RETURNING TO WORK  [ back to Recovering from a Brain injury ]
There are two schools of thought about when to attempt a return to work following a TBI. One is that the person should not attempt to return until he has rested at home, gotten plenty of sleep and gradually regained orientation, alertness, strength, endurance and confidence. This approach is based on the fact that some people rush back to work while in a state of denial, failing to acknowledge they are still tired and still having troubles with concentration, cognitive slowing and short term memory. These people tend to "bomb out," and experience a sharp drop in confidence, with onset of significant depression, in reaction to their failure to do well on their return to work.

However, the other school of thought says its even worse to get cognitively "rusty" sitting at home doing nothing, and just as the injured leg needs physical therapy, the injured brain needs targeted stimulation to re-strengthen or re-grow damaged circuits. These schools of thought are not mutually exclusive. There is no reason a person who is on leave from work cannot get extra sleep and and pursue guided cognitive rehab at home, or in day treatment. After a period of recovery, the person can start a gradual, phased return to work instead of jumping back full time, full duty. A partial return to work helps expose areas of strength that can be built upon and areas of weakness that can be compensated for in creative ways. A lighter schedule will make the initial return to work more successful. Too many demands too soon is likely to meet with fatigue and a sense of being overwhelmed.

A partial return to work can be prefaced by take-home assignments, followed by short trips to the workplace. The approach works better still when a supervisor or co-worker agrees to co-participate. This would involve monitoring how the injured work handles assignments, helping him solve problems giving him the most trouble, recommending adjustments in the challenge level of the material and even recommending modifications of the physical workplace or the mechanics of how the job is carried out. It is common for someone with a brain injury to experience severe tiredness after a morning of work. Until that resolves, it would be best to allow the person to work half days when they are freshest, or at least to allow a nap time before resumption of afternoon work.

A person with a "moderate" TBI may need more assistance with the return to work. Typically he would have some post-acute rehabilitation, either in-patient or on an intensive out-patient basis at a clinic near home. This may be done in tandem with taking courses at a community college, which gets the person back into a learning mode, and lets them take chances without the stigma or economic consequences of job failure. At some point a vocational assessment will be done to determine what the person is qualified to do. If it is believed he can return to the old job with support, it is common to see a "job coach" hired to make this happen. This is much more involved, than just having a supervisor or co-worker look in on the person from time to time. The job coach is involved on a daily basis with the injured worker, getting him readjusted to the workplace, and trouble shooting problems for him, until he gets comfortable.

If the use of a job coach is not feasible for practical or economic reasons, another way of moving towards re-employment, after a period of disability, is to get a Dept. of Labor waiver until Title 6C of the Vocational Rehabilitation Act Amendments of 1986. This allows a company to take on a person with a TBI and allow him to work for free, so that he can test his capacities and improve them through challenge, without having the burden of justifying a salary of fearing termination because his work is flawed by slowness, errors or lack of completeness. The waiver enables a company to have someone work for them without having to pay a salary in the name of rehabilitation. This is typically accomplished with the help of a licensed vocational rehabilitation counselor who contacts the company and negotiates the terms of the plan.

Persons with a "severe" TBI have a tougher road. As a statistical matter, most of them do not return to work, and rehabilitation professionals usually look for ways to get them involved in volunteer work, social and recreational activities, or both. However, there are some remarkable exceptions. In-patient rehabilitation centers have begun setting up "simulated work environments," which may look and feel like a bakery, an auto repair shop, a doctor's waiting room or other workplace, where patients with a severe TBI can rehearse "scripts" and practice their skills. They also work in "group" to practice social skills, gain insight into and control over behaviors which may alienate others and work on conversational skills. Group is a place to be student and teacher, and to gain in confidence.

Today's workplace is very demanding and competitive, and operates at "Internet" speed. Many contemporary employers are less patient and less forgiving than those of old. We have seen some clients welcomed back on a part-time basis and given more work as they progress, while other clients were reassigned, demoted, laid off or terminated. What an employer can legally ask about your impairments following a TBI, and how he phrases such inquiries, is governed by the ADA (Americans with Disabilities Act). The Equal Employment Opportunity Commission released a written "Guidance" in September 2000. Whether a person with a TBI can still perform the "essentials" of her job with "reasonable accommodation" is also governed by the ADA. Many states have non-profit organizations called Protection and Advocacy, Inc. (PAI) that can answer questions about this and provide advocacy services for persons seeking to resume a job or re-enter the workforce.

The PAI in California has offices in Sacramento, Oakland, Los Angeles and San Diego. It is a model of how disabled persons can return to work, and is currently close to having persons with disabilities at 50% of its 200 employees. It helps disabled persons find suitable job listings, apply for jobs and negotiate "reasonable accommodations" with employers. Such accommodations involve transportation, accessibility, flexible work schedules, telecommuting, job shares, assistive technology, ergonomic furniture and other issues. PAI also helps disabled persons secure or keep government benefits while they search for work. They promote diversity training for California employers to make the workplace more open, more sensitive to and more accepting of persons with disabilities. PAI and other organizations have information about legislation (such as Ticket to Work) that enable disabled persons to use Dept. of Rehab funds to work with vocational rehab experts in the private sector. They are an excellent resource and publish their own newsletter. Their toll free phone number is 800-776-5746. Their jobline is at 916-658-2659. Their website is located at www.pai-ca.org. PAI directs job applicants seeking positions outside their organization to the California Dept. of Labor's Office of Disability Employment Policy's Job Accommodation Network.