Minimizing the effect of TBI-related physical sequelae on vocational return

Abstract

Abstract-This article evaluated the common physical sequelae that affect return to work (RTW) after traumatic brain injury (TBI). We performed a Medline search and evaluation of current TBI rehabilitation texts. The information presented is a combination of published literature and clinical guidelines. The limitations faced by many patients with TBI can best be overcome through clever job search, job redesign, and community linkages with business and industry that are willing to partner in helping the patient with TBI regain employment. The physician plays a key role in communicating suggestions to the vocational specialist. The comorbidities described represent challenges to successful RTW. These problems are recurrent, long-term, and clearly affect job procurement, nature of job, level of required support, and likelihood of job retention. Conversely, these challenges should not be viewed as impenetrable obstacles. With appropriate supports such as compensatory strategies, job coaching, assistive technology, medical management, and job restructuring, successful RTW is viable option. Physicians must focus on employment outcomes in real jobs and not settle for volunteer work, sheltered work, or assessment and planning. Individuals should be placed in real work for real pay. Through close collaboration between the survivor of TBI, the physician, the vocational specialist, and community resources, successful employment for survivors of TBI is possible and must be prescribed a high value.

Cognition and return to work after mild/moderate traumatic brain injury: A systematic review

“…One Level I systematic review [19] highlighted the role of cognitive interventions in improving neurobehavioral symptoms and successful RTW. Four Level IV descriptive reviews [8,[42][43][44] recommended cognitive interventions, with increased emphasis on compensatory strategies, to facilitate RTW.…”

“…Traumatic brain injuries range in severity from mild to severe and are typically classified based on the duration of unconsciousness, extent of posttraumatic amnesia, and findings on structural imaging [7]. Traumatic brain injury and other neurological dysfunctions prevent RTW by affecting physical, psychosocial, cognitive, and visual-perceptual skills [5,8,9]. Cognitively, they impair effective job performance by creating difficulties in learning new job tasks and attending to tasks [10].…”

Management of Spasticity After Traumatic Brain Injury in Children

“…Reintegration into the school environment is important for brain plasticity and reanimation of activities of daily living. However, this requires attention to movement impairment, psychosocial disability and cognitive challenges to avoid the child becoming despondent and resistant to rehabilitation efforts (42).…”

Rehabilitation Care of Combat Related TBI: Veterans Health Administration Polytrauma System of Care

“…These residential facilities provide a ''non-hospital'' environment to facilitate an optimal level of independence with limited restrictions to simulate the home environment. These programs place a strong emphasis on return to duty, work or school, community navigation and mobility, self-management of complex life skills, interactive social skills, teamwork and development of psychological adjustment and coping skills [32,33] …”