Enhanced vocational rehabilitation for Veterans with mild traumatic brain injury and mental illness: Pilot study

Abstract

Abstract-Work plays a significant role in how people identify themselves, and successful return to work is associated with significant psychological and rehabilitative benefits. Unfortunately, despite the many benefits of employment, Veterans who experience mild traumatic brain injury and have mental health issues often have significant difficulty getting their vocational needs met. Considering that a consistent relationship between cognitive dysfunction and difficulties with employability has been firmly established, cognitive rehabilitation may enhance engagement in vocational rehabilitation and return to work outcomes. In this pilot study, we evaluated a 12 wk cognitive rehabilitation intervention embedded within vocational rehabilitation services. Eighteen Veterans were randomly assigned to receive either the embedded cognitive rehabilitation intervention (n = 10) or a control condition offering supportive client-centered therapy that did not focus on employment or cognitive rehabilitation (n = 8); all Veterans (intervention and control groups) received vocational rehabilitation services. This pilot feasibility study demonstrated efficient implementation of an embedded cognitive rehabilitation intervention within vocational rehabilitation. The current pilot data revealed small to moderate effect sizes on employment outcomes. Given these preliminary findings, a larger outcome study is warranted.

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

“… Notes a Two research articles [ 67 , 100 ] reported two studies of different study designs and as such, data reported on study design are for 61 studies b All case studies c Excludes case studies; two before-after without control group, three controlled interventions d All conducted in the United States e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU f Some studies include more than one type of treatment and as such, the number of articles reported across treatment types exceeds 49 studies ED: Emergency department; MHSU: Mental health disorders or substance use; OT: Occupational therapy; PTSD: Post-traumatic stress disorder; rTMS: Repetitive transcranial magnetic stimulation; TBI: Traumatic brain injury …”

“… e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU …”

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

“…Although all showed positive gains in employment status following TBI rehabilitation, none was more effective than its comparator intervention. 6 Yet, as three 37,70,72,149 were US military based and one 71 was a civilian study in China comparing a virtual reality training programme with standard VR, they are not directly relevant to this study.…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Overall, current evidence for effectiveness of VR in TBI is limited and inconclusive. Of the five VR trials 37,[70][71][72][73] published to date, three 37,70,72 have been with US military personnel or veterans. Military studies differ from those in civilian populations as participants present with different challenges (e.g.…”

Supported Employment for Veterans With Traumatic Brain Injury: Provider Perspectives

“…Workforce participation is considered a significant indicator of recovery and has been closely studied in those who sustained TBI. [21][22][23][24][25][26][27][28] The return to work rate following TBI varies widely 29,30 and is associated with various demographic, injury-related, and post-injury rehabilitation factors, including use of vocational rehabilitation services. [31][32][33][34][35] For many civilians, return to pre-injury levels of functioning following mild TBI usually occurs within 3 to 12 36 months or sooner, 37,38 although up to 20% 39 continue to experience a range of cognitive, emotional, and physical symptoms 40 years after the injury that impact function.…”