Research and peoples’ own experience tell us that there are many factors that delay, or even prevent, people from returning to work. The impact of these factors varies greatly from person to person. Each person’s brain injury is unique so how it impacts on them and their return to work or other activities, is also an individual journey.

A brain injury can cause many obvious physical and sensory difficulties – for example, paralysis, sight or hearing impairments or difficulties with movement, balance or coordination. However, many people have difficulties that are not obvious – these are known as ‘hidden disabilities’. These difficulties can have a significant impact on going back to work.

Some hidden disabilities after a brain injury are:

• Fatigue.
• Changes in your ability to read, write, speak or understand language.
• Memory difficulties – for example, forgetting appointments, conversations or recent events.
• Reduced ability to take in and process information quickly.
• Attention and concentration difficulties.
• Reduced ability to plan and organise yourself or tasks.
• Difficulty thinking flexibly to solve problems.
• Trouble managing your emotions.
• Reduced tolerance of distractions, noise, bright lights or changes in temperature.
• A decrease in self-awareness.

Other common changes are:

• A drop in self-confidence.
• Changes in how you interact with other people.
• Loss of ability to drive.

“They see you and you look perfect. But, as I say to them: ‘Come on inside my head and try looking out. Then you’ll know all about it.’” – Anne, Co.Dublin

Even though you may want to go back to work as soon as possible, it is important that you take your time and wait until you are ready. If you are able to return to work, choosing the right time can increase your chance of success. The ‘right’ time for you is when you have made enough progress in your physical and cognitive recovery and you are adjusting well psychologically to any lasting effects from your brain injury.

1. The first thing to do is to check with your GP to see if they agree that you have recovered enough to go back to work. You might feel fine, but the medical advice may be that you need more time.
2. If you get the go-ahead from your GP, then contact your employer.

Now try this Check-list. Answering ‘Yes’ to most of the areas below, will give you a broad indication that you are ready to consider going back to work. You might like to ask someone you trust to fill this in also.

First try to develop a clear understanding of your strengths, challenges and any limitations.

A limitation is something that you cannot overcome through further rehabilitation or effort – for example, not being able to drive due to having epilepsy. Dealing with limitations involves looking at other options to get around them – for example, using public transport in this case.

Physical abilities and fatigue

If you have difficulties with movement, strength, coordination or balance, a Physiotherapist or Occupational Therapist, may be able to assist you to achieve further improvements.

Fatigue is common after a brain injury. Try the tips in the section on Fatigue and sleep. Contact your GP if you do not experience any improvement.

Sensory difficulties – like sight, hearing or touch

If you have difficulties in any of these areas that need further treatment or input, talk to your GP. You can also contact relevant organisations – for example, NCBI (National Council for the Blind Ireland) provide services to assist people with changes in their vision to maximise their independence at home or at work

Cognitive and perceptual skills

A Clinical Psychologist or Occupational Therapist can work with you to maximise your potential in skills such as problem solving, multi-tasking, planning, concentration, organising, spatial awareness and memory. They can also assess these skills and make recommendations.

• A Neuropsychological Assessment measures your current level of brain functioning identifies how this is impacting on you and makes helpful recommendations.
• A Vocational Assessment by an Occupational Therapist provides you with practical information on your strengths and challenges in relation to skills needed for work. This assessment also includes recommendations for aids and strategies.

Communication skills

If you have communication difficulties that you want further skills or strategies to deal with, contact a Speech and Language Therapist.

Social skills and community involvement

Your local community centre, library, sports centre or brain injury organisation are all good places to meet people and get involved.

Coming to terms with changes

Many people find counselling or psychotherapy helps them to come to terms with changes after their brain injury.

The ability to set yourself realistic goals, and to get on with other people, are two very important skills that increase the chances of successfully returning to work.

After a brain injury, some people may overestimate what they are capable of. For example, someone’s short-term memory may be worse than they realise. They may not be fully aware that how they interact with other people has changed – perhaps they have an abrupt way of speaking that they do not notice themselves.

If you (or someone close to you) set unrealistic goals, this can put you under unhelpful pressure and actually reduce your chances of success.

• You need to give yourself enough time after your injury to recover. Many people go back to work too soon and cannot meet the demands placed on them.
• You also need involvement with other people, to have a chance to see how you get on with them in different social situations.
• A Neuropsychological Assessment or Vocational Assessment may give you valuable feedback on any current limitations you have and on your strengths. You can use this feedback to help you set realistic goals and to guide you on what to do next. Contact a Psychologist or Occupational Therapist for advice.

“I genuinely thought when I got out of hospital I’d be back doing exactly the same role within a couple of months. I’m so happy I didn’t and that I got good advice. In the end, it took me two years to get back.” – Ronan, Co.Dublin

Given the proven benefits of the support of specialist services, it makes sense to link in to one of these services as soon as you feel well enough. They can assist you to look at your strengths and any limitations, to set realistic goals, to weigh up if you are ready for work, what steps you could take to get ready or to explore other options apart from work.

1. Organisations such as Headway, the National Learning Network, the Irish Wheelchair Association and the National Rehabilitation Hospital in Dun Laoghaire, offer services to people wishing to return to work after a brain injury.
2. Rehabilitative Training. The HSE has staff to support people who are under 65 years of age to explore options for training and re-building confidence after an illness or disability. Use the HSE information line to make contact with the HSE Occupational Guidance Officer, the HSE Disability Manager or the HSE Disability Case Manager in your area.
3. Employability is a nationwide service that supports people with a disability or illness to access work, where possible.
4. Local Employment Services Networks offer information, guidance and job-searching support as well as training and educational opportunities in many countries.
5. Adult Education Guidance Services are available through your local Education Training Board (formerly the VEC).
6. If you are studying, or wish to return to study, contact the college Access Officer for advice or additional support.
7. Contact www.ahead.ie for free advice and information for Third Level students with disabilities and work opportunities for graduates.

If you have an Income Protection Plan, Life Assurance or Health Insurance, check if you’re due any payments while you are not working.

Social Welfare Payments

If you are receiving Disability Allowance you can apply for an exemption to take up Rehabilitative Employment (subject to certain conditions). This is done in conjunction with your employer and your GP.

If you are receiving Illness Benefit or are on an Invalidity Pension and wish to return to work, you can apply for Partial Capacity Benefit. Partial Capacity 12 Benefit allows someone to work while keeping some social welfare benefits (subject to certain conditions).

Grants for returning to work

There are a number of government grants available to employees with disabilities, injuries or medical conditions- for example, the Workplace Equipment Adaptation Grant is available to make changes to the workplace or to get adaptive equipment. An employer, employee or a Self-employed person can apply.

• Reasonable accommodations are adjustments to working arrangements, equipment or facilities to accommodate someone’s disability, injury or medical condition.
• They are put in place to help an employee to do the job they were employed to do. Without such adjustments, an employee could be limited by the effects of their disability.
• An employer has a responsibility to provide reasonable accommodations unless doing so would cause undue hardship to the employer or would create a significant risk to the safety of the employee or other workers.

What your employer can do

• Discuss a flexible plan with you for returning to work.
• Ask you what helps you to work around any effects from your brain injury that may impact on your job.
• Give you a reduced workload to start off with.
• Re-structure work times and responsibilities to give you as much routine and predictability as possible.
• Support you to use the recommendations from any Neuropsychological Assessments or Vocational Assessments you’ve had done.
• Arrange for you to liaise with HR, your Employee Assistance Programme or a specialist vocational service, where available and as needed.
• Assign a trusted colleague or workplace mentor to give you daily guidance or re-training, as needed.
• Arrange regular, honest and constructive feedback sessions. These can assist you to adjust how you’re working, if needed, and provide encouragement.
• Take into account that fatigue, irritability and changes in emotions are common after brain injury.
• Visit www.edi.ie (Employer Disability Information) for information and advice.

What you can do

• If you have decided to disclose any difficulties, tell your employer any specific effects of your brain injury that may affect your work and what can help.
• Agree together what adjustments are feasible to your role, work hours and/or workstation, for example.
• Arrange regular meetings with your manager to keep them in touch regarding how you are getting on.
• If you feel comfortable, ask for your colleagues to have a brain injury awareness session. This may help them understand better the effects of a brain injury. This is particularly beneficial if you ‘look great’ but have difficulties that are not immediately obvious such as memory, fatigue, difficulty controlling emotions or speaking your mind more.

Tips that may help

• Reduce distractions by decluttering your work area and cutting out background noise and movement in the background if possible.
• For memory difficulties, try using a diary (Headway produce one) and a calendar, as well as reminders, notes or voice memos on your mobile phone or computer.
• Use checklists for tasks and finish them one at a time.
• Do more tiring tasks first and take regular breaks.

“Coming to the Headway group is brilliant. You’re with people you feel at home with. When you mention your brain injury, they know exactly what you’re talking about.” – Chrsis, Co.Limerick

“I think the biggest thing is not to be afraid of making mistakes. Everyone makes them – whether they are a CEO or someone starting their first job. We only get better at things because of mistakes. Don’t be hard on yourself. Remember, nobody is perfect.” – Conor, Co.Louth

Returning to paid work after a brain injury can be a complex process and may take months or even years. Going back to work is not possible for everyone. If you are not working now or have been told that you will not be able to go back to a paid job, it may be hard to accept. It can take some time to come to terms with this new reality.

Here are some suggestions for things to consider. Research has found that doing activities such as the ones listed below, gives people many of the same benefits as when they were in employment.

• It is important to remember that returning to work is not the only mark of success in recovering from a brain injury.
• If you can’t work, try to think about what alternative activities could bring you satisfaction and keep you busy – for example, volunteering, developing a new hobby, community involvement or joining a group.
• Some people find that their priorities change following their brain injury. Their pace of life changes and they may become more focused on enjoying life in a different way; this might mean spending more time with family, on hobbies or socialising.
• If you haven’t already, consider getting in touch with a brain injury organisation like Headway. This is a good way to meet other people who have gone through similar experiences, to learn more about living with a brain injury and to take part in positive activities.
• Your abilities may increase over time. So, going back to work may be a possibility in the future. Talk about this with your GP, Occupational Therapist or other people supporting your recovery.
• Some people return to education or develop a new interest or skill.
• If you are unable to go back to your job, other options you could investigate are starting your own business or becoming self-employed. Citizens Information has lots of useful information (www.citizensinformation.ie).

“I have a great deal of experience and an awful lot to give. I believe that I can bring something to an organisation. I’ve lost some skills but I still have the ability to contribute.” – Owen, Co.Dublin