The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI).
Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW.
The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work.
Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 - 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach - medical and psychosocial - eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.
"In Florida, employment rates for individuals with TBI receiving state vocational rehabilitation services range between 8.6% and 10%  . Underemployment and unemployment following TBI can have detrimental effects for individuals, their support systems, and their communities   . These include diminished life satisfaction and psychological well-being, as well as poor community reintegration in the areas of home, social, and leisure activities [2, 36, 58–60]. "
[Show abstract][Hide abstract] ABSTRACT: . Individuals with traumatic brain injury (TBI) face many challenges when attempting to return to work (RTW). Vocational evaluation (VE) is a systematic process that involves assessment and appraisal of an individual’s current work-related characteristics and abilities.
. The aims of this study are to (1) examine demographic and employment characteristics of vocational rehabilitation providers (VRPs), (2) identify the specific evaluation methods that are used in the VE of individuals with TBI, and (3) examine the differences in assessment method practices based upon evaluator assessment preferences.
. This exploratory case study used a forty-six-item online survey which was distributed to VRPs.
. One hundred and nine VRPs accessed the survey. Of these, 74 completed the survey. A majority of respondents were female (79.7%), Caucasian (71.6%), and holding a master’s degree (74.3%), and more than half (56.8%) were employed as state vocational rehabilitation counselors (VRCs). In addition, over two-thirds (67.6%) were certified rehabilitation counselors (CRCs). Respondents reported using several specific tools and assessments during the VE process.
. Study findings reveal differences in use of and rationales for specific assessments amongst VRPs. Understanding VRP assessment practices and use of an evidence-based framework for VE following TBI may inform and improve VE practice.
"Recovery from symptoms usually takes place within 1 to 3 months in mTBI, while 85% of improvements in functioning occur in the first six months and continue until one year after moderate to severe TBI . Unfortunately, these impairments, including in those related to sleep disturbances, persist over one year in 50% of moderate-severe TBI patients , affecting their autonomy, productivity, and their quality of life  "
[Show abstract][Hide abstract] ABSTRACT: L’occurrence d’un traumatisme craniocérébral (TCC) est un problème de santé publique majeure. Les troubles du sommeil et de l’éveil sont parmi les symptômes les plus persistants et les plus déshabilitants à la suite d’un TCC. Or, les études empiriques portant sur l’apparition de ces symptômes, leur chronicisation et leur traitement demeurent non concluantes. Cette revue narrative a comme but de recenser le niveau de connaissance actuel sur la nature (objective et subjective) des troubles du sommeil et de l’éveil chez les patients TCC, en tenant compte de la sévérité du traumatisme et de la phase de rétablissement. Un but secondaire est de cibler les causes potentielles de ses perturbations. En général, bien que la présence de troubles du sommeil et de l’éveil dans toutes les études conduites auprès de patients TCC soit observée indépendamment de la sévérité du traumatisme, des signes objectivables de la présence de telles perturbations ne sont pas rapportés de façon consistante dans ces études. Des études supplémentaires semblent être requises afin de mieux comprendre la complexité des troubles du sommeil et de l’éveil chez les patients TCC et d’optimiser la récupération à court et à long terme chez cette clientèle par l’entremise d’interventions ciblées.
"Medical treatment is becoming ever more advanced with ever-increasing numbers of survivors, rehabilitation programs are becoming more and more standardised    and the clinical factors correlated with RTW are better understood       . However, RTW rates remain quite low      . In addition to rehabilitation, several types of vocational support have been proposed to facilitate RTW in TBI. "
[Show abstract][Hide abstract] ABSTRACT: To analyse usefulness of the SPASE programme, a coordinated facility programme to assist traumatic brain injury (TBI) persons in returning to work and retaining their job in the ordinary work environment.
A retrospective study including 100 subjects aged over 18 who had suffered traumatic brain injury (GOS 1 or 2). The criterion for return to work (RTW) success was the ability to return to the job he/she had before the accident or to a new professional activity.
Factors associated with RTW success were at short-term (2-3 years): the presence of significant workplace support OR=15.1 [3.7-61.7], the presence of physical disabilities OR=0.32 [0.12-0.87] or serious traumatic brain injury OR=0.22 [0.07-0.66]. At medium-term (over 3 years) these factors were: significant workplace support OR=3.9 [1.3-11.3] and presence of mental illness OR=0.15 [0.03-0.7].
This study suggests that a case coordination vocational programme may facilitate the return and maintain to work of TBI persons. It reveals that the workplace support is a key factor for job retention in the medium-term.
Annals of physical and rehabilitation medicine 10/2013; 56(9-10). DOI:10.1016/j.rehab.2013.10.001
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