Supporting an employee with brain injury to return to work and perform their work roles can be challenging. Employers experience different attitudes and emotions while supporting an employee return to work following a brain injury. Being involved in the rehabilitation process will help the employee’s successful return to work.
We describe common challenges that may occur, signs that may indicate the problem and what you can do to help.
Each employee is unique, so an adjustment that may work for one employee may not work for another.
If an adjustment does not work, try another one or develop a different solution. Ask the employee what their preferred adjustment may be.
The employee’s rehabilitation team can support you apply workplace adjustments. They have health professionals who have experience applying adjustments. Adjustments can be for fatigue, cognitive changes, behavioural changes and communication issues.
Fatigue
Fatigue is very common after a brain injury. Fatigue can result from the additional physical and mental effort required to do tasks that once were performed with little or no effort.
Fatigue can be dangerous because it can lead to mistakes, accidents and injury.
Signs to watch for
- Becomes tired more quickly
- Works at a slower pace
- Is distractable
- Forgets things
- Has slowed or slurred speech
- Confuses sentences and cannot find the right word
- Has a vacant look in their eyes (‘zoning out’)
- Is irritable
- Isn’t getting through their work in the expected time frame
- Has increased errors
- Fatigue can make small problems seem worse than they are for the employee
Suggested workplace adjustments
- Plan a graded return to work with a gradual increase in hours and responsibilities. Resume tasks gradually, over weeks or even months.
- Encourage the employee to use a calendar or planner to improve organisation and help manage mental fatigue.
- Set a schedule that includes regular rest breaks.
- Encourage short breaks as soon as signs of fatigue appear, rather than waiting until the employee is fatigued.
- Start with familiar tasks that the employee can complete without fatigue.
Cognitive changes
Employees with cognitive changes may have difficulty remembering all the steps needed to complete tasks. They may be distracted or take more time to make decisions.
Signs to watch for
- Difficulty remembering routine work tasks
- Difficulty learning new work tasks or learning new information
- Forgets what they are doing from one task to the next task
- Forgets work colleagues’ names
Suggested workplace adjustments
- Plan a structured routine of daily work tasks.
- Encourage the employee to use memory aids and organisers, such as calendars, checklists, and a diary (paper or electronic).
- Avoid giving lots of instructions all at once. Break tasks down into smaller chunks.
- Provide written and verbal instructions for routine work tasks if the employee cannot remember.
- Provide written and verbal instructions for new information or work tasks. Include diagrams and flowcharts in the written instructions.
- Encourage the employee to write down new information and refer to it.
- Try to link new information and tasks with familiar information and tasks.
- Allow the employee to practice the task on many occasions so that it becomes a habit.
Signs to watch for
- Has trouble focusing on a task
- Is easily distracted
- Has difficulty doing more than one task at a time
- Does not remember what other people in the workplace have said
Suggested workplace adjustments
- Reduce distractions in the workplace.
- Reduce noise from the work area. Increase natural light and reduce clutter.
- Encourage the employee to focus on one task at a time and complete one task before moving to the next task. This is good for larger work tasks or projects.
- Encourage work colleagues not to distract the employee while they are working.
- Schedule brief work breaks between short periods of work.
- Modify the job demands so the work tasks are simpler to complete, then gradually increase job demands.
- Set up a buddy program with a co-worker who can provide extra support and encouragement to keep the employee on task.
- Ask the person to repeat back what you have just asked them to do.
Signs to watch for
- May hesitate when making decisions
- Has difficulty knowing when there is a problem
- Has difficulty understanding information
- Has difficulty deciding the best solution or won’t consider more suitable options
Suggested workplace adjustments
- Help the employee to work through problems to reach the best solution by exploring the options with them.
- Discuss the advantages and disadvantages of each option with the employee.
- Stop and think. Encourage the employee to stop and think.
- Picture diagrams and flowcharts may help with decision making
Signs to watch for
- Has trouble starting a work task
- Appears disinterested or unmotivated (unintentional)
- Doesn’t follow tasks through to completion
- Has difficulty planning the order of work tasks
- Appears disorganised at work
Suggested workplace adjustments
- Help the employee develop and follow a structured work routine or a to-do list for the day or week.
- Set a time frame for finishing tasks.
- Encourage the employee to use a calendar or diary (paper or electronic) to set deadlines for tasks to be started and finished.
- Divide large projects into smaller work tasks for the employee.
- Include the employee in any planning activities.
- Assist the employee to write a step-by-step list as a plan. Encourage the employee to refer to the plan and check off each task that is finished.
Signs to watch for
- Is unaware of their limitations or shortfalls (rarely intentional)
- Has difficulty understanding other people’s ideas or points of view
- Overestimates their abilities and underestimates problems
- May not listen to or accept feedback
Suggested workplace adjustments
- Anticipate the employee may show limited insight when they start working.
- Supervise the employee in the initial stages of their return to work.
- Use straightforward language that has an obvious meaning when talking with the employee.
- Encourage the employee to look at the situation from an outside viewpoint.
- Give realistic feedback to the employee about their behaviour.
Personality and behavioural changes
An employee with brain injury may have changes to their behaviour that affect their self-control, self-awareness and responses to social situations
Signs to watch for
- Acts or speaks without all the information or without considering the consequences
- Shows poor judgment and is impulsive
- Lacks inhibition with co-workers
- Becomes stuck on one idea or task instead of moving to other different tasks
Suggested workplace adjustments
- Understand the employee may not know how to act or behave in a social, work situation.
- Provide the employee limited choice of options for work tasks.
- Explain the reasons for completing the tasks to the employee.
- Provide feedback on behaviours that may not be appropriate.
- Encourage the employee to slow down or to think through tasks or responses.
Signs to watch for
- Has mood swings ranging from sad and angry.
- Inappropriately laughs or cries at work
- Has low tolerance for frustrating situations
- Becomes agitated or loses their temper quickly
Suggested workplace adjustments
- Remain calm if an emotional outburst occurs from the employee.
- Take the employee to a quiet area for time to calm down and regain control.
- Provide feedback after the employee has regained control.
- Gently redirect behaviour to a different topic or task.
- Understand that a brain injury may limit the employee’s ability to feel empathy.
Signs to watch for
- Has persistent sadness
- Displays signs of anxiety
- Is irritable at work
- Neglects personal responsibilities or personal care
- Lacks motivation, and energy and is always fatigued
- Feels helpless, worthless or hopeless.
Suggested workplace adjustments
- Encourage the employee to talk with their general practitioner about their feelings and physical symptoms.
- Talk with the employee to determine whether specific difficulties at work are causing frustration.
- If an employee expresses suicidal thoughts or threatens self-harm, call 000.
Signs to watch for
- Says negative things and is critical of themselves
- Focuses on negatives and ignores achievements
- Blames themselves when things go wrong
- Work performance decreases
Suggested workplace adjustments
- Point out the employee’s successes to them.
- Choose work tasks that the employee can complete.
- Encourage the employee to be independent with work tasks over time.
- Gradually allocate more responsibility to the employee over time.
Communication changes
Communication changes may be caused by many factors, including changes in behaviour and cognitive skills. Speech and the ability to understand language also may be affected by a brain injury.
Behaviours and actions that may occur
- Speech may be difficult to understand and may not be natural.
- Does not respond to conversations at work or questions or comments from colleagues
- Does not start conversations, ask questions or make comments
- Has difficulty thinking of the right word during the conversation
Suggested workplace adjustments
- Let the employee know when they have not been understood. Have a backup solution, e.g. pen and paper.
- Encourage the employee to participate. For example ask, ‘What do you think about that?’.
- Ask open-ended questions such as, ‘Tell me about…’.
- Give the employee time to organise their thoughts when responding to a request or question.
- Give the employee your full attention while they are thinking.
- Rephrase what the employee has said such as, ‘Do you mean…?’.
Behaviours and actions that may occur
- Has difficulty paying attention to what is said
- Misinterprets what is said
- Talks too much
- Does not give the listener time to speak
- Does not appear to adjust their communication for the situation
- Has difficulty keeping up with the conversation when the topic changes
- Does not always stay on topic
- Has problems explaining things clearly
Suggested workplace adjustments
- Ensure you have the employee’s attention before speaking to them.
- Reduce distractions in the work area including noise.
- Politely interrupt and ask for a chance to speak
- Highlight important information and offer to repeat what was said to the employee.
- Encourage the employee to ask for an explanation if they don’t understand.
- Ask the employee for their input about the conversation topic.
- Tell the employee you are becoming confused in the conversation.
- Allow the employee time to explain things clearly and prompt them if needed.
Behaviours and actions that may occur
- Does not seem to understand common nonverbal cues
- Stares at other people during a conversation
- Shows uncomfortable types of physical contacts, e.g. standing too close when talking to a person
- Uses facial expressions and body language that do not seem to match what is being said
Suggested workplace adjustments
- Ask the employee to maintain a comfortable distance if not acknowledging the person’s space.
- Tell the employee you are confused by the difference in their body language and spoken message.
- Politely ask the individual to stop any distracting movements.
- Understand that a brain injury may change an employee’s facial expressions.
Physical limitations
An employee’s walking, including coordination and balance, may be affected by their brain injury. An employee may use a mobility aid at the workplace, including crutches, walking stick, walking frame or a wheelchair. Physical adaptations to the workplace, such as ramps or handrails may need to be installed. Floor space may need to be always clear to ensure the employee is safe while walking around.
An employee’s upper limb strength and movement may be impacted by their brain injury. They may require physical adaptations depending on their work tasks. For example, modifying their computer set up.
An employee may not have returned to driving when they return to work. If driving a vehicle or machinery is part of their work role, the employee will need to complete different tasks until they are fit to return to driving. The employee’s rehabilitation can provide guidance about the process for the employee’s return to driving.
The Employment Assistance Fund, from the Australian Government as part of JobAccess can be accessed. The fund can provide financial assistance to employers to purchase work-related modifications, equipment and workplace support services to assist employees with a disability perform their work tasks.