Returning to work after a brain injury/concussion

Returning to work after a traumatic brain injury (TBI) or concussion is rarely a simple switch back to “normal.” In clinic, structure is built in. There are scheduled appointments, guided tasks, and therapeutic scaffolds. At work, that scaffolding often disappears. Employers may expect pre-injury performance. Families may assume that once someone is medically cleared, they are cognitively ready. When productivity dips, emails go unanswered, or mistakes increase, frustration builds on all sides.

From a speech-language pathology lens, return to work is about cognitive-communication. That includes attention, memory, organization, processing speed, social inference, self-monitoring, and fatigue management. These skills are essential for meetings, email communication, prioritizing tasks, learning new systems, and navigating workplace dynamics. In Burnaby and across the Lower Mainland, many of our clients are navigating return to work plans funded through WorkSafe BC or ICBC. The process works best when rehabilitation principles are translated directly into the workplace.

Assessment guides intervention. The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) evaluates real-world reasoning, planning, and problem solving under time constraints. It helps us see how someone manages complex, multi-step information similar to workplace demands. The P2W work readiness activities (Pathways to Work) simulate employment tasks and build graded exposure to cognitive load, stamina, and workplace expectations. Together, these tools clarify what is breaking down and why. They also provide objective data for employers and insurers, including WorkSafe BC and ICBC, when accommodations are needed.

After brain injury, people often experience cognitive fatigue, slowed processing speed, word-finding difficulties, reduced working memory, emotional regulation shifts, or increased sensory sensitivity. These are neurologically based changes. Many individuals work extremely hard to compensate, which can make fatigue worse by the end of the day. When families or employers interpret reduced output as lack of effort, morale drops quickly.

The heart of successful return to work planning is clarity. We start by defining what “done” looks like in very specific terms. “Return to work” is too vague. “Respond to client emails within 24 hours using the company template and log interactions in the CRM by 4:00 p.m.” is clear. “Complete payroll entries for 25 employees with zero data errors and submit to supervisor by Thursday at noon” is measurable. “Attend the weekly team meeting, contribute one prepared update, and send follow-up notes within two hours” is observable. For TBI survivors, precision reduces cognitive load because expectations are visible rather than implied.

Once “done” is defined, we break the pathway into small, concrete steps. For the email task, that might include opening the calendar to block two 30-minute email windows, creating a saved reply template, flagging priority messages, and setting a 10-minute review timer before sending. For payroll, it may include printing a checklist of required fields, entering data in batches of five employees, pausing for a brief stretch break every 20 minutes, and using a double-check system before submission. For meetings, it may include drafting three bullet points in advance, placing the agenda on the desk during the meeting, and setting a reminder to send notes immediately after.

Environmental engineering is a major focus because it removes friction before problems occur. If distraction is high, the employee may work in a low-traffic area or use noise-canceling headphones during focused tasks. If fatigue escalates mid-afternoon, cognitively demanding work can be scheduled earlier in the day, with administrative tasks later. If working memory is reduced, all instructions should be provided in writing, with one centralized digital task list rather than scattered emails. If processing speed is slower, extended deadlines or reduced caseloads during the initial phase can prevent repeated failure experiences. These accommodations work because they reduce the load on vulnerable neural systems and externalize executive demands.

For employees with memory impairments, structured note-taking systems and daily written summaries to supervisors can support accountability without constant verbal check-ins. For those with attention regulation challenges, time-blocking with visual timers and website blockers can support sustained focus. For individuals with word-finding or social communication difficulties, scripted email templates and pre-meeting rehearsal can reduce anxiety and improve clarity. For those experiencing sensory sensitivity after concussion, adjustments to lighting, screen brightness, and noise exposure can significantly improve endurance.

Families often feel worried when their loved one appears capable at home but struggles at work. Employers may feel uncertain about how much support is reasonable. In both cases, transparency is protective. Clear documentation of functional strengths and limitations, supported by assessment results and measurable progress, creates shared understanding. Return to work plans through WorkSafe BC or ICBC are most successful when accommodations are proactive rather than reactive.

Self-advocacy and metacognition are essential therapeutic targets. Employees need language to explain what helps them perform well. Practicing statements such as, “I work best when tasks are prioritized in writing,” or “I may need a brief break after long meetings to maintain accuracy,” builds autonomy. Metacognitive strategies include asking: What is the task? What could interfere? What support can I put in place before I start? This internal dialogue reduces repeated errors and builds independence over time.

Return to work after TBI is not about lowering expectations. It is about aligning expectations with brain recovery. With structured supports, environmental design, and collaborative planning, many individuals return to meaningful employment. In Burnaby, our SLP-led return to work programs integrate cognitive-communication therapy with real-world work simulations, supporting clients funded privately or through WorkSafe BC and ICBC. When the right systems are in place, work can become sustainable again.

If you are navigating return to work after concussion or TBI and need guidance in Burnaby, including coordination with WorkSafe BC or ICBC, our clinic provides comprehensive cognitive-communication assessment and individualized workplace planning.