Returning to work after brain injury

Good afternoon, everyone. Welcome, and thank you to Headway for giving me this opportunity to speak about a really important aspect of brain injury rehab, which, in my opinion, is greatly overlooked as part of the survivor's journey following their injury.

The plan for today is to reflect on the importance of work for everyone, including those with a brain injury. I want to look at the effects of injury on work and vocation, the importance of prevocational skills and roles, how we talk to colleagues about a brain injury, considerations for workplace adjustments, and the support available. It is important to remember that each individual brain injury survivor is unique, and while I would like to give detailed personalized information, this talk is an overview of an approach that may provide guidance.

I have worked as an Occupational Therapist since 2001 in Australia and the UK, focusing on neurological rehabilitation. Since 2013, I have worked independently. Early on, I was involved in a research group focusing on early intervention to help mild to moderate brain injury survivors return to work soon after hospital discharge. This provided me with a strong foundation in neuro-vocational rehab.

Work is an activity involving mental or physical effort to achieve a goal. While I am focusing on paid work or volunteering, unpaid roles like parenting and home maintenance are also vital. Work supports positive mental health, provides rewards, facilitates socialization, and helps develop professional and personal skills. It can even support longevity.

Returning to work should be part of a therapy and rehab plan, not separate from it. It can improve health outcomes—physical, cognitive, psychological, and social—and help reduce the risk of poverty and loss of income. However, work can also be a source of stress, especially if coping strategies are impacted by the injury, and we must consider the health and safety risks involved.

When assessing work readiness, we look at the type of work performed, the environment, and whether there is a role to return to. We must consider if the person is ready, how the injury affects them, and how colleagues may respond. Some roles are easier to adjust, and sometimes redeployment is necessary to suit the individual’s needs while still providing value to the employer. Safety is paramount; for instance, a roofer with vestibular dysfunction has different risks than a receptionist.

Every brain injury is unique, so we must understand the individual’s physical, sensory, cognitive, and emotional challenges, as well as fatigue and sleep disturbances. Returning to work is a marathon, not a sprint. We need to prepare by establishing routines, optimizing sleep, nutrition, and exercise, and testing the ability to handle challenging environments.

Disclosing a brain injury is a personal choice but can be very helpful in securing reasonable adjustments under the Equality Act 2010. Having an information sheet about your needs can facilitate this process and ensure managers and colleagues understand how to support you. Reasonable adjustments might include flexible hours, remote working, voice recognition software, or a dedicated desk.

If returning to a previous role isn't possible, volunteering is a fantastic stepping stone. It provides structure, work hardening, and an opportunity to test strategies in real-world environments. I also recommend being proactive—polishing your CV and approaching businesses directly. There are resources available, including NHS vocational teams and charities like Headway.

'Access to Work' is a government-funded program that can provide assessments and financial support for things like communication support, specialized equipment, or taxi fares to and from work. While the process can be challenging, it is definitely worth exploring.

To illustrate, I shared the story of a 20-year-old who, through a personalized, proactive approach and workplace education, successfully returned to an apprenticeship in bodywork. Conversely, I worked with a 38-year-old whose previous role in finance was no longer realistic. Through a 'supportive failure'—testing tasks to raise his insight—we were able to recalibrate his goals, and he now flourishes in café and park run volunteer roles, which provide the structure and social connection he needs.

In conclusion, returning to work is an MDT (Multidisciplinary Team) approach with the survivor at the center. Whether through paid employment or volunteering, finding the right role can be life-changing. Thank you for your time.