Three important concepts for us to consider are cognitive work capacity, cognitive work demand, and cognitive reserve, the person’s residual functional capacity.

As a person is evaluated to return to work after experiencing a brain injury, a comparison will be made between his or her available work capacity and the job’s demands. If there is cognitive reserve, return to work can be readily undertaken. Without reserve, accommodations are necessary.

If the client has a focused impairment such as that occasioned by a small caliber gunshot wound or stabbing or a localized stroke, it may be possible to modify the job’s demands so that cognitive reserve is reestablished. If the job’s demands cannot be modified, it still may be possible to provide rehabilitation that restores adequate reserves, harnessing neurogenesis and neuroplasticity (Satz, Cole, Hardy, & Rassovsky, 2011).

White matter linkages between the parietal lobe and frontal lobe appear to be causally linked to cognitive capacity; greater linkage demonstrated by diffusion tensor imaging is related to higher levels of cognitive capacity as measured by tests of intelligence (Haut et al., 2007). These findings point to the importance of distinguishing global or diffuse brain injuries from focal brain injuries as we consider cognitive work capacity.

  • Haut, M., Moran, M., Lancaster, M., Kuwabara, H., Parsons, M., & Puce, A. (2007). White matter correlates of cognitive capacity studied with diffusion tensor imaging: Implications for cognitive reserve. Brain Imaging and Behavior, 1, 83–92.
  • Satz, P., Cole, M. A., Hardy, D. J., & Rassovsky, Y. (2011). Brain and cognitive reserve: Mediator(s) and construct validity, a critique. J Clin Exp Neuropsychol, 33(1), 121–130.