The Effects of Fatigue Following Catastrophic or Brain Injury and the Impact on Returning to Work: Part Two

In the first part of our exploration into this topic, Kemi Sanusi, Vocational Case Manager at Bush & Co, explained how fatigue differs from tiredness, the varying effects that fatigue can have on an individual, and how it is assessed when considering a return to employment. In this second part, Kemi delves further into how this translates practically into the workplace, the impact of the fear of failure and the importance of a well-coordinated support network.

Practical Adjustments That Support Return to Work

Employer engagement is one of the most important factors in supporting a sustainable return to employment. Establishing clear communication and building a reliable working relationship from the outset can make a significant difference.

Through this clear communication, the vocational case manager can give informed guidance on practical adjustments to the employer, which may include:

regular or extended rest breaks
flexible working arrangements, including remote working where appropriate
adaptive equipment and assistive technology
support with transport to and from work
clear written instructions and task prioritisation
time to attend medical appointments and therapy sessions

External funding support may also be available to help provide workplace assistance where employers are unable to meet these needs independently; this is particularly important when considering adaptive equipment or assistive technology requirements, which can be expensive to install and maintain.

Structured rest breaks can be essential in managing fatigue. Kemi expands on this further: “for individuals with brain injury there may be benefit in frequent, short breaks to prevent cognitive overload, while those with complex orthopaedic or polytrauma injuries may experience fatigue that is closely linked to pain levels and physical recovery”. Allowing an injured person to work flexibly, including remote or hybrid working, enables them to set their own pace as well as providing a calmer and more comfortable working environment.

In some cases, particularly those involving brain injury, repetitive or predictable work tasks can help support successful engagement, as can providing written instructions. Where ongoing therapy, appointments and/or medications are required, the vocational case manager can work with both the employer and the injured person to ensure that these are factored in to both the physical workplace and the injured person’s mental load, preventing further pressures on levels of physical or cognitive fatigue.

Managing Expectations and the Fear of Failure

Early expectation management plays a central role in helping individuals adapt to post-injury fatigue. Honest communication about recovery, capacity and long-term planning helps individuals develop realistic goals and maintain engagement in rehabilitation.

Close collaboration between the vocational case manager and the multidisciplinary team ensures that emerging challenges are addressed promptly and that individuals receive consistent guidance. Education for both the individual and those around them is particularly important where fatigue is not immediately visible. Motivational support can also be especially valuable, particularly for younger individuals who may have limited experience adjusting to major life changes.

There are several indicators that someone may be attempting to return to work before they are ready, and if these indicators are not promptly addressed, the risk of disengagement increases. In her experience, Kemi has experienced indicators such as “repeated absence from work, difficulty maintaining agreed responsibilities, emotional distress or a sudden loss of confidence following setbacks”.

In some cases, individuals may begin to disengage from the return-to-work process altogether. This can have a significant impact on motivation and self-worth, particularly where employment previously formed a central part of identity. Introducing appropriate adjustments and support at the right stage in recovery helps maximise the likelihood of maintaining engagement in paid employment where this is possible.

The Role of Employers and Families

Employers and families can sometimes (and often with good intention) underestimate the impact of fatigue, particularly where individuals appear physically well or present positively. One of the most common misconceptions about injury and returning to work relates to how individuals present: “whilst they may appear well in themselves, they may also still be experiencing significant fatigue and/or cognitive difficulty behind the scenes” clarifies Kemi.

Tasks that seem minor to others, or those that the injured person used to complete with ease, may be cognitively demanding for someone recovering from brain injury, especially if instructions are unclear or unexpected. This can cause frustration, impatience or concern, which exacerbates the situation for all involved.

Similarly, it may be difficult for families to adjust to a new long-term reality following catastrophic injury. The demands of returning to work can leave individuals with limited energy for family activities, which can create additional emotional strain if expectations are not aligned with their current capacity. The importance of the support network around the injured person cannot be underestimated, and so the vocational case manager has to factor in these wider influences when planning for, implementing and reviewing workplace engagement.

Developing an accurate understanding of day-to-day functioning is therefore essential. Clinical judgement, combined with regular communication with the individual, their employer and their family helps to ensure that rehabilitation planning reflects the reality of both short-term goals and long-term sustainability. Part of effective vocational rehabilitation involves supporting not only the individual but also those around them to better understand the nature of post-injury fatigue.

Fatigue is a significant often invisible barrier to returning to work following injury. Unlike everyday tiredness, post-injury fatigue can affect physical capacity, cognition, motivation and confidence, often in unpredictable ways that require careful monitoring and structured support. Effective vocational rehabilitation therefore depends not only on the early identification of appropriate employment options (including voluntary workplaces), but on timing interventions correctly, managing expectations and coordinating closely with employers, families and the wider multidisciplinary team.

An experienced vocational case manager such as Kemi plays a central role in this process, helping to interpret clinical presentation, guide individuals through realistic and meaningful pathways back to work or alternative vocation, and implement practical workplace adjustments where they are required. With the right support in place, fatigue can be managed proactively, enabling individuals to maintain engagement in employment and rebuild independence over time.