Author: Philippa McRae

Returning to work after brain injury: Information for employers

Providing the opportunity for an employee to return to work after a brain injury makes a positive contribution to their rehabilitation, retains valuable knowledge and experience within your business and fosters a supportive workplace culture for all employees.

What is a brain injury?
A brain injury refers to any damage to the brain that is acquired through accident/trauma (eg car accident, assault) or illness (such as a stroke, brain infection, lack of oxygen etc).
The effects of brain injury are different for each person, depending on how severe the injury was and which parts of the brain were affected. The brain controls everything in our body: our thinking, memory, movement, strength, co-ordination, speech, vision, mood and behaviour. An injury to the brain can affect all or just some of these aspects. The brain has some capacity to recover over time; most of the recovery occurring gradually for up to 2 years following the injury.
Some changes will be obvious (e.g. walking with a limp, paralysis of one arm), but many are not visible (e.g. poor memory, mental fatigue, changes to vision, difficulty tolerating loud noise). Sometimes people experience changes to their personality, which may be subtle (like being more talkative), or more noticeable (like difficulty controlling emotions).

How well a person manages at work depends on the demands of their job. One position may require physical strength, co-ordination and balance; where as another position has higher demands for cognitive skills like planning, problem solving and communication.

Brain injury is complex: the injury impacts on each person differently and changes over time as
recovery occurs.

Working with a brain injury is even more complex with the interplay of injury and job demands.

What is the timeframe for return to work (RTW)?
There is no “best time” to commence employment after acquiring a brain injury. Keep in touch with your employee and their family following their injury and be guided by the medical team about their readiness to commence work. Once back at work, the pace and duration of the RTW program will vary for each person.
What is done before a person commences work?
A vocational provider will assist you and your employee, commencing with:
1. Workplace assessment – assessing the physical and cognitive job demands and environment to determine how the brain injury may impact on the employee working in their usual role.
2. A Return to Work Plan – also known as a “suitable duties plan”, outlines the proposed duties, hours and supports for the employee to resume work. This plan is developed by the employer, employee and the vocational provider with input from the treating medical team. There may be a number of plans, gradually stepping up the duties and hours towards the set goal.
What support will the employee require when they are back at work?
Adjustments to the work role will vary from person to person. Typical adjustments in the ‘return to work plan’ may include:
Start on reduced hours and increase gradually over time
Work on non-consecutive days, if possible, and gradually build to consecutive days
Allocate tasks that are most familiar to the person
Schedule more demanding tasks in the morning
Use diary, checklists and written notes to aid memory
Increase the level of structure within tasks and the work routine
Reduce distractions in the work environment, this may include working in a different location
Schedule regular feedback that is timely, sensitive and specific, and that is reinforced over time
Avoid time-pressured work, initially
Reduce scope of responsibilities, e.g. not to supervise others in the initial period
Initial supervision of work tasks to assist with readjusting to the work routine
Regular rest breaks to reduce fatigue.
How is the Employer supported?
The provider will guide you through the Return to Work program:
Providing information regarding the employee’s condition and rehabilitation
Visiting on site to implement strategies with your team
Assist with contingency planning, to inform options if the plan is interrupted or changes unexpectedly.

Once the employee is back at work, the employer is responsible for workers compensation, wages and entitlements as per standard employment practises.

Summary of the RTW Process

Stage of RTW

Key actions

Preparing for work

Early discussions between employer, employee and rehabilitation providers.
Rehabilitation assessments and activities continue
Workplace assessment and planning RTW
Agreement to the RTW plan

Returning to work

Suitable duties commence
Work hours and duties upgrade according to the plan
Onsite implementation of strategies
Any required adjustments to the plan are discussed and arranged
Regular feedback is provided to all parties

Concluding rehabilitation and
planning for the future

Determine when job stability has been achieved
Conclude the RTW program and determine any outstanding issues
Withdrawal of the Vocational Provider
Arrange ongoing supports if required - internal and external to the company

Examples of Return to Work Experiences

Instructions for this section (please delete before you print): Please choose the most relevant example(s) and delete those not relevant

Name: Brian
Employment: Casual Retail Sales Assistant (clothing)
Details of injury: car accident causing severe brain injury, resulting in fatigue and cognitive problems (slower speed of thinking, difficulty holding concentration for long periods and keeping track of multiple tasks at once).
Goal: Resume pre-injury position on part-time hours with the following adjustments:
Do not allocate shifts during busy periods
10 minute break every hour
Use the store ipad to record notes and reminders
Focus on customer service on the floor and avoid cash register duties initially
Progress: Brian commenced work 5 months after his injury. He gradually upgraded from 8 hours per week to 30 hours per week over the course of 4 months. He found work tiring, requiring more sleep. He was allocated a “buddy” to support his learning of cash register duties as this was new to him. He met with his manager fortnightly to discuss how he was going.
Outcome: Brian was back working his usual casual hours after 4 months.

Name: Peter
Employment: apprentice carpenter (employed by a house builder)
Details of injury: fall at work sustaining brain injury and fractured shoulder. Peter had difficulties with speech (finding the right words and articulating clearly) though this was improving. He also developed epilepsy so was unable to drive. The shoulder injury healed well.
Goal: trial working as an apprentice carpenter
Restrictions and strategies in the initial period:
Work part-time (Mon/Wed/Fri of 4 hours)
Workmates provide transport or use public transport where possible
Work only on houses after ‘lock up’ stage (ie not on construction sites)
No climbing ladders or working at heights
No use of heavy machinery or power saws
Progress: Peter worked within the above arrangements for 12 months but was unable to progress to completing his apprenticeship due to the restrictions related to epilepsy (including part-time work and no climbing and use of machinery). He was frustrated by only doing simple tasks and so decided to change careers.
Outcome: Peter obtained work at an apprenticeship centre, co-ordinating on-site assessment of apprentices.

Name: Jason
Employment: Storeman
Details of injury: Fell from his skateboard causing severe brain injury, resulting in mild incoordination and balance problems; difficulty with memory and with managing frustration.
Goal: Commence suitable warehouse duties and gradually upgrade to full pre-injury duties.
Tasks:
Picking order
Dispatching orders
Restrictions and strategies in the initial period:
No use of forklift
Supervisor to check orders before dispatched
15 minute seated rest break every 2 hours
Complete one order before commencing the next
Mark off each item picked in the order.
Progress: Jason returned to work 7 months after his injury at 8 hours and worked up to 25 hours per week across the initial 3 months. He resumed driving forklifts after passing the forklift test. Jason was always keen to step up his work hours but after a while found it hard to keep up the routine. He had trouble with fatigue and developed headaches. It was agreed to drop back to 20 hours per week and maintain this for 6 months before upgrade more gradually.
Outcome: Jason upgraded to full-time work with the same employer after 18 months.

Name: Judy
Employment: Accountant with a large pharmaceutical company
Details of injury: Brain aneurysm resulting in slowed speed of thinking, difficulty planning/problem solving and poor memory. Judy had not worked for 12 months; had lost confidence and experienced fluctuations in her emotions.
Goal: Trial completing her pre-injury position as an accountant on a part-time basis
Plan:
Judy will only manage accounts for one section of the business
Meet with manager each morning to discuss priorities and organise work schedule
Use daily checklists
Manager to check work for accuracy
Progress: Judy found it difficult to manage the complexities of her accounting role and after 6 months the opportunity arose for her to trial the role of accounts payable clerk (a role she held for 10 years before completing her accounting degree). This work was more routine and procedural.
Outcome: Judy was re-employed as a part-time accounts payable clerk, 3 days per week.