Vocational outcome 6-15 years after a traumatic brain injury

PRIMARY OBJECTIVE

To describe vocational outcome 6-15 years after a traumatic brain injury (TBI) among individuals who were productive by working or studying at the time of their TBI and determine the associations with variables related to the time of injury and at follow-up.

METHODS AND PROCEDURES

Thirty-four individuals with a mild TBI and 45 with a moderate-to-severe TBI were assessed on average 10 years post-injury. Logistic regression was used to determine the association between their current vocational situation and variables related to the time of injury (gender, age, injury severity and educational level) and at follow-up (time since injury, marital status and overall disability).

RESULTS

A total of 67% were productive at follow-up. Age at injury, injury severity and the degree of disability at follow-up were strongly associated with being productive. Younger individuals with milder TBI and less severe disability were significantly more likely to be fully productive. No significant associations were found between productivity and gender, education, time since injury or marital status.

CONCLUSIONS

This study indicates that return to productivity in a long-term perspective after a TBI is possible, in particular when the individual is young, has sustained a mild TBI and has a milder form of overall disability.

Relationship between psychiatric disorders and 1-year psychosocial outcome following traumatic brain injury

OBJECTIVE

To investigate the relationship of psychiatric functioning with psychosocial functioning at 1 year following traumatic brain injury (TBI), after controlling for relevant demographic, injury-related, and concurrent factors.

DESIGN

Prospective 1-year longitudinal study.

PARTICIPANTS

Participants were 122 individuals with TBI and 88 proxy informants.

SETTING

Rehabilitation hospital.

MAIN MEASURES

The Structured Clinical Interview for DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision)) Axis I Disorders, Hospital Anxiety and Depression Scale, Sydney Psychosocial Reintegration Scale, and Glasgow Outcome Scale--Extended.

RESULTS

At 1 year postinjury, occupational activities were the area of most change after TBI followed by interpersonal relationships and independent living skills, according to the Sydney Psychosocial Reintegration Scale. The majority of participants were rated as having moderate disability on the Glasgow Outcome Scale--Extended. After controlling for relevant background factors, preinjury, acute postinjury, and concurrent psychiatric disorders were significantly related to 1-year psychosocial outcome.

CONCLUSION

Screening in the acute postinjury stage for presence of preinjury psychiatric history or current distress may help identify individuals who require more intensive rehabilitation and psychiatric support and more active postdischarge monitoring. Further research exploring potential causal mechanisms for these findings is required.

Traumatic brain injuries in the construction industry

OBJECTIVE

This study analyses factors associated with work-related traumatic brain injury (TBI), specifically in the construction industry in Ontario, Canada.

METHODS

This cross-sectional study utilized data extracted from the Ontario Workplace Safety and Insurance Board (WSIB) records indicating concussion/intracranial injury that resulted in days off work in 2004-2005.

RESULTS

Analyses of 218 TBI cases revealed that falls were the most common cause of injury, followed by being struck by or against an object. Mechanisms of injury and the temporal profile of injury also varied by age. For instance, a significantly higher proportion of injuries occurred in the mornings for young workers compared to older workers.

CONCLUSIONS

The results of this study provide important information for prevention of TBI which suggest important age-specific strategies for workers in the construction industry.

Functioning and disability 6-15 years after traumatic brain injuries in northern Sweden

OBJECTIVES

To assess long-term functioning and disability after traumatic brain injury (TBI).

MATERIAL AND METHODS

Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6-15 years post-injury.

RESULTS

There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity.

CONCLUSIONS

Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability.

The effects of traumatic brain injury during adolescence on career plans and outcomes

Traumatic brain injury (TBI) often occurs during the years when individuals are aiming for vocational goals and acquiring skills needed to achieve vocational success. This exploratory study aimed to describe the perceived long-term impact on career outcomes for individuals who were hospitalized with a TBI during adolescence. This study used a retrospective cohort design. A telephone questionnaire was administered 5 years postinjury to a consecutive series of 51 participants aged 15-19 years at time of injury, as well as 46 informants who knew the participants well. Participants and informants described the impact the injury had on career plans and outcomes. The nature of occupation postinjury was compared with preinjury plans, with results indicating many participants altering preinjury career plans following TBI.

Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury

PURPOSE

To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI).

METHOD

This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes.

RESULTS

Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes.

CONCLUSIONS

The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.

Aging with traumatic brain injury: long-term health conditions

Although traumatic brain injury (TBI) is a leading cause of death and disability in young adults, older adults over the age of 75 are also at high risk for TBI. As even mild injury can lead to disabling consequences, the long-term consequences of TBI need to be better understood, especially as the survival rate has increased dramatically in the last few decades. This research examined the prevalence of long-term health conditions after TBI. Using a retrospective cohort design, we examined consecutive records of adults with moderate to severe TBI discharged from a large rehabilitation hospital in Pennsylvania from 1974 to 1989. Baseline clinical information was abstracted from medical records. We interviewed consenting participants up to 24 years after injury. Our findings show a higher than expected prevalence of self-reported arthritis in the middle-aged population. There was also a high prevalence of problems with sleep and nerves many years post-injury. Some of the health conditions documented in this study could potentially be addressed early in rehabilitation; this study supports the screening of more physical health conditions in persons aging with TBI.

Long-term outcomes after moderate to severe traumatic brain injury

OBJECTIVE

This research examined the long-term outcomes of rehabilitation patients with moderate to severe traumatic brain injury (TBI).

DESIGN

Retrospective cohort study.

SETTING AND SUBJECTS

We examined consecutive records of persons with moderate to severe traumatic brain injury who were discharged from a large rehabilitation hospital in Pennsylvania from 1973 to 1989. We interviewed consenting participants (n = 306) up to 24 years post-injury.

MAIN OUTCOME MEASURES

Self-rated health, activity limitations, employment, living arrangements, marital status, Community Integration Questionnaire, and use of rehabilitation services.

RESULTS

Participants were most limited in activities such as managing money and shopping. Twenty-nine per cent of our participants were working full time. There were significant relationships between activity limitations and residual cognitive impairment at follow-up. Self-rated health was correlated with most instrumental activities of daily living.

CONCLUSION

Our findings document health and function in a large post acute TBI population and implications for rehabilitation are discussed.