I agree with the subjective and objective elements. But, using the subjective elements to make return to work decisions is problematic.

Even a BESS or iMPACT or other simplified test will likely fall far short in determining return to work condition. A full, day long Neuro Psych Assessment would be more accurate in assessing return to work readiness.

Recovery assessment is a 24/7 issue. It needs to include performance/function over the long term. Eight hour shifts, stressful events, and the myriad of other influences on a worker need to be considered.

A worker may be fully capable of doing their full job assignment but need a quiet environment to last 8 hours. The many permutations of functions and limitations need to be considered.

Any grading of recovery level is always relative to the current assessing environment and recent history.

One of my Neuro-Psych Assessments was performed in a very sterile environment (quiet and without visual stimulation) . I know that I performed much better on some tests than I would have performed in a more normal work environment.

I find it interesting how doctors often struggle to diagnose a concussion but often have no problem diagnosing a complete recovery. They usually rely upon subjective information and the history of the impact to diagnose a concussion. What information do they use to diagnose a recovery?