According to a study published in Brain Injury, nearly 40 percent of people with TBI or a non-traumatic acquired brain injury are able to return to work after one to two years. Among people with TBI, a substantial number of individuals were unable to return to their original occupation and some were unable to return to work ever. But a study published in Disability Rehabilitation found that a significant number of patients with TBI, including those who are severely injured, could return to productive employment if sufficient and appropriate effort was invested. “There are no two traumatic brain injuries that are alike, just like there are no two people that are alike,” says Kristen Dams-O’Connor, PhD, an associate professor in the department of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City. “Return-to-work trajectories can vary tremendously.”
Common Symptoms After Brain Injury
Once patients return to work, they often experience symptoms that can make their workday more challenging. The Mayo Clinic’s publication Understanding Brain Injury: A Guide for Employers explains that employees with a brain injury may display memory, attention, and cognitive issues. The guide also states that people with a brain injury can have trouble with decision making, initiation, carrying out an action plan, self-control, self-awareness, and mood swings. The Brain Injury Association of America (BIAA) recommends patients return to work gradually. “I’ve had a lot of patients who are high-functioning professionals before their injury and they just want to run back to work full speed ahead and go back to the job they were doing,” says Dr. Dams-O’Connor, adding that maybe they can start working just a few hours a day and gradually add more time. She also recommends that patients volunteer before going back to work, because there is less pressure at a volunteer job and it will give them time to assess their skill level. Danielle Sandsmark, MD, PhD, an assistant professor of neurology at the Hospital of the University of Pennsylvania, says it’s important to start doing something after the injury, even if that means starting small. “Most people try to do too much too fast. I tell people to start slow and have low expectations. Sometimes that might be staying at home and getting on their work email, and seeing what they can do. I try to think about what people need to do in their jobs and what’s the most important,” she says.
TBI Survivors Share Their Most Challenging Symptoms at Work
Kathleen Bartl, a published author, public speaker, and former corporate manager, had just started a big position in her company when she suffered a TBI. She was performing at a dressage competition (a high-skilled European style of horse riding) when her foot fell out of the stirrup and her horse bolted. Bartl was hanging off the horse when she hit her head on a wooden beam, cracking her skull. She doesn’t remember how long she was in a coma, but when she woke up, she had to relearn everything, from crawling and walking to talking. After a year of recovery, she tried everything to return to her corporate job, to no avail. She had 24/7 vertigo, short-term memory loss, and an inability to multitask or concentrate in the chaotic open-office layout with cubicles surrounding her workspace. She says she was also incapacitated daily by extreme lack of stamina and had developed massive migraine syndrome. Since she was unable to return to her pre-injury occupation, she went back to working with horses, something she loved. She trained with her horse five times a week, which helped to manage vertigo and overall improved her physical functioning substantially. “I value my life so much more now after 20 years of being able to figure out my own way through this maze. I get to do things because I am not so driven to get to the next job and I get to use that drive to just get better,” said Bartl. Jeff Sebell, a published author and a former sales representative, was a sophomore in college when he had a bad car accident. He was in a coma for a month. After a few months of healing, he went back to college and finished his education. After he graduated, he started working at a radio station, where he struggled with slurred speech. Soon after, Sebell started working for the family business as a sales representative, where he said he struggled with his memory. He also had trouble processing conversations quickly, and sometimes he would not respond appropriately. Despite his injury, Sebell worked in sales for 25 years. “Everybody has to find their equilibrium … Sure, there are things that you can’t do as well because of your brain injury, but there must be stuff that we can do better or new things that we can find. It is a whole time of discovery, to discover what your new abilities are, and to discover what you are good at, because so much has changed … You can’t rely on the stuff that you used to be able to do. You really need to learn about yourself all over again,” said Sebell. Kelli Williams Gary, PhD, an assistant professor in the department of occupational therapy at Virginia Commonwealth University in Richmond suffered a traumatic brain injury from a serious car accident. She fell asleep at the wheel and caused a five-car pileup. She said the accident was so bad that she should have died. She was in a coma for a few weeks. When she returned to work at her first career job five years later, she struggled the most with her memory and her emotional health. To help with her memory she would take notes in a notebook and would use sticky pads. She also tried to keep a repetitive routine to help with her memory. “Going back to work after TBI can be extremely difficult. It is important to accept that learning and performance will not be the same but it is not impossible to learn and perform well at work. It can be frightening to change positions or do something totally different, but my advice is to try and find something related to what you enjoy and that is not difficult for you to do with new limitations,” says Dr. Gary. Colleen Cruice was a behavioral technician when she was severely assaulted by one of her adolescent clients in his home. Soon after the incident, she was diagnosed with a mild TBI and post-traumatic stress disorder (PTSD). She took a year and a half to recover, and when she returned to work as a pediatric occupational therapist she experienced mental exhaustion and fatigue. “I went into a new job, and it was all these new expectations, all these new people, all these new faces, all these new names, you know, all the different rooms where things are located and navigating all that … My strategy was to be very consistent on a routine, for sure. I would say the first couple of weeks of my job … I was in bed by like, eight o’clock, and I was able to get that stamina up in my body," says Cruice.
Special Accommodations to Help People With TBI Return to Work
The Americans With Disabilities Act states that employers are required to make reasonable accommodation to “the known physical or mental limitations of otherwise qualified individuals with disabilities, unless it results in undue hardship.” According to BIAA, reasonable accommodations for employees with a brain injury include:
Modifying examinations, training materials, or policies (for example, an untimed test or providing a reader or scribe)Modifying work schedules
Job restructuring:
Reassignment to an open position that better meets the special needs of the worker with brain injuryReasonable accommodations can also include recommended compensation techniques, such as: more frequent breaks, reduced distractionWritten instructions and checklistsDividing complex tasks into smaller stepsA paper or electronic organizer
Cruice is very vocal about her injury and recommends that others advocate for themselves at work. She has made her own personalized accommodations to make her workday easier. “I have a designated work spot. There’s always a quiet space that I can find.” She also makes sure her work area is free from distractions. “I don’t have tons of pictures on my desk. It affects my ability to focus,” she says, adding that she also wears a watch, uses checklists and an electronic organizer, and divides larger assignments into smaller tasks. Cruice is a firm believer in work-life balance. “Self-care is something I value as an occupational therapist and brain injury survivor,” she says. She practices good sleep hygiene (eight to nine hours a night), exercises (light to moderate), eats healthy foods (a large variety of fruits and veggies), attends a small group Bible study, prays, and journals. She also makes time to visit her friends outside of work for coffee or a meal. Cruice believes TBI survivors should openly share about their injury in the workplace. “I just tell people you have nothing to lose. One of the biggest things is to overcome the shame of it,” she said, adding that TBI survivors should seek out support and advice from family, close friends, or professionals to help through this process.
