Returning to Work After a Concussion or Brain Injury

If you’ve acquired a concussion or brain injury, you may be wondering when you’ll be “back to normal” and ready to resume regular activities. While many people recover within days or weeks, others continue to experience persistent symptoms for months. These lingering effects can influence how a person thinks, feels, and functions, even when their injury is not visible to others.

Many people feel pressure to get back to their normal routine as quickly as possible, especially if they are eager to return to work or regain a sense of independence. While returning to activity can actually help speed up recovery, returning too quickly without the right tools and strategies can aggravate symptoms and worsen outcomes. That’s why a successful return to work after injury often calls for a clear understanding of an individual’s current abilities, implementation of work accommodations, and a gradual and sustainable return to work plan.

Barriers to Work Participation

Returning to work after a concussion or acquired brain injury may feel hard in ways that are difficult to explain. An employee may be able to perform a task, but not at the same speed, for the same length of time, or in the same environment as before. Because these types of injuries are not always obvious to others, workers may feel misunderstood or worry that people expect them to perform as they did before. Employees may feel pressured to push through symptoms or avoid asking for help.

Persistent symptoms can make regular tasks much more draining. Common symptoms include:

• Fatigue
• Sleep difficulties
• Mood changes
• Balance and vision difficulties
• Headaches
• Cognitive difficulties, such as issues with sustained concentration, multitasking, memory, communication, screen use, quick decision-making, or problem-solving

Bright lights, busy environments, background noise, frequent interruptions, and long periods of computer work can all aggravate symptoms. Even the commute to work can use up valuable energy before the workday begins.

Returning to Daily Activity

It is important to begin adding regular daily activities into your routine post-injury, and it is normal to experience symptoms as you resume. You may be able to complete parts of a job or task but not yet have the endurance to manage a full cognitive load, physical demands, or pace of a typical workday. The key to building your tolerance is to be doing more each day than the day before in either intensity or duration. However, your symptoms should not increase to a point where they interfere with your ability to perform other activities within your day. Start slow, even if you’re only doing a task 30 seconds longer than the day before.

A gradual return to work plan may involve reduced hours, modified duties, or fewer high-demand tasks that slowly increase over time. It may mean starting with simpler tasks before reintroducing responsibilities that require high cognitive load (e.g., reading, computer use, demanding social interactions, or tasks requiring sustained concentration or multitasking). Strategies to support the transition back to work can be developed collaboratively with the employee, employer, and an occupational therapist, and should be guided by the employee’s current function and symptom tolerance rather than based on how much time has passed since the injury.

Environmental and Sensory Accommodations

Work accommodations reduce barriers for those recovering from injury so that work can become manageable and productive again. Accommodations should be matched to the employee’s actual barriers rather than applied in a generic way. Strategies may include:

• A quieter workspace to reduce distraction and cognitive overload
• Adjusted lighting to reduce glare on screens or using a desk lamp instead of overhead fluorescent lighting to help those with light sensitivity or visual strain
• Adjusted screen settings, background colours, or coloured paper to reduce eye strain
• Reducing interruptions throughout the day to support concentration and energy management (e.g., limiting unnecessary meetings, responding to emails at scheduled times instead of constantly monitoring them, or setting aside uninterrupted work periods for tasks that require focus)
• Cognitive strategies such as written instructions, checklists, extra time to complete tasks, or breaking large tasks into smaller steps to reduce mental fatigue

How to Build a Routine that Supports Recovery

Following a healthy lifestyle can promote recovery and decrease post-concussive symptoms. Some simple lifestyle tips include:

• Daily exercise, specifically low-level, low-impact aerobic activity such as swimming, stationary biking, and using the elliptical. These activities are recommended over running because they cause less movement of the brain in the skull. Ensure you talk to your doctor before engaging in physical activity.
• Eating a healthy diet. This may include limiting foods with high sugars and fats and increasing foods that are “heart-healthy” (a registered dietician can help recommend food sources with the nutrition you need).
• Avoiding alcohol and recreational drugs. During recovery, your brain is even more sensitive to their effects and can slow down recovery from injury in the long run.
• Practicing self-care to take care of your emotional health. Consider activities that can be done in a quiet space and make you feel happy and relaxed.

The Four Ps of Energy Conservation

It is common to feel more tired than usual during recovery. Fatigue can often interfere with your ability to complete important and necessary activities in your day. Practicing the Four Ps of Energy Conservation can help you manage your energy and return to your normal schedule.

1. Plan – thinking ahead about what needs to be done and when. It can be helpful to reflect on when symptoms are worse or more manageable and what tasks drain or support energy. You can plan to complete demanding tasks when you have the most energy, alternate between light and heavy tasks, and set goals to help you gradually increase activity. It’s also helpful to have a back-up plan, as extreme fatigue can be unexpected.
2. Prioritize – focusing energy on the most important tasks rather than trying to everything at once. If there are tasks that can be completed at a later time or date, don’t be ashamed to put tasks off. It is also important to prioritize purposeful rest breaks in your day.
3. Pace – spreading effort out and taking breaks before symptoms escalate. Giving yourself extra time to complete tasks and breaking tasks down into smaller steps allows you to go slower and step away as needed.
4. Position – adjusting posture, body mechanics, or the set-up of activities to reduce strain. This can include completing a task from a seated position rather than standing, bending with your knees rather than your hips so that your head doesn’t go lower than your chest, and organizing your space so that commonly used items are closer and easier to access.

How Can Gowan Consulting Help?

At Gowan Consulting, we know that returning to work after injury can be complex. That’s why our team of occupational therapists supports employees and works with organizations to develop safe, unique return-to-work strategies and plans.

We support:

• Functional assessments and accommodation planning
• Development of gradual return-to-work plans and programs
• Mental health support for employees recovering from injury or illness
• Training for managers to support a psychologically safe environment

Contact us to find the best solution for you or make a referral today.