Episode #179:  Work-Related Traumatic Brain Injuries and Supporting the Return to Work



This podcast is brought to you by the Canadian Centre for Occupational Health and Safety.


Brain injuries can be among the most serious of workplace injuries. Over the last 10 years the number of reported concussions has gone up. Despite this increase in reports work-related traumatic brain injuries are an understudied area, especially when it comes to civilian workers. To help us get a better understanding of acquired brain injuries, their impact on employees, and their employers, and the importance of support, we're joined by Dr. Angela Colantonio, Professor of Occupational Science and Occupational Therapy at the University of Toronto. Dr. Colantonio also holds a Canada Research Chair in Traumatic Brain Injury in Underserved Populations.

Also joining us, Dr. Tatyana Mollayeva, an Affiliate Scientist at the KITE Toronto Rehabilitation Institute, part of the University Health Network and an Assistant Professor at the Dalla Lana School of Public Health.

Also joining us is Halina Haag, Registered Social Worker, PhD candidate, and contract faculty member at the Wilfred Laurier Faculty of Social Work. Welcome to you all and thank you for being here.

Starting with Dr. Colantonio, can you tell us a bit about your research and the types of brain injuries you found in workers?

Dr. Angela Colantonio

So, in our acquired brain injury lab at the University of Toronto and the Toronto Rehabilitation Institute, we have tracked traumatic and non-traumatic brain injuries in Ontario across the continuum of care to provide timely data to stakeholders about survivors of brain injury for health service planning, resource allocation, policy making, evaluation, education, and prevention. And in our research related to traumatic brain injury among underserved populations but explore factors that affect the incidence and prevalence of traumatic brain injury, provision of, and access to, services, community  reintegration after the injury, and prevention of injury and re-injury, in populations with traumatic brain injuries. And some of the populations, we studied include persons who experience homelessness, involvement with the justice system, brain injury due to violence, brain injury in older adults, children, adolescents, and also in indigenous and racialized communities.

Now, our lab has done the most, we believe worldwide, on work-related traumatic brain injury, which is an understudied area. A lot of attention is focused on elite workers such as professional athletes and those serving in Canadian Armed Forces, but we focus on civilian populations overall. And this is important because brain injuries can be among the most serious workplace injuries. And also, the increase in reported concussions, a milder form of brain injury, has increased dramatically over the last 10 years.

Now, our research on work-related traumatic brain injury has identified risk factors relevant to specific industry sectors and the presence of distinct distributions bisects across industry sectors and mechanisms of injury. We found that most work-related fatalities, or work-related fatalities, that involve brain injury have been in male workers and that male workers are five times more likely to have a workplace related to traumatic brain injury.

However, when we looked at traumatic injuries caused by assault at the workplace in Ontario. We found that female workers often sustained, comorbid injuries to other body parts in addition to head injuries. Female workers with traumatic brain injury from assault in the workplace tended to come from health care, social service, and educational sectors. Whereas male workers often work in law enforcement or public administration. Overall workers who sustain their brain injury through assault at the workplace tended to be off work longer.


So, both male and female workers are experiencing traumatic, brain injuries at their workplace but in different sectors and in different roles.

Dr. Colantonio

We also found that the risk of exposure to work-related traumatic brain injury hazards differed, with male workers being more likely to experience a work later. Traumatic, brain injury due to equipment breakdown or malfunction, and these differences could reflect how gender roles shape career choices and result in different types of exposure to occupational hazards.

Overall, we've had a strong focus on women's health outcomes following traumatic brain injury; including long-term outcomes on reproductive health, but more recently, we've looked at traumatic brain injury among women survivors of intimate partner violence. Working with community partners to identify social and environmental factors that affect our experiences. Then we've explored barriers and supports to things like health care, social support, and employment. And, this is to inform the development of resources to meet the needs of women survivors of intimate partner violence and traumatic brain injury.


Dr. Mollayeva, what did your research tell you about workers and return to work?

Dr. Tatyana Mollayeva

This is an interesting question; we do both quantitative and qualitative research.

Our quantitative research on the return to work after traumatic brain has found that younger age, higher, pre-injury occupation, better mental and physical health, stable employment history, pre-injury, and workplace support, all associated with a successful return to work after a traumatic brain injury.

Our qualitative research on the return to work following brain injury, that focused on the lived experiences of workers, showed that re-engagement in paid employment is a challenging experience for both men and women and it requires ongoing workplace support.

We found also that return to full-time duties, which is a goal valued by rehabilitation professionals, is not always seen as an accurate indicator of successful rehabilitation for workers with traumatic brain injury.

In one of our study of Ontarians, who experience a work-related mild traumatic brain injury all participants reported that employers and workers compensation representatives didn't have an adequate understanding of the consequences of this injury. and upon return to work, half of them reported of being re-injured.


There seems to be a noticeable difference between genders and their experiences.

Dr. Mollayeva

We also found a more positive return to work experience in women working in traditionally feminine roles such as healthcare and social care, relative to those workers in environments to be considered more masculine such as in construction and law enforcement.

We also found that factors associated with return to work differed between male and female workers, which suggests that reintegration efforts that take gender into account may assist in the development of successful policies and practices for workers who returned to work after a work-related traumatic brain injury.


Were there any key learnings in what workers found helpful, as they went back into the workforce after a brain injury?

Lin Haag

Well, we've heard a lot from a lot of folks, but one study that we conducted, the support of family and friends, was the top facilitator in returning to work. Followed by the help of treatment providers and workplace accommodations.

Some of those key learnings that we've heard from folks, as they went back after their injury, were related to individualized, workplace support, positive employer and co-worker relations, and a safe workplace to return to. Individualized workplace support that meets workers’ needs was has definitely been a recurrent theme in discussions. They need to, there's a need for support that included, but was not limited to, the availability of colleagues who were able to provide modifications, accommodations to duties, assess for a depth of adaptive devices, and the possibility of part-time work, slow reintegration and a positive reinforcement and recognition of efforts by supervisors.

Workers with traumatic brain injuries report, who are talking about supportive environments with return to work, they've stressed the importance of a non-judgmental employer and co-worker relations. So, they described their peers as looking out for them when they return to work following their injury.

Some mentioned the significant role of opportunities to socialize with other employees and the opportunity for salary increase and advancement were both extremely valuable. These factors all promoted a sense of belonging and trust. One of the things that I specialize in is working in the area of

intimate partner violence and traumatic brain injury. And when we spoke with women who had experienced that about their challenges around finding employment or maintaining employment, they discussed the importance of compassion and understanding from their employers. They talked about how much they appreciate an employer who had clear policies about who to tell and how to ask for help, rather than just trying to figure that out on the fly. They valued flexibility and support around their needs for things that were sort of specialized like needing additional time to attend appointments that might come up or challenges that they were experiencing with childcare. Some women, highlighted employers, who specifically supported enhanced workplace, safety planning, providing them with the security they needed to be able to focus on their job. All of the women spoke about the importance of employment in their life and how it provided not only financial stability, but also a sense of self-worth and self-identity, that was critically important to them overall.

Workplace safety issues themselves, that result in traumatic, brain injury, are important to discuss as well, when you're looking at things like a successful return to work. Our research highlights that there are unnecessary risks and hazards that are contributing to workers injuries. We found that workers with work-related traumatic brain injury frequently expressed disappointment that their injuries did not directly lead to improved occupational health and safety policies and practices within the organization. We feel that these are findings that require attention, specifically because of things like the foundation of Ontario's compensation model is based on a 1914 Meredith Report, which is at historical compromise, where in exchange for giving up the right to sue employers for their workplace injuries, workers, irrespective of fault, should receive compensation for their work related injuries. Under Ontario's Occupational Health and Safety Act, workers can refuse work or stop work that they feel is dangerous. So, for a worker, returning to work where the worker was injured, it should satisfy occupational, health and safety requirements.

Overall, strong health and safety cultures that encourage open analysis of all injury events facilitate OHS improvements with greater attention to the structural and social elements of the workplace and fair compensation for workers effort to return to work after the injury, can facilitate both return to work and general traumatic brain injury outcomes.

Chris (11:51)

Have you found any specific information that could be helpful for workplaces who are preparing for the return of workers who have suffered a brain injury?

Dr. Mollayeva

Our research, and the research of that of others, has shown that much of the variability in return to work outcomes after a traumatic brain injury is accounted for by what takes place in the workplace. For an employer, work-related injury affects both the productivity and the cost of production, potentially resulting in lower profits and complicating optimal return to work opportunities, for the injured worker. The employer may even view absence from work as a best option for an employee who sustained traumatic brain injury and is experiencing physical and cognitive impairments, especially if the worker’s income is covered by insurance.

However, our research shows that return to work can be successfully facilitated after traumatic brain injury with the implementation of accommodations and open communication between the employee and the employer.

I'm going to share a quote from someone who participated in our research and who discussed the significant role her employer and co-worker played throughout their support and accommodation of her cognitive impairment stemming from traumatic brain injury. These people focused instead on the worker’s abilities and eliminated job tasks the injured worker could no longer complete. She said:

“So, what ended up happening was that my employer went and said, “I want her to continue working”, which was amazing. Because in some way, I guess I'm a little bit of a liability like I'm not at my full tilt and she me use that I couldn't do paperwork but she me knew that I was really still good with clients.”

In specific groups of people with traumatic brain injuries due to intimate partner violence, women repeatedly told us what mattered most to them, was to have someone they could trust, they could tell, who could help them navigate systems at play. Finding that support can be very difficult, particularly with the intersection of traumatic brain injury with other forms of vulnerability like intimate partner violence, or visible minority workers, or immigrants, among other vulnerabilities. Only recently, have we started to build capacity toward achieving a better understanding. There are resources we have developed like the Abuse and Brain Injury Tool Kit, where employers and workers with traumatic brain injury can get information about an intersection between traumatic brain injury and other forms of vulnerabilities.


Before we finish. Is there any advice or tips you can provide for when workers re-enter the workplace?

Dr. Mollayeva

This is a very important question. And one point that we didn't mention, is that our research and the research of other people, highlights the impact of psychological factors on how workplace injuries are perceived and experienced. The psychological factors of self-efficacy, coping patterns, and personality disposition to optimism, are very much interrelated and are influenced by a large extent by family and social, and workplace support, as well as physical environments.

Modifications at the workplace are absolutely important. These modifications can take many forms and it is definitely advisable that workers with traumatic brain injury, who are preparing to return to work, are aware of them. In our research on persons with traumatic brain injury, key formal accommodations were modified work duties, or some due to restrictions, gradual return to work, modified work or specific scheduling that meets the injured worker needs, change of job, change to commute. Allowances for medical appointments, frequent breaks, environmental strategies, such as addressing working, sensitivity to light and sound, and availability of assistive technologies and devices.

Rehabilitation specialists and professionals are very well-equipped to develop individualized return to work plans that suits the needs of individual workers with traumatic brain injuries. And this definitely can support workers in their attempts to return to work after the injury.


I'd like to thank each of you for joining us today and sharing your current research. The issues workers with brain injuries face when returning to work and how workplaces can support them. You can find more information on supporting workers back to work at CCOHS.ca. Thanks for listening.