Synapse - reconnecting lives

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 brain injury.

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 work.

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.

POTENTIAL BARRIERS

Some of the barriers in returning to work are:

• An individual's desire to work being greater than their actual readiness
• Accessing support e.g. being linked with the right employment support agency
• Cognitive impairment
• A lack of opportunities for people to demonstrate what they are capable of
• Poor control over emotions
• Fatigue and other physical problems e.g. dizziness and headaches
• Experiencing a loss of self-confidence after unsuccessful attempts
• Loss of motivation.

 
SUPPORT

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 adjustment.

 
Remediation

This involves relearning skills with practice until a certain level has been achieved e.g. practising typing speed.

 
Substitution

Substitution requires maximising previous skills or learning a new skill to overcome a difficulty e.g. using self-instruction to improve concentration skills.

 
Accommodation

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

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 adaptability.

 
VOLUNTEER WORK

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.

 
MANAGING FATIGUE

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.

 
LEGAL ISSUES

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 so.

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.