Comorbid Traumatic Brain Injury and Visual Impairment: Vocational Rehabilitation Service Provision and Agency-Level Outcomes

Introduction:

The purpose of this study was to investigate how services are provided to state–federal vocational rehabilitation consumers with comorbid traumatic brain injury (TBI) and visual impairment and the prevalence of and competitive employment rates for this population.

Methods:

We utilized a mixed-methods approach by incorporating interview data from 51 vocational rehabilitation agency administrators (to identify strategies used to serve these consumers) and case service data (to identify prevalence and competitive employment rates at the agency level). We combined the data to examine the relationship between strategies used and the prevalence of and employment outcomes for this population. A modified grounded theory approach was used for qualitative data analysis and descriptive statistics, and analyses of variance were used for quantitative data analyses.

Results:

Strategies used to serve these consumers included collaboration between counselors, involvement of external organizations, specialized TBI units or caseloads, staff training in TBI, and personnel with dual expertise in TBI and visual impairment. Over a third of agency administrators reported that they did not do anything special or different to serve this population. The average percentage of consumers with visual impairments who also had TBIs being served by agencies was 2.1%. Their average competitive employment rate by agency was 43.2%. Employing staff with dual expertise in TBI and visual impairment was associated with serving a greater percentage of consumers and having a higher competitive employment rate.

Discussion:

No agencies had a unique service delivery program or method to serve this population, perhaps due to its low prevalence. Agencies had substantial variability in the proportion of consumers with TBI and visual impairment served and their competitive employment rates. Implications for practitioners: Training vocational rehabilitation professionals to develop expertise in both TBIs and visual impairments may help agencies better serve these consumers.

Development of a mild traumatic brain injury-specific vision screening protocol: a Delphi study

Although traumatic brain injury (TBI) can happen to anyone at any time, the wars in Iraq and Afghanistan have brought it renewed attention. Fortunately, most cases of TBI from the recent conflicts are mild TBI (mTBI). Still, many physical, psychological, and social problems are associated with mTBI. Among the difficulties encountered are oculomotor and vision problems, many of which can impede daily activities such as reading. Therefore, correct diagnosis and treatment of these mTBI-related vision problems is an important part of patient recovery. Numerous eye care providers in the Department of Veterans Affairs, in military settings, and in civilian practices specialize and are proficient in examining patients who have a history of TBI. However, many do not have this level of experience working with and treating patients with mTBI. Recognizing this, we used a modified Delphi method to derive expert opinions from a panel of 16 optometrists concerning visual examination of the patient with mTBI. This process resulted in a clinical tool containing 17 history questions and 7 examination procedures. This tool provides a set of clinical guidelines that can be used as desired by any eye care provider either as a screening tool or adjunct to a full eye examination when seeing a patient with a history of mTBI. The goal of this process was to provide optimal and uniform vision care for the patient with mTBI.