Residual impairments and work status 15 years after penetrating head injury

Schwab, Karen; Grafman, Jordan; Salazar, Andrés M.; Kraft, Joan F.

doi:10.1212/wnl.43.1_part_1.95

Cited by 89 publications

(32 citation statements)

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“…Otherwise, the GOS is widely consid- ered a relevant indicator of long-term functional outcome after TBI (25,26). The finding of no relation between LPTS and employment also is partly at variance with other studies (27,28), but it may largely depend on socioeconomic circumstances. There are still widespread prejudices against epilepsy, and affected patients are often discriminated against in social and professional life.…”

Section: Discussionmentioning

confidence: 89%

Early and Late Posttraumatic Seizures in Traumatic Brain Injury Rehabilitation Patients: Brain Injury Factors Causing Late Seizures and Influence of Seizures on Long‐Term Outcome

1999

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Summary: Purpose: To demonstrate risk factors involved in the origin of late posttraumatic seizures (LPTSs) in civilian traumatic brain injury (TBI) rehabilitation patients and the occurrence of LPTSs in this population. as well as the time of the first late seizures, and influence of these seizures o n functional and occupational long-term outcome.Mrtlrods: A consecutive sample of 490 patients (age range, 0.8-71 years) with TBI, and with postinjury problems in their education and employment, were followed up for 2 5 years from the time of injury in a rehabilitation and reemployment program. The study was carried out at the outpatient neurologic clinic of the Kauniala Hospital, which specializes in brain injuries in Finland and works in close cooperation with the Department of Clinical Neurosciences at the Helsinki University Central Hospital. Main outcome measures were functional outcome, as measured o n the Clasgow Outcome Scale (GOS), and the capacity for employment at the end of follow-up. Outcomes were studied separately among patients with late seizures and lor the nonseizure group.Ke.cu1t.s; Children age 7 years or younger at time of injury more often had early posttraumatic seizures (EPTSs). than did adolescents or adults. The time elapsed between brain injury and the first late seizure also was longer in older age groups. EPTSs and depressed skull fracture had a statistically significant relation to the origin of LPTSs. Permanent posttraumatic neurologic deficit, linear skull fracture, and permanent local brain lesion documented on 21 computed tomography (CT) scan appeared clinically important as risk factors. Late seizures did worsen the functional outcome but had n o significant influence on reemployment at the end of follow-up.Cowlusions: Young children are more prone to early seizures. and adolescents and adults, to late seizures. The main risk factors for LPTSs are early seizures and depressed skull fracture. Severity of brain injury, as measured by a low GCS score, prolonged unconsciousness, and posttraumatic amnesia (PTA) without local brain lesion, should not be considered risk factor for LPTSs. Thorough follow-up of patients with TBI with seizures and adequate antiepileptic therapy may help attain rehabilitation goals and reemployment.

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Section: Discussionmentioning

confidence: 89%

Early and Late Posttraumatic Seizures in Traumatic Brain Injury Rehabilitation Patients: Brain Injury Factors Causing Late Seizures and Influence of Seizures on Long‐Term Outcome

1999

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“…10-17 For those who attempt to return to work, interpersonal problems are a common reason for post-injury job loss. 10,18-20 Job instability after TBI is a problem for both the individual, significantly affecting quality of life, 21 and for society at large. Most of the substantial societal cost related to the 1.7 million TBIs every year is related to long-term underemployment, 22 and only 40% of persons with TBI maintain stable employment after injury.…”

Section: Introductionmentioning

confidence: 99%

Job stability in skilled work and communication ability after moderate–severe traumatic brain injury

Meulenbroek

Turkstra

2015

Disability and Rehabilitation

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Purpose Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. Methods Participants were 31 adults with moderate-severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable (UE) employment. Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. Results Measures of spoken language comprehension, verbal reasoning, social inference, reading, and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β = −0.18, p = 0.05) and social inference (β = 0.19, p = 0.05) were predictive independent of the overall model. The second model included discourse data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). Conclusion Communication measures were positively associated with stable employment in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills.

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“…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). The percentage of subjects returning to work ranged from 38.9% to 75%.…”

Section: Introductionmentioning

confidence: 99%