Return to work following a concussion

Sound icon A concussion is a mild traumatic brain injury that can result in symptoms that affect someone returning to work (RTW). Poor sleep, headaches and fatigue are all common symptoms that may impact, as well as difficulty with attention, memory, balance, visual changes and noise / light sensitivities. Fatigue impairs all functions and its management is critical in returning to work. Establishing a good sleep routine is important to assist with fatigue management.

You cannot consider RTW if you haven’t moved from the FOG stage, as you simply do not have the capacity to do a paid job. The FOG stage is evident with reduced concentration to task, floating through the day rather than actively planning or pre planning what you are about to do, poor motivation and initiation and drive to actually achieve something. However, when you start to get bored with routine home tasks and are actively wanting to be involved in more each day you are then ready to look at a graded return to work.

When returning to work you need to consider if you have all the skills to do the job at the standard you would usually and if you can sustain that performance day after day. It is common for fatigue to impact on your performance, with resuming more demanding activity. It is important to return to work when you are capable of achieving the job. Just because a job has been part of life for however long, does not necessarily make it any less cognitively demanding, YOU still have to make the decisions. A person may decide that they no longer want to return to a stressful and demanding job and choose to consider alternatives that can still utilise their skill set and interests.

 

General guidelines:

  • Return to work only when the majority of symptoms have diminished and your physical and cognitive endurance can be maintained over the day. A general guide is when you can concentrate / physically engage with activities at home for about 2 hours and / or 45 minutes on a computer screen, dependent on the job you are returning to.
  • When returning to work, it is good to start on reduced hours/duties and have a day off in between to manage fatigue. Also consider reduced responsibilities, time pressures and restricted duties initially. Consider three mornings a week for 3 to 4 hours. The day off in between provides flexibility to check how you are bouncing back after work demands. Gradually increase to full work days and when ready to add in back to back days, even consider working four days with Wednesdays off, with the second day potentially shorter initially before progressing to a full working week.
  • Every step up in your return to work plan (hours and duties) needs time for your body to readjust. You may feel quite fatigued the first time, but better the next time or the next week. These step ups are essential to reach your best function.
  • Open communication with the workplace to support graded return to work plan (GRTWP).
  • An occupational therapist can write up a GRWTP, signed off by your GP if required by your workplace.
  • Support in the workplace is integral between being given the opportunity and confidence to pace back to part or full time work and valued duties. The workplace can either ask too much or not enough, both of which is not helpful.

 

Apply energy conservation strategies (eg prioritise, plan, pace) while at work and for life balance

  • Allow yourself ‘micro-breaks’ throughout the day before you feel fatigued, eg start with a 5 to 10 minute break each hour. A ‘micro-break’ allows you to stop your cognitive / physical effort and visual processing, removing yourself from your busy stimulating environment / demanding tasks and going to a quieter space.
  • It can be as simple as closing your eyes, blocking out the visual overstimulation and only thinking relaxing thoughts or nothing at all
  • Modify or simplify the activities you do such as break large tasks into smaller achievable tasks
  • Prioritise – set daily goals, use a daily / weekly planner
  • Reduce your workload initially, so that you have additional time to complete each job effectively
  • Allow yourself more time to complete tasks or projects, so to reduce stress / time pressure and errors. Even routine tasks (eg computer admin / paswords) may not come back automatically, it may take more thought than prior to initiate/start, access the knowledge / memory and process.
  • It may take you more time to complete your work, however it is important to also take your regular lunch and coffee breaks.
  • Plan the more challenging tasks at the beginning of the work day when fresh and/or spread throughout the working week.
  • If you start tiring change to a different task, to refocus.

The following are common issues that you may experience, to varying degrees, particularly in the early stages of recovery.

 

Some people try all strategies to support themselves in returning to their usual job, but find they are still unable to manage certain duties, responsibilities or full work hours. If returning to your previous role continues to be a challenge, consult your healthcare professional about your options.

Short term memory problems

Problems may include forgetting or difficulty accessing people’s names, forgetting instructions, repeating conversations, losing a train of thought and confusing appointment times.

What you can do:

  • Use external cues / structures for day to day memories and planning, to optimise recall and reduce cognitive demands
  • Use a diary and notebook or computer diary to write down schedules, appointments and tasks to do and tick off as you go
  • Develop consistent work routines and stick to them
  • Repeat the information, eg You say back “you need me to phone Mr Jones to change the order to XYZ.” to double check the accuracy of the information and assist with retention
  • Document all discussions and decisions, in a structured manner, that you can easily review at a later date to help you keep on track.

Reduced attention and concentration

Problems may include short attention span, easily distracted, difficulty resuming the task following a distraction, difficulty attending to multiple tasks.

What you can do:

  • Focus on one task at a time, deal with one person at a time, avoid multitasking so to reduce errors
  • Avoid or limit being in a noisy, busy, over stimulating area, working where practical, in a quiet environment, eg turn off radios, face away from distractions, use ear plugs / noise eliminating head phones, reduce brightness on screen / reduce number of overhead lights turned on, enlarge open window on computer to eliminate extraneous information. Note: This is also true for noise / light sensitivity
  • Set boundaries on other staff, so that they understand there are only specific times you can be interrupted to improve your efficiencies
  • Alternate tasks after 30 minutes
  • Take regular rest breaks.

Cognitive inefficiencies

Problems may include:

  • slowed decision-making and reasoning skills,
  • difficulty working through large amounts of information,
  • difficulty following conversations and in group meetings,
  • difficulty with finding the word you would like to say,
  • difficulty with starting an activity or monitoring how you are progressing
  • difficulty with spelling, reading and numbers.

 

What you can do:

  • Schedule additional time to complete tasks, especially when starting for the first time, reduce time pressure to reduce stress and errors.
  • Write down the sequence of steps for the process.
  • Talk out loud through the steps in the process.
  • Ask for clarification when you do not understand something.
  • Reduce the amount of verbal or written information you need to work with at one time, use a highlight pen for main points within the information
  • Edit written works and use spell-check etc.
  • Start with more simple jobs/tasks
  • Take a breath, describe the word you cannot remember, be honest
  • Alarms can be used to start, end and prompt for breaks

Note: Errors can be made at any time and are not necessarily as a direct result of your concussion.

Fatigue and headaches

Reduced physical, emotional and mental stamina. This occurs because activities that once took little effort may now require greater amounts of concentration and energy.

If you start to feel very tired or your headache returns consider:

  • Taking a break from that activity
  • the energy conservation strategies (PPP) in your approach to RTW
  • pain medication
  • drinking water.

Balance

A person’s balance may be affected and they may also experience episodes of dizziness. It is important to initially avoid undertaking any activity or work at heights.

Visual changes

The initial blurriness or double vision should have resolved, but some symptoms can last longer with light sensitivity and visual attention.

You may require a new prescription with your optometrist to take these into account.

Return to work for the employer

Return to work fact sheet (PDF) 

Last Updated: 10/08/2023