Effects of mild, moderate and severe closed head injury on long-term vocational status

Abstract

Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

Computerized working memory training after stroke–A pilot study

“…One reason to schedule the intervention during the chronic phase, rather than during the early phase after the stroke, is that it is not until the chronic phase, when patients try to go back to normal life and old working habits, that they become aware of their cognitive deficits [42] and may be motivated to re-train these functions.…”

A survey of vocational status 10 years after traumatic head injury

“…Work has always been a primary outcome variable after TBI because resumption of gainful employment is generally regarded as an important criterion of recovery in Western society (Stambrook, Moore, Peters Deviaene, & Hawryluk, 1990;Ponsford, Olver, Curran & Ng, 1995;Webb, Wrigley, Yoel & Fine, 1995). 'Employment, in reality, is one of the most telling of outcome variables after TBI as it relies upon the multi-dimensional integration of all functional areas' (Zasler, 1989, p. 332), as does all occupation.…”

“…'Employment, in reality, is one of the most telling of outcome variables after TBI as it relies upon the multi-dimensional integration of all functional areas' (Zasler, 1989, p. 332), as does all occupation. Occupational therapy recognizes the benefit of occupation as it provides structure, stability and purpose to life (Stambrook et al, 1990). However, there is tremendous societal support for the time structuring that employment provides (i.e.…”

“…However, there are studies that indicate people who sustain severe head injuries continue to make gradual improvements in functioning for at least 10 years after injury (Sbordone, Liter & Pettler-Jennings, 1995). Some studies suggest a general trend of increasing rates of RTW and full-time employment with greater elapsed time since injury (Stambrook et al, 1990). In reviewing the literature of long-term vocational outcomes of at least 10 years post-injury, there is also marked variation in RTW rates (Miller & Stern, 1965;Adey, 1967;Rusk, Block & Lowman, 1969;Bruckner & Randle, 1972;Dresser et al, 1973;Lundholm, Jepsen & Thomval, 1975;Gilchrist & Wilkinson, 1979;Lewin, Marshall & Roberts, 1979;Reyes, Bhattacharyya & Heller, 1981;Sweeney & Smutok, 1983;Thomsen, 1984;Rappaport, HerreroBacke, Rappaport & Winterfield, 1989;Tate, Lulham, Broe, Strettles & Pfaff, 1989;Thomsen, 1992;Kraft, Schwab, Salazar & Brown, 1993;Schwab, Grafman, Salazar & Kraft, 1993;Sbordone, Liter & Pettler-Jennings, 1995;Tennant, MacDermott & Neary, 1995).…”

Neuropsychiatric predictors of occupational persistence in HIV/AIDS.

“…However, studies that did report a significant relationship between age at the time of the study and employment concluded that older adults tended to experience less favorable employment outcomes than younger adults, although the studies did not specify the age group in which the odds of returning to work decrease (Rao, et aI., 1990;Ruff, et aI., 1993;Stambrook, Moore, Peters, Deviaenes, & Hawryluk, 1990). …”