regular working week.
  • Execute this programme as if you had returned to work.
  • Try your commute to work.
  • Perform tasks that can help you to exercise your concentration, memory, decision-making, etc.
  • Make adjustments that can support you, e.g. enlist additional help so you can rest.

• 💡Tip 11. Inform yourself of the financial consequences of (returning to) work.
  • As a result of your brain injury you might not be able to return to full-time work.
  • Do not allow your employment contract to be amended too quickly. It might have an impact on your benefit entitlements.
  • Do not resign. Being fired might have fewer financial consequences.

• 💡Tip 12. Consider what information you want to share with your working environment.
  • You are not obliged to say that you have a brain injury.
  • Sharing information can create greater understanding/support from others.
  • Make it clear to your colleagues and/or manager how they can tell if you are having more difficulty.
  • Agree on practical signals so that difficulties can be discussed quickly.
  • For example, if you have communication difficulties, you can agree to hold a pen in front of your face if you can no longer follow the explanation. This will avoid frustration not only for yourself, but also for your colleagues or manager. 

• 💡Tip 13. . Be kind to yourself and take into account the consequences of the brain injury.
  • Write down what you can do.
  • Write down what has changed since the brain injury.
  • 🧰Tool: you might use colour coding:
    • Green: tasks you can perform without any problem.
    • Orange: tasks you can perform, but it takes more time, more energy or support.
    • Red: tasks you cannot perform (yet). 

This is very personal and depends on many factors, such as:

• the severity of the brain injury: a brain injury varies from mild to severe.
  • A mild brain injury often involves a short hospital stay. Invisible consequences of the brain injury might hinder your return to work.
  • A moderate to severe brain injury may immediately involve an extended period of disability and a greater need for rehabilitation in a hospital or rehabilitation centre.
• the job you did before the brain injury and the expectations/requirements you have to meet.
• the personal meaning your job has for you.
• your personal life, such as your personality, family situation and work-life balance.

There is a difference between considering (a return to) work and actually (returning to) work.

• Considering (a return to) work means that you consider
  • relevant parties that need to give their consent for you to (return to) work.
  • benefit entitlements and legal rights.
  • challenges that you need to overcome before (returning to) work.
  • aids/people that can support you when (return to) work.
  • things you can and would like to do.
• Actually (returning to) work means that you start working.

🤝Together: it is never too early to ask your doctor/rehabilitation team about returning to work. Together, you can discuss the pros and cons.

🚧Challenge: do not avoid this question, just ask it.

• Remember that the doctor/rehabilitation team may recommend a longer period of sick leave.
• By asking the question, you are also indicating to the rehabilitation team that you are thinking about returning to work.

💪Opportunity: specifically, you can think about:

• how do you feel about work?
  • How important is work for you?
  • How/when do you see yourself returning to work?
  • How feasible do you think it to be?
  • How confident are you of success?
• what role does work play for you?
  • Do you work to receive an income?
  • Does work give you structure and/or meaning?
  • Do you feel connected to your work?
• what work experience do you have?
  •  What is your job?
  • What demands does the job have?

💡Tips & tricks: it is important to talk about 'work' early on in the rehabilitation process and get answers to any questions you are struggling with.

• Considering work does not mean that the doctor/rehabilitation team expects you to return to work quickly.
• It does mean that questions about work (resumption) are given a place and you are given sufficient information about this.

It is not an obligation.

You may not be thinking about work yet or may not see yourself returning to work after the brain injury.
Returning to work is very personal and depends on many factors, such as:

• the severity of the brain injury: a brain injury varies from mild to severe.
  • A moderate to severe brain injury may immediately involve an extended period of disability and a greater need for rehabilitation in a hospital or rehabilitation centre.
  • A mild brain injury often involves a short hospital stay.
  • Both groups might need support when returning to work.
• the job you did before the brain injury and the expectations/requirements you have to meet.
• the personal meaning your job has for you.
• your personal life, such as your personality, family situation and work-life balance.

🫶Together: it is never too early to discuss the topic with your doctor/rehabilitation team . It is important to address 'work' early on in the rehabilitation process and get answers on any questions you are struggling with.

•  Considering a return to work does not mean that the rehabilitation team expects you to return to work quickly.
•  It does mean that your concerns about work (resumption) are given a place and you are given enough information about this. Together, you can discuss how they view this.

There is no one answer to this question.

The length of your disability and when you can return to work depends on many factors. Consider, for example:

• the severity of your brain injury: this can vary from mild to very severe.
• the physical, emotional and/or cognitive consequences of your brain injury.
• the physical, emotional and/or cognitive challenges of these consequences on the workplace:
  • what is expected of you at work? What are the required tasks?
  • physical challenges for example, do you need to work with both hands? Do you need to stand for long periods?
  • emotional challenges for example, are you afraid of making mistakes? Are you emotional vulnerable?
  • cognitive challenges for example, how do you cope with background noise? Is it hard(er) for you to remember tasks?
• the time investment your rehabilitation requires and whether it is compatible with a return to work.
• possibilities of adapting your work with your previous employer or with a new employer.

🚧Challenge: to return to work, you need various skills including cognitive, social, communication and physical skills. These are often affected after a brain injury. Returning to work is a personal journey and requires time, energy and effort. There is no ready-made solution.

💪Opportunities

• Rehabilitation that focuses on the skills you need in the workplace, so-called vocational rehabilitation, can be an important step in returning to work.
• Often, you build up your return slowly, starting with a few hours and if that goes well, you increase your working hours. The danger is that you overestimate yourself and want to return to your previous level of functioning quickly. A flexible, progressive schedule should be drawn up by mutual agreement.

🤝Together

• The doctor or someone from the rehabilitation team can provide a preliminary plan here.
• Together with the employer and your doctor/rehabilitation team
  • look for possibilities and challenges in how you function
  • look for adjustments and (new) possibilities.
  • mention how you see the work itself and whether returning to work seems a feasible plan for you.

There are no Belgian figures on returning to work after brain injury. They often refer to a Dutch study, where four in 10 people with a brain injury (return) to work two years after the brain injury. Other studies give different percentages for return to work after brain injury.

🔀 There are several reasons for this:

• Was the study done on individuals with mild or severe brain injury?
• What is the definition of 'return to work'? Full-time or part-time?
• How much time after brain injury are researchers looking at whether someone is back to work?
• in which country are they doing the research? Each country has its own legislative framework and different options for returning to work. This does not make it easy to compare figures.

🚧Challenge: Whether or not someone with a brain injury returns to work depends on many factors such as:

• the severity of the injury,
• the personal significance of work,
• the expectations or task demands of the job,
• or the employer's openness to returning to work.

💪Opportunity: returning to work may mean for you that you are back to being a full part of society and feeling meaningful. Thus, work can be a part of your recovery provided your work is appropriate and matches your capabilities.

In Western society, personal identity is often closely related to work, and being able to work in the labour market provides a social role that is often fundamental to our personality. Work can give our life more meaning. When we meet someone, we often ask them about their job.

Scientific studies have shown that a return to work can potentially act as proof of being rehabilitated and having overcome the brain injury.
What work means to you is very personal.
Through work, for instance,

•  you get recognition for your own qualities.
•  you can make yourself useful or feel useful.
•  you receive an income.
•  you have colleagues who are part of your social life.

For many people, being able to work again means getting back to the life they had before the brain injury.

🚧Challenge: it is important that there is a balance between your work and your abilities.

• It might be that the amount of work you can handle is reduced and this may impact your return to work.
• A full-time job from the start might be too overwhelming.

💪Opportunity: part-time work or volunteering can be a great way to remain active and experience the positive effects of work.

💡Tips & tricks: understand that the concept of 'work' can be very broad, for example, from paid to unpaid work and from a few hours a week to a full-time job.

Just as there is no 'one brain injury', there is not 'one suitable job'.

Depending on the consequences of your brain injury, what you consider important in the workplace and would like to do, suitable work may look completely different for you than for someone else with a brain injury.

💪Opportunities:  there are however some characteristics that indicate that work is or will be suitable for you :

• there is a balance between work and other areas of your life: you still have energy for other important things, such as your family, hobbies or household chores.
• your tasks at work and your working environment match what is (now) possible for you, what is important to you and what you feel you are good at.
• if work is suitable, it can be part of your recovery process.

🚧Challenge: look at

• your own abilities and aspirations: what can you do?
• the required tasks: what do you need to do?
  • physical demands, e.g. how many hours do you have to work standing up per day?
  • socio-emotional demands, e.g. do you often have contact with customers/patients/clients?
  • cognitive demands, e.g. do you have to organise your work yourself or is this planned out for you?
• working environment: where do you need to do it?
  • physical working environment, e.g. an uneven terrain.
  • cognitive working environment, e.g. a lot of background noise or crowds.
• balance between
  • (work) abilities and work demands.
  • work and other important life areas.
• Check whether the work is suitable for you and matches your (residual) abilities.

💪Opportunity: if everything is balanced, then the work is suitable for you.

• You can make your work suitable by changing the required tasks or the working environment.
  • For example, you can make the working environment calmer and less busy.
  • Specifically, you could choose a separate, enclosed workspace with fewer posters and an empty desk.

No, this is a personal choice.

💪Opportunity: if you return to work after a brain injury, you can be open with your employer, your supervisor and/or your colleagues by informing them about (the impact of) your brain injury. However, this is not an obligation.

Explaining in an understandable language what (the impact of) your brain injury on the job is for you can help them to understand you better. This will give your employer, supervisor and/or colleagues a better idea of what has changed for you and what is difficult. You can inform them about:

• things that will help you function well at work, such as working with earplugs as a solution to overstimulation.
• what they can do to support you, such as issuing assignments in writing.
• why certain adaptations are helpful for you, such as taking some time off during your lunch break to really unwind instead of chatting with your colleagues.

🫶Together: sharing the invisible consequences of a brain injury (e.g. reduced long-term concentration, hypersensitivity to stimuli or fatigue) can help your employer to think about options:
• how can you still continue to work with your brain injury?

This depends on several factors, including

• the severity, location and extent of the brain injury,
• your personal characteristics,
• your task demands,
• your work environment,
• your colleagues,
• ... .

In vocational rehabilitation, the treatment team examines and compares your (work) capabilities and your task demands:

• What (work) capabilities do you have?
• What are your work tasks that you have to perform?
• Under what conditions do you have to perform these tasks?
• What are the health risks?

🤝Together: With your treatment team, your occupational physician and your nearest and dearest, you compare your own capabilities, your work demands and your work environment. You consider whether it is feasible to return to work, whether adjustments/support are needed, or whether you are looking for other work.

A brain injury can impact your functional abilities, including your capacity to drive.

Following a brain injury, driving a motor vehicle is prohibited for six months.

• You are required to surrender your driver's license at your local town hall.
• Subsequently, a comprehensive assessment of your driving skills is necessary.You can independently register for this evaluation at the Centre for Driving Fitness and Vehicle Adaptation (CARA). Alternatively, your physician can refer you to CARA. This assessment does not mandate a new driving test.
  • If your job entails driving a vehicle (e.g., a truck, forklift, or bus), obtaining medical clearance from the occupational physician (or prevention advisor-occupational physician) is crucial.
  • For driving Group 1 vehicles (AM, A1, A2, A, B, B+E, and G licenses) for personal or recreational purposes, your treating physician can certify your fitness to drive using a standard form.

Evaluating your fitness to drive involves balancing your personal rights, desire for independent mobility, and overall road safety.

• CARA employs a multidisciplinary team to assess your medical, psychological, and practical aptitude for driving.
• If deemed fit to drive, CARA will issue a driving fitness certificate.
• They may recommend vehicle modifications or impose restrictions to ensure safety on the road.

Following a brain injury, there is a risk of developing epilepsy.

• Epileptic seizures result from sudden, temporary disruptions in brain electrical activity.
• Driving during an epileptic seizure can pose significant risks to both yourself and other road users.If you experience an epileptic seizure, you must refrain from driving until a medical evaluation is conducted.
  • For a single seizure, you must remain seizure-free for at least six months before regaining driving eligibility.
  • In cases of two or more seizures within five years, you must be seizure-free for a minimum of one year to resume driving, with a maximum one-year clearance period.

Indeed, it is possible.

What constitutes an occupational disability?

An occupational disability refers to a mental, psychological, physical, or sensory condition that hinders the ability to secure or carry out work tasks. While a brain injury can qualify as an occupational disability, the VDAB is responsible for determining this designation. Depending on the extent of the brain injury and its effect on your job performance, seeking recognition of your work disability may be advisable.

What are the advantages of this acknowledgment?

💰Assistance: Upon recognition of your brain injury as an occupational disability, you become eligible for employment support initiatives.One prominent initiative is the Flemish Support Premium (VOP). This premium provides financial assistance towards your wage expenses, particularly if you work at a slower pace or require additional assistance.Furthermore, adjustments to your workplace or tools may also be facilitated.

How do I apply for such recognition?

Your treating doctor fills in a form for this, which you can find on the VDAB website. This contains questions such as 'what problems do you have performing work?', 'can you perform work in the normal economic circuit?', 'how is the disability measured?'.

With the answer to these questions, the employment support team of the VDAB assesses whether you need measures when returning to work.

You can.

A personal budget is a tailor-made budget that you receive from the Vlaams Agentschap voor Personen met een Handicap (VAPH) to pay for your support. You can use this budget for practical help and/or support with daily activities. Specifically, your carer can take you to work or support you at work to go to the toilet.

🤝Together: discuss this with your employer.

⚠️ Please note that this budget is not intended to be used for employment support measures.