Episode 3 - Return to Work: Re-integration After Concussion/TBI
Episode 3 - Synopsis
Moderator: Leslie Birkett
Episode Description: Leslie Birkett, an Occupational Therapist and Assistant Clinical Professor (Adjunct) at McMaster University facilitates this discussion about participants’ experiences returning to work following a concussion/TBI. The conversation explores challenges, balancing life’s stressors and accommodations.
how to listen
MAIN POINTS, TIMESTAMPS, THEMES & RESOURCES
Return to work timelines – 7:25
Varies from person to person and even presents itself different when the same person has multiple concussions.
Disclosing symptoms is an important part of the process because in the moment it may be easier to underplay the severity of symptoms to fulfill your “duties” at work. When this happens, a person risks re-injury or returning to work too quickly – leading to potential setbacks in recovery.
Slow and graduated return to work usually works best.
Mental health difficulties from the trauma response can lead to additional setbacks if proper precautions are not taken.
The return-to-work process is an individualized experience.
Experiencing pressure to return to work – 14:11
Internal pressure plays a big role when returning to work. Being able to accept and scale back your workload can be hard to work through.
External pressures like having to fill out numerous forms when applying for accommodations and support.
The feeling of letting others down (friends, family, coworkers and healthcare providers). This feeling can intermingle with a person’s purpose in life making it quite hard to manage alone.
There is often guilt and shame associated with not working but still getting compensated.
Understanding the balance between pushing yourself and resting can be hard when you are feeling both internal and external pressure to return to work.
Challenges and Barriers in Returning to Work – 19:16
Differentiating between concussion symptoms and other lingering things that you (personally think) can push through.
Not always a question of whether symptoms are present but more about how severe the symptoms are.
Managing the intensity versus the presence of symptoms it’s okay to work with a headache but it’s generally not good to push if the intensity gets worse
Monitoring energy expenditure is an important thing to be mindful of. Finding the balance between pushing yourself a little bit, but not to the point of a setback.
Having symptoms is not a reason to not return to work, it is more about the severity of the symptoms.
The type of work you’re returning to matters. There is a need to assess the risk of re-injury and other overstimulating factors that may contribute to the return-to-work process.
Internal pressure may encourage you to jump right back into your work. Being mindful of this process is important, ensuring a gradual return can help this process.
It can be difficult to have others understand or even communicate that you are not 100% but you are trying to push yourself.
Performance does not always equate to how the person feels.
Having expectations in recovery can be hard to reconcile if you do not meet the expectations.
Physical and cognitive symptoms can dissipate at different rates. This can be hard to communicate with your co-workers or employer, especially when they see you thriving in one aspect of your work.
Example: Being able to go cycling but not being able to tolerate 1+ hour of screen time.
Available Supports and Accommodations – 31:22
Parents were able to sign for paperwork and support dealing with insurance if you call in and ask.
Family or friends who have experience with concussion can help you learn more about the injury and its various intricacies.
Return to work specialists can also play a key role in supporting someone through this process.
Trustworthy health care practitioners can play a vital role in the return-to-work process.
Finding people in your life that can advocate for you and have a relative understanding of the health care and insurance systems can be helpful. It is nice to have someone as a sounding board for what you may be thinking.
Advocating for yourself is an important part of attaining these supports.
Having reduced hours, ensuring less lifting or screen time is helpful as well.
Gradual return to work and re-evaluating hours and tasks – constantly re-evaluating how you are progressing or regressing and making any necessary adjustments.
Planning the whole week based on task difficulty, creating longer breaks after bigger tasks.
Having flexible, built in breaks throughout the day can help this process.
For more outdoor or loud work environments (such as a warehouse) earplugs and sunglasses can help eliminate sensitivity to light or noise.
Unions can provide you with resources and be supportive of your safe return to work process.
By law, employers are legally responsible to accommodate their employees to the point of undue hardship.
In summation, accommodations can be categorized by time, duties and safety.
Response from co-workers – 45:10
It is different at each workplace.
Sometimes comments made by coworkers can take a psychological toll, especially the comments like “oh you look fine”, “I get a headache too”.
Co-workers typically want to help you but often do not know how.
It can be hard to explain the differences between neural fatigue and general fatigue.
To explain what neural fatigue is, consider the example below.
Example: Prior to concussion, overnight your battery (brain) is typically always fully charged. When you have a concussion or brain injury your battery is never fully charged, leaving you always playing catch up.
What makes neural fatigue even harder is the fact that internally you are always comparing yourself to the energy you had before the injury. This can sometime be hard to overcome, being kind to yourself in this instance is helpful.
Strategies to prevent burnout or increased symptoms – 49:22
Take time to learn your new limits and work within them. Pushing yourself too hard, too fast is not productive.
Celebrate the small wins and milestones throughout your recovery process.
Taking a mindful approach to recovery where you are focusing on managing the day-to-day opposed to a month or yearly basis can help.
Having mental health support throughout this process can help you come to terms with the incident.
Processing the injury and understanding how different mental health factors can potentially exacerbate symptoms can help you understand your recovery journey. This can also allow you to work past certain recurring events or traumas that negatively impact your recovery process.
Having self-compassion and love is very important.
Meeting yourself where you’re at and knowing that up and downs are normal. Mindfulness and meditation can help with gaining this understanding.
Ask friends to still invite you out to social events, even if they expect you to say no - it’s important to feel wanted.
Recognize who you were prior to your injury and try not to compare yourself to the idealized version of “who you used to be”.
Instead of focusing on the person you were before, focus on the person you are becoming!
Resources
Helpful resource braininjuryguidelines.org