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Work Skills and Brain Injury

In instances where a severe brain injury has occurred, returning to work is divided into four phases:

  • Pre-vocational rehabilitation
  • Vocational rehabilitation
  • Job placement
  • Follow-up consultation

The pre-vocational rehabilitation period begins during inpatient hospitalization. The basic goals of the inpatient stay – functional communication, reduction of confusion, independent mobility, and independence in basic activities of daily living – are the same goals that must be met before vocational rehabilitation activities begin.

During the pre-vocational phase, it's often too early to tell whether the patient will be able to return to his or her former job. The rehabilitation physician will try to give you and your family member a general idea as to when a determination can be made. While this “wait and see” approach can be frustrating, it is the most honest answer. The patient is encouraged to focus his energy on successfully completing the basic goals.

After the basic rehabilitation goals are met, vocational rehabilitation may begin. Often, vocational rehabilitation is done at the same time the therapist is working on other independent living skills.

Generally, patients have been discharged from the hospital by the time they are ready to begin vocational rehabilitation. Before discharge, the inpatient social worker may contact a vocational rehabilitation counselor or rehabilitation case manager to start addressing concerns related to returning to work.

Outpatient therapists will plan the patient’s rehabilitation program around the goal of returning to work, if the goal appears to be realistic.

Since the effect of a brain injury varies from person to person, different goals and services will be provided, depending on needs. Examples of vocational goals include:

  • Increasing speed of work
  • Improving attention and problem solving as it relates to certain job tasks
  • Improving ability to organize work tasks
  • Improving communication skills needed to get work done

The outpatient therapy team, with the rehabilitation physician, will decide whether the patient can return to his or her former job or whether other employment options should be sought. Individuals recover at different speeds and there may be a period of time when returning to work is not recommended, and yet rehabilitation therapies may be less than full time. Therapeutic recreation for leisure skills help brain injured persons constructively use their free time during this period. 

A formal vocational rehabilitation program from an accredited vocational rehabilitation facility may be recommended if extensive vocational rehabilitation services are needed.

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