Returning to work after a brain injury is rarely straight forward, with many survivors left with neurological and mental health problems that can make it hugely difficult to meet the demands of working life.
We asked our members and the wider neuro-rehab community:
What do you wish employers and HR departments understood about the trajectory of brain injury recovery in working adults?
Here’s what they had to say.
Stephanie Potts, clinical advisor and neuro physiotherapist, Lusio Rehab
For many, a person’s work identity is a key contributor to their self esteem and sense of purpose.
When recovering from a brain injury the re-invention and re-establishment of this work identity can be central to the longevity and success of rehabilitation.
Adults re-entering the workplace after brain injury have much to offer. They can challenge the status quo and ask us all to think more creatively, efficiently and kindly.
Given support, resources, flexibility and time, these adults can enjoy workplace success and enrich the worklife of their colleagues.
Let’s play the long game and keep our workforce dynamic and productive for the longer term.
Martin Gascoigne, CEO, NCMUK
It is my hope that Employers/HR Departments together learn that any individual who experiences a significant brain injury will have up to two years where the brain can become rewired and relearn new tasks and skills.
After this time, the brain becomes “fixed” and there is no further rehabilitation/development potential.
Scott Rigby, partner in the International Injury department at Stewarts
The first thing is to consider whether an employee is ready to return to work, and if so, then making arrangements for a phased reintegration to their duties.
Once an employee is back to work, policies need to be flexible enough to accommodate issues such as cognitive fatigue.
Employers also need to understand the symptoms of brain injury, and ensure that any reduced performance is treated as a medical issue rather than misconduct.
Overall, employers should be sure they fully recognise hidden disabilities in the workplace and accommodate accordingly.
Justin Keenan, CEO and co-founder, Lusio Rehab
From a clinical perspective, recovery from a brain injury in working adults takes time and rarely follows a neat, predictable path.
Fatigue, cognitive load, and emotional regulation all play a real role, and capacity can change from day to day, even when someone looks fine.
When workplaces push for consistency and full performance too early, it can slow recovery.
The best outcomes come when work is approached with flexibility and understanding, allowing people the space to rebuild their capacity and return to contributing in a sustainable way.
Cher Goodyer El-Meheiry, clinical lead for Agincare’s Complex Injury Partnership:
Everyone’s experience of brain injury is different, even though people can have brain injuries in the same area of the brain and with a similar cause, how your brain repairs itself is unique to you.
Your brain has to essentially “borrow” from other areas of the brain and retrain it, and the route it chooses for each individual will always be different.
Employers and HR departments will look at statistics to assess how quickly a person will recover, while this theory works well for simple issues such as broken legs or a simple operation, in Brain Injury the statistics are not accurate enough.
They don’t show the amount of compensation required in other areas of the brain to learn a new function to reach a level of recovery suitable for returning to work.
So many things can need to be relearned depending on the type of injury.
This can be frustrating and even depressing for the person involved.
Even the DWP recognises the difficulties, as both physical and mental health are always covered when assessing work capability in adults for benefit claims.
Employers and HR departments need to rely on individual evidence given by the health professionals and care providers of the person to get an accurate, up to date picture with their estimate of how soon the person can work again.
Putting pressure on someone with a brain injury to return to work too soon can also cause more harm than good as they too will begin to feel they are failing, leading to further mental health problems.
The most important thing to remember is that there is no set recovery time in Brain Injury however they occur.
Dr Elizabeth Mateer, neuropsychology fellow and researcher, Harvard Medical School (US)
After a brain injury, people often recover skills in a different order than employers expect: basic stamina and cognitive endurance may lag long after someone can physically return.
If HR understands that recovery involves rebuilding capacity, not just ‘symptom resolution,’ they can prevent avoidable failures by adjusting workload, deadlines, and meeting demands early on.
Supportive, proactive accommodations aren’t special treatment; they’re what keep talented employees employed.
Dr Michael Drzewiecki, DC, MS, FABBIR, DACNB, CCSP, director of clinical neuroscience and a partner at The Neurologic Wellness Institute (US)
Brain injury recovery is about capacity, not motivation.
When someone struggles after a concussion or other brain injury, it is not because they lack effort, discipline, or desire to work.
Their brain is using more energy to do tasks that once felt automatic. Supporting recovery means respecting those limits while the brain rebuilds its efficiency.
When employers understand this, they don’t just protect the employee, they protect the organisation.
People recover better, return stronger, and stay engaged when they are given time, flexibility, and trust during the healing process.
Joel Blackstock, founder and clinical director, Taproot Therapy Collective (US)
The most critical thing HR departments miss is that the trajectory of brain injury recovery is not a straight line—it is a jagged spiral.
An employee may have the capability to perform a high-level task, but lack the capacity to sustain it for eight hours without severe neuro-fatigue.
We often see employers mistake this biological necessity for rest as a lack of motivation or sudden incompetence.
True accommodation isn’t just about dimming the lights; it’s about restructuring the workflow to allow for ‘cognitive buffering’—short, frequent periods of nervous system downregulation that prevent the physiological crashes that look like regression but are actually just exhaustion.
Lynn Schaefer, Ph.D., ABPP, clinical neuropsychologist at Lynn A. Schaefer, Ph.D., ABPP (US)
Recovery from a brain injury can take months, if not years, and the person may never truly return to exactly the way they were before their injury.
I encourage close communication with the person’s rehabilitation professionals, to determine when and how they may return to work.
They may have to return in a graduated fashion, such as part-time initially, or shorter days. They will likely need various supports, or a modification of duties.
Unfortunately, the person with the brain injury may not even be aware of their limitations or what they need, and may be eager to return to “normal,” so employers really need to seek recommendations from the professionals to avoid the person returning too soon or setting themselves up for failure.
