NEUROPSYCHOLOGICAL IMPAIRMENT AND RETURN TO WORK FOLLOWING SEVERE CLOSED-HEAD INJURY - IMPLICATIONS FOR CLINICAL MANAGEMENT

Aims. To study the rate and timing of return to work following severe closed head injury, and to compare the neuropsychological functioning of patients who successfully return to work with that of patients who fail to return to work. Methods. The vocational status, level of cogni tive functioning and personality functioning of a consecutive series o f 66 patients who survived severe closed head injury was assessed betw een six months and three years postinjury. The level of cognitive and personality functioning of patients who returned to work, were compare d with that of patients who failed to return to work. Results. Twenty five percent of patients failed to return to work, and a further 17% r eturned to work under special conditions of employment. Failure to ret urn to work was related to the degree of neuropsychological impairment (cognitive deficit and adverse personality change), injury severity ( duration of posttraumatic amnesia), and age. Multiple regression analy sis found the total number of neuropsychological symptoms to be the st rongest predictor of the patients' return to work. Conclusions. These findings suggest that neuropsychological symptoms are the main mechani sm through which severe brain injury affects the ability to return to work. It is recommended that vocational rehabilitation of severe close d head injury patients be based on a comprehensive neuropsychological assessment.