Helping Employers Understand Traumatic Brain Injury: Setting Up for Success


Return to work after traumatic brain injury can be difficult for both employers and employees.



Traumatic brain injury (TBI) is a physical trauma to the head that results in impaired function of the brain. TBI is a life-changing event not only for the individual who is injured, but also for those who surround them. A single patient’s TBI reverberates even further. Injured workers are necessarily removed from their workplace ecosystem, causing more disruption. Employers with little experience and understanding of TBI are left with the uncertainty of the individual’s recovery.

What we have is an unavoidable and difficult ambiguity regarding the timing, nature, and certainty of a return to work for the injured person. Employers are faced with choices of preserving versus filling the injured worker’s role, anticipating a process for an eventual return to work or, in some instances, even choosing whether to recognize the validity of various aspects of their worker’s compensation claim. In some cases, 1 or more of these choices may not be available to the employer, which can cause them to feel even more hapless and at the mercy of the situation. An understanding of the process of a return to work can help employers feel more in control of their own situation and avoid unnecessary tension between valuing their employee’s health and the employee’s family’s well-being, and respecting the need for business continuity.

TBI can impair an individual’s ability to return to work in many different ways. When individuals suffer from physical impairments such as paralysis, gait instability, balance impairment, impaired coordination, spasticity, or any of various orthopedic issues, limitations to a return to work are easily appreciated by employers. By contrast, when impairments are less obvious to a lay person, it can be difficult for employers to understand not only the nature of the injuries, but also the return-to-work path.

For example, some individuals with TBI suffer from subtle impairments that are cognitive in nature. They might have trouble with higher-level sensory processing, making visual or auditory processing difficult. They could be dealing with subtle language impairment, making it harder to comprehend complex information or to communicate difficult or complex information clearly. Alternatively, impaired attention might be a relevant limiting factor. Subtle alterations in mood, personality, social functioning, or behavior can cause problems with workplace relationships and productivity. The long list of complications from TBI that can result in a failed return to work if not adequately identified and treated is beyond the scope here, but it is clear that employers who are dealing with this situation need help from professionals who understand the landscape to navigate it properly.

Setting up for a successful return to work helps both the patient and the employer. Patients benefit from an empathetic, holistic approach that invests early in their recovery and allows them to achieve a maximum level of independent function. Work is a central, driving force in most people’s lives. Without it, many struggle to maintain their personal identity, particularly if they experienced TBI in their prime working years. Employers benefit in the return of an employee who adequately performs their duties, engages positively in the workforce, and avoids unnecessary disability.

Employers should know that individuals returning from injury may require specific return-to-work programming to afford the best chance of success. This might come in the form of reduced hours, increased oversight or review of the work product, scheduled breaks/resting periods, or use of adaptive equipment or strategies. Therapeutic providers skilled in the treatment and management of TBI can provide education and planning for this process to help employers manage this difficult but important transition in conjunction with the patient/employee, where both parties can realize the benefit to one another.

Dr Ashley is a neurologist and chief medical officer for the Centre for Neuro Skills.

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