Returning to Work After a Concussion? Here’s What You Should Know

Returning to Work After a Concussion? Here’s What You Should Know

Did you know that just one concussion could lead to cognitive impairment? The risk of developing long-term or permanent cognitive impairment increases with the severity of the head injury, but even mild traumatic brain injuries (mTBIs) like concussions can temporarily impact cognition. While symptoms resolve in the majority of individuals after three months post-injury, persisting symptoms (referred to as post-concussion syndrome) occur in about 15% of individuals.

Cognition, or thinking skills, can impact many aspects of work, and employees and employers should be aware of possible limitations that could impact the worker’s ability to complete certain job tasks.

For more information on brain injuries and minimizing the risk of concussions, read Part 1: Brain Injury Awareness Month.

How Do Concussions Impact Cognition?

Some cognitive abilities that can be affected by traumatic brain injuries include the following:

  • Attention and concentration
  • Processing and understanding information
  • Memory
  • Planning, organizing, and assembling
  • Reasoning, problem-solving, decision-making, and judgement
  • Communication

What Does This Mean for Work?

Employees who have experienced concussions should resume pre-injury activities within the first few days to weeks of their injury, as activity is more likely to speed up rather than delay recovery (Ontario Neurotrauma Foundation, 2018). However, this physical and cognitive return to activity should be gradual in order to avoid symptom aggravation and worse outcomes for the affected employee.

Activities at work that require a high cognitive load should be minimized and slowly integrated back into the employee’s schedule. Some activities that are associated with high cognitive load include the following (2018):

  • Reading
  • Computer or cell phone use
  • Demanding social interactions
  • Tasks requiring sustained concentration, attention, or problem-solving

In addition to cognitive difficulties, other common barriers to return to work include “the invisibility of the injury, persistent symptoms affecting the ability to do the job, and lack of advice and guidance on returning to work” (2018). Occupational Therapists can help employees and employers overcome these barriers. They can assess the employee’s level of cognitive function and provide a structured approach to return to work that considers symptom management and activity resumption.

Functional Cognitive Assessments

A Functional Cognitive Assessment is a thorough, objective assessment that results in a detailed report that highlights an employee’s cognitive strengths and limitations. Following the report, an Occupational Therapist can provide resources, tools and skills that will assist the employee with increasing their abilities where they don’t necessarily excel.

These comprehensive assessments allow Occupational Therapists to help employers and employees implement more targeted work tools to improve work engagement and productivity. The goal of a Return to Work plan is to enable the worker to fully participate in work tasks without symptom exacerbation. This may look different for different employees. In some cases, employees can resume regular duties, while others may need temporary workload accommodations or placement in another job role.

Strategies to Return to and Stay at Work

  • Unless it is medically necessary, it is important for employees not to wait until they are “fully recovered” before returning to work. Prolonged rest should be avoided and gradual resumption of activities should be begin as soon as tolerated (Ontario Neurotrauma Foundation, 2018).
  • Try cognitive remediation. This is a goal-oriented and time-limited treatment that focuses on teaching long-lasting skills that can help restore and maintain everyday functioning (Weill Cornell Brain and Spine Center). It incorporates psychotherapy and attention-enhancing and memory exercises.
  • Try a work hardening program. These programs focus on work simulation activities to help employees build tolerance.
  • Create a gradual return to work plan. Start with reduced work hours or incorporate multiple breaks into the workday. Slowly reintroduce work tasks until full duties of the job can resume.
  • Consider the four Ps: Prioritize your tasks, Pace yourself, Plan ahead, and consider your Position and posture (InMotion Health Centre).
  • Implement work accommodations that compensate for cognitive limitations (e.g., scheduling, energy management, microbreaks/pacing).
  • Get help from an Occupational Therapist to assess the employee and implement the above strategies.

What Can Employees Do?

Employees can use the following strategies to help their cognitive function at work:

  • Write things down. Make lists of processes or tasks to refer to later.
  • Set reminders on your phone or calendar to help improve memory.
  • Ask coworkers or managers to repeat things if you can’t follow what they are saying.
  • Break information or activities into smaller chunks.
  • Focus on one task at a time.
  • Take breaks and conserve your energy.
  • Take time to review and practice new information.
  • Eliminate distractions. Try to work in a quiet environment to improve your concentration.

What Can Employers Do?

  • Provide employees with simple strategies such as checklists, cuing, provision of noise cancelling headsets to reduce environmental distractions, and provision of steps and sequences with flowcharts.
  • Engage employees in trying new learning techniques and different skills.
  • Encourage employees to pace themselves and take their breaks.
  • Get a functional cognitive assessment of the employee’s cognitive ability so that you can customize strategies and allow the employee to stay productive. Make a referral to get an assessment from a trained Occupational Therapist.

How Can Gowan Consulting Help?

We strive to be the leading providers of sustainable health and disability management in the workplace. We genuinely care and want your business to be healthy and safe, resulting in more productive employees. Our team of highly trained Occupational Therapists can help individuals who have acquired brain injuries in the workplace. Whether it’s a matter of an accommodation, return to work, or a functional cognitive assessment, our team works in collaboration with employers to ensure all employees are set up for success and maximum productivity.

You may also be interested in our training services, such as our Cognitive Demands Analysis Certificate Program, which provides step-by-step skill training to complete a CDA and create a return to work plan. Or, if you’re more interested in mental health, you may be interested in our upcoming Manager Mental Health Training taking place on June 16th.

If you would like further information on our services, please contact us! We would love to work together for your healthy business!


Model Systems Knowledge Translation Center. (2020). Cognitive Problems after Traumatic Brain Injury.

Results You Deserve. (2017, May 20). Use Your Head: Workplace Safety to Prevent Head Injuries. Retrieved from

Ontario Neurotrauma Foundation. (May 2018). Guidelines for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms.

Sunnybrook Health Sciences Centre. Changes in thinking, memory and concentration following concussion.

Weill Cornell Brain and Spine Center. (Updated 2020). Post-Concussion Syndrome. InMotion Health Centre Inc. Returning to Work After A Concussion.

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