3. Planning RTW

Planning RTW

Returning to work with the pre-injury employer provides the best chance of success following TBI, for several reasons including:

  • often an established relationship exists between employer and employee that may provide for commitment and flexibility in accommodating altered working conditions

  • the client may feel more comfortable and supported in returning to the familiar social networks in the workplace thereby reducing anxiety; and

  • resuming familiar tasks and routine minimises the need for new learning often complicated by memory impairments post TBI.

Some of the practical considerations and strategies for planning return to work are:

Timeframe of return to work commencement

Commencing discussions with the pre-injury employer at an early stage post-injury is important to preserve the job opportunity and gather details regarding the client’s job and workplace culture.  However, the timing for commencing work requires more careful consideration. Commencing work too early can be just as problematic as delaying return to work, because the impact of cognitive and other changes post injury may take some time to become apparent.

A structured return to work program

It is uncommon that employers encounter TBI within their workforce and providing guidance via a written return to work plan that specifies the schedule of upgrading tasks and hours, specific restrictions and compensatory strategies will be required to help facilitate a successful outcome.


Typically, a return to work program commences with part-time hours to reduce fatigue, with gradual upgrading over time.  It is also best to avoid consecutive days of work (e.g., working Monday/Wednesday/Friday initially). Upgrading to pre-injury hours, particularly if the client worked full-time prior to the injury may take an extended period particularly if fatigue is present and it may eventuate that maintaining part-time hours long term is the better goal.

Compensatory strategies

Compensatory strategies allow clients with cognitive impairment to operate more independently.  General strategies for return to work include:

  • Commence working part-time and gradually increase hours of work

  • Initially avoid consecutive days of work if possible

  • Allocate work that is most familiar and routine

  • Allow extra time to complete tasks

  • Try to complete one task before moving onto the next

  • Reduce distractions in the work environment

  • Reduce the range of responsibilities in the initial stages to avoid stress

  • Follow a set work structure; review daily goals/priorities with supervisor

  • Use diary, checklists and written notes to assist with memory and organising skills

Specific strategies will need to be identified individually for each client, considering the impact of the TBI and nature of the job role and workplace.   


Strategies for clients with limited insight:  

Clients experiencing reduced insight into the impact of their injury may be unlikely to identify a need for compensatory strategies.  Providing positive feedback in conjunction with highlighting any issues is recommended through providing practical examples.  Strategies more likely to succeed in this instance will be external (i.e. environmental modification).

Case examples for insight

Tom is an IT technician who sustained an extremely severe TBI. 

As a result of his injury Tom has poor recall of new information, difficulty sustaining his attention, reduced complex planning ability and limited insight into what this means for him when back at work. The employer and vocational provider worked together to set up the compensatory strategies needed before Tom could return to work.

Workplace changes included: reduced scope of responsibilities, reduced hours in the initial stages of return to work, seating Tom in a desk that is away from distracting stimuli (eg. non-cluttered, quiet, out of frequent foot traffic area) and use of an internal task-tracking program. The vocational provider scheduled regular reviews with Tom and his employer to discuss Tom’s performance and plan gradual increases as Tom demonstrated the skills and capacity required.

Emma is a clerical assistant who has sustained a severe TBI. 

As a result of her injury she has difficulty recalling information, reduced speed of information processing and difficulty with tasks requiring divided attention. 

Emma has good awareness of these difficulties and was able to discuss the impact in her workplace with the employer and vocational provider and jointly they identified useful compensatory strategies.

The compensatory strategies used in the workplace included: audio-recording meetings so that Emma can write the minutes at a later time, using checklists, breaking larger tasks into smaller steps, using reminders on phone and computer.  

Emma was able to review her own performance with her employer and contact her vocational provider to explore what other strategies would assist as her duties increased.

More examples of compensatory strategies

Executive functioning including
planning, problem solving, reasoning, decision making:

  • Divide large assignments into smaller steps

  • Schedule weekly meetings with supervisor to track task progress

  • Provide written instructions

  • Task-specific routines (via task analysis and instructions/check list)

  • The use of organisational aids (e.g. written calendars, smart phones)

  • To assist with impulsivity, train the client to systematically problem solve (identify the problem, identify possible solutions, eliminate unsuitable solutions etc.)

Psychological issues:

  • Establish long term and short term goals

  • Flexible scheduling (accommodate appointment needs)

  • Provide education/sensitivity training to co-workers

  • Schedule weekly meetings with supervisor to encourage open communication and feedback


  • Schedule breaks and work when most alert

  • Incorporate multiple short breaks into work schedule

  • Use headset to cancel out background noise

  • Set up work space in quiet location

  • Reduce clutter in the work environment

  • Task management: perform one task at a time, utilise earplugs to minimise distractions and redirect calls to an answering machine to avoid interruptions, if suitable option within the workplace


There are different type of memory functions and some may remain unaffected following TBI (e.g., procedural and semantic memory related to knowledge and learned facts). However other types of memory more typically affected by TBI include learning new information and prospective memory (remembering what needs to be done). Memory strategies include:

  • Record meetings on audio device

  • Internal compensatory strategies (e.g. word associations)

  • External compensatory strategies (posted lists, labelled file cabinets, calendars, alarms, timers, computer-based reminders, mobile phones and medication organisers.

For Interpersonal/ behaviour changes:

(e.g., disinhibition, impulsivity, socially inappropriate behaviour, and lack of initiation).
  • Environmental modification (identify antecedents/triggers)

  • Establish clear expectations

  • Identify positive reinforcers

  • Direct, immediate feedback

  • Strategies for initiation (alarms etc.)