Returning to Work After Stroke or Brain Injury: What Happens in a Telehealth Occupational Therapy Vocational Assessment?

Returning to work after a stroke or brain injury can feel exciting, overwhelming, and uncertain all at once. You may be wondering: Am I ready? Will I cope with fatigue? What if my memory, concentration, communication, or confidence has changed? What should I tell my employer?

An occupational therapy vocational assessment can help you answer these questions in a structured, supportive way. It looks at you as a whole person: your health, your work role, your daily routines, your environment, and what you need to return to work safely and sustainably.

Vocational rehabilitation is widely recognised as support that helps people with health conditions stay in, return to, or remain in work. For stroke survivors, return-to-work support is also recognised as an important part of rehabilitation planning.  

What is a vocational assessment?

A vocational assessment is an occupational therapy (OT) assessment focused on work.

Rather than simply asking whether you are “fit” or “not fit” for work, an OT looks at the match between:

You: your physical, cognitive, emotional, sensory, communication, and fatigue-related needs.

Your job: the tasks, hours, responsibilities, pace, environment, travel, technology, and social demands.

Your workplace: the supports, barriers, adjustments, and expectations around your role.

The aim is to understand what is realistic now, what might need to change, and what steps could support a safe return to work.

For people with stroke or acquired brain injury, work can be affected by visible and invisible changes, including fatigue, reduced concentration, slower processing, memory difficulties, reduced confidence, changes in mood, headaches, communication changes, physical weakness, visual difficulties, or sensory overload. Planning ahead can make the return-to-work process less stressful and more manageable.

Can a vocational assessment be done by telehealth?

Yes. Many parts of a vocational assessment can be completed effectively by telehealth using video call.

A telehealth assessment may be especially helpful if travelling is tiring, you are not yet driving, you live far from services, or you feel more comfortable being assessed from home. It also allows your OT to see parts of your home working setup, such as your desk, chair, computer equipment, lighting, noise levels, and daily routine.

In some cases, a workplace visit or additional in-person assessment may still be recommended. Your OT will discuss this with you if they feel it would add important information.

What happens before the appointment?

Before your telehealth appointment, your OT may ask you to complete forms or provide information about:

your brain injury history, your current symptoms, your job title and main duties, your usual working hours, your travel requirements, what you are most worried about, or what you hope to achieve.

You do not need to have everything perfectly prepared. The assessment is designed to help organise the information with you.

What does the OT ask about during the assessment?

Your OT will usually begin by getting to know you and your work story. This may include what your job involves, what you enjoy about work, what has changed since your stroke or brain injury, and what a successful return would look like for you.

The assessment may explore:

Physical abilities - This may include strength, coordination, balance, walking, hand function, pain, endurance, vision, and how your body copes across a day.

Cognitive skills - The OT may ask about memory, attention, planning, problem-solving, processing speed, multitasking, reading, screen use, decision-making, and managing interruptions.

Fatigue and energy levels - Fatigue is one of the most common barriers to returning to work after stroke or brain injury. Your OT will explore when fatigue happens, what makes it worse, how long recovery takes, and how work demands might need to be graded.

Emotional wellbeing and confidence - Returning to work can bring anxiety, frustration, grief, reduced confidence, or fear of making mistakes. These are common and valid concerns. Your OT can help identify strategies and supports.

Communication and social demands - This may include meetings, phone calls, written communication, word-finding, managing conflict, customer contact, or working in a busy team environment.

Daily routine outside work - Work readiness is not only about the job itself. Your OT will also consider sleep, personal care, meals, medication routines, childcare, household tasks, exercise, appointments, and recovery time.

Workplace demands - The OT will look closely at your actual role. For example, a desk-based job may involve long periods of concentration, screens, meetings, deadlines, and multitasking. A practical or physical role may involve lifting, standing, driving, machinery, noise, risk management, or fast-paced decision-making.

Will I have to do tests?

Sometimes. The OT may use questionnaires, screening tools, work-readiness checklists, fatigue scales, cognitive screening tasks, or structured interview tools.

These are not about passing or failing. They help build a clearer picture of your current strengths, challenges, and support needs.

If more detailed assessment is needed, your OT may recommend input from other professionals, such as neuropsychology, speech and language therapy, physiotherapy, occupational health, your GP, or Consultant.

What recommendations might come from the assessment?

Every plan is individual. Depending on your situation, recommendations may include:

a phased return to work, working from home or hybrid working, extra rest breaks, a later start time, a quieter workspace, memory aids, reduced multitasking, temporary changes to duties, adjustments to workload or deadlines, ergonomic equipment, regular review meetings with your manager, education for your employer about stroke or brain injury symptoms, or strategies for fatigue management.

The goal is usually to help you build work capacity gradually, rather than returning too quickly and experiencing a setback.

What is a phased return to work?

A phased return means going back to work in stages. You may start with fewer hours, fewer days, simpler tasks, or lower-pressure responsibilities. Over time, the plan can be reviewed and adjusted.

A phased return should be realistic, flexible, and based on how you are functioning in daily life, not just how you feel on a good day.

Can the OT speak to my employer?

Yes, but only with your consent.

Some people want their OT to help explain their needs to their employer or occupational health provider. Others prefer to receive a report and share it themselves.

With your permission, your OT can help communicate:

what has changed since your stroke or brain injury, what tasks may be difficult at first, what adjustments may help, how to structure a phased return, how to monitor progress, and when to review the plan.

This can reduce misunderstandings and help your workplace support you appropriately.

What will I receive after the assessment?

At your request, you can receive a comprehensive written report. This may include:

your current work-related strengths, the main barriers to returning to work, how your stroke or brain injury affects work tasks, recommended workplace adjustments, a suggested phased return plan, fatigue and pacing strategies, or recommendations for further therapy.

This report can be used to support conversations with your employer, occupational health, insurer, GP, or rehabilitation team, depending on your circumstances.

Is telehealth suitable for everyone?

Telehealth works well for many people, but it is not always the whole answer. Some people may need an in-person workplace assessment, equipment trial, or hands-on physical assessment.

Aisling will phone you in advance of booking your appointment to determine if telehealth is suitable, or whether additional assessment would be beneficial.

Why see an occupational therapist for return-to-work support?

Occupational therapists are trained to understand the relationship between the person, the task, and the environment. This makes OT especially relevant when work has become difficult after a health event.

For adults with stroke or brain injury, this whole-person approach is important. Returning to work is not just about whether you can perform one task. It is about whether you can manage your work role alongside fatigue, thinking demands, communication, travel, home life, and recovery.

When should I arrange a vocational assessment?

You may benefit from an OT vocational assessment if:

you are on sick leave and thinking about returning to work, you have tried to return but are struggling, your employer has asked what adjustments you need, you are unsure whether your old role is still suitable, fatigue or cognitive changes are affecting your work, you need a phased return plan, you are considering changing roles or reducing hours, or you want professional guidance before speaking with your workplace.

You do not need to wait until you feel fully recovered. In fact, early planning can often make the return-to-work journey feel clearer and more manageable.

Taking the next step

Returning to work after stroke or brain injury is a big milestone. It is normal to feel unsure, especially when symptoms are invisible or fluctuate from day to day.

A telehealth occupational therapy vocational assessment gives you space to talk through your concerns, understand your current abilities, and create a practical plan for work. With the right support and adjustments, many people can take meaningful steps toward work in a way that protects their health, confidence, and long-term wellbeing.

Need support with returning to work after stroke or brain injury?

A private occupational therapy vocational assessment can help you understand your options, plan a safe phased return, and communicate your needs clearly with your workplace. You can contact Aisling to arrange an assessment via the webpage contact form, or by emailing aisling.neurorehab@gmail.com.