The Determinants of Work Adjustment following Traumatic Brain Injury: A Focus for Career Counsellors

Abstract

PAT RI C I A M U RP H Y, G r i ffi t h U n i ve r s i t yThis longitudinal study examined the determinants of work adjustment in the traumatic brain injury (TBI) population, using the frameworks provided by Hershenson (I 996) and Moos (2002) as a guide for selecting variables. Based on these frameworks, the predictive utility of a range of variables (Len, self-esteem, perceived support, situational stressors, appraisal of stress and self-efficacy and coping responses) was examined. Eighty-one individuals withTBl provided data for the study.The prediction of work adjustment was improved beyond that accounted for by initial adjustment when these previously-mentioned variables were entered into regression equations. Specifically, short-term work adjustment was associated with high levels of social support and self-efficacy as well as the effective use of problem-solving. In the longterm, however, internal resources such as self-esteem became more important to work adjustment, as did the effects of lesion location and cognitive impairment. Greater focus on these determinants of work adjustment in the career counselling process could foster the development of a preventative approach toTBI vocational rehabilitation. In particular, it may be possible to identify individuals who are likely to experience work adjustment difficulties and assist them to maintain and develop the resources that will, in turn, improve their likelihood of vocational success.A u s t r a l i a n J o u r n a l of C a r e e r D e v e l o p m e n t

Functional limitations in TBI and their relationship to job maintenance following work re-entry

“…Individuals with difficulty regulating their emotions are more prone to anger outbursts, crying, or verbal attacks, which can be interpreted as insubordination or violations of workplace conduct rules. As a result, the individual will likely be disciplined, up to and including termination [9,12,13,16,27,32,38,48]. Anosognosia, which is a lack of awareness of one's deficits, can contribute to problems with emotional dysregulation.…”

“…Many authors cite cognitive and emotional deficits as the most persistent and disabling, particularly in terms of employment [7,13,17,29,35,41]. Thus, a variety of rehabilitation and job-placement services, including job accommodations, may be needed for people with TBI to return to work and maintain employment [27]. This has resulted in a substantial amount of research devoted to examining employment issues after TBI.…”

“…Issues that contribute to work adjustment include social support, quality of services received, and functional limitations [16]. Similar to job acquisition, people with severe impairments, especially cognitive, executive, and emotional/behavioral deficits, have less successful work adjustment than those with mild or no impairment [14,16,27,38,44].…”