Academic journal article The Journal of Rehabilitation

Return to Work after Traumatic Brain Injury

Academic journal article The Journal of Rehabilitation

Return to Work after Traumatic Brain Injury

Article excerpt

It can be expected that ability to resume some form of employment is important to many persons with traumatic brain impairment, especially the youthful group most commonly affected. Many studies consist of youthful males, many of whom had been employed prior to injury, but who have experienced problems of vocational and social re-integration since injury.

Analyses of these problems in the literature have not always been conclusive. Early post-war research was confounded by varying standards of clinical severity of impairment and social outcome (Humphrey & Oddy, 1980). There was also a tendency to present occupational re-settlement in broad outline, and as the major criteria of rehabilitation outcome. Later studies presented a more detailed analysis whereby return to work was treated as one aspect of psycho-social outcome, and as not necessarily indicating absence of sequelae after onset of traumatic brain impairment. They have also reflected the now generally accepted view that employment status is determined by both the individual's residual deficits and environmental factors.

Recent studies have also included a greater proportion of persons with severe injuries who survived trauma due to improvements in medical technology, and who often experienced social and vocational dislocation following injury. Most of the earlier studies (reviewed by Humphrey and Oddy, 1980) sampled persons with less severe disabilities, and reported very high rates of return to work.

This review presents a broad perspective of the information available from empirical studies of the past 15 years. Studies were included if they provided descriptive, correlational or multivariate analyses of vocational outcome. Those factors commonly identified in the literature were: (a) severity of injury measured, for example, by post-traumatic amnesia; (b) cognitive deficits; (c) personality change; (d) psycho-social adaptation; (e) physical disability; (f) age; (g) pre-injury work/education history; and (h) access to rehabilitation. The studies that focused on these factors are listed in Table 1.

Severity of Injury

Severity of injury has often been measured by post-traumatic amnesia (PTA). Concerning the relationship of PTA to occupational re-settlement, Brown (1975) stated that in most instances where PTA exceeded 24 hours, 20 to 30 percent of the individuals required less taxing employment than before injury and 10 percent were unemployable. Oddy, Humphrey and Uttley (1978) TABULAR DATA OMITTED found that persons with less severe disabilities (e.g., PTA 1-7 days) returned to work more quickly than those with more severe disability (PTA 7 days). Kaplan (1988) reported that longer PTA (i.e., PTA 14 days) was associated with a lower probability of returning to pre-disability activity levels (i.e., work and school). Similar results were evident in other studies (Fraser, Dikmen, McLean, Miller & Temkin, 1988; Klonoff, Costa & Snow, 1986; McMordie, Barker & Paolos, 1990; Rao, Rosenthal, Cronin-Stubbs, Lambert, Barnes & Swanson, 1990; Van Zomeren & Van Den Berg, 1985).

Prospects for return to work appear better for persons with mild injuries, i.e., PTA 36 hours (Fraser et al., 1988; Wrightson & Gronwall, 1980). However, statistically viable generalizations conceal individual variations; difficulties in social and vocational adjustment do not necessarily decrease among individuals with mild deficits who attempt to cope in demanding work environments (Brown, 1975; Burke, Wesolowski & Guth, 1988; Jennett, Snoek, Bond & Brooks, 1981; McMordie et al., 1990; Newcombe, 1982; Ranseen, 1990; Tate, Lulham & Strettles, 1982; Wehman, Kreutzer, Wood et al., 1989b).

Cognitive Deficits and Personality Change

The long-term process of psycho-social adaptation to residual disability has been the focus of many studies, whereas discussion concerning the influence of pre-morbid personality upon vocational outcome has been largely speculative (Haas, Cope & Hall, 1987, theoretical (Cohen, 1985; Long, Gouvier & Cole, 1984) and lacking in empirical support (Brooks, McKinlay, Symington, Beattie & Campsie, 1987). …

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