Hi everyone,

I'm wondering at what point in the recovery is it ok to try to make a return to work? I've been on medical leave for two months now. I work in advertising and i would be using my laptop a lot as well as using my brain to come up with creative marketing ideas. My employers are well aware that my workload as well as the hours i come back at should be significantly reduced. I would be returning at 2 hours per day, then if all goes well it would increase as time goes on as far as i can handle it.

So before you return to work, should you be completely symptom free? (I'm not)
Relatively symptom free? I'm just a bit confused as when to go back. Any thoughts?

I think you are doing it right, and two hours a day sounds very reasonable. I started back at work doing 4 hours a day, and it was VERY rough starting out. I had constant dizziness, disorientation, difficulty reading, and a hard time dealing with stress, in addition to almost fainting at a few meetings, but after a couple weeks I felt myself getting better slowly but surely. I am still up and down and have my struggles, but I look back every few weeks and realize I can do a little more than I could the weeks before even though it feels like I haven't made progress. Hope this helps.

I feel compelled to respond to you, although I have to say that this is my very first post on this forum. I have never seen a discussion from the point of view of someone who has to use their brain creatively and communicate with others as part of their job. I am now 9 months post concussion. I am the director of a busy, highly visible, non-profit organization. I constantly juggle many competing priorities and initiatives.
I heard the same advice re: being free of symptoms, but it didn't seem to jibe with my reality. I was (and am) never without symptoms (mostly vestibular). The good news is that I have improved and I continue to improve. Slowly. My doctor tells me that I can expect to continue making progress over the course of at least the next year.
I have experienced a number of setbacks, partly as a result of pushing too hard- so please learn from my mistakes. With that said, I don't think there is any way of knowing what will work until you try it. There is, in my view, a difference between being "symptomatic" and being unable to function because the symptoms are so bad. Obviously you want to avoid the latter. The best advice I can give is to be kind to yourself, and to be patient. I would recommend testing the waters by working two hours a day every other day, and see how you feel. Work closely with your doctor. For me, the fear that I might never be the same person (in terms of mental quickness and abilities) that I was before my concussion has been a challenge. I do see a therapist who specializes in working with people who have traumatic brain injuries, and I highly recommend it, if you have similar concerns.


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Also- I had been working 50+ hours per week. I am now up to about 30 hours per week. But not all days are equal. Some days I can comfortably tolerate 7-8 hours of work. Other days it's 2 hours. I still take a day off occasionally. Pay attention to your symptoms and go from there.


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At my brain injury support group meeting last week, we had a very interesting speaker. He is a neuro-psychologist who explained how the brain works post concussion.

The important point to remember is that the brain works differently. I have told people many times that we usually need to learn new ways to learn. He added to that. The research shows that the average brain learns short cuts throughout life that make it very easy to take on complex tasks or multiple tasks.

It's like driving a car. When the car in front of you slows, you use a brain short cut to apply your brakes. Back in your early days of driving, you would have had to process the information as : That car is slowing down (sight to cognitive) I'm going to run into it (more cognitive) What should I do? (cognitive) Oh, I should apply the brakes (cognitive) Move foot from the gas to the brake pedal and push (muscle control/motor function)

The practiced brain has a short cut for that that goes directly from sight to motor control. There is no or very little cognitive involvement. They can observe these shortcuts with qEEG brain mapping.

The injured brain often looses these short cuts. For many, the short cut will slowly return to function or will be relearned/re-stimulated. For others, we lose the ability to access these shortcuts.

It's like that foreign language learned in high school but has not been used for decades. For some, they can quickly regain access to those old skills. For others, they would need to start over to learn that language.

The important point is this. When you return to work, you will be tempted to try to function just as you did prior to your concussion. Some may be able to do this. For those who struggle, they need to develop new ways to do things that were so easy previous to the concussion.

For many of this, we need to learn to Stop to Think to give our brain time to get the task done without trying to force the shortcut.

an_also, I would encourage you to start spending time on your computer doing the same tasks as you will do at work. Maybe a make-believe project. "If the Red Cross needed to promote issue XYZ, how could we develop a campaign to do that." Or analyze and redo poorly done ad campaigns you see around you. There would be not pressure to meet deadlines or other demands so you could take you time to learn how your brain works in this environment.

An example. We have a doc in the box chain of clinics that uses negative issues to promote their clinics. After seeing each ad, my wife and i come away with a negative sensation, not toward the clinic but as a result of hearing the injury or illness. They like to use people's irresponsible actions to create the need for a visit to Primary Health Clinic.

You could redesign the campaign as a "This is how I would do that." project like you likely did in college. The tasks are the same. The intensity would be lowered so you could learn your new ways of processing and executing the task.

Writing things down vs trying to remember will be important. If you meet somebody in the hall and they tell you something you need to remember and follow though on, even though in the past, you would remember and get it done successfully, now you may need to tell them, Send that idea to me in an email or text.

I suspect one of your struggles will be keeping up with verbal only communication. Using more written communication will solve most of that problem but you need to tell you coworkers that you need the written communication.

Start slow. Learn your new ways to work and you will be come a stronger person and able to accomplish much. If you try to force your new square peg brain into the old round peg brain hole, you will struggle and frustrate yourself.

Been there. Done that. Learned hard lessons.

My best to you.

Mark, many thanks for that detailed rundown! That's a great idea about doing some self created projects to test out my cognitive function. I will make some projects for myself to do.

AA,

I missed 10 months of work.

When I returned I knew it would be tough, being self employed and local competitors circling like vultures waiting for me to die or not return forced me to do what I had to do to protect my family.

I started at 2 hours and worked my way up as I could tolerate it. I believe the tolerate did not always mean feeling better, but, instead it meant learning to moderate symptoms before they got out of hand.

It took 5 months of working my way up from part time before I was full time. April 12 this year was 2 years post and just recently I feel mostly full bore again.

Learn to recognize what triggers your symptoms, the early warning signals your body sends of increasing symptoms and modify what you need to make it work.

Sometimes just a matter of a couple of minutes to rest and refocus is enough, sometimes more.

I will add that I work in a family business and I had to lean upon my sons a lot...I passed decisions off to them when I was overwhelmed, they accepted the challenge. My daughter drive me around in the afternoons, the mornings wore me out mentally and I think we are better off for the experience now. They grew up some and I had to trust!

Bud