A rehabilitation plan can look complete and still have a gap in it. The goals are agreed, the therapy is under way, the employer is willing, and then the person cannot follow the team meeting or tires out by lunchtime for reasons nobody has pinned down. Sometimes the missing piece is sight or hearing, never looked at because everything else in the case was louder.
Sensory loss rarely arrives alone in a vocational rehabilitation case. It sits alongside brain injury, stroke, trauma or a long-term condition, and it can be the one factor that makes a sensible return to work plan fall over. This article covers how to spot it, when a specialist workplace assessment adds something, and what a useful report should contain.
Why sight and hearing are easy to miss in complex cases
The most reliable UK evidence on how often vision is affected comes from stroke. A multi-centre study of 1,033 people admitted to acute stroke units, reported by Rowe and colleagues in 2019, found visual problems in 73% of those assessed by orthoptists, with new-onset problems in 60% of stroke survivors once pre-existing eye conditions were excluded. The authors describe visual problems as an under-reported consequence of stroke. The study also separated new problems from pre-existing ones, so a person’s sight before the event matters as much as the change after it.
Hearing evidence is thinner. A 2018 systematic review of peripheral hearing problems after traumatic brain injury concluded that the range and frequency of auditory dysfunction remain unclear, that the highest level of evidence among the 20 studies retained was low, and that diagnostic and best practice guidelines were lacking. Its search ran to 2016, so it is best read as a caution rather than a figure to quote. Headway, the brain injury charity, notes that hearing and vision can both change after brain injury and that glasses or hearing aids may address only part of the problem.
NICE takes a firmer line for stroke. Its 2023 stroke rehabilitation guideline recommends a specialist orthoptist assessment as soon as possible for people in hospital after stroke, hearing screening within the first six weeks, and referral for an audiology assessment where difficulties are found. It also asks that return to work issues, including the communication demands of the job, are identified as soon as possible and reviewed regularly. Outside stroke, no equivalent UK guidance was found that sets out routine sight and hearing screening for every complex case, so much depends on whether the case manager thinks to ask.
Common gaps in rehabilitation cases
The first gap is absence of screening. Where nobody has asked about sight and hearing since the event, the plan rests on assumptions. The second is misattribution. Difficulty reading, losing the place in a document, missing a colleague speaking from the side, or withdrawing from group conversations can be put down to cognition, mood or fatigue when a visual or hearing cause is part of the picture. Neither explanation should be assumed. Both deserve checking.
The third gap is assumptions about capability. A person who cannot see the screen clearly or hear the meeting has not lost the ability to do the job, and a plan that treats the barrier as a limit on the person tends to narrow the role unnecessarily. The fourth is equipment bought before the work has been looked at, which can sit unused because it does not suit the tasks, the room or the person. The fifth is an employer who does not know what is needed, or that a legal duty may already apply.
When a return to work assessment needs a sensory loss specialist
Optometry, orthoptics, ophthalmology and audiology establish what is happening with the eyes and ears. Occupational health considers health in relation to work. Occupational therapy looks at function and daily activity. A specialist workplace assessment sits alongside these. It is practical and non-clinical, and it looks at how the sight or hearing difficulty meets the particular job, equipment, building and team.
Specialist input is worth considering when a return to work assessment turns on a sensory question the rest of the team cannot answer. Typical triggers are a planned return involving screens, documents or meetings that are now harder to access, equipment suggested but never tested against real tasks, an employer asking what adjustments could reasonably be made, or a plan that keeps stalling for reasons that may be sensory. A visual impairment workplace assessment or a hearing loss workplace assessment can be commissioned while the person is still in rehabilitation or already back at work, and it should complement the clinical and rehabilitation work rather than replace any of it.
What to ask for in the report
A report is only useful if the next person can act on it. Case managers can reasonably set out the following in the instruction.
| Area | What to ask the report to cover | Why it helps the case |
|---|---|---|
| Practical adjustments | Specific changes to tasks, workflow, documents and routines, with the reason for each | Gives the employer something concrete to agree or decline |
| Equipment | Features needed, how they fit the actual tasks, and what to trial before purchase | Avoids buying equipment that does not suit the job |
| Communication | How meetings, calls, instructions and informal conversation will work in practice | Addresses the barrier most often missed in a plan |
| Environment | Lighting, glare, acoustics, layout, routes and signage in the real workplace | Shows that some barriers sit in the setting, not the person |
| Fatigue and pacing | Where sensory effort may add to existing fatigue, and how the day could be structured | Links the report to the wider rehabilitation picture |
| Training and awareness | What the person, manager and team may need to know, and who will deliver it | Stops adjustments depending on one well-informed colleague |
| Funding routes | Which items may sit with the employer as reasonable adjustments and which may be suited to Access to Work | Speeds up decisions and avoids duplicated applications |
| Link to the case plan | Which goals, timescales and professionals each recommendation relates to, and who owns each action | Makes the report part of the plan, not an appendix |
The report should describe functional barriers and proportionate support. It should not diagnose, give a prognosis or offer a view on fitness for work, which remain matters for the clinicians and decision makers involved. A good report also states what it could not assess and where a clinician should be consulted, for example if symptoms appear to be changing.
Hints and tips for the individual
Say what you can and cannot see or hear in specific tasks, such as reading a screen, following a meeting or finding your way around, rather than in general terms.
Mention any sight or hearing difficulty that existed before your injury or illness, as well as any change since.
Ask for the findings in a format you can read or listen to comfortably.
Keep a short note of what works and what does not in the early days back.
Decide who needs to see what. You can ask for a summary for your employer that leaves out clinical detail.
Working with the employer
The employer is often the missing party in a rehabilitation case, and the point where good recommendations are won or lost. A short conversation about the job as it is done, not as it appears on paper, tends to produce better adjustments than a general letter. It also helps to separate what the employer is likely to be responsible for from what wider support may cover.
Access to Work, which GOV.UK describes as help to get or stay in work with a health condition or disability, can contribute to specialist equipment and assistive software, support workers, travel costs and some physical changes to the workplace. Eligibility requires paid work, or a start or return to paid work within 12 weeks, and a diagnosis is not required. The scheme covers England, Scotland and Wales, with a different system in Northern Ireland, and civil servants receive support from their employer instead. GOV.UK also states that Access to Work will not pay for reasonable adjustments, which are the employer’s legal responsibility, though it can advise the employer on which changes should be made.
The person’s consent and control of their information
A sensory loss assessment involves health information, which UK data protection law treats as special category data deserving extra protection. The practical consequence is that the person should decide, with clear information, what is shared, with whom and for what purpose. Headway makes the point that a person with a brain injury does not have to disclose it to their employer, though doing so can help in identifying adjustments. NICE guidance on long-term sickness absence also stresses confidentiality and informed consent when sharing information.
For the case manager this means agreeing the scope of sharing before the assessment, letting the person read the report first, and considering a shorter employer version that sets out the adjustments needed without clinical detail. Access to Work follows the same principle: the workplace contact named on an application is not approached without the person’s permission.
Legal rights and support
Under the Equality Act 2010, a person is disabled where they have an impairment with a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. Schedule 1 ignores the effect of treatment and aids such as hearing aids, though sight impairment correctable by ordinary glasses or contact lenses is taken into account, and paragraph 8 treats someone with a progressive condition as meeting the test before the effect becomes substantial if it is likely to do so. Where the definition is met, an employer must make reasonable adjustments. That duty does not apply if the employer does not know, and could not reasonably be expected to know, that the person has a disability and is likely to be placed at a disadvantage, which is a further reason to agree what the employer is told. The Act does not apply in Northern Ireland.
Whether the definition is met for a particular person depends on their circumstances, and this article is general information rather than legal advice.
Summary
Sight and hearing deserve a place on the screening list for any complex case, because they shape reading, communication and energy across the day, and are easy to overlook. Ask early, record what is found, and commission a specialist workplace assessment when a sensory question is holding the plan back. Ask for a report that is specific and tied to the case plan, keep the person in control of what is shared, and give the employer information they can act on.
Watch the short film
A short film that follows a case manager who receives a workplace report she cannot act on, and what a usable report needs to contain.
Frequently Asked Questions
No general UK rule was found that applies to every condition. For stroke, NICE recommends orthoptist assessment, hearing screening and audiology referral where difficulties are found. For other conditions, the case manager decides whether to ask, and a simple question early in the case costs little.
No. Occupational health considers the person's health in relation to work and advises the employer. A specialist workplace assessment is practical and non-clinical. It looks at how sight or hearing difficulties meet the person's tasks, equipment, environment and communication, and it works alongside occupational health, audiology, optometry, orthoptics and occupational therapy.
It depends on the item and the circumstances. Reasonable adjustments are the employer's legal responsibility, and Access to Work does not pay for them. Access to Work may contribute to specialist equipment, assistive software and support workers for eligible people. The current position is on GOV.UK.
Not necessarily. Headway notes that disclosure of a brain injury is a personal choice, though sharing some information can help the employer identify adjustments. An employer's duty to make reasonable adjustments can depend on what it knows or could reasonably be expected to know.
If you or someone in your team has sight or hearing loss and would like expert, tailored support to stay productive and comfortable at work, you can arrange a workplace assessment with us.
Sources
NICE, Stroke rehabilitation in adults (NG236), recommendations on assessment, vision, hearing and returning to work (2023): https://www.nice.org.uk/guidance/ng236/chapter/Recommendations
NICE, Workplace health: long-term sickness absence and capability to work (NG146) (2019): https://www.nice.org.uk/guidance/ng146/chapter/Recommendations
Rowe FJ and others, High incidence and prevalence of visual problems after acute stroke, PLoS One (2019): https://pubmed.ncbi.nlm.nih.gov/30840662/
Sarkic B, Douglas JM, Simpson A, Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature, Brain Injury (2019): https://pubmed.ncbi.nlm.nih.gov/30415586/
Headway, Returning to work after brain injury: https://www.headway.org.uk/about-brain-injury/individuals/practical-issues/returning-to-work-after-brain-injury/
Headway, Physical effects of brain injury: https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/physical-effects-of-brain-injury/
Vocational Rehabilitation Association UK, What is VR: https://www.vrassociationuk.com/about/what-is-vr
British Association of Brain Injury and Complex Case Management, About us: https://www.babicm.org/about-us/
GOV.UK, Access to Work: get support if you have a disability or health condition: https://www.gov.uk/access-to-work
GOV.UK, Access to Work eligibility: https://www.gov.uk/access-to-work/eligibility
GOV.UK, Access to Work, after you apply: https://www.gov.uk/access-to-work/after-you-apply
GOV.UK, Reasonable adjustments for workers with disabilities or health conditions: https://www.gov.uk/reasonable-adjustments-for-disabled-workers
GOV.UK, Definition of disability under the Equality Act 2010: https://www.gov.uk/definition-of-disability-under-equality-act-2010
legislation.gov.uk, Equality Act 2010, Schedule 1, Part 1: https://www.legislation.gov.uk/ukpga/2010/15/schedule/1/part/1
legislation.gov.uk, Equality Act 2010, Schedule 8, Part 3 (lack of knowledge of disability): https://www.legislation.gov.uk/ukpga/2010/15/schedule/8/part/3
Information Commissioner’s Office, What is special category data?: https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources/lawful-basis/special-category-data/what-is-special-category-data/