NeuroRehabilitation - Volume 21, issue 4

Authors: Magrega, Dennis J.

Article Type: Introduction

DOI: 10.3233/NRE-2006-21401

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 267-268, 2006

Authors: Kim, Hwan | Colantonio, Angela | Chipman, Mary

Article Type: Research Article

Abstract: Introduction: Traumatic brain injury (TBI) occurring in the workplace carries major economic repercussions such as lost wages and hospital costs. Little is known about the profile of risk factors for work-related traumatic brain injury. Aims: This study describes the pre-injury demographic characteristics, injury-related characteristics and outcomes of work-related TBI and compares them with those of non work-related TBI. This study aims to provide profiles of work-related TBI to improve our understanding and awareness of TBI in the workplace and to better inform prevention efforts. Methods: Cross-sectional study using the Comprehensive Data Set (CDS) of Ontario …(Canada) Trauma Registry (OTR) from 1993 to 2001. Cases with the ICD-9-CM codes for head injury were included in the database of serious injuries from lead trauma hospitals. Results: The study identified 950 (7.3%) people with work-related TBI. Pre-injury demographics and injury-related characteristics of work-related TBI were significantly different from non work-related TBI such as age, gender, mechanisms of injury, Injury Severity Score, length of stay and in-hospital death. Discussion: This research provides the first comprehensive overview of work-related TBI based on Canadian data. It identifies high risk profiles to better target prevention. Show more

Keywords: Brain injury, occupational, epidemiology, Ontario Trauma Registry

DOI: 10.3233/NRE-2006-21402

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 269-278, 2006

Authors: Catalano, Denise | Pereira, Ana Paula | Wu, Ming-Yi | Ho, Hanson | Chan, Fong

Article Type: Research Article

Abstract: This study analyzed the Rehabilitation Services Administration (RSA) case service report (RSA-911) data for fiscal year 2004 to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns on employment outcomes of persons with traumatic brain injuries (TBI). The results indicated that European Americans (53%) had appreciably higher competitive employment rates than Native American (50%), Asian Americans (44%), African Americans (42%), and Hispanic/Latino Americans (41%). Clients without co-occurring psychiatric disabilities had a higher employment rate (51%) than those with psychiatric disabilities (45%). Clients without work disincentives showed better employment outcomes (58%) than those with disincentives (45%). An important …finding from this analysis was the central role of job search assistance, job placement assistance, and on-the-job support services for persons with TBI in predicting employment outcomes. A data mining technique, the exhaustive CHAID analysis, was used to examine the interaction effects of race, gender, work disincentives and service variables on employment outcomes. The results indicated that the TBI clients in this study could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns. Show more

Keywords: Traumatic Brain Injury (TBI), state-federal vocational rehabilitation services, employment outcomes, job placement, work disincentives, CHAID analysis

DOI: 10.3233/NRE-2006-21403

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 279-293, 2006

Authors: Guérin, Fanny | Kennepohl, Stephan | Léveillé, Geneviève | Dominique, Aysha | McKerral, Michelle

Article Type: Research Article

Abstract: Beyond issues of MTBI etiology, a key question remains the characterization and early identification of those individuals at risk of poor functional outcome. Using a retrospective analysis, the current study aimed at identifying the specific indicators related to return to work in adults with both symptomatic MTBI and functional impacts, having completed a specialized intervention program. In terms of outcome, 59.1% of the cohort (n = 110) returned to some form of work-related activity by the end of intervention whereas the rest had not. Three of the sixteen variables studied were retained (logistic regression) as providing unique and significant …(p < 0.05) contributions to the prediction outcome model, namely age, number of subjective symptoms and the presence of a public insurance provider. There was also an interaction between the presence of a public insurance provider and referral delay. Overall percentage of cases correctly classified by the model was 70%, positive predictive accuracy was 72.9%, whereas negative predictive accuracy was 65%. Our findings suggest that any studies attempting to assess functional outcome need to take account of the multifactorial nature of MTBI, including not only more objective psychological/physiological variables related to the injury, but also subjective complaints and environmental factors. Show more

Keywords: Mild traumatic brain injury, post-concussion symptomatology, vocational outcome, prognostic indicators

DOI: 10.3233/NRE-2006-21404

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 295-303, 2006

Authors: Deutsch, Paul M. | Kendall, Sherie L. | Daninhirsch, Carrie | Cimino-Ferguson, Sara | McCollom, Patricia

Article Type: Research Article

Abstract: This retrospective cohort study examined the vocational outcomes in forty-four traumatically brain injured patients. Patient files selected were limited to those who were seen for the development of an original Life Care Plan and were subsequently seen at least once for a complete update of that plan. Patients who were retired at the time of the brain injury were excluded. Each participant was actively involved in litigation at the time of the initial evaluation as well as at the time of his or her update evaluation. Traumatic brain injury resulted from various etiologies. Vocational outcomes were analyzed in relation to …severity of injury, age at onset, gender and education. Vocational outcome was reported as a return to work, supported employment, return to school or training or permanent total disability. Twenty-one patients were classified as permanent-total disabilities. Twenty-three returned to work, supported employment, or were successfully in school and expected to return to work. This 52% rate of vocational or school participation is particularly noteworthy since all cases were actively in litigation. A significant trend was found for severity of injury, and level of education, but not for age at onset or gender. These factors are discussed in relation to the subjects' participation in third party civil litigation and implications for Life Care Planning. Show more

Keywords: Return to work, traumatic brain injury, vocation, life care plan, disability, rehabilitation

DOI: 10.3233/NRE-2006-21405

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 305-314, 2006

Authors: Mateer, Catherine A. | Sira, Claire S.

Article Type: Research Article

Abstract: The effects of a traumatic brain injury on vocational outcome can be predicted on the basis of several factors. Environmental factors such as a supportive work environment, and person specific factors, including the client's age, premorbid occupation, injury variables, level of awareness, psychosocial adjustment, coping skills, and cognitive deficits have all been found to predict return to work following a traumatic brain injury. Some of these factors are amenable to treatment, and clinicians can impact clients' likelihood of returning to work by intervening in various ways. Through case studies and a literature review on the effectiveness of cognitive rehabilitation interventions, …we have outlined specific strategies and recommendations for interventions. Cognitive rehabilitation strategies that address attention, memory and executive deficits can improve clients' abilities to manage workplace tasks and demands. Many clients continue to experience problems with social and emotional adjustment following a brain injury that impact return to work. Cognitive behavioural therapy is well suited for improving coping skills, helping clients to manage cognitive difficulties, and addressing more generalized anxiety and depression in the context of a brain injury. Show more

Keywords: Cognitive rehabilitation, vocational outcome, brain injury, rehabilitation, emotion

DOI: 10.3233/NRE-2006-21406

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 315-326, 2006

Authors: Gamboa Jr, A.M. | Holland, Gwendolyn H. | Tierney, John P. | Gibson, David S.

Article Type: Research Article

Abstract: In 2000, the United States Census Bureau began the annual American Community Survey (ACS), which collects data on earnings and employment for persons with various types of impairment. One of the impairments is cognitive disability, defined as existing when a person has a condition lasting six months or more that results in difficulty learning, remembering, or concentrating. Individuals with such limitations are often defined as having mild traumatic brain injury (TBI). Persons with mild TBI often retain the ability to work competitively. Such individuals, however, typically earn less when employed year-round, full-time than do persons without disability and have …lower levels of employment, resulting in reduced worklife expectancy. This article focuses on the effects of cognitive disability on earnings and employment. The ACS data are reported by gender and education level for those without disability or with cognitive disability. Employment levels are translated into worklife expectancies and the method of conversion through use of a joint probability of life, participation, and employment is examined. Show more

Keywords: Disability, brain injury, earnings, employment, American Community Survey

DOI: 10.3233/NRE-2006-21407

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 327-333, 2006

Authors: Johnstone, Brick | Reid-Arndt, Stephanie | Franklin, Kelly Lora | Harper, John

Article Type: Research Article

Abstract: Although there is considerable research on the vocational outcomes of individuals with traumatic brain injuries (TBI), there has been minimal research on the characteristics of persons with TBI who seek services from state vocational rehabilitation services. Such research is deemed critical given the significant number of individuals who request such services, as well as the significant federal and state costs associated with these programs. The current article reviews a series of studies completed collaboratively between the University of Missouri-Columbia and Missouri Division of Vocational Rehabilitation (DVR). Information is reported regarding the typical demographic, injury severity, and neuropsychological characteristics of DVR …clients with TBI, as well as the most common DVR services provided to them and their vocational outcomes (i.e., successful, unsuccessful). Studies are reviewed which indicate that the provision of specific DVR services predict successful vocational outcomes, although traditional medical and neuropsychological variables do not. Additional studies are reviewed which examine the impact of gender, race, age, geographic location (i.e., rural vs. urban), and concomitant disabilities on vocational outcomes. Results indicate the importance of considering environmental and social factors when providing vocational rehabilitation services to clients with TBI, and that specific DVR services can lead to successful vocational outcomes regardless of TBI severity. Implications for future clinical services and research are presented. Show more

Keywords: Traumatic brain injury, state vocational rehabilitation, rehabilitation

DOI: 10.3233/NRE-2006-21408

Citation: NeuroRehabilitation, vol. 21, no. 4, pp. 335-347, 2006