Return to work after brain injury: planning, adjustments and support

Headway warns that one of the most common difficulties is going back too soon because the effects of the injury on work performance are not yet understood. This is especially likely when physical recovery is good, because people often assume cognitive abilities have recovered too. Returning to work frequently reveals the full extent of difficulties, and poor performance can damage confidence.

It advises avoiding major decisions and stressful situations until ready, being honest about abilities, preparing thoroughly and not rushing recovery. It suggests not taking on overtime, shift work or new responsibilities until ready. A neuropsychological or occupational therapy assessment can give an objective picture of memory, attention, processing speed and executive function.

NICE guidance on neurological rehabilitation says discussion about remaining in or returning to work should happen with the person and employer as early as possible, may include a work capacity evaluation, should help set expectations and solve barriers, and may involve occupational health, human resources and legal colleagues. When the person returns, the employer and rehabilitation practitioners review the effectiveness of adjustments and agree future adjustments.

Headway suggests requesting a return to work interview to discuss a gradual return, for example starting at three mornings a week or working from home, shorter hours, more breaks, a lighter workload or a different role, plus regular follow-up meetings. All employees can request flexible working from their first day in a job, and statutory sick pay rules should be checked with the employer.

Headway says you do not have a legal duty to disclose a brain injury and employers may not ask about health unless it relates directly to job requirements, but you must disclose anything that could put you or others at risk, for example if you have been told not to drive because of seizure risk. Telling your employer can unlock reasonable adjustments under the Equality Act 2010.

Keeping in touch while off, understanding your sick pay entitlement, giving employers information about brain injury, asking a clinician to speak to the employer and being honest about uncertainty over tasks are all suggested. NICE adds that the person should be asked whether and how workplace adjustments are explained to colleagues and what remains confidential.

NICE stroke guidance gives examples of what rehabilitation teams do: identify the physical, cognitive, communication and psychological demands of the job, such as multi-tasking in a busy office, and the problems affecting performance, such as fatigue preventing a full day, then tailor interventions. These might include strategies for multi-tasking or memory, voice-activated software for people who find typing hard, work simulations, workplace visits, liaison with employers and a phased return.

• Use diaries, task lists, alarms and checklists to cover memory and planning problems.

• Reduce distractions with a quiet workstation and scheduled focus time.

• Plan the hardest tasks for the time of day when energy is best, and schedule recovery breaks.

• Agree one point of contact at work and review progress at regular meetings.

Headway describes several routes. Access to Work is a government scheme offering financial support for adaptations such as specialist equipment or accessible environments, subject to eligibility. Vocational rehabilitation is described as an extension of NHS rehabilitation, involving occupational therapists, physiotherapists and employment services, and a local NHS brain injury rehabilitation team can say whether it is offered. Jobcentre Plus has disability employment advisers in some locations, and work trials allow someone to try a job for up to 30 days on a voluntary basis without affecting benefits, subject to conditions. Employers displaying the Disability Confident symbol have committed to supporting disabled employees.

NICE says that where return to a particular role is not possible, support should be provided to help the person leave work or change role, and that voluntary work and self-employment are covered by the same recommendations. NICE stroke guidance also advises considering referral to a return-to-work programme for people who were working before their stroke.

Headway suggests alternatives such as vocational training or adult education, starting a business or voluntary work if someone is not ready, and notes that choosing the right job is easier with advice from family, friends and professional services, especially where memory, decision-making or insight are affected. A new role should draw on retained skills, strengths and motivations, as NICE recommends when assessing ability to work.

Benefits and sick pay questions are best raised early, and charities such as Headway offer advice. Driving rules also matter for work that involves travel, which our driving guide covers.