Hey Manager of a concussed person, read this!

A checklist to effectively lead someone who just got an mTBI

Devon de Balasi Brown
12 min readMay 20, 2019
Photo by Tuce on Unsplash

I work at for a global, high-growth brand in the outdoor industry. Last year, a critical member of my team got a concussion. They valiantly battled through a very difficult recovery, and I gained new insight into this type of injury from up-close, as I fumbled my way through trying to support them.

Almost a year later I got a concussion of my own. I write this post following my five month concussion anniversary. I still can’t work a full day without my symptoms spiking, but I’m slowly making progress and I’m thinking clearly enough now to reflect and connect some dots.

A concussion is a mild traumatic brain injury (mTBI). “Mild” denoting that there isn’t any bleeding or structural damage. After a mTBI the brain and brain cells are left damaged from being knocked around, and some nasty chemical changes have taken place. A colleague of mine who studied neuroscience suggests the analogy of a forest: Imagine your brain is a forest with a bunch of nice walking paths going through it. You’ve been building these paths since you were born and they make it easy to move through the forest. Well, toxic trees just fell across a whole bunch your concussed employees walking paths… The process of rebuilding the paths needs to start, and how long it takes will depend on many factors.

What you’re about to read is a collection of my thoughts, organized into a checklist, for how to best support someone who works for you in the weeks following their concussion.

Okay, someone on your team just got a concussion. What should you expect?

Well, it sucks. It sucks for the business because less work gets done. It sucks for your HR/P&C team because they probably aren’t prepared to help anyone involved. It sucks for the peers of this person, because they likely don’t understand what is going on. It sucks for you, as their manager, because it’s both emotionally draining, productivity stunting, and a totally new leadership challenge. But it sucks most for the person with the concussion. It’s confusing, scary, lonely, anxiety-provoking, patience-draining, painful, sleepless, and identity-unravelling.

In the blink of an eye, or the crack of a skull, you just turned into a critical piece of their support network. Under the circumstances, your team member will have trouble practicing “self-leadership,” and their doctor may not know how to guide them. From this point forward you can help their situation or hinder recovery. Choose, because you can’t opt out.

This injury could take two weeks or nine months to recover from. It’s worth doing everything possible to try to make it two weeks.

What can you do to help?

This checklist is loosely sequential, though some points overlap with others.

Photo by Aaron Burden on Unsplash

1. Time Off

Strongly encourage them (*ahem* force them) to take time off. Use some sick days or give them time-off “for free” for at least a few days no matter how bad they think their concussion is at this point. Many people will want to push through and try to get back to work immediately. This is noble, but stupid, because intensifying symptoms hinders a natural gradual “exposure” therapy protocol (whether official or self-directed) and lengthens recovery time. It’s what I did, and I regret it now. After a concussion they will be in shock, their body is in a stress/survival response mode, and they are likely in denial (it’s really scary to acknowledge how awful and strange everything feels). They are NOT able to reflect and take inventory of how messed up they really feel. They will figure it out eventually, so create space for them to start now so the recovery process can begin.

2. Reorganize workload

Make a plan with the rest of your team to take-over their work. Try to hand-off everything, which will reduce pressure for them to return to work too soon. If they recover in a few days, great news, if they don’t, you’ll be happy you planned ahead.

3. Real Talk

Schedule a non-time constrained meeting to have some ‘real talk.’ If they are resting at home, meet them in a park or a quiet coffee shop near their house, or if necessary just chat on the phone. Your goal is to create space for dialogue about how they’re actually doing so you can lead your team and manage the work effectively. Try asking questions like these, which show you have a sense of what they might be experiencing and that it’s okay to talk about it. There’s nothing in particular you can do or fix, just listen and learn. Then revisit during your subsequent check-ins/1:1s:

  • How are you feeling? Are you feeling more emotional? Irritable? This is normal, their brain chemicals are completely jumbled up right now.
  • Are you getting headaches? Almost everyone gets a lot of headaches. They are usually worse at first (sometimes lasting many days).
  • Are you having trouble following conversations or remembering words? Do you find yourself spacing out? Expect conversations with a concussed person to be slow and clunky.
  • Do normal tasks feel like they take an insane amount of effort and focus right now? Talking about this will help them feel less crazy or embarrassed about the fact that making a smoothie took them 30 minutes and the sound of the blender made them wince…
  • When you’re resting, what do you do? Many people, myself included, have completely forgotten how to rest, like REALLY rest. When you flop down on your couch to “rest” what are the top things you do? I’ll put money on the fact that it’s either grabbing your phone, flipping open your laptop, or throwing Netflix on. All these activities, believe it or not, represent an intense cognitive load (you only realize this once you brain is damaged and working at a fraction of its normal capacity). Brainstorm some things that they could do to “really rest” and let their brain shut-off or wander (and heal!). My favourite resting trick is taking long baths with soft lighting (candles are good for concussed person care packages). If I get too bored, chill music or an audiobook is perfect.
  • Are you having trouble falling asleep, or are you waking up in the middle of the night? Issues with sleep are quite common and intensify all the other symptoms the next day. It’s especially cruel, because concussed people need SO much sleep to heal. Even at the five month mark I sleep 9–10 hours a night. At the beginning I was napping every day and sleeping 12 hours at night. It was astonishing how much time my brain wanted to be asleep, but it makes total sense — that is the best time for the body to repair itself.
  • Are you feeling sensitive to bright lights (like the fluorescent lights in the office) or noise (like open offices or restaurants)? These symptoms surprised me, and are one of the reasons why working from home can be so helpful when it’s an option.
  • What do you feel like in the morning? How does it change throughout the day? This gets the conversation started for what will eventually lead into creating a gradual return to work plan.

4. Counselling or Therapy?

If your company’s extended medical package includes clinical counselling or therapy ask if you can schedule them an appointment with someone who knows about concussions or trauma. If they’ll let you, taking on the administrative tasks of selection and scheduling is key, because their brain is jumbled and this type of thing will feel 10–100 times harder than normal. My team member said that the counselling they eventually got in their concussion rehab program was one of the most useful treatments they received. The mental/emotional suffering caused by concussions is probably the most overlooked by family, friends and colleagues. Having a brain injury is scary, lonely, and patience-testing.

5. Schedule 1:1 Meetings

If you do not have weekly or bi-weekly one-on-one meetings scheduled, now is the time to schedule them with this person. This is very important for you (to have the information you’ll need to manage the business and know where your team member is at) and for them (to stay motivated, get reassurance, and have an ally at work).

6. Non-Computer Work

Work with the rest of your team to make a list of all the non-computer intensive tasks you could get them to do. These will be the first things you get them to try when they start to come back to work. Let the rest of your team do their computer heavy work. It’s the office job equivalent of “light duties.” If their work is all on the computer, see if it’s possible for them to work from home, or a quieter/darker part of the office (where the environment might be less taxing). Choose some specific deliverables with them, and ask them to track the time they were working.

7. Start Back Slowly

The modern advice is to try to reintroduce “normal” aspects of life in small doses as soon as possible (it’s called exposure therapy). It fights atrophy, and is part of the process of rebuilding cognitive pathways and stamina. Ask them how much work they think they could do before their symptoms (for example, having trouble in conversation, spacing out, or getting a headache) would kick-in and start them at half of that. If they said “2 hours I think,” you say “great, let’s plan for you to come in for one hour tomorrow — I’ve got some non-computer tasks I’d like you to try. Check in with me after that hour and let’s see how you’re feeling.” If they still feel okay, try another 3o minutes.

The key thing is to build the habit of self-awareness and dialogue, and as soon as they start feeling the symptoms increase, tell them to go home and rest. Here are a few examples of types of work that are cognitively demanding for a concussed person: anything on the computer, reading, decision-making, analysis, and meetings with more than one other person. Once you’ve found the “starting point” for how much they can usually work while staying asymptomatic, create a rough plan for how you can slowly increase the time and complexity of their work. When you find the point at which their symptoms flare up, dial it back a bit, and repeat.

As an example, I can consistently work four hours a day now, but it’s really hard not to get stuck at work and then push way too far into my symptoms (which can make the rest of the day hell and the next day worse — a vicious cycle). My latest tactic is to schedule afternoons as out-of-office, and only book meetings in the morning. This way I can work more than four hours on days when I am able to, but since I’m not in meetings it’s easier to stop as soon as my symptoms kick in.

8. Take Breaks Seriously

Start them on a rigorous break schedule. A break might look like a nap in the car, a walk around the block, or eventually just looking away from the screen for a couple minutes. They are crucial. Get them to put themselves on a 30–60 minute timer or remind them regularly.

9. Rehab?

Suggest they get professional help with rehab. This is a touchy one because first, their doctor may have told them they just have a “mild concussion,” and to “try to rest and avoid screens for a while,” before sending them on their way (in my case even dissuading me from seeing anyone to help with rehab). We want to trust our doctors, but GPs don’t always know the modern science on concussion recovery, or have time to keep up with it.

Second, these appointments cost time and money (depending on the extended medical benefits available). As a manager, you could help with time if you make them stay at home to rest and delegate their work to other team members, but you don’t know the ins and outs of their financial situation. In Canada we have some concussion rehab programs that are covered by our basic health care, but they have long wait lists.

Finally, it’s hard to know what kind of professional help to try. I got lots of recommendations from caring people in my life (physiotherapists, chiropractors, massage, craniosacral, doctors, nutritionists, etc.). For a long time I was stuck in analysis paralysis (and with a damaged brain, the analysis part was just about impossible at first). I started by getting craniosacral therapy from a friend, and some manual lymphatic drainage massage at a place near my house. Eventually I bit the bullet and went to an integrative clinic that does concussion rehab. They are doing manual therapy for my back and neck, and have me on a regime of anti-inflammatory food, supplements, stretches, eye and neck exercises, and cardio at a specific heart rate. At the very least, getting professional help is motivating and will reduce the loneliness and fear, and at best it will fast track recovery by a lot.

Suggest that they ask a friend or family member to schedule the first appointment for them. Then most importantly, follow-up (this is where your role is really beneficial). Then follow-up again (because they won’t do it at first). And again, until they’ve been to their first appointment and the ball is rolling.

10. Be Ready for Ups and Downs

It’s going to be a roller coaster ride. A great day can be followed by a terrible day. A good streak can be interrupted by a bad week. It’s discouraging, and your team member will probably feel some serious shame every time it happens. Remind them that it’s normal, that the recovery trend line is always jagged with concussion. Reassure them that they’re doing the right thing when they listen to their body so it can heal.

11. Get Educated

Now it’s time to educate yourself. Poll your friends on Facebook to find people who have had a concussion before. Ask them what it was like, and what kind of support they benefited from or wished for at work. Do a Google search. Here’s a recent Globe & Mail article that does a nice job of hitting on many of the struggles associated with a concussion.

Photo by 2Photo Pots on Unsplash

Here’s the bottom line: Your employee needs you right now, and the opportunity cost of doing what you can to help them heal as fast as possible can be huge for everyone involved. One of the things that science has proven is that returning to work/normal life too soon lengthens recovery time.

Remember that there’s no “right” way of dealing with this situation, so don’t beat yourself up for doing it wrong. These injuries are so complex. The length of recovery depends on the accident, pre-existing health, and many other factors. As you encourage your team member to cut themselves some slack, rest like crazy and accept that their life will be different for a while, do the same for yourself. There’s no perfect way to support someone through this. Do your best by being patient, caring, and pave the way for them by putting this checklist into action.

Adversity like a concussion presents the opportunity for learning and trust building. Skills like prioritization, patience, and empathy will be tested, and hopefully strengthened throughout the process. That is a silver lining worth reminding ourselves of.

To everyone out there who is on the bumpy road to concussion recovery, I wish you the best, and I invite you to get in touch with me to share your experience or ask questions about mine. In a future post I’ll write more about what worked for me, in my process healing from my own concussion.

For the keeners, here are some big picture things to consider in your business:

  1. Does your company have a policy for supporting people through injuries, something like a short-term disability plan?
  2. Does your company intentionally cultivate a culture that opens dialogue about mental health issues?
  3. Do your extended health care benefits cover counselling/therapy?
  4. Do your extended health care benefits cover paramedical disciplines like physiotherapy?

Disclaimer: I am not a doctor! This is basically my “note to self” for the next time I end up in this situation (knock on wood), and I hope you’ll benefit from it to. It’s a collection of things I tried, experienced, and would like to try next time.